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

74 Scopus citations

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)
Pages (from-to)1263-1270
Number of pages8
JournalJournal of Trauma
Volume63
Issue number6
DOIs
StatePublished - Dec 2007

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Keywords

  • Ethnic disparities
  • TBI

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Shafi, S., Marquez de la Plata, C., Diaz-Arrastia, R., Shipman, K., Carlile, M., Frankel, H., Parks, J., & Gentilello, L. M. (2007). Racial disparities in long-term functional outcome after traumatic brain injury. Journal of Trauma, 63(6), 1263-1270. https://doi.org/10.1097/TA.0b013e31815b8f00