In a recent study conducted at Oregon Health & Science University, people of color were found to be more than twice as likely to die after a traumatic brain injury (TBI) than white people.
In the study, published in Frontiers in Surgery, researchers reviewed outcomes for 6,352 patients treated for TBI between 2006 and 2017. The overall mortality rate was 9.9% among all patients. However, among the 1,504 patients who identified as racial or ethnic minorities, 14.6% died.
According to the CDC, American Indian/Alaska Native children and adults have higher rates of TBI-related hospitalizations and deaths than any other racial or ethnic group. Factors that contribute to this include higher incidences of motor vehicle accidents, substance abuse, suicide, and difficulty accesssing proper healthcare services. In general, among all racial, ethnic, and minority groups, follow-up or rehabilitative care is less likely to be received after a TBI, leading to poorer psychosocial, functional, and financial/employment outcomes after a TBI event.
In addition to racial and ethnic disparities that exist related to TBI, veterans, people in correctional facilities, people experiencing homelessness, and survivors of domestic abuse are all more likely to have worse outcomes after a TBI.
More than 450,000 US service members were diagnosed with a TBI between 2000 and 2021 (CDC). Military activity does put service members at a higher risk of TBI, but most TBIs actually occur when members are out of service, such as in motor accidents. Studies suggest that service members and veterans who have sustained a TBI may experience more severe co-occurring health conditions such as PTSD and depression, have difficulty accessing mental health services, and report thinking about a suicide attempt. These outcomes are similar for survivors of domestic violence who received a TBI due to assault.
Additionally, research has shown that nearly half (46%) of people in correctional facilities have experienced a TBI. Research further shows an association between mental health and substance use disorders, violence/abuse during childhood, difficulty controlling anger, and suicidal thoughts with a history of TBI in patients in correctional facilties. Regarding the homeless population, people who experience homelessness are 2 to 4 times more likely to have a history of any type of TBI, and are up to 10 times more likely to have experienced a severe TBI.
For all of these populations, long-term health problems related to TBIs may not be screened for, and access to care following a TBI is often below standard. Survivors of TBIs may face a difficult road to recovery, oftentimes requiring consistent physical therapy, doctors visits, and mental health treatment especially after a traumatic event. However, this may not be available to populations who are historically underinsured and of low socioeconomic background.
This also becomes a significant issue for people living in rural areas; those living in rural areas have a greater risk of dying due to a TBI as more time is needed to travel to an emergency facility, there is less access to Level 1 Trauma centers, and less access to specialized TBI care, in addition to the higher rates of uninsured and low-income people who live in rural areas.
To mitigate this, the CDC has created virtual training programs to educate and provide support to healthcare providers in rural areas caring for individuals, particularly pediatric patients, with TBI. The program–ECHO–uses video conferencing to train professionals on how to treat TBIs that would often be referred to a specialist in a larger urban center.
Addressing the underlying causes of health disparities in TBI–from substance use to rates of motor vehicle accidents–remains the fundamental issue. However, conducting surveillance and research to support data-driven solutions to preventing TBI in vulnerable communities continues to be a priority. For example, in order to prevent motor vehicle crash-related TBIs among tribal nations, the CDC developed the Roadway to Safer Tribal Communities Toolkit, which includes posters and fact sheets raising awareness on the importance of child safety seat use, seat belt use, and the importance of decreasing alcohol-impaired driving. Of course, this information is only useful when it is disseminated to the people in a culturally relevant manner, which remains one of the goals that needs to be addressed moving forward.