Abstract
Introduction We evaluated outcome and resource utilization disparities between commercially insured,
Medicaid, and Medicare patients. We further analyzed racial disparities in a subset
cohort.
Methods We reviewed the MarketScan database (2000–2009) for adult traumatic brain injury
(TBI) patients. Analyses were performed to evaluate outcome differences by insurance
type and race. Outpatient service utilization disparities by insurance and race were
also evaluated.
Results Our study included 92,159 TBI patients, 44,108 (47.9%) of whom utilized commercial
insurance, 19,743 (21.4%) utilized Medicaid, and 28,308 (30.7%) utilized Medicare.
In-hospital mortality was lowest for commercially insured (5.0%) versus 7.6% and 8.5%
for Medicaid and Medicare patients, respectively (p < 0.0001). Medicaid patients had a longer hospitalization than commercially insured
(12 days versus 6 days; p < 0.0001). Medicaid patients were 1.29 and 1.78 times more likely to die and experience
complications than the commercially insured. Females had a lower mortality risk (odds
ratio [OR]: 0.80, p < 0.0001) and less complications (OR: 0.67; p < 0.0001) than males. Higher comorbidities increased mortality risk (OR: 2.71; p < 0.0001) and complications (OR: 2.96, p < 0.0001). Mild injury patients had lower mortality (OR: 0.01; p < 0.0001) and less complications (OR: 0.07; p < 0.0001). Medicare (OR: 1.33; p < 0.0001) and higher comorbidity (OR: 1.26; p < 0.0001) patients utilized outpatient rehabilitation services more frequently. Medicare
patients had twice the emergency department visits as the commercially insured (p < 0.0001). Medicare (16.6%) patients utilized more rehabilitation than commercially
insured (13.4%) and Medicaid (9.1%) patients. Racial disparities were analyzed in
a subset of 12,847 white and 4,780 African American (AA) patients. Multivariate analysis
showed that AAs were more likely to experience a complication than white patients
(OR: 1.13; p = 0.0024) and less likely to utilize outpatient rehabilitation services (OR: 0.83;
p = 0.0025) than whites.
Conclusions Insurance and racial disparities continue to exist for TBI patients. Insurance status
appears to have an impact on short- and long-term outcomes to a greater degree than
patient race.
Keywords
traumatic brain Injury (TBI) - disparities - length of stay (LOS) - discharge disposition
- resource utilization
