Summary: The likelihood of death following a traumatic brain injury is twice as high for people of color than white people, a new study reports. Researchers found no bias in health care following TBI, and suggest the increased risk is due to underlying disparities.
Source: Oregon Health and Sciences University
People of color are more than twice as likely to die after a traumatic brain injury as white people, according to a new retrospective review from Oregon Health & Science University.
The study published today in the journal Frontiers in Surgery.
In the report, “Racial and Ethnic Inequities in Mortality During Hospitalization for Traumatic Brain Injury: A Call to Action,” the researchers analyzed more than a decade of data related to the health outcomes and demographics of thousands of patients treated for traumatic head injuries at OHSU Hospital, one of two Level 1 trauma centers in the state.
They found a clear delineation of worse outcomes for people of color.
“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,” they write. “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.”
The researchers found no bias in the treatment patients received while in the hospital. Measurements including the number of days spent in intensive care and charges for hospital services were similar between groups.
Rather, they say the findings highlight underlying disparities in health that disproportionately affect people of color.
“If you ran the same analysis with patients with pneumonia, you might find the same results,” said senior author Ahmed M. Raslan, M.D., FAANS, associate professor of neurological surgery in the OHSU School of Medicine. “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.”
The study is the first to review racial and ethnic disparities in the field of neurosurgical trauma.
Researchers reviewed outcomes for 6,352 patients treated for traumatic brain injuries between 2006 and 2017. The overall mortality rate was 9.9% among all patients. Among the 1,504 patients who identified as racial or ethnic minorities, 14.6% died.
Weighted for severity of injury, age and other factors, researchers calculated an in-hospital mortality hazard ratio of 2.21 for minority patients compared to white patients.
“Dr. Raslan’s research is incredibly important in highlighting disparities in health outcomes experienced by people of color,” said Nathan Selden, M.D., Ph.D., professor and chair of neurological surgery in the OHSU School of Medicine. “Together with our department’s efforts to improve the care of traumatic brain injuries, and more broadly to improve diversity in medicine, I am confident OHSU can really make a difference.”
Co-authors along with Raslan included Emma A. Richie, the lead author, and Joseph G. Nugent, students in the OHSU School of Medicine who conducted this line of research in the Department of Neurological Surgery under Raslan’s mentorship.
Racial and Ethnic Inequities in Mortality During Hospitalization for Traumatic Brain Injury: A Call to Action
The health disparities which drive inequities in health outcomes have long plagued our already worn healthcare system and are often dismissed as being a result of social determinants of health.
Herein, we explore the nature of these inequities by comparing outcomes for racial and ethnic minorities patients suffering from traumatic brain injury (TBI). We retrospectively reviewed all patients enrolled in the Trauma One Database at the Oregon Health & Science University Hospital from 2006 to October 2017 with an abbreviated injury scale (AIS) for the head or neck >2. Racial and ethnic minority patients were defined as non-White or Hispanic.
A total of 6,352 patients were included in our analysis with 1,504 in the racial and ethnic minority cohort vs. 4,848 in the non-minority cohort. A propensity score (PS) model was generated to account for differences in baseline characteristics between these cohorts to generate 1,500 matched pairs.
The adjusted hazard ratio for in-hospital mortality for minority patients was 2.21 [95% Confidence Interval (CI) 1.43–3.41, p < 0.001] using injury type, probability of survival, and operative status as covariates. Overall, this study is the first to specifically look at racial and ethnic disparities in the field of neurosurgical trauma.
This research has demonstrated significant inequities in the mortality of TBI patients based on race and ethnicity 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.