K. McQuistion1, H. Jung1, T. Zens1, M. Beems1, G. Leverson1, A. O’Rourke1, A. Liepert1, J. Scarborouh1, S. Agarwal1 1University Of Wisconsin,Surgery,Madison, WI, USA
Introduction:
There is increasing evidence that socioeconomic factors affect patient outcomes after traumatic brain injury. However, these factors are often considered in isolation. The goal of the present study was to assess the effect of race/ethnicity and method of payment on hospital length of stay, mortality, and discharge disposition after traumatic brain injury.
Methods:
A retrospective cohort study using the National Trauma Data Bank years 2002-2012 was performed. Patients aged 14-89 with ICD-9 codes for one of six closed head injuries (Concussion, Cerebral Contusion, Cerebellar or Brainstem Contusion, Subarachnoid Hemorrhage, Subdural Hemorrhage, and Extradural Hemorrhage) were analyzed. Univariate logistic and linear regression was used to assess the effect of demographic and injury characteristics on each outcome variable. All significant predictors were included in the multivariate models for hospital length of stay, mortality, and discharge disposition.
Results:
The analytical sample consisted of 201,553 TBI patients, including 2.5% Asian, 12.0% Black, 10.1% Hispanic, 0.7% Native American, and 74.7% White patients. Of these, 9.0% had Medicaid, 25.2% had Medicare, 12.3% had other insurance, 37.9% were privately insured, and 15.6% were uninsured. Compared to White patients, Black and Hispanic patients were less likely to die in the hospital (Black OR=.792, p<.001; Hispanic OR=.840, p=.002), had longer hospital lengths of stay (Black coeff=.451, p<.001; Hispanic coeff=.249, p<.001), and were less likely to be discharged to inpatient rehabilitation (Black OR=.885, p<.001; Hispanic OR=.703, p<.001). Hispanics were also less likely to receive any continuing care after discharge than Whites (OR=.762, p<.001). Compared to the Privately Insured, the Uninsured were more likely to die in the hospital (OR=1.487, p<.001), less likely to receive any continuing care after discharge (OR=.564, p<.001) including inpatient rehabilitation (OR=.516, p<.001), and had shorter lengths of stay (coeff=-.095, p=.042). Patients with Medicaid were more likely to die in the hospital (OR=1.166, p=.019), had longer lengths of stay (coeff=1.493, p<.001), and were more likely to receive continuing care after discharge (OR=1.396, p<.001) including inpatient rehabilitation (OR=1.141, p<.001) than the Privately Insured.
Conclusion:
Race/ethnicity and insurance status both significantly effect patient’s outcomes after TBI, even after controlling for other demographic and injury characteristics. The strongest disparities can be seen for uninsured patients who are more likely to die in the hospital, less likely to receive any continuing care after discharge, particularly any inpatient rehabilitation, and have shorter lengths of stay than any other group. These socioeconomic outcome differences warrant further investigation into their root cause.