TY - JOUR
T1 - Socioeconomic Status and Hospitalization Costs for Children with Brain and Spinal Cord Injury
AU - Zonfrillo, Mark R.
AU - Zaniletti, Isabella
AU - Hall, Matthew
AU - Fieldston, Evan S.
AU - Colvin, Jeffrey D.
AU - Bettenhausen, Jessica L.
AU - Macy, Michelle L.
AU - Alpern, Elizabeth R.
AU - Cutler, Gretchen J.
AU - Raphael, Jean L.
AU - Morse, Rustin B.
AU - Sills, Marion R.
AU - Shah, Samir S.
N1 - Funding Information:
Supported by the Children's Hospital Association and Eunice Kennedy Shriver National Institute of Child Health and Human Development ( K08HD073241 ). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Children's Hospital Association or the National Institutes of Health. The authors declare no conflicts of interest.
Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2016/2/1
Y1 - 2016/2/1
N2 - Objective To determine if household income is associated with hospitalization costs for severe traumatic brain injury (TBI) and spinal cord injury (SCI). Study design Retrospective cohort study of inpatient, nonrehabilitation hospitalizations at 43 freestanding children's hospitals for patients <19 years old with unintentional severe TBI and SCI from 2009-2012. Standardized cost of care for hospitalizations was modeled using mixed-effects methods, adjusting for age, sex, race/ethnicity, primary payer, presence of chronic medical condition, mechanism of injury, injury severity, distance from residence to hospital, and trauma center level. Main exposure was zip code level median annual household income. Results There were 1061 patients that met inclusion criteria, 833 with TBI only, 227 with SCI only, and 1 with TBI and SCI. Compared with those with the lowest-income zip codes, patients from the highest-income zip codes were more likely to be older, white (76.7% vs 50.4%), have private insurance (68.9% vs 27.9%), and live closer to the hospital (median distance 26.7 miles vs 81.2 miles). In adjusted models, there was no significant association between zip code level household income and hospitalization costs. Conclusions Children hospitalized with unintentional, severe TBI and SCI showed no difference in standardized hospital costs relative to a patient's home zip code level median annual household income. The association between household income and hospitalization costs may vary by primary diagnosis.
AB - Objective To determine if household income is associated with hospitalization costs for severe traumatic brain injury (TBI) and spinal cord injury (SCI). Study design Retrospective cohort study of inpatient, nonrehabilitation hospitalizations at 43 freestanding children's hospitals for patients <19 years old with unintentional severe TBI and SCI from 2009-2012. Standardized cost of care for hospitalizations was modeled using mixed-effects methods, adjusting for age, sex, race/ethnicity, primary payer, presence of chronic medical condition, mechanism of injury, injury severity, distance from residence to hospital, and trauma center level. Main exposure was zip code level median annual household income. Results There were 1061 patients that met inclusion criteria, 833 with TBI only, 227 with SCI only, and 1 with TBI and SCI. Compared with those with the lowest-income zip codes, patients from the highest-income zip codes were more likely to be older, white (76.7% vs 50.4%), have private insurance (68.9% vs 27.9%), and live closer to the hospital (median distance 26.7 miles vs 81.2 miles). In adjusted models, there was no significant association between zip code level household income and hospitalization costs. Conclusions Children hospitalized with unintentional, severe TBI and SCI showed no difference in standardized hospital costs relative to a patient's home zip code level median annual household income. The association between household income and hospitalization costs may vary by primary diagnosis.
KW - AIS Abbreviated injury scale
KW - FPL Federal poverty level
KW - ICD-9-CM International Classification of Diseases, Ninth Revision, Clinical Modification
KW - ISS Injury severity score
KW - PHIS Pediatric Health Information System
KW - SCI Spinal cord injury
KW - TBI Traumatic brain injury
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U2 - 10.1016/j.jpeds.2015.10.043
DO - 10.1016/j.jpeds.2015.10.043
M3 - Article
C2 - 26563534
AN - SCOPUS:84959297311
SN - 0022-3476
VL - 169
SP - 250
EP - 255
JO - Journal of Pediatrics
JF - Journal of Pediatrics
ER -