A Single-Center Study of Insurance Status as a Socioeconomic Determinant of Severe Traumatic Brain Injury Outcomes

Severe traumatic brain injury (sTBI) is a leading cause of morbidity and mortality. Individuals from lower socioeconomic backgrounds often experience worse health outcomes due to limited health care access and reduced support mechanisms. This study aimed to determine whether disparities in sTBI outcomes are associated with insurance status as a proxy for socioeconomic status. We reviewed the medical records of 632 adult patients with sTBI admitted to our institution between 2010 and 2021 and compared injury characteristics and outcomes across insurance groups. Multivariable regression analyses were performed to evaluate associations between insurance status and functional outcomes after adjusting for injury severity and clinical factors. Compared with Medicare beneficiaries, privately insured patients demonstrated higher rates of recovery of command following and higher functional outcome scores. Privately insured patients also had higher rates of in-hospital survival, improved neurologic recovery, and greater access to rehabilitation than uninsured patients. Medicaid insurance was not associated with worse outcomes but rather lower in-hospital mortality. In this exploratory analysis, insurance status was associated with meaningful differences in neurologic recovery and functional outcomes following sTBI. Larger, prospective, multicenter studies are needed to further elucidate how differential access to post-acute care and rehabilitation contributes to outcome disparities and to inform strategies aimed at improving equity in sTBI recovery.