Race Plays Role In Pedestrian Vs. Car Accidents

BALTIMORE, MD - Uninsured minority pedestrians hit by cars are at a significantly 
higher risk of death than their insured white counterparts, even if 
the injuries sustained are similar, new research from Johns Hopkins suggests.

The death rate disparity is compounded by the fact that minority 
pedestrians are far more likely than white pedestrians to be struck 
by motor vehicles, according to a study published in the August issue 
of the journal Surgery.

"It's a double whammy," says Adil H. Haider, M.D., M.P.H., an 
assistant professor of surgery at the Johns Hopkins University School 
of Medicine and the study's senior author. "Minorities are much more 
likely to get injured by this mechanism and much more likely to die 
by this mechanism."

Haider and Rubie Sue Maybury, M.D., M.P.H., reviewed National Trauma 
Data Bank information on 26,404 patients hit by vehicles between 2002 
and 2006. African-American patients had a 22 percent greater risk of 
death and Hispanic patients a 33 percent greater risk of death than 
white patients involved in similar crashes. Meanwhile, the 
researchers said, uninsured patients had a 77 percent greater risk of 
death than those who were insured, even though the care they received 
was in emergency departments, long believed to be a great equalizer 
in health care delivery.

The greater mortality rates from pedestrian trauma in minorities and 
the uninsured are not accounted for by greater rates of injury, Haider says.

"Do we treat minorities and the uninsured differently? I don't think 
so, but we've got to ask the question," says Haider, who is also 
co-director of the Johns Hopkins Center for Surgical Trials and 
Outcomes Research. "We don't actually know what is leading to these 
disparities."

Previous studies have shown that insurance status and race may 
increase mortality risk because of treatment delay or differences in 
services provided. A greater prevalence of, or lack of treatment for, 
comorbidities, such as obesity, diabetes or hypertension, could be 
factors that raise the risk of death among injured minority or 
uninsured crash victims.

Since the underlying causes of the disparities can't be easily 
answered, Haider says, policy makers need to focus in the short term 
on better pedestrian injury-prevention programs, particularly in the 
inner city, where many of these deadly crashes occur. He points to 
successes in getting people to use seat belts and in getting parents 
to put their children in safety seats - two innovations that have 
saved many lives. He concedes, however, that the problem of 
pedestrian injury may be more complicated.

Other Johns Hopkins researchers who worked on this study are 
Cassandra Villegas; Elliott R. Haut, M.D.; Kent Stevens, M.D., 
M.P.H.; and David T. Efron, M.D.