S2738 Insurance Status and Outcomes Following Liver Injury From Motor Vehicle Accidents: An Analysis of the National Trauma Data Bank (2017-2022)

Introduction: Motor vehicle accidents (MVA) are a leading cause of injury and death among adults, frequently causing liver injury and an average of 37,000 deaths per year in the United States. Insurance status has been studied to improve long-term outcomes post-trauma, but there are few studies investigating its impact for patients with liver trauma post-MVA. This study presents mortality outcomes of liver trauma after MVA using the National Trauma Data Bank (NTDB). Methods: Adult patients with liver trauma from a motor vehicle accident (MVA) were identified in the 2017–2022 NTDB using International Classification of Diseases, Tenth Revision (ICD-10) codes. Patients were grouped by insurance status including self-pay, public insurance (Medicaid, Medicare, other government), private insurance, and others. Associations between insurance status and mortality adjusting for sex, race, ethnicity, comorbidities, and injury severity scores (ISS) were evaluated with multivariable logistic regression analysis. Results: Among the 73,900 identified patients, 12,253 (16.5%) were self-pay, 21,549 (29.2%) had public insurance, 34,924 (47.3%) had private insurance, and 5,174 (7%) had other forms of insurance. Self-paying patients were more likely to be younger, man, Black, and be intoxicated by alcohol compared to other forms of insurance (all P < 0.001). Despite having greater ISS scores, self-paying patients had shorter hospital and ICU lengths of stay (all P < 0.001). After adjusting for confounding variables, patients with public insurance (OR = 0.50, 95% CI = 0.46-0.56, P < 0.001), private insurance (OR = 0.44, 95% CI = 0.40-0.49, P < 0.001), or other forms of insurance (OR = 0.55, 95% CI = 0.47-0.65, P < 0.001) had about 2 times lower odds of mortality compared to self-paying patients. Conclusion: Despite having greater ISS scores for liver trauma after a MVA, self-paying patients spent less time in the hospital and ICU. Insurance status was significantly associated with in-hospital mortality, with being insured decreasing their odds by 2-fold. These findings underscore the critical role insurance status has on healthcare resources and survivability after MVA. Strategies should be developed to promote equitable resource allocation and interventions to ensure that insurance status does not impact health outcomes.