Influence of Socioeconomic Status on Traumatic Brain Injury Outcomes: A Single-Center Retrospective Analysis Using the Distressed Communities Index

Introduction: Low socioeconomic status (SES) is increasingly recognized as a risk factor for traumatic brain injury (TBI). The effect of SES on the hospital care of TBI patients is less described, representing an opportunity to identify disparities and formulate targeted interventions.

Methods: A single-institution database of TBI admissions from 2013-2020 was queried. The Distressed Communities Index (DCI) was used as a proxy for SES; this is a composite of unemployment, education level, poverty rate, median income, business growth, and housing vacancy by ZIP code ranging from 0 (no distress) to 100 (severe distress). DCI was dichotomized into low ( < 50) and high distress (≥ 50) groups. The primary outcome was a composite of neurological deterioration, neurosurgical intervention, and mortality. Multivariable logistic regression was used to examine the effect of DCI on outcomes, adjusted for age, sex, mechanism of injury, GCS, coagulopathy, skull fracture, and intracranial hemorrhage pattern.

Results: Analysis included 530 complete patient records. In univariate analysis, high distress was associated with significantly greater likelihood of the composite outcome (11.5% vs 19.3%, P = 0.012), as well as with neurosurgical intervention and mortality; the proportions of patients with skull fractures, epidural hematomas, and midline shift were significantly higher. Rotterdam scores were higher in the distressed group (1.67 vs 1.93, P < 0.001). Multivariate analysis, adjusting for the aforementioned confounders, did not show high distress as predictive of the composite outcome (OR 1.35, 95% CI 0.73-2.47).

Conclusion : After adjusting for known clinical factors associated with TBI outcome, DCI was not an independent predictor of the composite outcome. The influence of injury mechanism, pattern, and severity likely play a larger role than SES in determining TBI outcome. SES may still mediate TBI outcome through pre- and post-hospital factors, but these were not examined in the present study.