Data_Sheet_2_Racial and Ethnic Inequities in Mortality During Hospitalization for Traumatic Brain Injury: A Call to Action.pdf

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.

健康结果中的不平等，其根源在于影响健康的社会决定因素，长期以来一直困扰着我国已显疲态的医疗体系，且常被忽视为这种不平等现象的成因。本研究旨在探究此类不平等的本质，通过对比遭受脑外伤（TBI）的种族和民族少数群体患者的预后情况。我们对俄勒冈健康与科学大学医院创伤一数据库中2006年至2017年10月期间所有入组的、头部或颈部损伤简明损伤量表（AIS）评分超过2分的患者进行了回顾性分析。将非白人或西班牙裔患者定义为种族和民族少数群体患者。在本次分析中，共纳入6,352名患者，其中1,504名属于种族和民族少数群体队列，4,848名属于非少数群体队列。为了弥补这些队列在基线特征上的差异，我们生成了一个倾向评分（PS）模型，以生成1,500对匹配样本。使用损伤类型、生存概率和手术状态作为协变量，对于少数群体患者的院内死亡率调整后的危害比（HR）为2.21[95%置信区间（CI）1.43–3.41，p < 0.001]。总体而言，本研究首次针对神经外科创伤领域中的种族和民族不平等进行了专门的研究。研究结果表明，基于种族和民族差异，TBI患者的死亡率存在显著不平等，这表明有必要重塑当前的医疗体系，并倡导建立更安全、更具支持性的院前社会系统，以预防这些危及生命的并发症。