Research Reports - Accelerated death rate in population-based cohort of persons with traumatic brain injury
J Head Trauma Rehabil. 2013 Jul 3
Selassie AW, Cao Y, Church EC, Saunders LL, Krause J
OBJECTIVES:: To determine the influence of preexisting heart, liver, kidney,
cancer, stroke, and mental health problems and examine the influence of low
socioeconomic status on mortality after discharge from acute care facilities for
individuals with traumatic brain injury.
PARTICIPANTS:: Population-based retrospective cohort study of 33 695 persons
discharged from acute care hospital with traumatic brain injury in South
MAIN MEASURES:: Days elapsing from the dates of injury to death established the
survival time (T). Data were censored at the 145th month. Multivariable Cox
regression was used to examine the independent effect of the variables on death.
Age-adjusted cumulative probability of death for each chronic disease of interest
RESULTS:: By the 70th month of follow-up, rate of death was accelerated from
10-fold for heart diseases to 2.5-fold for mental health problems. Adjusted
hazard ratios for diseases of the heart (2.13), liver-renal (3.25), cancer
(2.64), neurological diseases and stroke (2.07), diabetes (1.89), hypertension
(1.43), and mental health problems (1.59) were highly significant (each with P <
.001). Compared with persons with private insurance, the hazard ratio was
significantly elevated with Medicaid (1.67), Medicare (1.54), and uninsured
(1.27) (each with P < .001).
CONCLUSION:: Specific chronic diseases strongly influenced postdischarge
mortality after traumatic brain injury. Low socioeconomic status as measured by
the type of insurance elevated the risk of death.