Abstract
Background:
The purpose of this study was to identify demographic, clinical, and socioeconomic factors associated with follow-up adherence among hand trauma patients at an urban level I trauma center.
Methods:
A retrospective cohort study was conducted using electronic health records of adult patients presenting with hand trauma between June 2022 and March 2024. A 1:1 age- and sex-matched case-control sample of 1000 patients was created, divided by follow-up status. Variables included race, insurance type, injury category, likelihood of surgery, surgical treatment, multi-system injury, and Area Deprivation Index (ADI). Logistic regression was used to identify predictors of follow-up.
Results:
Insurance status and injury type were independently associated with follow-up. Patients with Medicaid (odds ratio [OR] 0.61, P = .024) or self-pay (OR 0.44, P = .014) were less likely to return than those with commercial insurance. Patients with soft-tissue injuries were significantly less likely to follow up than those with closed fractures or dislocations (OR 0.09, P < .001). Race and ADI were not independently predictive. The model demonstrated strong performance with an area under the curve (AUC) of 0.863.
Conclusions:
Insurance type and injury severity were significant predictors of follow-up adherence. Broader demographic and neighborhood-level socioeconomic measures were not independently associated. These findings may inform targeted strategies to reduce disparities in postinjury care.
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