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Helen R. Burstin, MD, MPH; Stuart R. Lipsitz, ScD; Troyen A. Brennan, MD, JD, MPH

JAMA. 1992;268(17):2383-2387.

Abstract
Objective.
—To assess whether the socioeconomic status of the patient was associated with the risk of adverse events, defined as medical injuries caused by medical management, and the proportion of these events that resulted from substandard care.

Setting.
—51 hospitals in New York State.

Methods.
—Rates of medical injury and substandard care by gender, race, income, and payer status were developed from reviews of 30195 medical records in New York in 1984. We evaluated these socioeconomic parameters in a multivariate analysis, while controlling for hospital-level factors.

Results.
—We found that uninsured patients (odds ratio, 2.35; 95% confidence interval, 1.40 to 3.95) were at greater risk for substandard care. The characteristics of the hospitals to which patients were admitted did not affect this result. Race, gender, and income were not independently associated with risk for medical injury or substandard care in multivariate analyses.

Conclusion.
—Our findings suggest that the uninsured are at greater risk for suffering medical injury due to substandard medical care.

(JAMA. 1992;268:2383-2387)

Author Affiliations
From the Division of General Medicine, Brigham and Women's Hospital and Harvard Medical School (Drs Burstin and Brennan), and the Departments of Health Policy and Management (Dr Brennan) and Biostatistics (Dr Lipsitz), Harvard School of Public Health, Boston, Mass.

Footnotes
Presented in part at the annual meeting of the American Federation of Clinical Research, May 4, 1991, Seattle, Wash.

Reprint requests to Division of General Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (Dr Brennan).

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