Incarceration Status is Associated With Rates of Operative Neurosurgical Intervention and Inpatient Mortality After Traumatic Brain Injury

BACKGROUND AND OBJECTIVES: Incarcerated individuals face well-established healthcare disparities, yet limited research has examined outcomes after traumatic brain injury (TBI). The aim of this study was to evaluate whether incarceration status is independently associated with inpatient mortality after TBI and to assess potential disparities in neurosurgical intervention. METHODS: A retrospective cohort study was conducted using the American College of Surgeons Trauma Quality Programs data set (2017-2022) to identify adult patients with TBI after blunt injury. Multivariable hierarchical logistic regression and propensity score matching (20:1) were used to examine associations between incarceration status and inpatient mortality. A secondary analysis evaluated associations with cranial surgery and external ventricular drain or intracranial pressure monitor placement. RESULTS: Among 243 547 patients, 1740 (0.7%) were incarcerated. These patients were younger (median, 40 years vs 64 years; standardized mean difference = 0.95) and more likely to have experienced a struck-by mechanism of injury (41% vs 6.9%; standardized mean difference = 1.2). After matching, incarcerated patients had significantly higher adjusted odds of inpatient mortality (odds ratio [OR], 1.49; 95% CI, 1.12-1.99; P < .01). There was a significant interaction between incarceration status and patient age for inpatient mortality ( P < .01). Finally, incarcerated patients had lower odds of receiving cranial surgery (OR, 0.76; 95% CI, 0.60-0.97; P = .03) but similar odds of external ventricular drain or intracranial pressure monitor placement (OR, 1.11; 95% CI, 0.77-1.59; P = .57). CONCLUSION: Incarceration status was independently associated with increased inpatient mortality after TBI and reduced likelihood of operative neurosurgical intervention. These findings highlight critical disparities in neurosurgical care for incarcerated individuals with TBI, underscoring the need for policy and institutional reforms to ensure equitable treatment.