To evaluate the association between race/ethnicity and insurance status with triage and mortality after renal trauma.

We conducted a retrospective cohort study using the National Trauma Databank of adult patients with renal trauma without severe extra-renal injuries. Demographics, injury characteristics, treatment setting, and outcomes were analyzed. Primary outcomes were (1) under-triage (definitive care at a non-Level I/II trauma center) and (2) inpatient mortality. Multivariable generalized estimating equation models adjusted for patient, injury, and hospital characteristics.

Among 44,915 renal trauma patients, 5.5% were under-triaged and 8.2% died during index admission, with 65% of deaths occurring within 24 hours. Under-triage was significantly less common among Black patients (OR 0.97, P  = .046), while Hispanic and Other patients had similar rates compared with White patients (OR 0.97, P  = .10). Despite this, all non-White groups had higher adjusted odds of inpatient mortality (Black: OR 1.39, Hispanic: OR 1.29, Other: OR 1.31, all P  values  <  .05). Black patients experienced excess early mortality (OR 1.57, P   <  .001), whereas Hispanic patients had persistently increased mortality beyond 24 hours (OR 1.44, P  = .003). Self-pay insurance and treatment at hospitals serving predominantly minority populations were also independently associated with increased mortality.

Racial and socioeconomic disparities in renal trauma mortality persist despite similar or lower rates of under-triage among minority patients. Excess early mortality among Black patients and sustained mortality among Hispanic patients, along with disparities in outcomes based on insurance status and hospital context, suggest structural inequities beyond triage decisions alone.