JOHNS HOPKINS (US)—Uninsured or minority pedestrians hit by cars are significantly more likely to die than insured whites with similar injuries.

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.

“It’s a double whammy,” says Adil Haider, assistant professor of surgery at Johns Hopkins University 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 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.

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.

Details appear in the August issue of the journal Surgery.

“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 of other kinds of injuries and illnesses 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, other conditions, such as obesity, diabetes, or hypertension, could also be factors that raise the risk of death among injured minority or uninsured pedestrian accident 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 lives. He concedes, however, that the problem of pedestrian injury may be more complicated.

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