Racial disparities in mortality after severe traumatic brain injury in childhood: mediators identified by Oaxaca-Blinder decomposition of trauma registry data

Abstract

Background In the United States social disparities in health outcomes are found wherever they are sought, and they have been documented extensively in trauma care. Because social factors cannot cause a trauma outcome directly, there must exist mediating causal factors related to the nature and severity of the injury, the robustness of the victim, access to care, or processes of care. An understanding these mediators is the point of departure for addressing inequities in outcomes. Findings Data were extracted from the registry of the Trauma Quality Improvement Program of the American College of Surgeons for 2007 through 2010. Inclusion criteria were age less than 19 years and head Abbreviated Injury Scale score of 4, 5, or 6. An Oaxaca-Blinder decomposition was undertaken to analyze the relative contributions of a large set of covariates to the difference in mortality rates between Black and White children. Covariates were aggregated into the following categories: “Severity,” “Structure and Process,” “Mechanism,” “Demographics,” and “Insurance.” Eligible for analysis were 7273 White children and 2320 Black children. There were 1661 deaths (17.3%) The raw mortality rates were 15.6 and 22.8% for White and Black children, respectively. Factors categorized as “Severity” accounted for 95% of the mortality difference, “Mechanism” accounted for 13%, “Insurance” accounted for 5%, and “Demographics” accounted for 2%. The contribution of “Structure and Process” did not attain statistical significance. Conclusions Severity of injury accounts for most of the disparity between Black and White children in traumatic brain injury mortality rates. Mechanism, insurance status, and gender make a small contributions. Because insurance status like other social factors cannot directly affect trauma survival, what mediates its contribution requires further study.

Social determinants of trauma care: Associations of race, insurance status, and place on opioid prescriptions, postdischarge referrals, and mortality

“…29 Moreover, racial disparities in mortality among children with severe traumatic brain injury were largely explained by differences in injury characteristics (i.e., severity, mechanism), with insurance and demographic variables also playing a role. 37 Notably, more pronounced racial disparities emerged as a function of age in the present study, with Black injury patients being more likely to die than their White counterparts starting in middle age (at approximately 35 years of age) and this disparity becoming more pronounced in old age. Together, these findings suggest that racial disparities in mortality differ according to patient age and may be driven, in part, by differences in insurance status.…”

“…Previous studies have reported that racial disparities in mortality rates are diminished when controlling for insurance status 36 and eliminated after adjusting for both insurance status and neighborhood poverty 29 . Moreover, racial disparities in mortality among children with severe traumatic brain injury were largely explained by differences in injury characteristics (i.e., severity, mechanism), with insurance and demographic variables also playing a role 37 . Notably, more pronounced racial disparities emerged as a function of age in the present study, with Black injury patients being more likely to die than their White counterparts starting in middle age (at approximately 35 years of age) and this disparity becoming more pronounced in old age.…”

Prevalence and Correlates of Suspected and Diagnosed Traumatic Brain Injuries among US School-Aged Children

“… 32 , 33 This is particularly concerning because children from racial and ethnic minority groups are more likely to experience more severe TBIs and TBI outcomes compared with non-Hispanic White children. 32 , 33 , 34 …”

Review of wearable technologies and machine learning methodologies for systematic detection of mild traumatic brain injuries

“…Therefore, despite the considerable public interest on sports-related concussion (SRC) in youth, the findings in this report suggest that TBIs attributable to older adult falls, many of which result in hospitalization and death, should receive public health attention. There is also a growing body of evidence on racial and ethnic disparities within TBI and in the United States social disparities in health outcomes are found wherever they are sought [5,6].…”