Objective: To compare level 1 and 2 trauma centers with similarly sized non-trauma centers on survival after major trauma among older adults.

Data sources and study setting: We used claims of 100% of 2012-2017 Medicare fee-for-service beneficiaries who received hospital care after major trauma.

Study design: Survival differences were estimated after applying propensity-score-based overlap weights. Subgroup analyses were performed for ambulance-transported patients and by external cause. We assessed the roles of prehospital care, hospital quality, and volume.

Data collection: Data were obtained from the Centers for Medicare and Medicaid Services.

Principal findings: Thirty-day mortality was higher overall at level 1 versus non-trauma centers by 2.2 (95% confidence interval [CI]: 1.8, 2.6) percentage points (pp). Thirty-day mortality was higher at level 1 versus non-trauma centers by 2.3 (95% CI: 1.9, 2.8) pp for falls and 2.3 (95% CI: 0.2, 4.4) pp for motor vehicle crashes. Differences persisted at 1 year. Level 1 and 2 trauma centers had similar outcomes. Hospital quality and volume did not explain these differences. In the ambulance-transported subgroup, after adjusting for prehospital variables, no statistically significant differences remained.

Conclusions: Trauma centers may not provide longer survival than similarly sized non-trauma hospitals for severely injured older adults.