Increased Traumatic Brain Injury Severity and Mortality in Undocumented Immigrants

BACKGROUND AND OBJECTIVES:Health disparities related to traumatic brain injury (TBI) have focused on socioeconomic status, race, and ethnicity. We sought to characterize TBI patterns and outcomes based on undocumented status.METHODS:Patients who presented to University of California, San Diego Health Trauma Center with a TBI between 2019 and 2022 were identified and stratified based on undocumented status. Undocumented immigrants were identified using validated methods of absent or invalid social security number and key terms through chart review. Demographic information, injury characteristics, and neurosurgical interventions were recorded. Univariable and multivariable analyses were performed to determine the impact of patient factors on outcomes.RESULTS:Of 1654 patients with TBI, 76 (4.6%) were undocumented. Undocumented immigrants were younger (50 vs 60 years; P <.001) and had higher Injury Severity Score (17 vs 13; P <.001). They presented from farther distances (12.8 vs 5.3 miles, P <.001) with greater midline shift (1.49 vs 0.91 mm; P =.003). A greater proportion had basal cistern compression/effacement (14% vs 4.6%; P =.001) and required neurosurgical intervention (18% vs 9.6%; P =.012). Undocumented immigrants had higher hospital charges ($208 403 vs $128 948; P <.001), length of stay (5 vs 4 days; P =.002), and were discharged to a health facility at a lower rate (18% vs 32%; P =.012). They had nearly double the mortality rate (14% vs 7.3%; P =.021), with undocumented status trending as a predictor on multivariable regression (odds ratio = 2.87; P =.052).CONCLUSION:Undocumented immigrants presented from farther distances with increased TBI severity, likely from both more severe trauma and delayed presentation, requiring more neurosurgical intervention. They also had greater length of stay, charges, and nearly double the mortality rate. Importantly, undocumented status was a strong predictor for mortality. Despite worse outcomes, they were discharged to a health care facility at a lower rate. Advocacy efforts should be directed at increasing health care coverage and migrant community engagement and education.