Urban-Rural Inequalities in Care and Outcomes of Severe Traumatic Brain Injury: A Nationwide Inpatient Database Analysis in Japan

Abstract

This study aimed to investigate urban-rural inequalities in care and outcomes of severe traumatic brain injury (TBI). This observational study identified patients with severe TBI from the Japanese Diagnosis Procedure Combination inpatient database from 1 July 2010 to 31 March 2020. The patients were dichotomized into rural and urban groups based on the geographical location of their residence, using the urban employment area scheme. The primary outcome measure was in-hospital mortality. Multivariable regression analyses adjusted for patient-level covariates were performed to compare the outcomes between the 2 groups. A total of 48,910 patients (rural group, n= 5423; urban group, n= 43,487) were evaluated. In-hospital mortality was significantly higher in the rural group than that in the urban group (49.9% vs. 45.1%; adjusted odds ratio [OR], 1.26; 95% confidence interval [CI], 1.18-1.35). The standardized in-hospital mortality of the rural group was consistently higher than that of the urban group in each fiscal year, and there was no significant trend for closing the gap (P for trend=0.95). Patients in the rural group were less likely to undergo craniotomy/craniectomy (adjusted OR, 0.83; 95% CI, 0.77-0.89) and intracranial pressure monitoring (adjusted OR, 0.53; 95% CI, 0.46-0.61) and achieve independent activities of daily living atdischarge (8.2% vs. 10.5%, adjusted OR, 0.85; 95% CI, 0.76-0.96). There are significant urban-rural inequalities in TBI in Japan, and the gap in in-hospital mortality has not improved over the last 10years. Improving TBI care in rural communities may be a target for reducing disparities in health care.