Date of Award

12-2020

Degree Name

Master of Science (MS)

Advisor(s)

VAHED MAROUFY

Second Advisor

DAVID AGUILAR

Third Advisor

GEORGE WILLIAMS

Abstract

Background: Racial/ethnic and socioeconomic status (SES) disparities have been reported among patients following traumatic brain injury (TBI), which results in worse health outcomes of TBI patients. The objective of this thesis was to study the effects of racial/ethnic and socioeconomic disparities on clinical outcomes: in-hospital mortality, discharge dispositions, and hospital length of stay (LOS) among TBI patients. Methods: The study was a retrospective analysis of TBI cohorts by analyzing 1995-2015 Nationwide Inpatient Sample (NIS) database of the Health Cost and Utilization Project (HCUP) managed by the Agency for Healthcare Research and Quality (AHRQ). Multivariable logistic regressions, multinomial logistic regressions, and cox proportional hazard models were applied to investigate disparities effects on clinical outcomes. Results: The study included 532,852 TBI patients from the year 1995-2015. African American and Hispanic TBI patients had significantly lower in-hospital mortality, longer hospital LOS, and lower likelihood to be discharged to rehabilitation than White TBI patients. Asian TBI patients were less likely to be discharged to rehabilitation and had longer hospital LOS than White patients. Medicaid and self-pay TBI patients had significantly higher in-hospital mortality and lower likelihood to be discharged to rehabilitation than Medicare TBI patients. Medicaid patients had longer LOS, whereas self-pay patients had shorter LOS than Medicare patients. The third and the fourth (highest income) income quartile TBI patients were significantly more likely to be discharged to rehabilitation than the first income quartile TBI patients. Conclusions: Racial/ethnic and insurance disparities had significant influences on in-hospital mortality, discharge dispositions, and hospital length of stay among the TBI population. Income disparities had significant effects on discharge dispositions, but there were no significant income disparities effects found on in-hospital mortality or hospital length of stay.

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