The economic divide in outcome following severe head injury

Abstract

Background: Socioeconomic status is an important determinant of the standard of living and health status of people. Objectives: To assess the influence of economic status on the outcome following severe head injury. Materials and Methods: Adult patients of severe head injury, whose guardians' volunteered information on family income, were enrolled for the study. The family per capita income was then calculated. They were studied prospectively in relation to various factors and followed-up. Results: Among 99 patients, monthly per capita income of Rs. <500, 500-1000, 1000-2000, and >2000 were noted in 20, 43, 22, and 14 patients, respectively. The credibility of information on income was confirmed by positive correlation with patients' mid arm circumference measurements (P<0.001). They were divided into two groups (family monthly per capita income ≤Rs.1000 and >Rs.1000). The comparability of both groups based on age, Glasgow Coma Scale, systemic injury, and surgical intervention was confirmed (P>0.05). Mortality at one month was 49% among patients whose monthly per capita income ≤Rs.1000 compared with 17% of the rest (Odds ratio [OR] 4.0, P=0.003). Unfavorable outcome at three months was noted in 63% of patients whose monthly per capita income ≤Rs.1000, as compared with 35% of those with per capita income >Rs.1000 (OR 4.1, P=0.01). In multivariate analysis, family monthly per capita income ≤Rs.1000 emerged as an independent risk factor for unfavorable outcome at three months (P=0.02). Conclusion: In patients of severe head injury, lower economic status is significantly associated with unfavorable outcome at three months, independent of other factors.