Racial and Socioeconomic Disparities in Traumatic Brain Injury Outcomes: Insights From a Nationwide Analysis.

BACKGROUND AND OBJECTIVES

To examine the effects of racial and socioeconomic disparities on clinical outcomes: in-hospital mortality, discharge dispositions, and hospital length of stay (LOS) among patients with traumatic brain injury (TBI) stratified by race and socioeconomic status (SES).

METHODS

We conducted a retrospective analysis by analyzing the 1995-2015 Nationwide Inpatient Sample database. Adjusted logistic regressions and multinomial logistic regression models with and without propensity score matching were applied to investigate the effects of disparities on clinical outcomes.

RESULTS

African American and Hispanic patients with TBI had a lower risk of in-hospital mortality, longer hospital LOS, and lower likelihood of being discharged to rehabilitation compared with White patients. The TBI patients with poor SES (pSES) had lower in-hospital mortality and were more likely to leave against medical advice compared with non-pSES TBI patients.

CONCLUSION

Racial and socioeconomic disparities had significant influences on in-hospital mortality, discharge dispositions, and hospital LOS among the TBI population. Our study observed pSES TBI patients had a lower likelihood of in-hospital mortality than non-pSES patients, which may be partially attributed to the fact that most of the pSES TBI patients were hospitalized in urban teaching hospitals and hospitals with large bed size. In effect, our data suggest that the Social Safety Net of the United States is effective in preventing mortality in patients with TBI.