Intersectionality of Systemic Disadvantage on Mortality and Care Following TBI.
Amy J Starosta, Felicia Mata-Greve, Andrew Humbert and 6 others
PMID 36883896WHAT IT FOUND
Older adults with TBI had significantly lower survival and less access to inpatient rehabilitation than younger White English speakers.
Racial disparities in survival and opioid prescribing narrowed or disappeared after adjusting for injury severity, suggesting these gaps were driven by more severe injuries rather than bias.
Key findings
01Classes with more systemic disadvantage experienced higher rates of mortality following TBI.
02Older adults were significantly more likely to discharge to another care facility rather than inpatient rehabilitation compared to the reference group.
03The disparity in survival between the privileged White English-Speaking Adult group and the POC Adult group became non-significant after adjusting for detailed measures of TBI severity.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study used data from a single healthcare system, so findings may not generalize to other regions or hospitals. Race and ethnicity were dichotomized into 'White' and 'People of Color', which hides important differences within these broad groups. The data came from electronic health records and trauma registries, which may contain errors or miscategorizations of social determinants like insurance or language. The study could not determine why these disparities exist, such as whether they are due to bias, patient preference, or clinical appropriateness.
Declared interests
The study was supported by Non-U.S. Governmental sources. No specific commercial funding or personal conflicts of interest were reported in the provided text.
The easy way to misread this
Do not conclude that racial bias in opioid prescribing or survival was disproven. The non-significant results for POC groups after adjustment suggest that these patients had more severe injuries, not that the disparity was explained away. The lack of statistical significance in adjusted models does not prove the absence of bias, only that injury severity was a stronger predictor in this dataset.