OBJECTIVE To determine the association between residence in racialized neighborhoods with direct healthcare expenditure and days at home (DAH) after moderate to severe traumatic brain injury (TBI). SUMMARY BACKGROUND DATA Differences in ethno-racial background have been associated with health outcome disparities. Much of this prior research was conducted in settings without universal healthcare coverage. The influence of ethno-racial background on health outcomes after TBI in universal healthcare settings remains unclear. METHODS This retrospective multicenter cohort study utilized linked administrative health data to identify adults sustaining moderate to severe TBI between 2009-2021. The primary exposure was an area-level index corresponding to the degree of racialized and immigrant populations within neighborhoods of residence (Q1-least racialized; Q5-most racialized). Co-primary outcomes were direct healthcare expenditure and DAH365days after injury. Secondary outcomes included discharge to rehabilitation and functional independence measure (FIM) scores at rehabilitation discharge. RESULTS 6,188 patients met inclusion criteria. Patients in the most racialized neighborhoods incurred higher crude and adjusted direct healthcare costs compared to those in the least racialized neighborhoods. This effect was driven predominantly by physician claims and acute care costs. There were no significant differences in crude or adjusted DAH across quintiles. Access to rehabilitation and discharge FIM scores were comparable for patients residing different racialized neighborhood quintiles. CONCLUSIONS Despite differences in healthcare expenditure, this study found similar home time, access to rehab and discharge FIM scores for TBI patients according to racialized neighborhood residence. Recognizing the limitations of area-level indices, our findings suggest equitable care delivery in a publicly funded universal care environment.

中文翻译：

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种族边缘化与中度至重度创伤性脑损伤后的直接医疗保健支出、居家时间和康复机会之间的关联。


目的 确定居住在种族化社区与直接医疗保健支出与中度至重度创伤性脑损伤 （TBI） 后在家天数 （DAH） 之间的关联。摘要 背景数据 民族-种族背景的差异与健康结果差异有关。之前的大部分研究都是在没有全民医疗保健覆盖的环境中进行的。在全民医疗保健环境中，民族种族背景对 TBI 后健康结果的影响尚不清楚。方法 这项回顾性多中心队列研究利用相关的行政健康数据来确定 2009-2021 年间患有中度至重度 TBI 的成年人。主要暴露是一个区域级指数，对应于居住社区内种族化和移民人口的程度（Q1 - 种族化程度最低;Q5 - 最种族化）。共同主要结局是直接医疗保健支出和受伤后 365 天的 DAH。次要结局包括出院至康复和康复出院时功能独立性测量 （FIM） 评分。结果 6,188 例患者符合纳入标准。与种族化程度最低的社区相比，种族化程度最低的社区的患者承担了更高的粗略和调整后的直接医疗保健费用。这种影响主要是由医生索赔和急性护理费用驱动的。在五分位数中，粗 DAH 或调整后 DAH 没有显著差异。对于居住在不同种族化社区五分位数的患者，获得康复和出院的 FIM 评分具有可比性。 结论 尽管医疗保健支出存在差异，但本研究发现，根据种族化的社区居住地，TBI 患者的家庭时间、康复机会和出院 FIM 评分相似。认识到区域级指数的局限性，我们的研究结果表明，在公共资助的全民护理环境中提供公平的护理服务。