Citation

Shafi S, Marquez de la Plata C, Diaz-Arrastia R, Shipman K, Carlile M, Frankel H, Parks J, Gentilello LM. J. Trauma 2007; 63(6): 1263-8; discussion 1268-70.

Affiliation

Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9158, USA. shahid.shafi@uthsouthwestern.edu

Copyright

(Copyright © 2007, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0b013e31815b8f00

PMID

18212648

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.

Language: en