Trend and geographic analysis for traumatic brain injury mortality and cost based on MarketScan database

The objective of the current research was to examine the current epidemiology of traumatic brain injury (TBI); to determine the effects of geographic region, co-morbidities, year of injury, injury severity, and demographics on hospital costs, length of stay (LOS), and mortality. All subjects were drawn from the Thomason Reuters MarketScan(®) database. Statistical methods used included descriptive analysis, bivariate analysis, logistic regression, and the Geographic Information System (GIS) software, ArcMap. We studied 76,313 patients with TBI from 2004 to 2009 (52,721 with commercial insurance and 23,592 with Medicare) from the MarketScan database. As age increased, mortality rate and median LOS increased. The median hospital costs for adults were the highest ($13,000 for ages 18-64) compared with children ($8000 for age 0-14) and elderly persons ($9000 for age ≥ 65). The mortality rate for the elderly population has decreased slightly (11.1% in 2004 to 9.9% in 2009 for men, and 7.0% to 6.9% for women); however, their hospital costs have increased significantly ($6899 in 2004 to $11,567 in 2009 for men; $6784 to $9782 for women). Concerning the impact of geography, the western United States (e.g., Washington and California) had lower mortality rates and higher median costs while the southeast United States had the highest mortality and mixed median costs. Both overall mortality and median LOS have remained relatively stable over the years. Hospital cost, however, has increased for the elderly population even after accounting for the inflation. There is significant geographic variation for both mortality and hospital costs.