title: Socioeconomic Status and Hospitalization Costs for Children with Brain and Spinal Cord Injury.
abstract: OBJECTIVE
  To determine if household income is associated with hospitalization costs for severe traumatic brain injury (TBI) and spinal cord injury (SCI).
  
  
  METHODS
  Retrospective cohort study of inpatient, nonrehabilitation hospitalizations at 43 freestanding children's hospitals for patients <19 years old with unintentional severe TBI and SCI from 2009-2012. Standardized cost of care for hospitalizations was modeled using mixed-effects methods, adjusting for age, sex, race/ethnicity, primary payer, presence of chronic medical condition, mechanism of injury, injury severity, distance from residence to hospital, and trauma center level. Main exposure was zip code level median annual household income.
  
  
  RESULTS
  There were 1061 patients that met inclusion criteria, 833 with TBI only, 227 with SCI only, and 1 with TBI and SCI. Compared with those with the lowest-income zip codes, patients from the highest-income zip codes were more likely to be older, white (76.7% vs 50.4%), have private insurance (68.9% vs 27.9%), and live closer to the hospital (median distance 26.7 miles vs 81.2 miles). In adjusted models, there was no significant association between zip code level household income and hospitalization costs.
  
  
  CONCLUSIONS
  Children hospitalized with unintentional, severe TBI and SCI showed no difference in standardized hospital costs relative to a patient's home zip code level median annual household income. The association between household income and hospitalization costs may vary by primary diagnosis.
authors.affiliation: Department of Emergency Medicine and Injury Prevention Center, Hasbro Children's Hospital, Providence, RI; Alpert Medical School of Brown University, Providence, RI. Electronic address: zonfrillo@brown.edu.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Zonfrillo
authors.affiliation: Department of Statistics, University of Missouri, Columbia, MO.
authors.forename: Isabella
authors.initials: I
authors.lastname: Zaniletti
authors.affiliation: Children's Hospital Association, Overland Park, KS.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hall
authors.affiliation: Alpert Medical School of Brown University, Providence, RI; Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Evan S
authors.initials: ES
authors.lastname: Fieldston
authors.affiliation: Department of Pediatrics, Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City School of Medicine, Kansas City, MO.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Colvin
authors.affiliation: Department of Pediatrics, Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City School of Medicine, Kansas City, MO.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Bettenhausen
authors.affiliation: Department of Emergency Medicine, Child Health Evaluation and Research Unit, Division of General Pediatrics, C.S. Mott Children's Hospital, University of Michigan Medical School, Ann Arbor, MI.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Macy
authors.affiliation: Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Alpern
authors.affiliation: Department of Pediatric Emergency Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN.
authors.forename: Gretchen J
authors.initials: GJ
authors.lastname: Cutler
authors.affiliation: Department of Pediatrics, Section on Academic General Pediatrics, Baylor College of Medicine, Houston, TX.
authors.forename: Jean L
authors.initials: JL
authors.lastname: Raphael
authors.affiliation: Children's Health System of Texas, Dallas, TX.
authors.forename: Rustin B
authors.initials: RB
authors.lastname: Morse
authors.affiliation: Children's Hospital Colorado, Aurora, CO.
authors.forename: Marion R
authors.initials: MR
authors.lastname: Sills
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH.
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D001930:Brain Injuries / Q000191:economics*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics*; D006776:Hospitals, Pediatric / Q000191:economics*; D006801:Humans; D007182:Income; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012923:Social Class; D013119:Spinal Cord Injuries / Q000191:economics*