Research Reports - Comorbidity and insurance as predictors of disability after traumatic brain injury

Arch Phys Med Rehabil. 2014 Dec;95(12):2396-401

Gardizi E(1), Hanks RA(2), Millis SR(2), Figueroa MJ(3)

OBJECTIVE: To examine the unique contribution of self-reported medical
comorbidity and insurance type on disability after traumatic brain injury (TBI).
DESIGN: Inception cohort design at 1-year follow up.
SETTING: A university affiliated rehabilitation hospital.
PARTICIPANTS: Adults with mild-complicated to severe TBI (N=70).
INTERVENTION: Not applicable.
MAIN OUTCOME MEASURES: Self-reported medical comorbidities were measured using
the Modified Cumulative Illness Rating Scale, while insurance type was classified
as commercial or government-funded; disability was measured using the Disability
Rating Scale.
RESULTS: Two models were run using multiple linear regression, and the
best-fitting model was selected on the basis of Bayesian information criterion.
The full model, which included self-reported medical comorbidity and insurance
type, was significantly better fitting than the reduced model. Participants with
a longer duration of posttraumatic amnesia, more self-reported medical
comorbidities, and government insurance were more likely to have higher levels of
disability. Meanwhile, individual organ systems were not predictive of
disability.
CONCLUSIONS: The cumulative effect of self-reported medical comorbidities and
type of insurance coverage predict disability above and beyond well-known
prognostic variables. Early assessment of medical complications and improving
services provided by government-funded insurance may enhance quality of life and
reduce long-term health care costs.

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