Rural-urban disparities in health care costs and health service utilization following pediatric mild traumatic brain injury

Health Serv Res. 2019 Apr;54(2):337-345. doi: 10.1111/1475-6773.13096. Epub 2018 Dec 3.


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, 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 mTBI among rural versus urban children (<18 years).

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: 2660-2897) among rural children, compared to $2499 (95% CI: 2471-2528) among urban children (adjusted cost ratio 1.11, 95% CI 1.06-1.16). Rural-urban 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.

Keywords: health care costs; health service utilization; pediatrics; rehabilitation; rural health.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Brain Concussion / epidemiology
  • Brain Concussion / rehabilitation
  • Brain Concussion / therapy*
  • Child
  • Child, Preschool
  • Comorbidity
  • Female
  • Health Expenditures / statistics & numerical data*
  • Health Resources / economics
  • Health Resources / statistics & numerical data
  • Health Services / economics
  • Health Services / statistics & numerical data
  • Humans
  • Infant
  • Male
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Residence Characteristics / statistics & numerical data
  • Retrospective Studies
  • Rural Population / statistics & numerical data*
  • Socioeconomic Factors
  • Trauma Severity Indices
  • Urban Population / statistics & numerical data*