Volume 54 | Number 2 | April 2019

Abstract List

Janessa M. Graves, Jessica L. Mackelprang PhD, Megan Moore PhD, MSW, Demetrius A. Abshire PhD, RN, Frederick P. Rivara, Nathalia Jimenez MD, Molly Fuentes MD, MS, Monica S. Vavilala MD


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

Data Source

MarketScan Commercial Claims and Encounters Data, 2007‐2011.

Study Design

We compared health care costs and outpatient encounters for physical/occupational therapy, speech therapy, and psychiatry/psychology encounters 180 days after among rural versus urban children (<18 years).

Principal Findings

A total of 387 846 children had , with 13 percent residing in rural areas. Adjusted mean total health care costs in the 180 days after were $2778 (95% : 2660‐2897) among rural children, compared to $2499 (95% : 2471‐2528) among urban children (adjusted cost ratio 1.11, 95% 1.06‐1.16). Rural‐urban differences in utilization for specific services were also found.


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 .