Racial Health Disparities Impact Mortality Rates After Brain Injury

Non-White and Hispanic patients are more than twice as likely to die after a traumatic brain injury, underscoring the impact of racial health disparities, a recent report published in Frontiers in Surgery reveals.

Researchers from Oregon Health & Science University (OHSU) analyzed over 6,000 patient records from OHSU’s Trauma One Database entered between 2006 to 2017. Overall, the in-hospital mortality rate was 9.9 percent. While White and non-Hispanic patients had an in-hospital mortality rate of 8.5 percent, minority patients experienced a rate of 14.6 percent.

The adjusted hazard ratio for minority patient deaths was 2.21. Researchers had adjusted for age, operative status, and injury type to account for baseline characteristic differences. The results indicate that minority patients are more than twice as likely to die in the hospital after a traumatic brain injury.

“Treating patients under our care is our greatest privilege and responsibility as physicians,” the report stated. “As such, we have a societal and professional duty to recognize and accept that the effects of structural racism have taken hold of our patients' health long before they arrive in our trauma bays, ICU beds, and operating tables. These disparities permeate our society and contribute to inequitable health outcomes, and we must take action to identify the factors which perpetuate this disproportionate suffering.”

In the field of neurosurgical trauma, the report explains, health disparities are heightened by insurance concerns, access to trauma centers, a lack of financial support, and access to rehabilitation. Traumatic brain injuries require access to fast and reliable care to increase the likelihood of survival.

Of all hospital admission records in the cohort, 96.5 percent of traumatic brain injury admissions were the result of blunt trauma, while 3.5 percent were from penetrating trauma. While 2.9 percent of the White and non-Hispanic cohort experienced penetrating trauma, 5.3 percent of the minority group did.

Most patients (47.5 percent) had a traumatic brain injury due to a fall and 17 percent were involved in a car accident. Of the minority group, 4.7 percent of the injuries were related to work, while this was the case for only 3.2 percent of the White and non-Hispanic group.

"If you ran the same analysis with patients with pneumonia, you might find the same results," explained lead author Ahmed M. Raslan, MD, associate professor of neurological surgery in the OHSU School of Medicine, in a press release.

"Our findings point to the problem in a more robust and clear way. The problem is rooted in social determinants of health, including factors such as diet, lifestyle, occupations and access to health care."

Commercial insurance was the primary payment method for 31.5 percent of the White and non-Hispanic patient group, while vehicle insurance was most common for the minority group, at 26.2 percent. Medicare followed for White and non-Hispanic patients, with 21.4 percent use. Meanwhile, commercial insurance was second for minority patients, at 20.2 percent. Minority patients paid out-of-pocket 11.1 percent of the time, compared to 7.3 percent for White and non-Hispanic patients.

“It is well-studied in many other aspects of medicine and epidemiology that patients receive differing quality of healthcare and therefore have significantly different outcomes as a result of these health disparities,” the report stated.

“Not only do minority patients face persistent unconscious bias in the healthcare field and have differential access to baseline healthcare, it has also been shown that the healthcare that they do end up receiving likely is less adequate to handle surgically or medically complex issues due to shortages of necessary specialists, technology gaps, or timely access to services.”

As the study noted, systemic racism and health disparities are embedded in the US healthcare system. Researchers recently found that Medicare’s Comprehensive Care for Joint Replacement (CJR) model may be causing hospitals to avoid treating non-Hispanic Black patients for joint replacement surgeries due to perceived higher health risks which could cause additional spending.  

In addition, a recent study shed light on symptom reporting disparities in women with early-stage breast cancer, which could have significant implications on treatment. Currently, Black women are significantly more likely to die from breast cancer than White women, according to the Centers for Disease Control and Prevention’s (CDC) website.

The traumatic brain injury report adds to the growing evidence of worsened health outcomes due to racial disparities. The report reveals significant and quantifiable inequities, “and indicates a substantive need to reshape the current healthcare system and advocate for safer and more supportive pre-hospital social systems to prevent these life-threatening sequelae."