Traumatic Brain Injury Healthcare Utilization: Examining the Impact of Race and Insurance
Background: Traumatic brain injury (TBI) is a condition which ranges from mild to severe severity that can result in death or permanent disability. The most recent statistics indicate that approximately 2.5 million cases of TBI were reported in 2010. Race and insurance status are predictors associated with poorer outcomes such as increased emergent healthcare utilization. However, little is known regarding the association of race and insurance status on healthcare utilization following TBI. Thus, the purpose of this project was to examine the presence of disparities when considering the interaction of race and insurance status on healthcare utilization among individuals with TBI at a local Level 1 Trauma Acute Care Facility within one year after onset of TBI. Methods: A retrospective cohort was used to examine 4,150 patients admitted to Baylor University Medical Center (BUMC) with a TBI between the dates of January 1st, 2003 and June 30th, 2014. The cohort of patients and demographic and injury information was retrieved from the BUMC trauma database. Then, this database was combined with the Dallas Fort Worth Hospital Council (DFWHC) Database to track subsequent hospital admissions data in the Dallas Fort Worth Metroplex. Poisson regression determined the association of the interaction of race/ethnicity plus insurance status and the number of emergency, emergency and inpatient, and total healthcare encounters adjusting for age, gender, length of stay at initial admission after onset of TBI, total charges at initial admission, cause of injury, Glasgow coma score, and discharge status. Results: Patients were primarily male (64.5%), Caucasian (44.1%), aged 50±21.9 years, uninsured (37.0%), with falls (37.9%) and motor vehicle collisions (35.8%) as the leading causes of injury. All race and insurance interaction groups except Hispanic with insurance had significantly more subsequent emergency healthcare visits compared to the Non-Hispanic White with private insurance reference group (p<0.05) with Non-Hispanic Black with Public insurance having the greatest relative risk (RR: 4.04; CI: 3.43, 4.77). Conclusion: There is considerable variation with the amount of healthcare utilization services when considering race and insurance status. Interventions to target at risk groups are imperative to reduce these disparities.
Callender, Librada, "Traumatic Brain Injury Healthcare Utilization: Examining the Impact of Race and Insurance" (2017). Texas Medical Center Dissertations (via ProQuest). AAI10274630.