Racial Disparities in the Incidence of Pressure Ulcers in Patients Admitted for Traumatic Brain Injury

Introduction: Pressure ulcers (PUs) are a source of significant morbidity and mortality for patients. The purpose of this study is to evaluate whether there are racial and ethnic disparities in the incidence of PUs in patients admitted for TBI.

Methods: The National Trauma Data Bank was queried from 2017-2019 for patients with TBI, and patients were separated into groups based on reported race/ethnicity and propensity-matched on age, sex, pre-admission comorbidities, hospital length of stay, Glasgow-Coma Scale score, and BMI (n=66). A one-way ANOVA was performed to compare the incidence of PUs between the propensity-matched groups. Logistic regression was then performed on the unmatched cohort (n=32,130) to assess the independent risk factors for developing PUs.

Results: Black-Hispanic patients had a higher incidence of PUs compared to American Indian patients, Hispanic patients, White-Hispanic patients, and Asian patients (15.15% vs. 3.03%, 1.51%, 0%, and 0%, respectively, p< 0.05). The results of the logistic regression identified advanced directives limiting care (OR=1.31, p< 0.05) and diabetes (OR=1.34, p< 0.001) as variables associated with increased odds of developing PUs. Female sex (OR=0.62, p< 0.001), alcoholism (OR=0.68, p< 0.001), mental disorders (OR=0.74, p< 0.001), and bleeding disorders (OR=0.65, p< 0.05) were associated with lower odds of developing PUs.

Conclusion : Our results indicate that Black-Hispanic patients admitted for TBI are disproportionately affected by PUs when compared to other racial and ethnic groups. This research underscores the need for targeted interventions and improved healthcare delivery to mitigate racial/ethnic disparities in TBI care. Additionally, our study showed that patients with diabetes and advanced directives limiting care are at an increased risk for developing PUs, and clinicians should be vigilant and proactive when caring for these patients.