Exploring racial/ethnic disparities in rehabilitation outcomes after TBI: A Veterans Affairs Model Systems study

Article type: Research Article

Authors: Liou-Johnson, Victoria^{a; b} | Merced, Kritzia^c | Klyce, Daniel W.^{c; d; e} | Agtarap, Stephanie^f | Finn, Jacob A.^{g; h} | Chung, Joyce S.ⁱ | Campbell, Thomas^c | Harris, Odette A.^j | Perrin, Paul B.^{c; k; *}

Affiliations: [a] Polytrauma System of Care, VA Palo Alto Health Care System, Palo Alto, CA, USA | [b] Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, CA, USA | [c] Central Virginia Veterans Affairs Health Care System, Richmond, VA, USA | [d] Department of Physical Medicine and Rehabilitation, Virginia Common wealth University, Richmond, VA, USA | [e] Sheltering Arms Institute, Richmond, VA, USA | [f] Department of Research, Craig Hospital, Englewood, CO, USA | [g] Rehabilitation and Extended Care, Minneapolis VA Health Care System, Minneapolis, MN, USA | [h] Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA | [i] Rehabilitation, VA Palo Alto Health Care System, Palo Alto, CA, USA | [j] Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA | [k] School of Data Science and Department of Psychology, University of Virginia, Charlottesville, VA, USA

Correspondence: [*] Address for correspondence: Paul B. Perrin, Ph.D., Elson Student Health Center, 400 Brandon Ave., #177, Charlottesville, VA 22903, USA. E-mail: [email protected].

Abstract: BACKGROUND:Almost one-third of the U.S. military population is comprised of service members and veterans (SMVs) of color. Research suggests poorer functional and psychosocial outcomes among Black and Hispanic/Latine vs. White civilians following traumatic brain injury (TBI). OBJECTIVE:This study examined racial/ethnic differences in 5-year functional independence and life satisfaction trajectories among SMVs who had undergone acute rehabilitation at one of five Veterans Affairs (VA) TBI Model Systems (TBIMS) Polytrauma Rehabilitation Centers (PRCs). METHODS:Differences in demographic and injury-related factors were assessed during acute rehabilitation among White (n = 663), Black (n = 89), and Hispanic/Latine (n = 124) groups. Functional Independence Measure (FIM) Motor, FIM Cognitive, and Satisfaction with Life Scale (SWLS) scores were collected at 1, 2, and 5 years after injury. Racial/ethnic comparisons in these outcome trajectories were made using hierarchical linear modeling. RESULTS:Black SMVs were less likely than White and Hispanic/Latine SMVs to have been deployed to a combat zone; there were no other racial/ethnic differences in any demographic or injury-related variable assessed. In terms of outcomes, no racial/ethnic differences emerged in FIM Motor, FIM cognitive, or SWLS trajectories. CONCLUSION:The absence of observable racial/ethnic differences in 5-year outcome trajectories after TBI among SMVs from VA TBIMS PRCs contrasts sharply with previous research identifying disparities in these same outcomes and throughout the larger VA health care system. Individuals enrolled in VA PRCs are likely homogenized on key social determinants of health that would otherwise contribute to racial/ethnic disparities in outcome trajectories.

Keywords: Traumatic brain injury, racial/ethnic disparities, Service Members and Veterans, functional independence, life satisfaction

DOI: 10.3233/NRE-220225

Journal: NeuroRehabilitation, vol. 52, no. 3, pp. 451-462, 2023