This study examines how race, insurance, hospital type, age, and gender affect outcomes in TBI patients, including mortality, length of stay, and hospital costs.

TBI is a major cause of death and disability, and outcomes may be affected by demographic and systemic disparities. Prior research suggests that social determinants and hospital resources can significantly influence recovery, yet large-scale data on these associations remain limited, especially for severe TBI. 

Data was drawn from the 2022 Nationwide Inpatient Sample (NIS), focusing on adults (18+) diagnosed with severe TBI using ICD-10 codes (S06—). Variables analyzed included race, primary insurance, hospital teaching status and location, age, and gender. Outcomes measured were average length of stay (LOS), total hospital charges, and mortality. Comparisons used white patients, private insurance, and urban teaching hospitals as reference groups.

From around 3,500  admissions, the average age was 56 (SD = 21.65747); 42% were female. Patients stayed on average for 10.4 days; mortality was 18.7%; and average charges totaled $122,319 (SD = 213104.3). Mortality was higher among Black patients (22.1%) vs. White patients (17.5%), and the length of stay was longer (12.1 vs. 9.7 days). Medicaid patients had higher mortality (24.3%) and costs ($95,400) than those with private insurance. Rural hospitals showed longer stays (12.8 days) and higher mortality (23.5%) than urban teaching hospitals (16.1%). Women had better outcomes, with lower mortality and shorter stays. Patients over 65 had worse outcomes overall.

Significant disparities exist in TBI outcomes based on race, insurance type, hospital setting, gender, and age. These likely reflect differences in care quality, injury severity, and hospital resources. Future research should explore long-term outcomes, trauma system performance, and strategies to reduce inequities in TBI care.