دورية أكاديمية
أعرض في EDS

Association Between Health Insurance and Outcomes After Traumatic Brain Injury: A National ACS-TQP-PUF Database Study.

التفاصيل البيبلوغرافية
العنوان: Association Between Health Insurance and Outcomes After Traumatic Brain Injury: A National ACS-TQP-PUF Database Study.
المؤلفون: Galicia KE; Department of Surgery, Loyola University Medical Center, Maywood, Illinois; Burn and Shock Trauma Research Institute, Stritch School of Medicine, Loyola University Chicago Health Sciences Division, Maywood, Illinois., Haider SD; Stritch School of Medicine, Loyola University Chicago Health Sciences Division, Maywood, Illinois. Electronic address: shaider5@luc.edu., Reidy LE; Stritch School of Medicine, Loyola University Chicago Health Sciences Division, Maywood, Illinois., Anstadt MJ; Department of Surgery, Loyola University Medical Center, Maywood, Illinois., Kubasiak JC; Department of Surgery, Loyola University Medical Center, Maywood, Illinois; Burn and Shock Trauma Research Institute, Stritch School of Medicine, Loyola University Chicago Health Sciences Division, Maywood, Illinois., Gonzalez RP; Department of Surgery, Loyola University Medical Center, Maywood, Illinois; Burn and Shock Trauma Research Institute, Stritch School of Medicine, Loyola University Chicago Health Sciences Division, Maywood, Illinois., Patel PP; Department of Surgery, Loyola University Medical Center, Maywood, Illinois.
المصدر: The Journal of surgical research [J Surg Res] 2023 Oct; Vol. 290, pp. 16-27. Date of Electronic Publication: 2023 May 10.
نوع المنشور: Journal Article; Research Support, N.I.H., Extramural
اللغة: English
بيانات الدورية: Publisher: Academic Press Country of Publication: United States NLM ID: 0376340 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1095-8673 (Electronic) Linking ISSN: 00224804 NLM ISO Abbreviation: J Surg Res Subsets: MEDLINE
أسماء مطبوعة: Publication: New York, NY : Academic Press
Original Publication: Philadelphia [etc.]
مواضيع طبية MeSH: Patient Protection and Affordable Care Act* , Brain Injuries, Traumatic*, Male ; United States/epidemiology ; Humans ; Insurance, Health ; Length of Stay ; Medically Uninsured ; Insurance Coverage ; Retrospective Studies
مستخلص: Introduction: According to the US Census Bureau, roughly 8.6% of the population lacks health care coverage. Increasing evidence suggests that insurance status plays a role in outcomes after trauma. However, its role in the setting of traumatic brain injury (TBI) remains poorly understood.
Methods: The Trauma Quality Programs Participant Use Files were queried from 2017 to 2019. All patients with isolated TBI were identified. Isolated TBI was defined as: 1) Head Abbreviated Injury Scale (AIS) > 3 and 2) AIS <3 in all other anatomical regions. Patients dead on arrival, with Head AIS = 6, or missing key data were excluded. Demographic and clinical information was compared between those with and without insurance. Multivariate regressions were used to assess associations between insurance status and TBI outcomes (inhospital mortality, discharge to facility, total ventilator days, Intensive Care Unit length of stay (ICU LOS), and hospital LOS).
Results: In total, 199,556 patients met inclusion criteria; 18,957 (9.5%) were uninsured. Compared to the insured, uninsured TBI patients were younger with a greater proportion of males. Uninsured patients were less severely injured and less comorbid. Uninsured patients had shorter unadjusted LOS in the ICU and hospital. Yet, uninsured patients experienced greater unadjusted inhospital mortality (12.7% versus 8.4%, P < 0.001). When controlling for covariates, lack of insurance was significantly associated with increased likelihood of mortality (OR 1.62; P < 0.001). This effect was most noticeable in patients with Head AIS = 4 (OR 1.55; P < 0.001) and Head AIS = 5 (OR 1.80; P < 0.001). Lack of insurance was also significantly associated with decreased likelihood of discharge to facility (OR 0.38), decreased ICU LOS (Coeff. -0.61), and decreased hospital LOS (Coeff. -0.82; all P < 0.001).
Conclusions: This study demonstrates that insurance status is independently associated with outcome disparities after isolated TBI. Despite the Affordable Care Act (ACA) reform, lack of insurance appears significantly associated with inhospital mortality, decreased likelihood of discharge to facility, and decreased time spent in the ICU and hospital.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
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معلومات مُعتمدة: T32 GM008750 United States GM NIGMS NIH HHS
فهرسة مساهمة: Keywords: Brain injuries; Health care disparities; Insurance status; TBI mortality; TBI outcomes; Traumatic brain injury outcomes
تواريخ الأحداث: Date Created: 20230512 Date Completed: 20230710 Latest Revision: 20231124
رمز التحديث: 20231215
مُعرف محوري في PubMed: PMC10330247
DOI: 10.1016/j.jss.2023.03.050
PMID: 37172499
قاعدة البيانات: MEDLINE
الوصف
تدمد:1095-8673
DOI:10.1016/j.jss.2023.03.050