In other words, the difference is probably even worse for the broad populations of the insured vs the uninsured.

I thought I saw an article about this last week, and the majority of the penetration wounds were either caused by knife or gunshot.

Theory A: White-collar jobs are more likely to have insurance; low-grade physical labor jobs are less likely to. (High-risk physical labor generally carries its own insurance.)

Theory B: People who choose to not wear seatbelts are more likely to get into accidents; it appears to be a personality thing. If someone is stressed because they don't have insurance, might they get into more accidents? (Not to mention the associated "dangers of poverty" category which increases the exposure to physical violence.)

Theory C: I make enough money for insurance, therefore I make enough to get a safer car. Someone who is barely eking by might have a clunker with a frame that isn't quite right anymore.

It's probably impossible to test, much like my question if car seats for kids have reduced car sickness (because by raising them up where they can see the road, the discrepancy between visual and balance is reduced.) But I am interested.

I am interested to see if there are more trauma injuries to people who are uninsured, on the theory that they may be in situations where trauma is more likely.

Theory D: Young people, especially men, are less likely to have insurance (partly because they are less likely to need it). They are also more likely to have major trauma.

So the controlled study would throw out a bunch of good outcomes (fixable traumas fixed) for insured patients that weren't matched by similar uninsured patients.

In other words, the difference is probably even worse for the broad populations of the insured vs the uninsured.

An excellent point. They miss out on the benefit from insurance due to it making you more likely to get treated.

The fact that they are looking at mortality reduces the impact of this: fatal injuries are fairly likely to end up in hospital at some point, even if it's too late. If they were looking at whether the accidents lead to chronic pain or disability there would be a much larger bias.

Disease and Disadvantage in the United States and in England

Health Insurance and Mortality in US Adults

Both are cited in the Liberal Oasis post linked above.

As to RTS being a predictor of mortality across mechanisms of injury, I expect that work has been done in other studies.

I am interested to see if there are more trauma injuries to people who are uninsured, on the theory that they may be in situations where trauma is more likely.,

Actually, we can tell from the proportions in the paper. 47% of the patients were uninsured, which is substantially higher than the proportion of the population uninsured, even taking age into account. The insurance coverage rate is well above 53% even in people under 35, everywhere except the south Texas border region.

Also: untreated chronic disease can complicate recovery from trauma. A person with uncontrolled diabetes is more likely to have a poor outcome than that same person with the same injury would have with the diabetes under control. Same for heart disease, asthma, etc. By observation, a person without insurance is less likely to get the regular checkups that would detect underlying disease processes and would be less likely to have them under control.

In the recent past I've seen two where diabetes was diagnosed postmortem. In one, the patient had a syncopal episode, vomited, aspirated, and died. In the second, the patient had a heart attack and died. Neither of those patients had health insurance (although both were employed).

First, you have to agree
All Information derived from the NTDB from The American College of Surgeons, Committee on Trauma shall remain the full and copyrighted property of The American College of Surgeons, Committee on Trauma and shall be so noted in educational material, website presentations, and publications., that is, you have to agree that the information that uninsured patients have twice the mortality rate is copyrighted by the ACS. This is ludicrous. Even claiming copyright on the raw data would be ambitious, especially as the information transfer agreement with the participating hospitals doesn't mention copyright.

Second, you have to
Indemnify the American College of Surgeons, its Committee on Trauma and their employees and agents from any and all liability, loss, or damage suffered as a result of claims, demands, costs, or judgments arising out of use of NTDB information.

The university would be responsible for me, as long as I didn't do anything outrageous, but not for a student, and I can't really ask students to indemnify the American College of Surgeons even if the risk is vanishingly unlikely.

Theory E (similar to B & possibly D): People who are flying without insurance because they don't feel like they need it are more likely to get themselves into dangerous situations by working on the assumption that they're not going to get hurt.

He was 21 years old. We couldn't find any nursing home or rehab facility that would accept him, so he stayed in the hospital for many months.

He was also an illegal immigrant. His only relative stateside (I don't know if he was here legally or not) was not able to care for him. His mother offered to come up from their country of origin to care for him here, but they wouldn't let her out. Initially, country-of-origin also refused to let him back in. Eventually they relented. A special medical flight had to be chartered to take him home and he was released into the custody of his mother. I often wonder if he survived.

Needless to say, the long hospital stay plus the very expensive chartered flight rang up WAY more expenses for this patient that would have been required if he'd been insured and could have been discharged to a nursing home.

It would not surprise me at all if lack of follow-up care in situations where emergency and non-emergency care are both required has caused some of these deaths.

But we don't ask about insurance status before we treat critical patients. Besides, EMTALA guarantees evaluation and treatment regardless of ability to pay.