Risk of hospitalization due to motor vehicle crashes among Iraq and Afghanistan War Veterans diagnosed with traumatic brain injury

Issue title: Special Section: Unintentional Injury Following Traumatic Brain Injury

Guest editors: Juliet Haarbauer-Krupa

Article type: Research Article

Authors: Carlson, Kathleen F.^{a; b; *} | O’Neil, Maya E.^{a; c} | Forsberg, Christopher W.^a | McAndrew, Lisa M.^{d; e} | Storzbach, Daniel^{f; g} | Cifu, David X.^{h; i; j} | Sayer, Nina A.^{k; l}

Affiliations: [a] Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D 66), Portland, OR, USA | [b] School of Public Health, Oregon Health and Science University, Portland, OR, USA | [c] Department of Psychiatry and Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA | [d] Department of Educational and Counseling Psychology, War Related Illness and Injury Study Center, VA New Jersey Health Care System, East Orange, NJ, USA | [e] University at Albany, State University of New York, Albany, NY, USA | [f] Neuropsychiatry Section, VA Portland Health Care System, Portland, OR, USA | [g] Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA | [h] Physical Medicine and Rehabilitation Services, Veterans Health Administration, Department ofVeterans Affairs, Washington, D.C., USA | [i] Physical Medicine and Rehabilitation Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA | [j] Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA | [k] Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, MN, USA | [l] Departments of Medicine and Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA

Correspondence: [*] Address for correspondence: Kathleen F. Carlson, PhD, Center to Improve Veterans Involvement in Care, VA Portland Health Care System (R&D 66), 3715 SW U.S. Veterans Hospital Road, Portland, OR 97239, USA. Tel.: +1 503 220 5282 /Ext. 52094; Fax: +1 503 273 5367; E-mail: [email protected].

Abstract: BACKGROUND: Traumatic brain injury (TBI) was deemed the ‘signature injury’ of the Iraq and Afghanistan Wars (OEF/OIF/OND). Civilians with severe TBI have increased risks of motor vehicle crashes (MVCs). Little is known about MVC risk among Veterans with TBI, many of whom incurred TBIs that were mild in severity. OBJECTIVE: To examine associations between TBI and MVC-related hospitalizations among OEF/OIF/OND Veterans who use Veterans Health Administration (VA) healthcare. METHODS: Using national VA data, we identified 277,330 Veterans who enrolled in VA within one year of deployment. MVC, TBI, and other diagnoses were identified using ICD-9-CM codes. We estimated risk of subsequent MVC hospitalization for those with, versus without, TBI using time-to-event analyses. Time-varying Cox proportional hazards models were used to compute hazard ratios (HR) and 95% confidence intervals (CI) while controlling for potential confounders, including psychiatric diagnoses. RESULTS: There were 28,551 Veterans diagnosed with TBI; 130 were subsequently hospitalized for MVC. In adjusted models, those with TBI were four times more likely to be hospitalized for MVC than those without (HR = 4.2; CI = 3.3–5.3). CONCLUSION: Veterans with TBI had substantially greater risk of MVC-related hospitalizations. These Veterans may benefit from enhanced driving safety interventions to reduce risk.

Keywords: Traumatic brain injury, motor vehicle crash, injury, health services use, veterans

DOI: 10.3233/NRE-161367

Journal: NeuroRehabilitation, vol. 39, no. 3, pp. 351-361, 2016