Barriers to Care: Examining the Unique Obstacles of Indigenous American Patients With Acute Neurosurgical Injuries.

Abstract

Historically, Indigenous American (IA) populations have faced barriers to adequate health care. Although IA people experience higher rates of traumatic brain injury-related mortality than other racial groups in the United States, attributes of their neurosurgical care have not been evaluated. We demonstrate and compare care patterns and outcomes in IA and non-IA adults with acute neurosurgical injuries and identify disparities limiting access to medical care. Adults hospitalized for acute neurosurgical injuries between 2017 and 2022 were identified in this retrospective cross-sectional study at our Level 1 trauma center. We evaluated demographics, distance to care, and in-hospital/aftercare characteristics in a propensity-matched analysis. A total of 81 IA patients were identified. Propensity score analysis matched 77 IA and 77 non-IA patients with similar inclusion criteria on demographics, medical comorbidities, and distance traveled to neurosurgical care. IA patients traveled longer distances for care (236.3 vs 146.4 miles, P < .001), were more often direct admissions (35.1% vs 0.0%), were more often transported via ambulance (72.7% vs 57.1%) and less often via helicopter (20.8% vs 41.6%), and came from a broader cross-section of states. Average time from injury to care was 6 hours (IQR 3.0, 9.4). In-hospital care did not differ between groups; however, IA patients were less often discharged to rehabilitation (2.6% vs 14.3%, P = .009). IA in-hospital traumatic brain injury-related mortality was 8.3%. Fewer follow-up visits were completed in IA than in non-IA patients (40.2% vs 90.0%, P < .001), despite more attempted contacts (66.7% vs 30.6%, P < .001), with low telemedicine use in both groups (2.7% vs 5.5%). IA status and distance traveled were independent predictors of unmet follow-up visits (odds ratio 6.22 [95% CI 1.49-25.99, P = .012] and odds ratio 12.34 [95% CI 1.19-127.99, P = .035], respectively). Clear barriers to care were demonstrated for IA patients with acute neurosurgical injuries. Our findings indicate improvements are needed for this vulnerable population.