Blacks and Hispanics Receive Less Care for Firearms-Associated Eye Injuries

A recent study published in JAMA Ophthalmology indicates that Black and Hispanic patients face disparities when it comes to firearms-associated ocular injuries (FAOIs), as the findings show that White patients have greater odds of being discharged to rehabilitation and other advanced care facilities (ACFs).

“Firearm injuries are associated with devastating visual outcomes. Several studies have demonstrated disparities in trauma care and discharge to rehabilitation and other (ACFs) due to race and ethnicity and insurance status. The identification of possible disparities in disposition of patients admitted with (FAOIs) is a crucial step in moving toward health equity,” the researchers wrote.

This retrospective study consisted of 8,715 patients (85.7% male, 35% African American, 46.6% White, mean age, 16.9) admitted with FAOIs. Data were obtained from the National Trauma Data Bank (NTDB) from 2008 through 2014 and comprised of cases from over 900 facilities. In total, they assessed 235,254 firearm injuries. The key endpoint of interest was defined as the odds of discharge to ACFs. Data were analyzed between April 16, 2017, and December 15, 2021.

According to the analysis, 3.7% of the firearm injuries were eye injuries. The study subjects most commonly had government insurance (31.5%), self-paid insurance (29.4%), and commercial insurance plans (22.8%). The most frequent dispositions were home (48.8%) and ACF (20.5%).

Blacks/Hispanics Sent Home More

The findings showed that the following factors were linked with discharge to ACF rather than home: hospital stays 6 days or longer (odds ratio [OR]= 3.05; 95% CI, 2.56-3.63; P < .001), age 65 years or older (OR=2.94; 95% CI, 1.94-4.48; P < .001), associated traumatic brain injury (OR=2.32; 95% CI, 1.94-2.78; P < .001), severe traumatic brain injury (OR=2.10; 95% CI, 1.79-2.46; P < .001), very severe Injury Severity Score (OR=2.22; 95% CI, 1.88-2.62; P < .001); and White race (OR= 2.00; 95% CI, 1.71-2.33; P < .001), which was correlated with higher odds of ACF than Medicare insurance (OR=1.64; 95% CI, 1.16-2.31; P = .01).

“These findings suggest that older, more severely injured, Medicare-insured, or White patients have higher odds of ACF placement than younger, less severely injured, otherwise insured, and Black and Hispanic patients,” the researchers concluded.

The investigators noted that the study was limited by its retrospective design, as well as the fact that they were unable to discern for these disposition differences. They added in their conclusion that: “Nevertheless, this work highlights that disparities may exist in disposition after FAOIs that may limit the rehabilitation potential of specific populations.”