title: Ethnic disparities exist in trauma care.
abstract: BACKGROUND
  An estimated 5.3 million people in the United States live with permanent disability related to traumatic brain injury (TBI). Access to rehabilitation after TBI is important in minimizing these disabilities. Ethnic disparities in access to health care have been documented in other diseases, but have not been studied in trauma care. We hypothesized that access to rehabilitation after TBI is influenced by race or ethnicity.
  
  
  METHODS
  Retrospective analysis of the National Trauma Data Bank patients with severe blunt TBI (head abbreviated injury score 3-5, n = 58,729) who survived the initial hospitalization was performed. Placement into rehabilitation after discharge was studied in three groups: non-Hispanic white (NHW 77%), African American (14%), and Hispanic (9%). The two minority groups were compared with NHW patients using logistic regression to control for differences in age, gender, overall injury severity (injury severity score), TBI severity (head abbreviated injury score and Glasgow Coma Scale score), associated injuries, and insurance status.
  
  
  RESULTS
  The three groups were similar in injury severity score, TBI severity, and associated injuries. After accounting for differences in potential confounders, including injury severity and insurance status, minority patients were 15% less likely to be placed in rehabilitation (odds ratio 0.85, 95% confidence interval 0.8-0.9, p < 0.0001).
  
  
  CONCLUSIONS
  Ethnic minority patients are less likely to be placed in rehabilitation than NHW patients are, even after accounting for insurance status, suggesting existence of systematic inequalities in access. Such inequalities may have a disproportionate impact on long-term functional outcomes of African American and Hispanic TBI patients, and suggest the need for an in-depth analysis of this disparity at a health policy level.
authors.affiliation: Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA. shahid.shafi@uthsouthwestern.edu
authors.forename: Shahid
authors.initials: S
authors.lastname: Shafi
authors.forename: Carlos Marquez
authors.initials: CM
authors.lastname: de la Plata
authors.forename: Ramon
authors.initials: R
authors.lastname: Diaz-Arrastia
authors.forename: Aaron
authors.initials: A
authors.lastname: Bransky
authors.forename: Heidi
authors.initials: H
authors.lastname: Frankel
authors.forename: Alan C
authors.initials: AC
authors.lastname: Elliott
authors.forename: Jennifer
authors.initials: J
authors.lastname: Parks
authors.forename: Larry M
authors.initials: LM
authors.lastname: Gentilello
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D017677:Age Distribution; D001930:Brain Injuries / Q000208:ethnology* / Q000534:rehabilitation*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D015601:Injury Severity Score; D007348:Insurance, Health / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D012046:Rehabilitation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data