Race and ethnicity considerations in traumatic brain injury research: Incidence, reporting, and outcome

Diversity trends in traumatic brain injury clinical trials in the United States

BACKGROUND

This study aims to understand the demographic representation of patients in Traumatic Brain Injury (TBI) clinical trials by evaluating the proportions of patients from various demographic categories amongst completed TBI clinical trials in the United States.

METHODS

ClinicalTrials.gov was queried for active TBI clinical trials. One hundred and eight completed trials in the United States were selected based on inclusion criteria, and information regarding intervention, setting, age, sex, race, and ethnicity was extracted. 2002-2006 TBI incidence data was obtained from the CDC. Chi-squared testing was applied to analyze the relationship between distributions of race and sex in the collected clinical trials and the national TBI data, and logistic regression was conducted to identify variables that may predict reporting of race or ethnicity.

RESULTS

About 53.7% of selected clinical trials reported racial data and 34.3% reported ethnicity data. Logistic regression identified that clinical trials in defined phases were more likely to report racial data (p = 0.047 [1.015, 9.603]).

CONCLUSION

Current TBI trials do not consistently report race or ethnicity data. Future efforts to ensure equitable representation in clinical trials may involve reform of recruitment processes and accountability measures implemented within the grant application process to ensure proper racial and ethnicity data reporting.

Accelerated Aging after Traumatic Brain Injury: An ENIGMA Multi-Cohort Mega-Analysis

OBJECTIVE

The long-term consequences of traumatic brain injury (TBI) on brain structure remain uncertain. Given evidence that a single significant brain injury event increases the risk of dementia, brain-age estimation could provide a novel and efficient indexing of the long-term consequences of TBI. Brain-age procedures use predictive modeling to calculate brain-age scores for an individual using structural magnetic resonance imaging (MRI) data. Complicated mild, moderate, and severe TBI (cmsTBI) is associated with a higher predicted age difference (PAD), but the progression of PAD over time remains unclear. We sought to examine whether PAD increases as a function of time since injury (TSI) and if injury severity and sex interacted to influence this progression.

METHODS

Through the ENIGMA Adult Moderate and Severe (AMS)-TBI working group, we examine the largest TBI sample to date (n = 343), along with controls, for a total sample size of n = 540, to replicate and extend prior findings in the study of TBI brain age. Cross-sectional T1w-MRI data were aggregated across 7 cohorts, and brain age was established using a similar brain age algorithm to prior work in TBI.

RESULTS

Findings show that PAD widens with longer TSI, and there was evidence for differences between sexes in PAD, with men showing more advanced brain age. We did not find strong evidence supporting a link between PAD and cognitive performance.

INTERPRETATION

This work provides evidence that changes in brain structure after cmsTBI are dynamic, with an initial period of change, followed by relative stability in brain morphometry, eventually leading to further changes in the decades after a single cmsTBI. ANN NEUROL 2024;96:365-377.

"Somewhere along the line, your mask isn't going to be fitting right": institutional racism in Black narratives of traumatic brain injury rehabilitation across the practice continuum

BACKGROUND

Over two decades of research about traumatic brain injury (TBI) rehabilitation emphasized the persistence of racial health disparities in functional outcomes that disproportionately impact Black populations without naming or addressing racism as the root problem. Further, the experiences of Black people with TBI have yet to be documented and accounted for in scientific scholarship from the perspectives of Black persons in Canada.

PURPOSE

This study intended to examine the rehabilitation narratives of Black TBI survivors, family caregivers, and rehabilitation providers and use critical race theory as a conceptual framework to understand how anti-Black racism manifests in those experiences.

METHODS

Through critical narrative inquiry informed by a critical constructivist paradigm and a critical race theory lens, in-depth narrative interviewing were conducted with seven survivors, three family caregivers, and four rehabilitation providers. Data were analyzed using reflexive thematic analysis within and across groups of participants to conceptualize themes and sub-themes.

FINDINGS

Themes captured how racism becomes institutionalized in TBI rehabilitation: (1) the institutional construction of deficient Black bodies, (2) the institutional construction of rehabilitation access, (3) the institutional investment in resisting and approximating whiteness in rehabilitation practice, and (4) the institutional construction of deficient Black futures.

CONCLUSION

Study findings point to the dire need to ensure rehabilitation programs, services, and the delivery of care are not determined based on inequitable practices, racial biases and assumptions about Black people, which determine who deserves to get into rehabilitation and have opportunities to be supported in working towards living a full and meaningful life.

Traumatic brain injury, race, ethnicity and cognition in newly diagnosed persons with multiple sclerosis

We sought to determine whether a history of traumatic brain injury (TBI) could explain the lower symbol digit modalities test (SDMT) scores observed among newly diagnosed multiple sclerosis (MS) and control participants identifying as Black or Hispanic versus white in the MS Sunshine Study (n = 1172). 330 (29.2 %) participants reported a history of ≥1 TBI. Accounting for TBI did not explain the significant independent associations between having MS, being Black or Hispanic and lower SDMT. The pervasive effects of systemic racism in the United States remain the best explanation for the lower SDMT scores observed in Black and Hispanic participants.

Multidisciplinary care for patients with persistent symptoms following concussion: a systematic review

PURPOSE

To systematically characterize and assess the effectiveness of multidisciplinary care for patients with persistent post-concussion symptoms (PPCS).

MATERIALS AND METHODS

Only studies describing multidisciplinary treatment, defined as intervention provided by no less than 2 healthcare disciplines, each with independent scopes of practice, for patients with PPCS were considered.

RESULTS

A total of 8 of the 1357 studies identified were included. The studies were comprised of heterogenous patient populations, care delivery systems, healthcare providers, treatment approaches, and outcomes.

CONCLUSIONS

Findings suggest multidisciplinary care, using a needs-based approach with individual- or group-based interventions, may be more beneficial than usual care to; 1) immediately reduce concussion-related symptom complaints and improve mood and quality of life in adolescents following sports-related concussion (SRC) and, 2) may produce immediate and lasting improvements in symptom complaints of young, primarily female, adults following a non-SRC. Future studies should clearly describe the decision-making processes used to deliver care through a needs-based approach and prioritize the inclusion of objective, performance-based measures to assess outcomes.

Building an ethnically and racially diverse neurology workforce

As diversity among patient populations continues to grow, racial and ethnic diversity in the neurology workforce is increasingly essential to the delivery of culturally competent care and for enabling inclusive, generalizable clinical research. Unfortunately, diversity in the workforce is an area in which the field of neurology has historically lagged and faces formidable challenges, including an inadequate number of trainees entering the field, bias experienced by trainees and faculty from minoritized racial and ethnic backgrounds, and 'diversity tax', the disproportionate burden of service work placed on minoritized people in many professions. Although neurology departments, professional organizations and relevant industry partners have come to realize the importance of diversity to the field and have taken steps to promote careers in neurology for people from minoritized backgrounds, additional steps are needed. Such steps include the continued creation of diversity leadership roles in neurology departments and organizations, the creation of robust pipeline programmes, aggressive recruitment and retention efforts, the elevation of health equity research and engagement with minoritized communities. Overall, what is needed is a shift in culture in which diversity is adopted as a core value in the field.

ENIGMA's simple seven: Recommendations to enhance the reproducibility of resting-state fMRI in traumatic brain injury

Resting state functional magnetic resonance imaging (rsfMRI) provides researchers and clinicians with a powerful tool to examine functional connectivity across large-scale brain networks, with ever-increasing applications to the study of neurological disorders, such as traumatic brain injury (TBI). While rsfMRI holds unparalleled promise in systems neurosciences, its acquisition and analytical methodology across research groups is variable, resulting in a literature that is challenging to integrate and interpret. The focus of this narrative review is to address the primary methodological issues including investigator decision points in the application of rsfMRI to study the consequences of TBI. As part of the ENIGMA Brain Injury working group, we have collaborated to identify a minimum set of recommendations that are designed to produce results that are reliable, harmonizable, and reproducible for the TBI imaging research community. Part one of this review provides the results of a literature search of current rsfMRI studies of TBI, highlighting key design considerations and data processing pipelines. Part two outlines seven data acquisition, processing, and analysis recommendations with the goal of maximizing study reliability and between-site comparability, while preserving investigator autonomy. Part three summarizes new directions and opportunities for future rsfMRI studies in TBI patients. The goal is to galvanize the TBI community to gain consensus for a set of rigorous and reproducible methods, and to increase analytical transparency and data sharing to address the reproducibility crisis in the field.

Racial and Ethnical Discrepancies and Similarities in the Epidemiology, Survival, and Neurological Outcomes After Acute Traumatic Spinal Cord Injury: A Retrospective Cohort Study Using Data from the NASCIS-1 Trial

Background

Little is known about the impact of race/ethnicity on the clinical and neurological outcomes after acute traumatic spinal cord injury (tSCI).

Objectives

This study examined the influence of race/ethnicity on the individuals' survival and neurological recovery within the first year after tSCI.

Methods

The 306 cases enrolled in the First National Acute Spinal Cord Injury Study (NASCIS-1) were grouped as African American individuals (n = 84), non-Hispanic White individuals (n = 159), and other races/ethnicities that included Hispanic individuals (n = 60) and Asian individuals (n = 3). Outcome measures included survival and neurological recovery within the first year after tSCI. Data analyses were adjusted for major potential confounders.

Results

There were 39 females and 267 males with mean age of 31 years who mostly sustained cervical severe tSCI after motor vehicle accidents or falls. The three groups were comparable regarding sex distribution, level and severity of tSCI, level of consciousness at admission, and total received dose of methylprednisolone. African American individuals were significantly older than non-Hispanic White individuals (p = .0238). African American individuals and individuals of other races/ethnicities more often had a tSCI with open wound caused by missile and water-related accidents than non-Hispanic White individuals (p < .0001). Survival rates within the first year after tSCI were comparable among the three groups (p = .3191). Among the survivors, there were no significant differences among the three groups regarding motor and pinprick and light-touch sensory recovery (p > .0500).

Conclusions

The results of this study suggest that, while there were few differences among the racial/ethnical groups regarding the epidemiology of tSCI, race/ethnicity did not influence survival rate or neurological recovery within the first year post-tSCI.

An Examination of Racial/Ethnic Differences on the Neurobehavioral Symptom Inventory Among Veterans Completing the Comprehensive Traumatic Brain Injury Evaluation: A Veterans Affairs Million Veteran Program Study

OBJECTIVE

The purpose of this study was to explore racial/ethnic differences in neurobehavioral symptom reporting and symptom validity testing among military veterans with a history of traumatic brain injury (TBI).

METHOD

Participants of this observational cross-sectional study (N = 9,646) were post-deployed Iraq-/Afghanistan-era veterans enrolled in the VA's Million Veteran Program with a clinician-confirmed history of TBI on the Comprehensive TBI Evaluation (CTBIE). Racial/ethnic groups included White, Black, Hispanic, Asian, Multiracial, Another Race, American Indian or Alaska Native, and Native Hawaiian or Other Pacific Islander. Dependent variables included neurobehavioral symptom domains and symptom validity assessed via the Neurobehavioral Symptom Inventory (NSI) and Validity-10, respectively.

RESULTS

Chi-square analyses showed significant racial/ethnic group differences for vestibular, somatic/sensory, and affective symptoms as well as for all Validity-10 cutoff scores examined (≥33, ≥27, ≥26, >22, ≥22, ≥13, and ≥7). Follow-up analyses compared all racial/ethnic groups to one another, adjusting for sociodemographic- and injury-related characteristics. These analyses revealed that the affective symptom domain and the Validity-10 cutoff of ≥13 revealed the greatest number of racial/ethnic differences.

CONCLUSIONS

Results showed significant racial/ethnic group differences on neurobehavioral symptom domains and symptom validity testing among veterans who completed the CTBIE. An enhanced understanding of how symptoms vary by race/ethnicity is vital so that clinical care can be appropriately tailored to the unique needs of all veterans. Results highlight the importance of establishing measurement invariance of the NSI across race/ethnicity and underscore the need for ongoing research to determine the most appropriate Validity-10 cutoff score(s) to use across racially/ethnically diverse veterans.

Predictors of High School and College Graduation After Sustaining a Moderate-to-Severe Traumatic Brain Injury

OBJECTIVE

To identify early predictors of US high school and college graduation after moderate-to-severe traumatic brain injury (TBI).

SETTING

Inpatient rehabilitation and community.

PARTICIPANTS

TBI Model Systems participants, aged 16 to 24 years, enrolled as high school or college students at time of injury.

DESIGN

Prospective cohort study.

MAIN MEASURES

Successful graduation was defined as having a diploma (high school) or an associate/bachelor's degree (college) at 1-, 2-, or 5-year follow-up. Predictors were sex, race/ethnicity, urbanicity, preinjury substance abuse, primary rehabilitation payer, and functional independence at inpatient rehabilitation discharge.

METHOD

We descriptively characterized differences between those who did and did not graduate high school and college within the first 5 years postinjury and identified early predictors of successful high school and college graduation using 2 binomial logistic regressions.

RESULTS

Of those with known graduation status, 81.2% of high school and 41.8% of college students successfully graduated. Graduates in both groups were more often White than Black and had more functional independence at discharge. Among high school students, preinjury substance abuse was also a risk factor for not graduating, as was identifying as Hispanic or "other" race.

CONCLUSIONS

Sociodemographic factors and disability influence graduation outcomes, requiring structural, institutional, and personal interventions for success.

Comparison of Informational and Educational Resource Provision for Individuals Living With Traumatic Brain Injury Based on Language, Nativity, and Neighborhood

OBJECTIVE

To examine a resource provision program for individuals living with moderate-to-severe traumatic brain injury (TBI), using a comparison of the resources provided across social differences of language, nativity, and neighborhood.

SETTING

The Rusk Rehabilitation TBI Model System (RRTBIMS) collects data longitudinally on individuals from their associated private and public hospitals, located in New York City.

PARTICIPANTS

A total of 143 individuals with TBI or their family members.

DESIGN

An observational study of relative frequency of resource provision across variables of language, nativity, and neighborhood, using related-samples nonparametric analyses via Cochran's Q test.

MAIN MEASURES

Variables examined were language, place of birth, residence classification as medically underserved area/population (MUA), and resource categories.

RESULTS

Results indicate that US-born persons with TBI and those living in medically underserved communities are provided more resources than those who are born outside the United States or reside in communities identified as adequately medically served. Language was not found to be a factor.

CONCLUSION

Lessons learned from this research support the development of this resource provision program, as well as guide future programs addressing the gaps in health information resources for groups negatively impacted by social determinants of health (SDoH). An approach with immigrant participants should take steps to elicit questions and requests, or offer resources explicitly. We recommend research looking at what interpreter strategies are most effective and research on SDoH in relation to the dynamic interaction of variables in the neighborhood setting.

Exploring racial/ethnic disparities in rehabilitation outcomes after TBI: A veterans affairs model systems study

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 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.

Racial Disparity in Placement of Intracranial Pressure Monitoring: A TQIP Analysis

BACKGROUND

The Brain Trauma Foundation recommends intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (TBI). Race is associated with worse outcomes after TBI. The reasons for racial disparities in clinical decision-making around ICP monitor placement remain unclear.

STUDY DESIGN

We queried the TQIP database from 2017 to 2019 and included patients 16 years or older, with blunt severe TBI, defined as a head abbreviated injury score 3 or greater. Exclusion criteria were missing race, those without signs of life on admission, length of stay 1 day or less, and AIS of 6 in any body region. The primary outcome was ICP monitor placement, which was calculated using a Poisson regression model with robust SEs while adjusting for confounders.

RESULTS

A total of 260,814 patients were included: 218,939 White, 29,873 Black, 8,322 Asian, 2,884 American Indian, and 796 Native Hawaiian or Other Pacific Islander. Asian and American Indian patients had the highest rates of midline shift (16.5% and 16.9%). Native Hawaiian or Other Pacific Islanders had the highest rates of neurosurgical intervention (19.3%) and ICP monitor placement (6.5%). Asian patients were found to be 19% more likely to receive ICP monitoring (adjusted incident rate ratio 1.19; 95% CI 1.06 to 1.33; p = 0.003], and American Indian patients were 38% less likely (adjusted incident rate ratio 0.62; 95% CI 0.49 to 0.79; p < 0.001), compared with White patients, respectively. No differences were detected between White and Black patients.

CONCLUSIONS

ICP monitoring use differs by race. Further work is needed to elucidate modifiable causes of this difference in the management of severe TBI.

Consequences of inequity in the neurosurgical workforce: Lessons from traumatic brain injury

Women and minorities leave or fail to advance in the neurosurgical workforce more frequently than white men at all levels from residency to academia. The consequences of this inequity are most profound in fields such as traumatic brain injury (TBI), which lacks objective measures. We evaluated published articles on TBI clinical research and found that TBI primary investigators or corresponding authors were 86·5% White and 59·5% male. First authors from the resulting publications were 92.6% white. Most study participants were male (68%). 64·4% of NIH-funded TBI clinical trials did not report or recruit any black subjects and this number was even higher for other races and the Hispanic ethnicity. We propose several measures for mitigation of the consequences of the inequitable workforce in traumatic brain injury that could potentially contribute to more equitable outcomes. The most immediately feasible of these is validation and establishment of objective measures for triage and prognostication that are less susceptible to bias than current protocols. We call for incorporation of gender and race neutral metrics for TBI evaluation to standardize classification of injury. We offer insights into how socioeconomic factors contribute to increased death rates from women and minority groups. We propose the need to study how these disparities are caused by unfair health insurance reimbursement practices. Surgical and clinical research inequities have dire consequences, and until those inequities can be corrected, mitigation of those consequences requires system wide change.

Effects of preexisting stroke on acute hospital outcomes for older adults admitted with neurotrauma and orthopedic injury

OBJECTIVE

We aimed to examine acute trauma outcomes, specifically among those with neurotrauma (NT), in patients with preexisting cerebrovascular accident (CVA).

METHODS

We identified patients treated for neurotrauma or orthopedic trauma at hospitals in Pennsylvania with and without an identified history of stroke with residual deficits, aged 50-99 across four groups of N = 11,648 each. We assessed mortality, craniotomy, and total hospital, ICU, step-down, and ventilator days, functional status at discharge (FSD), and discharge destination.

RESULTS

Stroke history did not influence mortality but was predictive of patients undergoing craniotomy (OR = 1.25, p = 0.008). There was a moderate group effect on total ICU days, with the CVA+NT group in the ICU the longest (η2 = 0.10, p < 0.001). Patients with stroke history were less likely to be discharged to home (OR = 0.65, p < 0.001) and had poorer FSD scores across the various domains assessed.

CONCLUSIONS

Trauma patients with preexisting CVA were found to have poorer outcomes on a number of different metrics when compared to those without stroke history. While it is possible that functional differences pre-injury influenced FSD and discharge destination, given these results, clinicians should assess for possible comorbidities that may influence treatment.

Vulnerability to Hypertension Is a Major Determinant of Racial Disparities in Alzheimer's Disease Risk

BACKGROUND

Higher incidence levels of Alzheimer's disease (AD) in Black Americans are well documented. However, quantitative explanations of this disparity in terms of risk-factor diseases acting through well-defined pathways are lacking.

METHODS

We applied a Blinder-Oaxaca-based algorithm modified for censored data to a 5% random sample of Medicare beneficiaries age 65+ to explain Black/White disparities in AD risk in terms of differences in exposure and vulnerability to morbidity profiles based on 10 major AD-risk-related diseases.

RESULTS

The primary contribution to racial disparities in AD risk comes from morbidity profiles that included hypertension with about 1/5th of their contribution due to differences in prevalence (exposure effect) and 4/5ths to differences in the effects of the morbidity profile on AD risk (vulnerability effect). In total, disease-related effects explained a higher proportion of AD incidence in Black Americans than in their White counterparts.

CONCLUSIONS

Disease-related causes may represent some of the most straightforward targets for targeted interventions aimed at the reduction of racial disparities in health among US older adults. Hypertension is a manageable and potentially preventable condition responsible for the majority of the Black/White differences in AD risk, making mitigation of the role of this disease in engendering higher AD incidence in Black Americans a prominent concern.

Risk Factors Associated With Pressure Ulcers in Patients With Traumatic Brain Injury Admitted to the Intensive Care Unit

Pressure injuries (PIs) are one of the most important and frequent complications in patients admitted to the intensive care unit (ICU) or those with traumatic brain injury (TBI). The purpose of this study was to determine the incidence and risk factors of PIs in patients with TBI admitted to the ICU. In this retrospective study, the medical records of 237 patients with TBI admitted to the trauma ICU of a university hospital were examined. Demographic, trauma-related, and treatment-related characteristics of all the patients were evaluated from their records. The incidence of PIs was 13.9%, while the main risk factors were a higher injury severity score, use of mechanical ventilation, vasopressor infusion, lower Braden Scale score, fever, and period of enteral feeding. This study advances the nursing practice in the ICU by predicting the development of PIs and their characteristics in patients with TBI.

Person-centered data analysis with covariates and the R-package confreq

Configural Frequency Analysis (CFA) is a useful statistical method for the analysis of multiway contingency tables and an appropriate tool for person-oriented or person-centered methods. In complex contingency tables, patterns or configurations are analyzed by comparing observed cell frequencies with expected frequencies. Significant differences between observed and expected frequencies lead to the emergence of Types and Antitypes. Types are patterns or configurations which are significantly more often observed than the expected frequencies; Antitypes represent configurations which are observed less frequently than expected. The R-package confreq is an easy-to-use software for conducting CFAs; another useful shareware to run CFAs was developed by Alexander von Eye. Here, CFA is presented based on the log-linear modeling approach. CFA may be used together with interval level variables which can be added as covariates into the design matrix. In this article, a real data example and the use of confreq are presented. In sum, the use of a covariate may bring the estimated cell frequencies closer to the observed cell frequencies. In those cases, the number of Types or Antitypes may decrease. However, in rare cases, the Type-Antitype pattern can change with new emerging Types or Antitypes.

A Population-Based Study of Pre-Existing Health Conditions in Traumatic Brain Injury

Health factors impacting both the occurrence of, and recovery from traumatic brain injury (TBI) vary in complexity, and present genuine challenges to researchers and healthcare professionals seeking to characterize injury consequences and determine prognosis. However, attempts to clarify causal links between injury characteristics and clinical outcomes (including mortality) often compel researchers to exclude pre-existing health conditions (PECs) in their samples, including psychiatric history, medication usage, and other comorbid conditions. In this pre-registered population-based study (total starting n = 939,123 patients), we examined trends in PEC incidence over 22 years in the state of Pennsylvania (1997-2019) in individuals sustaining TBI (n = 169,452) and individuals with orthopedic injury (n = 87,637). The goal was to determine how PECs interact with age and injury severity to influence short-term outcomes. A further goal was to determine whether number of PECs, or specific PEC clusters contributed to worse outcomes within the TBI cohort, compared with orthopedic injury alone. Primary findings indicate that PECs significantly influenced mortality within the TBI cohort; patients having four or more PECs were associated with approximately a two times greater likelihood of dying in acute care (odds ratio [OR] 1.9). Additionally, cluster analyses revealed four distinct PEC clusters that are age and TBI severity dependent. Overall, the likelihood of zero PECs hovers at ∼25%, which is critical to consider in TBI outcomes work and could potentially contribute to the challenges facing intervention science with regard to reproducibility of findings.

Racial and Ethnic Inequities in Mortality During Hospitalization for Traumatic Brain Injury: A Call to Action

The health disparities which drive inequities in health outcomes have long plagued our already worn healthcare system and are often dismissed as being a result of social determinants of health. Herein, we explore the nature of these inequities by comparing outcomes for racial and ethnic minorities patients suffering from traumatic brain injury (TBI). We retrospectively reviewed all patients enrolled in the Trauma One Database at the Oregon Health & Science University Hospital from 2006 to October 2017 with an abbreviated injury scale (AIS) for the head or neck >2. Racial and ethnic minority patients were defined as non-White or Hispanic. A total of 6,352 patients were included in our analysis with 1,504 in the racial and ethnic minority cohort vs. 4,848 in the non-minority cohort. A propensity score (PS) model was generated to account for differences in baseline characteristics between these cohorts to generate 1,500 matched pairs. The adjusted hazard ratio for in-hospital mortality for minority patients was 2.21 [95% Confidence Interval (CI) 1.43-3.41, p < 0.001] using injury type, probability of survival, and operative status as covariates. Overall, this study is the first to specifically look at racial and ethnic disparities in the field of neurosurgical trauma. This research has demonstrated significant inequities in the mortality of TBI patients based on race and ethnicity and indicates a substantive need to reshape the current healthcare system and advocate for safer and more supportive pre-hospital social systems to prevent these life-threatening sequelae.