Does Variation in Hospital Density and Social Deprivation Across Small Geographic Areas Play a Role in Perceived Barriers to Care Among People With Traumatic Brain Injury?

Objective: To examine the role of area-level variables (hospital density and social deprivation) in the experience of health care access and quality among individuals with traumatic brain injury.

Setting: Online questionnaire of community dwelling individuals Participants: 300 individuals with a history of traumatic brain injury with loss of consciousness.

Design: Cross-sectional observational survey.

Main measures: Barriers to Care Questionnaire, Social Deprivation Index, Hospital Density.

Results: In an unadjusted regression model, less social deprivation and higher hospital density were associated with better perceived health care access and quality. After adjusting for personal factors of race, ethnicity, age, injury severity, food insecurity, and housing insecurity, the effect of social deprivation was fully attenuated whereas the effect of hospital density on health care access and quality remained significant. A model containing only the personal factors demonstrated reduced health care access and quality among individuals identifying as Hispanic. However, this effect was non-significant with the inclusion of the area-level contextual factors in a fully adjusted model.

Conclusions: Higher area-level hospital density is associated with a reduction in perceived barriers to care among individuals with TBI. In addition, contextual, area-level data accounted for the reduced health care access and quality among Hispanic participants. Area-level data can provide explanatory value in the study of health disparities for people with TBI from underrepresented racial and ethnic groups.