Comorbidity and Insurance as Predictors of Disability After Traumatic Brain Injury

Objective: To examine the unique contribution of self-reported medical comorbidity and insurance type on disability after traumatic brain injury (TBI). Design: Inception cohort design at 1-year follow up. Setting: A university affiliated rehabilitation hospital. Participants: Adults with mild-complicated to severe TBI (N=70). Intervention: Not applicable. Main Outcome Measures: Self-reported medical comorbidities were measured using the Modified Cumulative Illness Rating Scale, while insurance type was classified as commercial or government-funded; disability was measured using the Disability Rating Scale. Results: Two models were run using multiple linear regression, and the best-fitting model was selected on the basis of Bayesian information criterion. The full model, which included self-reported medical comorbidity and insurance type, was significantly better fitting than the reduced model. Participants with a longer duration of posttraumatic amnesia, more self-reported medical comorbidities, and government insurance were more likely to have higher levels of disability. Meanwhile, individual organ systems were not predictive of disability. Conclusions: The cumulative effect of self-reported medical comorbidities and type of insurance coverage predict disability above and beyond well-known prognostic variables. Early assessment of medical complications and improving services provided by government-funded insurance may enhance quality of life and reduce long-term health care costs. (C) 2014 by the American Congress of Rehabilitation Medicine