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.

长期以来，加剧健康结局不公的健康差距问题始终困扰着本已不堪重负的医疗体系，且这类问题常被简单归因于健康的社会决定因素（social determinants of health）。为此，本研究针对创伤性脑损伤（traumatic brain injury, TBI）患者的健康结局展开对比分析，以探究此类健康不公的本质。本研究回顾性分析了2006年至2017年10月间，俄勒冈健康与科学大学医院创伤一级数据库（Trauma One Database）中所有头部或颈部简明损伤评分（abbreviated injury scale, AIS）>2的患者。本研究将非白人或西班牙裔人群定义为种族与族裔少数群体患者。最终纳入本研究分析的患者共计6352例，其中种族与族裔少数群体队列1504例，非少数群体队列4848例。为平衡两组队列的基线特征差异，本研究构建了倾向得分（propensity score, PS）匹配模型，最终得到1500对匹配患者。以损伤类型、生存概率与手术状态作为协变量时，少数群体患者的住院死亡率校正后风险比为2.21[95%置信区间（confidence interval, CI）1.43~3.41，p<0.001]。综上，本研究是首个专门针对神经外科创伤领域种族与族裔差距展开的研究。本研究证实了种族与族裔差异导致的TBI患者死亡率不公问题，并揭示了亟需重塑当前医疗体系、推动构建更安全且更具支持性的院前社会体系，以预防此类致命性后遗症的必要性。