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


CONCLUSIONS
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.
Shafi
Shahid
S
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9158, USA. shahid.shafi@uthsouthwestern.edu
Marquez de la Plata
Carlos
C
Diaz-Arrastia
Ramon
R
Shipman
Kristin
K
Carlile
Mary
M
Frankel
Heidi
H
Parks
Jennifer
J
Gentilello
Larry M
LM
D000328:Adult; D001930:Brain Injuries / Q000145:classification / Q000534:rehabilitation*; D005260:Female; D023261:Glasgow Outcome Scale / Q000706:statistics & numerical data*; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D017057:Medically Uninsured; D011287:Prejudice; D012047:Rehabilitation Centers