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Race and socioeconomic disparity in treatment and outcome of traumatic cervical spinal cord injury with fracture: Nationwide Inpatient Sample database, 1998-2009.
- Source :
-
Spinal cord [Spinal Cord] 2019 Oct; Vol. 57 (10), pp. 858-865. Date of Electronic Publication: 2019 Apr 16. - Publication Year :
- 2019
-
Abstract
- Study Design: A retrospective national administrative database study.<br />Objective: Advances in treatment of traumatic cervical spinal cord injury with fracture (TCSCIF) have led to significant improvements in clinical outcomes; however, progress in healthcare is seldom ubiquitous across demographic groups. Therefore, we explored if disparities in treatment and outcome after TCSCIF exist across race and socioeconomic status.<br />Setting: USA.<br />Methods: We queried the Nationwide Inpatient Sample database from 1998 to 2009 for TCSCIF hospitalizations. Multivariate analysis was used to identify the correlation between socioeconomic status and race to injury, treatment type, and outcome.<br />Results: There were 21,985 admissions for TCSCIF, 66.9% of whom had a favorable discharge disposition. In-hospital mortality rate was 12.5%. A total of 43.7% underwent surgery. Overall, surgery was associated with lower in-hospital mortality (OR 0.30, 95% CI 0.27-0.34, pā<ā0.01) and better discharge disposition (OR 0.68, 95% CI 0.62-0.74, pā<ā0.01) versus nonsurgical or no intervention. African-American (AA) race and low socioeconomic status (LSES) were significant predictors of lower odds to undergo surgery and unfavorable discharge disposition, respectively; potentially explained by a higher odds of increased New Injury Severity Score classification at presentation. Surgical and favorable discharge rates for LSES and non-Caucasian races, however, have been steadily improving over the study period.<br />Conclusions: Despite trending improved outcomes after TCSCIF, LSES, or AA race were more likely to have worse outcomes compared to their counterparts. In addition, LSES, AA, and Hispanic groups were less likely to undergo surgical treatment, suggesting disparities in management and outcome effect.
- Subjects :
- Adult
Aged
Female
Healthcare Disparities statistics & numerical data
Humans
Male
Middle Aged
Retrospective Studies
Social Class
Socioeconomic Factors
Treatment Outcome
United States
Cervical Cord injuries
Healthcare Disparities economics
Healthcare Disparities ethnology
Spinal Cord Injuries ethnology
Spinal Cord Injuries therapy
Spinal Fractures ethnology
Spinal Fractures therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1476-5624
- Volume :
- 57
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Spinal cord
- Publication Type :
- Academic Journal
- Accession number :
- 30992516
- Full Text :
- https://doi.org/10.1038/s41393-019-0280-6