Data_Sheet_1_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.

健康差异所驱动的健康结果不平等长期困扰着我国本已疲弱的医疗体系，且往往被忽视为健康社会决定因素的后果。本研究中，我们通过对遭受脑外伤（TBI）的种族和少数民族患者进行对比研究，探讨了这些不平等的本质。我们回顾性地分析了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月间所有纳入的、头部或颈部具有简明损伤量表（AIS）评分大于2的患者。将非白人或西班牙裔患者定义为种族和少数民族患者。我们的分析纳入了共计6,352名患者，其中1,504名属于种族和少数民族队列，而4,848名属于非少数民族队列。为了弥补这些队列在基线特征上的差异，我们构建了一个倾向评分（PS）模型，以生成1,500对匹配的病例。使用损伤类型、生存概率和手术状态作为协变量，对少数民族患者在院死亡率的调整危害比（HR）为2.21[95%置信区间（CI）1.43–3.41，p < 0.001]。总体而言，这项研究是首次专门研究神经外科创伤领域的种族和民族不平等。本研究揭示了基于种族和民族差异的TBI患者死亡率存在显著不平等，并表明重塑现行医疗体系、倡导更安全、更有支持性的院前社会系统以预防这些危及生命的并发症具有实质性的必要性。