McQuistion Kaitlyn, Zens Tiffany, Jung Hee Soo, Beems Megan, Leverson Glen, Liepert Amy, Scarborough John, Agarwal Suresh
Division of Trauma and Acute Care Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Division of Trauma and Acute Care Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
J Surg Res. 2016 Oct;205(2):261-271. doi: 10.1016/j.jss.2016.06.087. Epub 2016 Jul 4.
There is increasing evidence that race and socioeconomic factors affect patient outcomes after traumatic brain injury (TBI). Our goal was to assess the effect of race, ethnicity and insurance status on hospital length of stay, procedures performed, mortality, and discharge disposition after TBI.
This was a retrospective cohort study using the National Trauma Data Bank (2002-2012) to analyze patients aged 14-89 y with one of five closed head injuries. Univariate regressions identified demographic and injury characteristics that were significant predictors of outcomes. These variables were then included in multivariate regression models.
We analyzed 187,354 TBI patients. The sample was 78% white, 9% black, 9% Hispanic, 3% Asian, and 1% native American, and included 42% Medicare, 30% private insurance, 12% uninsured, 8% other insurance, and 8% Medicaid. Compared with white patients, black and Hispanic patients were more likely to have a TBI procedure (blacks odds ratio [OR] = 1.19, P < 0.001; Hispanics OR = 1.33, P < 0.001), had longer hospital stays (blacks coeff = 1.02, P < 0.001; Hispanics coeff = 0.61, P < 0.001), were less likely to die in the hospital (blacks OR = 0.90, P = 0.006; Hispanics OR = 0.90, P = 0.007), and more (black OR = 1.09, P = 0.001) or less likely (Hispanic OR = 0.76, P < 0.001) to be discharged to rehabilitation. Compared with the privately insured, the uninsured were less likely to have a TBI procedure (OR = 0.90, P = 0.001), had longer hospital stays (coeff = 0.24, P < 0.001), were more likely to die in the hospital (OR = 1.37, P < 0.001), and less likely to be discharged to rehabilitation (OR = 0.53, P < 0.001).
Race/ethnicity and insurance status significantly affect TBI patient outcomes, even after controlling for demographic and injury characteristics.
越来越多的证据表明，种族和社会经济因素会影响创伤性脑损伤（TBI）患者的预后。我们的目标是评估种族、民族和保险状况对TBI患者住院时间、所进行的手术、死亡率和出院处置的影响。
这是一项回顾性队列研究，使用国家创伤数据库（2002 - 2012年）分析14至89岁患有五种闭合性头部损伤之一的患者。单因素回归确定了作为预后显著预测因素的人口统计学和损伤特征。然后将这些变量纳入多因素回归模型。
我们分析了187,354例TBI患者。样本中78%为白人，9%为黑人，9%为西班牙裔，3%为亚洲人，1%为美国原住民，包括42%的医疗保险患者，30%的私人保险患者，12%的未参保患者，8%的其他保险患者和8%的医疗补助患者。与白人患者相比，黑人和西班牙裔患者更有可能接受TBI手术（黑人优势比[OR]=1.19，P<0.001；西班牙裔OR = 1.33，P<0.001），住院时间更长（黑人系数=1.02，P<0.001；西班牙裔系数=0.61，P<0.001），在医院死亡的可能性更小（黑人OR = 0.90，P = 0.006；西班牙裔OR = 0.90，P = 0.007），出院后接受康复治疗的可能性更大（黑人OR = 1.09，P = 0.001）或更小（西班牙裔OR = 0.76，P<0.001）。与私人保险患者相比，未参保患者接受TBI手术的可能性更小（OR = 0.90，P = 0.001），住院时间更长（系数=0.24，P<0.001），在医院死亡的可能性更大（OR = 1.37，P<0.001），出院后接受康复治疗的可能性更小（OR = 0.
