Insurance status affected the amount of treatment received and the patient’s chance of survival in cases of brain injury in children, a team of researchers from the University of Arkansas for Medical Sciences (UAMS) found in a study that used nationwide data.

The study was recently published in Critical Care Medicine.

It was conducted by a multidisciplinary team led by Austin Porter, Dr.P.H., M.P.H., an assistant professor in the UAMS Fay W. Boozman College of Public Health and deputy chief science officer for the Arkansas Department of Health; and Analiz Rodriguez, M.D., Ph.D., a neurosurgeon and assistant professor in the Department of Neurosurgery in the UAMS College of Medicine.

The team looked at 12,449 patients under the age of 18 from a nationwide database. Insured patients were 25 percent less likely to die while in care, even after the team used statistics to correct for the possible influence of other demographic factors like race, gender, and how the patients presented at the hospital. Having insurance increased the patient’s odds of receiving brain surgery by 32 percent and having intracranial pressure monitoring by 54 percent. Both are highly recommended basic lifesaving procedures.

“Uninsured patients were in worse condition when they arrived at the hospital, received less treatment, and had greater chances of dying compared with insured patients who were otherwise similar,” Porter said. “We hear about the effects of disparities in health care and this is just the latest in many studies that are finding this link.”

Despite a growing body of research about how insurance status can affect patient outcomes, Rodriguez said the results were still troubling to the research team.

“It’s surprising, especially for children,” Rodriguez said. “One would think that everything would be done to save this population. Our next studies will look more closely at this topic to try to determine the ‘why.’ As surgeons, we usually don’t know anything about the insurance status of our patients, so it’s hard for us to think about. We would like to think everyone in the health care system is making logical – and neutral – decisions about who receives what care. So we need to look at whether there is a systems issue involved or whether there are other outside forces we haven’t considered.”

Traumatic brain injury (TBI) is a leading cause of injury and death in children, affecting about 475,000 annually.

Coauthors included Clare Brown, Ph.D.; Mick Tilford, Ph.D.; Saleema Karim, Ph.D., MBA; and Namvar Zohoori, M.D., M.P.H., Ph.D.; of the College of Public Health, Todd Maxson, M.D., of the Division of Pediatric General Surgery, Kevin Sexton, M.D., of the Division of Trauma and Acute Care Surgery, and Kevin Thomas, an M.D./M.P.H. student working with Rodriguez. A similar study on insurance and adult brain injury is under review for publication.

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