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VOLUME 54 | NUMBER 2 | APRIL 2019


Ruralurban disparities in health care costs and health service utilization following pediatric mild traumatic brain injury

Objectives: To compare health care costs and service utilization associated with mild traumatic brain injury (mTBI) in rural and urban commercially insured children.

Data Source: MarketScan Commercial Claims and Encounters Data, 20072011.

Study Design: We compared health care costs and outpatient encounters for physical/occupational therapy, speech therapy, and psychiatry/psychology encounters 180 days after mTBI among rural versus urban children (

Principal Findings: A total of 387 846 children had mTBI, with 13 percent residing in rural areas. Adjusted mean total health care costs in the 180 days after mTBI were $2778 (95% CI: 26602897) among rural children, compared to $2499 (95% CI: 24712528) among urban children (adjusted cost ratio 1.11, 95% CI 1.061.16). Ruralurban differences in utilization for specific services were also found.

Conclusions: Total health care costs were higher for rural compared to urban children despite lower utilization of certain services. Differences in health service utilization may exacerbate geographic disparities in adverse outcomes associated with mTBI.

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