Comorbidity and Insurance as Predictors of Disability After Traumatic Brain Injury



      To examine the unique contribution of self-reported medical comorbidity and insurance type on disability after traumatic brain injury (TBI).


      Inception cohort design at 1-year follow up.


      A university affiliated rehabilitation hospital.


      Adults with mild-complicated to severe TBI (N=70).


      Not applicable.

      Main Outcome Measures

      Self-reported medical comorbidities were measured using the Modified Cumulative Illness Rating Scale, while insurance type was classified as commercial or government-funded; disability was measured using the Disability Rating Scale.


      Two models were run using multiple linear regression, and the best-fitting model was selected on the basis of Bayesian information criterion. The full model, which included self-reported medical comorbidity and insurance type, was significantly better fitting than the reduced model. Participants with a longer duration of posttraumatic amnesia, more self-reported medical comorbidities, and government insurance were more likely to have higher levels of disability. Meanwhile, individual organ systems were not predictive of disability.


      The cumulative effect of self-reported medical comorbidities and type of insurance coverage predict disability above and beyond well-known prognostic variables. Early assessment of medical complications and improving services provided by government-funded insurance may enhance quality of life and reduce long-term health care costs.


      List of abbreviations:

      BIC (Bayesian information criterion), DRS (Disability Rating Scale), EENT (eye/ear/nose/throat), HMO (health maintenance organization), MCIRS (Modified Cumulative Illness Rating Scale), PTA (posttraumatic amnesia), TBI (traumatic brain injury), TBIMS (Traumatic Brain Injury Model Systems)
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