The COVID-19 Stay-at-Home Order’s Unequal Effects on Trauma Volume by Insurance Status but not Race in Southern California

Abstract Background The rapid spread of COVID-19 in the United States led to a variety of mandates intended to decrease population movement and “flatten the curve”. However, there is evidence some are not able to stay-at-home (SAH) due to certain disadvantages, thus remaining exposed to both COVID-19 and trauma. We therefore sought to identify any unequal effects of the California SAH orders between races and insurance statuses in a multicenter study utilizing trauma volume data. Methods A post-hoc multicenter retrospective analysis of trauma patients presenting to 11 centers in California between the dates of 1/1/2020-6/30/2020 and 1/1/2019-6/30/2019 was performed. The number of trauma patients of each race/insurance status was tabulated per day. We then calculated the changes in trauma volume related to SAH orders for each race/insurance status and compared the magnitude of these changes using statistical resampling. Results Compared to baseline, there was a 40.1% drop in total trauma volume, which occurred 20 days after SAH orders. During SAH orders, the average daily trauma volume of patients with Medicaid increased by 13.7±5.3% while the volume of those with Medicare, private insurance, and no insurance decreased. The average daily trauma volume decreased for White, Black, Asian, and Latino patients with the volume of Black and Latino patients dropping to a similar degree compared to White patients. Conclusion This retrospective multicenter study demonstrated that patients with Medicaid had a paradoxical increase in trauma volume during SAH orders, suggesting that the most impoverished groups remain disproportionately exposed to trauma during a pandemic, further exacerbating existing health disparities.