1018 Understanding Traumatic Brain Injury in New York State: An Analysis of Race and Insurance Status Within the SPARCS Database

INTRODUCTION: Socially disadvantaged groups suffer higher morbidity and mortality rates from Traumatic Brain Injury(TBI), yet bio-social drivers of TBI disparities remain unclear. Investigating discharge outcomes may elucidate these mechanisms, particularly in socioeconomically diverse regions like New York State(NYS). The Statewide Planning and Research Cooperation System(SPARCS), containing extensive NYS hospital discharge data, offers a valuable resource for investigating these health inequities. METHODS: We retrospectively analyzed TBI discharges using diagnostic codes. Outcomes included discharge disposition, sociodemographics, mortality, length of stay, and cost. Statistical assessment included mean+/-SEM for continuous variables; proportion of counts for categorical variables; bivariate analyses; and inferential statistics. RESULTS: TBI discharges (n=154,186) decreased annually from 2009-2022. There was male predominance (male_60.7%:female_39.2%) and mean age was >70 years. Racial categories included 61.9%-White, 13.4%-Black, 23.9%-other race, <1%-multi-racial, and <1%-unknown. White patients had higher proportional Medicare coverage (64.81%,p<0.001) while Black patients and patients of Other Race category had higher proportional Medicaid coverage (35.71% and 34.90%, respectively;p<0.001). White patients had the highest likelihood of discharge to skilled nursing homes, while Black patients were more likely to be discharged to home/self-care and Medicaid-certified nursing facilities (p<0.001). Further evidence of Black patients’ social disadvantage surfaced in increased chances of leaving against medical advice or being discharged to law enforcement or psychiatric facilities (p<0.001). CONCLUSIONS: Sociodemographic trends of TBI discharges in SPARCS reveal insurance status and discharge disposition disparities consistent with structural racism. Database analysis limitations underscore the need for bio-social research that further elucidates drivers of these disparities. These data can inform health resource-allocation policies, promote health equity, and generate hypotheses for further investigation of TBI inequities.