Racial differences in underlying health problems among persons with Traumatic Brain Injury in South Carolina, 1997–2001

Purpose Underlying health conditions can predispose a person to Traumatic Brain Injury (TBI), and are increasing disparities in TBI-related health outcomes among population groups. Our objectives are to 1) describe the major differences in underlying health problems, causes of injury, and payer status as a function of race, and 2) examine the relationship between sustaining TBI and race in a multivariable log-linear model controlling for other covariates. Methods Persons with TBI were identified from the South Carolina Traumatic Brain Injury Surveillance System using CDCʹs case definition of TBI. A total of 73,428 persons with TBI were discharged from the hospital or were treated and released from one of the 64 Emergency Departments between 1997 and 2001. We identified underlying chronic health problems using the ICD-9-CM diagnosis codes and classified the comorbid conditions by the Centers for Medicare and Medicaid Services Comorbidity Index. Estimates of the odds of chronic diseases between the two race groups were calculated using multivariable logistic regression techniques. Results African-Americans (AA) were at a higher risk for many comorbid conditions that could predispose them to sustaining a TBI, including seizures (OR = 1.3, CI = 1.1,1.6), drug abuse (OR = 1.3, CI = 1.1,1.5), and alcohol abuse (OR = 1.2, CI = 1.01,1.43). The proportion of AA being injured either by violence or by being a pedestrian were almost double that of Whites. Twenty-eight percent of AA versus 42% of Whites had commercial insurance at time of injury. More AA were covered by Medicaid (21% to 9%) or uninsured (42% to 32%). Conclusion The proportion of TBI associated with underlying chronic health problems is significantly higher among AA. The finding suggests that the higher odds of underlying health problems among AA may be mediated by inadequate health insurance.