Socioeconomic Status and Hospitalization Costs for Children with Brain and Spinal Cord Injury

Mark R. Zonfrillo*, Isabella Zaniletti, Matthew Hall, Evan S. Fieldston, Jeffrey D. Colvin, Jessica L. Bettenhausen, Michelle L. Macy, Elizabeth R. Alpern, Gretchen J. Cutler, Jean L. Raphael, Rustin B. Morse, Marion R. Sills, Samir S. Shah

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Objective To determine if household income is associated with hospitalization costs for severe traumatic brain injury (TBI) and spinal cord injury (SCI). Study design Retrospective cohort study of inpatient, nonrehabilitation hospitalizations at 43 freestanding children's hospitals for patients <19 years old with unintentional severe TBI and SCI from 2009-2012. Standardized cost of care for hospitalizations was modeled using mixed-effects methods, adjusting for age, sex, race/ethnicity, primary payer, presence of chronic medical condition, mechanism of injury, injury severity, distance from residence to hospital, and trauma center level. Main exposure was zip code level median annual household income. Results There were 1061 patients that met inclusion criteria, 833 with TBI only, 227 with SCI only, and 1 with TBI and SCI. Compared with those with the lowest-income zip codes, patients from the highest-income zip codes were more likely to be older, white (76.7% vs 50.4%), have private insurance (68.9% vs 27.9%), and live closer to the hospital (median distance 26.7 miles vs 81.2 miles). In adjusted models, there was no significant association between zip code level household income and hospitalization costs. Conclusions Children hospitalized with unintentional, severe TBI and SCI showed no difference in standardized hospital costs relative to a patient's home zip code level median annual household income. The association between household income and hospitalization costs may vary by primary diagnosis.

Original languageEnglish (US)
Pages (from-to)250-255
Number of pages6
JournalJournal of Pediatrics
StatePublished - Feb 1 2016


  • AIS Abbreviated injury scale
  • FPL Federal poverty level
  • ICD-9-CM International Classification of Diseases, Ninth Revision, Clinical Modification
  • ISS Injury severity score
  • PHIS Pediatric Health Information System
  • SCI Spinal cord injury
  • TBI Traumatic brain injury

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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