Informal Employment, Fracture Pattern and In-Hospital Mortality after Traumatic Pelvic Ring Fracture in Indonesia: A Retrospective Cohort Study

Abstract

Background: Pelvic ring fractures carry substantial mortality. In low- and middle-income countries, socioeconomic position may influence survival through access to care; no Indonesian study has examined it.

Objective: To examine sociodemographic and clinical factors associated with in-hospital mortality after traumatic pelvic ring fracture.

Methods: Retrospective cohort of all patients admitted with traumatic pelvic ring fracture to Dr. Mohammad Hoesin General Hospital, Palembang (January 2021–June 2025). Associations were tested with exact methods and Holm correction. Characteristics were not cross-tabulated, so the odds ratio for informal-sector employment was bounded (sensitivity analysis) by fitting Firth-penalized models to every dataset consistent with the observed tables.

Results: Of 31 patients, 3 died (9.7%; 95% CI 3.3–24.9), all informal-sector workers: 3/8 (37.5%) against 0/5 formally employed and 0/18 not in paid work (occupation, exact p = 0.015; Holm-adjusted p = 0.117). Informal sector versus all others: risk difference 37.5 points (95% CI 9.7–69.4; Fisher p = 0.012). The odds ratio for informal-sector employment exceeded 1 in every admissible dataset with one or two recorded characteristics added (minimum 1.91) and in all but 10 of 372,434 with three; the fragility index was 2. No other factor was associated with death; fracture pattern could not reach significance with three deaths (most extreme attainable p = 0.533).

Conclusion: Informal-sector employment marked patients at high risk of in-hospital death, but the association rests on three deaths, does not survive multiplicity correction and cannot be separated from unrecorded injury severity. Multicenter studies recording physiology, delays and payer status are needed.