Socioeconomic Status Affects Outcomes After Severity-Stratified Traumatic Brain Injury

Haines, Krista; Nguyen, Benjamin P.; Vatsaas, Cory J; Alger, Amy; Brooks, Kelli; Agarwal, Suresh

doi:10.1016/j.jss.2018.09.072

Cited by 55 publications

(39 citation statements)

References 28 publications

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“…Socioeconomic status (SES) is in general considered to be an important determinant of general morbidity and mortality [5][6][7]. However, research on the association of SES with outcomes after injuries received only little attention until recent years [8], with studies focusing on TBI being even less common and relatively restricted as to study population, studied outcomes, or severity groups [9][10][11][12][13].…”

Section: Purposementioning

confidence: 99%

Characteristics and outcome of severe traumatic brain injuries based on occupational status

Plančíková

Leitgeb

Bražinová

et al. 2020

Eur J Trauma Emerg Surg

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Purpose The association of TBI with socioeconomic characteristics of patients has not been studied extensively. The objective of this study was to analyse the differences in injury characteristics and outcome in TBI patients based on their occupational status. Methods Data on patients from 13 centres based in Austria, Croatia, Slovakia, Bosnia and Herzegovina, and Macedonia were included in the analysis. Demographic characteristics, injury characteristics, treatment and outcome at various post-injury stages were compared according to occupational status. Logistic regression was used to adjust for the effect of co-variates. ICU mortality, hospital mortality, 6 months mortality, and outcome at 6 months were used as dependent variables. Results Overall, 886 patients were analysed with a mean age of 45.5 years. High-level falls were most prevalent in the bluecollar group (19%), most low-level falls occurred in the retired group. Traffic accidents were most common in students. The injuries were most severe in the blue-collar group and students. Highest mortalities and unfavourable outcomes were in the retired, students and white-collar workers had the best outcomes. Compared to retired patients, all groups had higher odds of favourable outcome at 6 months after adjusting for co-variates-OR from 2.2 (95% CI 1.1-4.6) for entrepreneurs to 3.6 (95% CI 1.8-7.2) for the blue-collar group. Conclusion Our paper provides clues pertaining specifically to variations in patterns and outcomes of TBI according to occupational status which can inform prevention and planning of services and can serve to plan priorities for further research.

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Section: Purposementioning

confidence: 99%

Characteristics and outcome of severe traumatic brain injuries based on occupational status

Plančíková

Leitgeb

Bražinová

et al. 2020

Eur J Trauma Emerg Surg

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show abstract

“…The study failed to examine the interaction between race and lack of insurance even though another study found that Black persons are more likely to be uninsured 33 . Another large NTDB study by Haines et al analyzed 131 461 moderate to critical TBI patients by factors including socioeconomic status and race (Table 2) 36 . Uninsured patients had a decreased likelihood of being discharged to inpatient rehabilitation as head AIS increased.…”

Section: Methodsmentioning

confidence: 99%

“…Length of stay increased for Black patients as AIS scores increased, especially for the critical patients with AIS of 5. Patients with more severe head injuries had the greatest deviation in treatment and outcome when stratified by race and socioeconomic status 36 . The TBIMS program has an extensive database and has also produced studies in regard to functional outcomes after TBI.…”

Section: Methodsmentioning

confidence: 99%

Disparities in Health Care for Black Patients in Physical Medicine and Rehabilitation in the United States: A Narrative Review

Odonkor

Esparza

Flores

et al. 2020

PM&R

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Racial health disparities continue to disproportionately affect Black persons in the United States. Black individuals also have increased risk of worse outcomes associated with social determinants of health including socioeconomic factors such as income, education, and employment. This narrative review included studies originally spanning a period of approximately one decade (December 2009‐December 2019) from online databases and with subsequent updates though June 2020. The findings to date suggest pervasive inequities across common conditions and injuries in physical medicine and rehabilitation for this group compared to other racial/ethnic groups. We found health disparities across several domains for Black persons with stroke, traumatic brain injury, spinal cord injury, hip/knee osteoarthritis, and fractures, as well as cardiovascular and pulmonary disease. Although more research is needed, some contributing factors include low access to rehabilitation care, fewer referrals, lower utilization rates, perceived bias, and more self‐reliance, even after adjusting for hospital characteristics, age, disease severity, and relevant socioeconomic variables. Some studies found that Black individuals were less likely to receive care that was concordant with clinical guidelines per the reported literature. Our review highlights many gaps in the literature on racial disparities that are particularly notable in cardiac, pulmonary, and critical care rehabilitation. Clinicians, researchers, and policy makers should therefore consider race and ethnicity as important factors as we strive to optimize rehabilitation care for an increasingly diverse U.S. population.

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“…Individuals with greater levels of social deprivation are at an increased risk of major diseases including cardiovascular conditions (1-3), diabetes (4), cirrhosis (5), hypertension (6,7), and an increased incidence of trauma (8)(9)(10). Similarly, lower SES has been correlated with a worse prognosis and a greater likelihood of disease progression for a variety of conditions, and a higher rate of surgical complications (11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”

Section: Introductionmentioning

confidence: 99%

Evaluating the Impact of Social Deprivation on Press Ganey® Outpatient Medical Practice Survey Scores

Stephens

Potter

Tyser

et al. 2020

Preprint

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Background Social deprivation has been shown to affect access to health care services, and influences outcomes for a variety of physical and psychological conditions. However, the impact on patient satisfaction remains less clear. The objective of this study was to determine if social deprivation is an independent predictor of patient satisfaction, as measured by the Press Ganey® Outpatient Medical Practice Survey (PGOMPS). Methods We retrospectively reviewed unique new adult patient (≥18 years of age) seen at a tertiary academic hospital and rural/urban outreach hospitals/clinics between January 2014 and December 2017. Satisfaction was defined a priori as achieving a score above the 33 rd percentile. The 2015 Area Deprivation Index (ADI) was used to determine social deprivation (lower score signifies less social deprivation). Univariate and multivariable binary logistic regression were used to determine the impact of ADI on PGOMPS total and provider sub-scores while controlling for variables previously shown to impact scores (wait time, patient age, sex, race, specialty type, provider type, and insurance status). Results Univariate analysis of PGOMPS total scores revealed a 4% decrease in odds of patient satisfaction per decile increase in ADI (p < 0.001). Patients within the most deprived quartile were significantly less likely to report satisfaction compared to the least deprived quartile (OR 0.79, p < 0.001). Multivariable analysis revealed that the odds of achieving satisfaction decreased 2% for each decile increase in ADI on the Total Score (p < 0.001), independent of other variables previously shown to impact scores. For PGOMPS Provider Sub-Score, univariate analysis showed that patients in the lowest ADI quartile were significantly less likely be satisfied, as compared to the least deprived quartile (OR 0.77; 95% CI 0.70 to 0.86; p < 0.001). A 5% decrease in a patient being satisfied was observed for each decile increase in ADI (OR 0.95; 95% CI 0.94 to 0.96; p < 0.001). Conclusions Social deprivation was an independent predictor of outpatient visit dissatisfaction, as measured by the Press Ganey® Outpatient Medical Practice Survey. These results necessitate consideration when developing health care delivery policies that serve to minimize inequalities between patients of differing socioeconomic groups.

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Socioeconomic Status Affects Outcomes After Severity-Stratified Traumatic Brain Injury

Cited by 55 publications

References 28 publications

Characteristics and outcome of severe traumatic brain injuries based on occupational status

Characteristics and outcome of severe traumatic brain injuries based on occupational status

Disparities in Health Care for Black Patients in Physical Medicine and Rehabilitation in the United States: A Narrative Review

Evaluating the Impact of Social Deprivation on Press Ganey® Outpatient Medical Practice Survey Scores

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