B. P. Nguyen1, K. Haines1, T. Zens1, C. Warner-Hillard1, S. K. Agarwal1 1University Of Wisconsin School Of Medicine And Public Health,Department Of Surgery, Division Of Trauma And Acute Care Surgery,Madison, WI, USA
Introduction:
Socioeconomic status and race has been shown to increase the chance of being afflicted by a Traumatic Brain Injury (TBI) and result in worse post-hospitalization outcomes. There is a paucity of data on how severity of TBI mediate these treatment and outcome factors. The goal of this study is to determine the effect disparities have on in-hospital mortality, discharge to inpatient rehabilitation, hospital length of stay (LOS), and TBI procedures performed based on insurance status and race/ethnicity throughout the range of TBI severity.
Methods:
This was a retrospective cohort study using the National Trauma Data Bank (2012-2015) analyzing patients with closed head injuries. Univariate and multivariate logistic/linear regression models were performed to determine the impact of race/ethnicity and insurance status on in-hospital mortality, discharge to inpatient rehabilitation, LOS, and TBI procedures performed in groups stratified by head Abbreviated Injury Scale (AIS).
Results:
We analyzed 708,261 TBI patients 76.6% white, 30% private insurance, 13% uninsured, the distribution of severity was 1.3% AIS of 1, 28.3% of AIS of 2, 30.1% of AIS of 3, 30.4% of AIS of 4, 9.9% of AIS of 5. As compared to privately insured patients, uninsured patients experienced greater mortality with increasing AIS, which began from an AIS of 3 (OR = 1.01, p < 0.001) and was the highest at an AIS of 5 (OR = 1.11, p < 0.001). As compared to privately insured patients, uninsured patients were less likely to be discharged to inpatient rehabilitation with increasing AIS as seen beginning from an AIS of 2 (OR = 0.98, p < 0.001) to an AIS of 5 (OR = 0.84, p < 0.001). As compared with white patients, black patients had a longer LOS as their AIS increased, this disparity started at an AIS of 2 (0.16 days, p < 0.001) and increasing to the longest LOS at an AIS of 5 (2.44 days, p < 0.001). As compared with non-Hispanic patients, Hispanic patients had a longer LOS with increasing AIS starting with an AIS of 2 (0.11 days, p < 0.001) increasing to the longest LOS at an AIS of 5 (1.124 days, p < 0.001). Compared with privately insured patients, Medicaid patients had a longer LOS in all AIS stratifications starting from an AIS of 1 (0.55 days, p < 0.001) increasing to the longest LOS at an AIS of 5 (5.52 days, p < 0.001).
Conclusion:
Disparities lead to differences in mortality, procedures performed, and discharge to inpatient rehabilitation for uninsured patients in higher ranges of TBI severity. Also, disparities lead to differences to LOS for black, Hispanic and Medicaid patients throughout the entire spectrum of TBI severity. The most vulnerable populations and minorities with the highest TBI severity seem to have the greatest disparities in treatment and outcome factors.