RT Journal Article SR Electronic T1 Effect of the COVID-19 pandemic on health insurance coverage among trauma patients: a study of six level I trauma centers JF Trauma Surgery & Acute Care Open JO Trauma Surg Acute Care Open FD BMJ Publishing Group Ltd SP e000640 DO 10.1136/tsaco-2020-000640 VO 6 IS 1 A1 Erica Sercy A1 Therese M Duane A1 Mark Lieser A1 Robert M Madayag A1 Gina Berg A1 Kaysie L Banton A1 David Hamilton A1 David Bar-Or YR 2021 UL http://tsaco.bmj.com/content/6/1/e000640.abstract AB Background Increased unemployment during the COVID-19 pandemic has likely led to widespread loss of employer-provided health insurance. This study examined trends in health insurance coverage among trauma patients during the COVID-19 pandemic, including differences in demographics and clinical characteristics by insurance type.Methods This was a retrospective study on adult patients admitted to six level 1 trauma centers between January 1, 2018 and June 30, 2020. The primary exposure was hospital admission date: January 1, 2018 to December 31, 2018 (Period 1), January 1, 2019 to March 15, 2020 (Period 2), and March 16, 2020 to June 30, 2020 (Period 3). Covariates included demographic and clinical variables. χ² tests examined whether the rates of patients covered by each insurance type differed between the pandemic and earlier periods. Mann-Whiney U and χ² tests investigated whether patient demographics or clinical characteristics differed within each insurance type across the study periods.Results A total of 31 225 trauma patients admitted between January 1, 2018 and June 30, 2019 were included. Forty-one per cent (n=12 651) were admitted in Period 1, 49% (n=15 258) were from Period 2, and 11% (n=3288) were from Period 3. Percentages of uninsured patients increased significantly across the three periods (Periods 1 to 3: 15%, 16%, 21%) (ptrend=0.02); however, there was no accompanying decrease in the percentages of commercial/privately insured patients (Periods 1 to 3: 40%, 39%, 39%) (ptrend=0.27). There was a significant decrease in the percentage of patients on Medicare during the pandemic period (Periods 1 to 3: 39%, 39%, 34%) (p<0.01).Discussion This study found that job loss during the COVID-19 pandemic resulted in increases of uninsured trauma patients. However, there was not a corresponding decrease in commercial/privately insured patients, as may have been expected; rather, a decrease in Medicare patients was observed. These findings may be attributable to a growing workforce during the study period, in combination with a younger overall patient population during the pandemic.Level of evidence Retrospective, level III study.Data are available on reasonable request. Because of agreements with the Institutional Review Boards overseeing this study, original deidentified datasets from the trauma registries at the six participating sites are not publicly available. Some limited analysis datasets and SAS code used to conduct statistical analyses may be available, on reasonable request to DB-O.