Racial disparities in long-term functional outcome after traumatic brain injury.

Shahid Shafi, Carlos Marquez de la Plata, Ramon Diaz-Arrastia, Kristin Shipman, Mary Carlile, Heidi Frankel, Jennifer Parks, Larry M. Gentilello

Research output: Contribution to journalArticle

72 Citations (Scopus)

Abstract

OBJECTIVE: Ethnic disparities have been demonstrated in several diseases, but not in trauma. We hypothesized that access to acute rehabilitation and long-term functional outcomes among traumatic brain injury (TBI) patients are influenced by patient race and ethnicity. METHODS: Patients with severe TBI (Abbreviated Injury Scale [AIS] score, 3-5) who were discharged alive from initial hospitalization were recruited from an urban Level I trauma center (1998-2005). Functional outcome was measured 6 to 12 months after injury using the Glasgow Outcome Scale-Extended (GOSE) score, and classified as good recovery (GOSE score, 7 and 8) or moderate to severe disability (GOSE score, 1-6). Ethnic minorities (n = 114) were compared with non-Hispanic Whites (NHW, n = 230). Logistic regression was used to measure the association between ethnicity and functional outcome while controlling for age, gender, Injury Severity Score (ISS), head AIS score, Glasgow Coma Scale (GCS) score, discharge disposition, and insurance. RESULTS: Minority and NHW groups had similar ISS, GCS score, and head AIS score. Ethnic minorities were less likely to be insured (uninsured, 66% vs. 31%, p < 0.001), but were equally likely to be placed in a rehabilitation facility upon trauma center discharge (47% vs. 42%, p = 0.417). Minority patients were more likely to have moderate to severe disability at follow-up (74% vs. 61%; adjusted odds ratio [OR], 2.17; 95% confidence interval [CI], 1.27-3.69). The relationship between ethnicity and functional outcome became insignificant when insurance was taken into account (OR, 1.52; 95% CI, 0.81-2.72). CONCLUSION: Despite equal access to acute rehabilitation, ethnic minorities have significantly worse long-term functional outcomes after TBI, which is related to lack of health insurance.

Original languageEnglish (US)
JournalThe Journal of trauma
Volume63
Issue number6
StatePublished - Dec 2007

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Abbreviated Injury Scale
Glasgow Outcome Scale
Glasgow Coma Scale
Injury Severity Score
Rehabilitation
Trauma Centers
Insurance
Craniocerebral Trauma
Odds Ratio
Confidence Intervals
Minority Groups
Wounds and Injuries
Health Insurance
Hospitalization
Logistic Models
Traumatic Brain Injury

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Shafi, S., Marquez de la Plata, C., Diaz-Arrastia, R., Shipman, K., Carlile, M., Frankel, H., ... Gentilello, L. M. (2007). Racial disparities in long-term functional outcome after traumatic brain injury. The Journal of trauma, 63(6).

Racial disparities in long-term functional outcome after traumatic brain injury. / Shafi, Shahid; Marquez de la Plata, Carlos; Diaz-Arrastia, Ramon; Shipman, Kristin; Carlile, Mary; Frankel, Heidi; Parks, Jennifer; Gentilello, Larry M.

In: The Journal of trauma, Vol. 63, No. 6, 12.2007.

Research output: Contribution to journalArticle

Shafi, S, Marquez de la Plata, C, Diaz-Arrastia, R, Shipman, K, Carlile, M, Frankel, H, Parks, J & Gentilello, LM 2007, 'Racial disparities in long-term functional outcome after traumatic brain injury.', The Journal of trauma, vol. 63, no. 6.
Shafi S, Marquez de la Plata C, Diaz-Arrastia R, Shipman K, Carlile M, Frankel H et al. Racial disparities in long-term functional outcome after traumatic brain injury. The Journal of trauma. 2007 Dec;63(6).
Shafi, Shahid ; Marquez de la Plata, Carlos ; Diaz-Arrastia, Ramon ; Shipman, Kristin ; Carlile, Mary ; Frankel, Heidi ; Parks, Jennifer ; Gentilello, Larry M. / Racial disparities in long-term functional outcome after traumatic brain injury. In: The Journal of trauma. 2007 ; Vol. 63, No. 6.
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abstract = "OBJECTIVE: Ethnic disparities have been demonstrated in several diseases, but not in trauma. We hypothesized that access to acute rehabilitation and long-term functional outcomes among traumatic brain injury (TBI) patients are influenced by patient race and ethnicity. METHODS: Patients with severe TBI (Abbreviated Injury Scale [AIS] score, 3-5) who were discharged alive from initial hospitalization were recruited from an urban Level I trauma center (1998-2005). Functional outcome was measured 6 to 12 months after injury using the Glasgow Outcome Scale-Extended (GOSE) score, and classified as good recovery (GOSE score, 7 and 8) or moderate to severe disability (GOSE score, 1-6). Ethnic minorities (n = 114) were compared with non-Hispanic Whites (NHW, n = 230). Logistic regression was used to measure the association between ethnicity and functional outcome while controlling for age, gender, Injury Severity Score (ISS), head AIS score, Glasgow Coma Scale (GCS) score, discharge disposition, and insurance. RESULTS: Minority and NHW groups had similar ISS, GCS score, and head AIS score. Ethnic minorities were less likely to be insured (uninsured, 66{\%} vs. 31{\%}, p < 0.001), but were equally likely to be placed in a rehabilitation facility upon trauma center discharge (47{\%} vs. 42{\%}, p = 0.417). Minority patients were more likely to have moderate to severe disability at follow-up (74{\%} vs. 61{\%}; adjusted odds ratio [OR], 2.17; 95{\%} confidence interval [CI], 1.27-3.69). The relationship between ethnicity and functional outcome became insignificant when insurance was taken into account (OR, 1.52; 95{\%} CI, 0.81-2.72). CONCLUSION: Despite equal access to acute rehabilitation, ethnic minorities have significantly worse long-term functional outcomes after TBI, which is related to lack of health insurance.",
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AU - Shafi, Shahid

AU - Marquez de la Plata, Carlos

AU - Diaz-Arrastia, Ramon

AU - Shipman, Kristin

AU - Carlile, Mary

AU - Frankel, Heidi

AU - Parks, Jennifer

AU - Gentilello, Larry M.

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N2 - OBJECTIVE: Ethnic disparities have been demonstrated in several diseases, but not in trauma. We hypothesized that access to acute rehabilitation and long-term functional outcomes among traumatic brain injury (TBI) patients are influenced by patient race and ethnicity. METHODS: Patients with severe TBI (Abbreviated Injury Scale [AIS] score, 3-5) who were discharged alive from initial hospitalization were recruited from an urban Level I trauma center (1998-2005). Functional outcome was measured 6 to 12 months after injury using the Glasgow Outcome Scale-Extended (GOSE) score, and classified as good recovery (GOSE score, 7 and 8) or moderate to severe disability (GOSE score, 1-6). Ethnic minorities (n = 114) were compared with non-Hispanic Whites (NHW, n = 230). Logistic regression was used to measure the association between ethnicity and functional outcome while controlling for age, gender, Injury Severity Score (ISS), head AIS score, Glasgow Coma Scale (GCS) score, discharge disposition, and insurance. RESULTS: Minority and NHW groups had similar ISS, GCS score, and head AIS score. Ethnic minorities were less likely to be insured (uninsured, 66% vs. 31%, p < 0.001), but were equally likely to be placed in a rehabilitation facility upon trauma center discharge (47% vs. 42%, p = 0.417). Minority patients were more likely to have moderate to severe disability at follow-up (74% vs. 61%; adjusted odds ratio [OR], 2.17; 95% confidence interval [CI], 1.27-3.69). The relationship between ethnicity and functional outcome became insignificant when insurance was taken into account (OR, 1.52; 95% CI, 0.81-2.72). CONCLUSION: Despite equal access to acute rehabilitation, ethnic minorities have significantly worse long-term functional outcomes after TBI, which is related to lack of health insurance.

AB - OBJECTIVE: Ethnic disparities have been demonstrated in several diseases, but not in trauma. We hypothesized that access to acute rehabilitation and long-term functional outcomes among traumatic brain injury (TBI) patients are influenced by patient race and ethnicity. METHODS: Patients with severe TBI (Abbreviated Injury Scale [AIS] score, 3-5) who were discharged alive from initial hospitalization were recruited from an urban Level I trauma center (1998-2005). Functional outcome was measured 6 to 12 months after injury using the Glasgow Outcome Scale-Extended (GOSE) score, and classified as good recovery (GOSE score, 7 and 8) or moderate to severe disability (GOSE score, 1-6). Ethnic minorities (n = 114) were compared with non-Hispanic Whites (NHW, n = 230). Logistic regression was used to measure the association between ethnicity and functional outcome while controlling for age, gender, Injury Severity Score (ISS), head AIS score, Glasgow Coma Scale (GCS) score, discharge disposition, and insurance. RESULTS: Minority and NHW groups had similar ISS, GCS score, and head AIS score. Ethnic minorities were less likely to be insured (uninsured, 66% vs. 31%, p < 0.001), but were equally likely to be placed in a rehabilitation facility upon trauma center discharge (47% vs. 42%, p = 0.417). Minority patients were more likely to have moderate to severe disability at follow-up (74% vs. 61%; adjusted odds ratio [OR], 2.17; 95% confidence interval [CI], 1.27-3.69). The relationship between ethnicity and functional outcome became insignificant when insurance was taken into account (OR, 1.52; 95% CI, 0.81-2.72). CONCLUSION: Despite equal access to acute rehabilitation, ethnic minorities have significantly worse long-term functional outcomes after TBI, which is related to lack of health insurance.

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