Socioeconomic Disparities in the Clinical Outcomes of Pediatric Traumatic Brain Injury: A Nationwide Analysis of the Past Decade

Socioeconomic status has historically influenced traumatic brain injury (TBI) outcomes, yet pediatric TBI disparities remain understudied. We aimed to analyze the National Inpatient Sample database for socioeconomic disparities in the outcomes of pediatric TBI patients. The National Inpatient Sample from 2011 to 2020 was retrospectively analyzed for pediatric TBI patients. Socioeconomic variables included age, sex, race, household income, geographic location, and primary expected payer. Outcomes included length of stay (LOS), in-hospital mortality, mortality risk, and illness severity. A total 45,109 pediatric TBI patients (63.9% male) were identified. Mean age was 7.76 years, mean LOS was 4.57 days, and overall mortality rate was 3.2%. African-American or Native American patients had significantly longer LOS (1.6 and 3.4 days, respectively; P < 0.01) than White patients. African-American patients had an odds ratio of mortality of 1.57 compared to White patients. Female patients had significantly higher mortality risk and LOS (0.5 days) than male patients (P < 0.001). Patients in the bottom 50% of income and those in rural counties had higher odds of mortality (2.20 and 1.27, respectively) compared to higher-income and urban patients. Regional mortality rate differences were significant (P < 0.001), with the East South Central region having the highest rate. Medicaid and self-pay patients had higher LOS (P < 0.001) and odds ratios of mortality (1.19 and 2.36, respectively) compared to private insurance patients. This study highlights significant differences based on race, sex, income, insurance type, and geographic location in pediatric TBI outcomes. Future research should focus on identifying factors contributing to inequalities and developing strategies to mitigate them.