Crossing Lines: Expiration of Title 42 and the Injury Landscape at the US-Mexico Border

Introduction: Title 42 is an emergency public health mandate reenacted in 2020 during the SARS-CoV-2 pandemic, allowing expulsion of migrants entering the United States. This policy ended on May 11, 2023. We hypothesized that border crossing injuries would continue to increase despite expiration. Methods: We performed a retrospective analysis of data from five US trauma centers along the US–Mexico border. Included patients were adults injured while crossing the border from November 10, 2022-November 12, 2023; the time periods 6 mo before (Title 42 Era) and after (Post 42 Era) expiration were compared. Data collected included demographics, injuries, need for surgery, and hospital outcomes and charges. Results: There were 531 patients in the Title 42 Era and 493 in the Post 42 Era. During Title 42, there was an upward trend in monthly injuries which ceased after Title 42 expired. There were less Central Americans (P = 0.004) and more South Americans in the Post 42 Era (P < 0.001). More patients Post 42 were discharged to law enforcement (P = 0.02). Median hospital charges per patient increased from $95,740 [$64,630-$179,773] to $104,678 [$70,775-$219,394] after Title 42 ended. Cohort was not associated with age, sex, Spanish language, intensive care unit or ventilator days, mortality, injury mechanism or severity, number of operations, or type of operation. Conclusions: The increasing numbers of monthly border-related injuries during the Title 42 Era flattened in the Post 42 Era, indicating that Title 42's expiration was not correlated with a rise in patient injuries. We did note differences in patient demographics, discharge location, and hospital charges per patient between eras.