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Tantillo GB, Sullivan-Baca E, Rehman R, López MR, Haneef Z. Health care utilization of Hispanic/Latino veterans with epilepsy: A national population-based study. Epilepsia 2024; 65:1668-1678. [PMID: 38557951 DOI: 10.1111/epi.17948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE Hispanic/Latino people with epilepsy are a growing population that has been understudied in clinical epilepsy research. U.S. veterans are at a higher risk of epilepsy due to greater exposures including traumatic brain injury. Hispanic/Latino Veterans with Epilepsy (HL-VWEs) represent a growing population; however the treatment utilization patterns of this population have been vastly understudied. METHODS HL-VWE were identified from administrative databases during fiscal year 2019. Variables compared between Hispanic and non-Hispanic VWEs included demographics, rurality, service era, utilization of clinical services/investigations, and service-connected injury. Chi-square and Student's t tests were used for comparisons. RESULTS Among 56 556 VWEs, 3247 (5.7%) were HL. HL-VWEs were younger (59.2 vs 63.2 years; p < .01) and more commonly urban-dwelling (81.6% vs 63.2%, p < .01) compared to non-HL-VWEs. They were also more likely to have served in recent missions such as the Persian Gulf War and post- 9/11 wars (p < .01). HL-VWEs had a higher utilization of all neurology services examined including neurology clinic visits, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, electroencephalography (EEG), epilepsy monitoring, and comprehensive epilepsy care (p < .01 for all). HL-VWEs were more likely to visit an emergency room or have seizure-related hospitalizations (p < .01). HL-VWEs were more likely to have a service-connected disability greater or equal to 50% (p < .01). SIGNIFICANCE This study is one of the largest cohorts examining HL-VWEs. We found higher utilization of services in neurology, epilepsy, and neuroimaging by HL-VWEs. HL-VWE are younger, more commonly urban-dwelling, and more likely to have served during recent combat periods and have higher amounts of service-connected disability. Given that the proportion of Hispanic veterans is projected to rise over time, more research is needed to provide the best interventions and mitigate the long-term impact of epilepsy on this diverse patient group.
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Affiliation(s)
| | - Erin Sullivan-Baca
- Baylor College of Medicine, Houston, Texas, USA
- Michael E. DeBakey Houston VA Medical Center, Houston, Texas, USA
| | - Rizwana Rehman
- Veterans' Administration Epilepsy Centers of Excellence (VA ECoE), Washington DC, USA
- Durham VA Medical Center, Durham, North Carolina, USA
| | - María Raquel López
- Veterans' Administration Epilepsy Centers of Excellence (VA ECoE), Washington DC, USA
- University of Miami Medical Center, Miami, Florida, USA
| | - Zulfi Haneef
- Baylor College of Medicine, Houston, Texas, USA
- Michael E. DeBakey Houston VA Medical Center, Houston, Texas, USA
- Veterans' Administration Epilepsy Centers of Excellence (VA ECoE), Washington DC, USA
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Dismuke-Greer C, Esmaeili A, Ozieh MN, Gujral K, Garcia C, Del Negro A, Davis B, Egede L. Racial/Ethnic and Geographic Disparities in Comorbid Traumatic Brain Injury-Renal Failure in US Veterans and Associated Veterans Affairs Resource Costs, 2000-2020. J Racial Ethn Health Disparities 2024; 11:652-668. [PMID: 36864369 PMCID: PMC10474245 DOI: 10.1007/s40615-023-01550-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 03/04/2023]
Abstract
Studies have identified disparities by race/ethnicity and geographic status among veterans with traumatic brain injury (TBI) and renal failure (RF). We examined the association of race/ethnicity and geographic status with RF onset in veterans with and without TBI, and the impact of disparities on Veterans Health Administration resource costs. METHODS Demographics by TBI and RF status were assessed. We estimated Cox proportional hazards models for progression to RF and generalized estimating equations for inpatient, outpatient, and pharmacy cost annually and time since TBI + RF diagnosis, stratified by age. RESULTS Among 596,189 veterans, veterans with TBI progressed faster to RF than those without TBI (HR 1.96). Non-Hispanic Black veterans (HR 1.41) and those in US territories (HR 1.71) progressed faster to RF relative to non-Hispanic Whites and those in urban mainland areas. Non-Hispanic Blacks (-$5,180), Hispanic/Latinos ($-4,984), and veterans in US territories (-$3,740) received fewer annual total VA resources. This was true for all Hispanic/Latinos, while only significant for non-Hispanic Black and US territory veterans < 65 years. For veterans with TBI + RF, higher total resource costs only occurred ≥ 10 years after TBI + RF diagnosis ($32,361), independent of age. Hispanic/Latino veterans ≥ 65 years received $8,248 less than non-Hispanic Whites and veterans living in US territories < 65 years received $37,514 less relative to urban veterans. CONCLUSION Concerted efforts to address RF progression in veterans with TBI, especially in non-Hispanic Blacks and those in US territories, are needed. Importantly, culturally appropriate interventions to improve access to care for these groups should be a priority of the Department of Veterans Affairs priority for these groups.
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Affiliation(s)
- Clara Dismuke-Greer
- Health Economics Resource Center (HERC), Ci2i, VA Palo Alto Healthcare System, 795 Willow Road, 152 MPD, Menlo Park, CA, 94025, USA.
| | - Aryan Esmaeili
- Health Economics Resource Center (HERC), Ci2i, VA Palo Alto Healthcare System, 795 Willow Road, 152 MPD, Menlo Park, CA, 94025, USA
| | - Mukoso N Ozieh
- Center for Advancing Population Science (CAPS), Division of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Medicine, Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Nephrology, Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA
| | - Kritee Gujral
- Health Economics Resource Center (HERC), Ci2i, VA Palo Alto Healthcare System, 795 Willow Road, 152 MPD, Menlo Park, CA, 94025, USA
| | - Carla Garcia
- Health Economics Resource Center (HERC), Ci2i, VA Palo Alto Healthcare System, 795 Willow Road, 152 MPD, Menlo Park, CA, 94025, USA
| | | | - Boyd Davis
- Department of English Emerita, College of Liberal Arts & Sciences, The University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Leonard Egede
- Center for Advancing Population Science (CAPS), Division of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Sakamoto MS, Hanson KL, Chanfreau-Coffinier C, Lai MHC, Román CAF, Clark AL, Marquine MJ, Delano-Wood L, Merritt VC. 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. Arch Clin Neuropsychol 2023; 38:929-943. [PMID: 36702773 PMCID: PMC10656879 DOI: 10.1093/arclin/acad005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/29/2022] [Accepted: 01/02/2023] [Indexed: 01/28/2023] Open
Abstract
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.
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Affiliation(s)
- McKenna S Sakamoto
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - Karen L Hanson
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | | | - Mark H C Lai
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | | | - Alexandra L Clark
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
| | - María J Marquine
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Lisa Delano-Wood
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
| | - Victoria C Merritt
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
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Holliday R, Smith AA, Kinney AR, Forster JE, Bahraini N, Monteith LL, Brenner LA. Research Letter: Traumatic Brain Injury Among Veterans Accessing VA Justice-Related Services. J Head Trauma Rehabil 2023; 38:184-190. [PMID: 36727701 DOI: 10.1097/htr.0000000000000822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Risk for traumatic brain injury (TBI) within both the Veteran population and among individuals with a history of criminal justice involvement is notably high. Despite this, research examining TBI among Veterans with a history of criminal justice involvement (ie, justice-involved Veterans) remains limited. The sequelae of TBI can impact justice-involved Veterans' engagement in Department of Veterans Affairs (VA) justice-related services (ie, Veterans Justice Outreach and Health Care for Re-entry Veterans), thus potentially increasing risk for recidivism and impacting psychosocial functioning. As such, further understanding of TBI risk among justice-involved Veterans has the potential to inform the need for tailored screening and interventional efforts within VA justice-related service settings. We sought to better understand relative risk for TBI diagnosis among male and female Veteran recipients and nonrecipients of VA justice-related services. SETTING Electronic medical record data for Veterans accessing VA services from 2005 to 2018. PARTICIPANTS 1517 447 (12.48% justice-involved) male and 126 237 (8.89% justice-involved) female Veterans. DESIGN A cross-sectional examination of national VA electronic medical record data. Sex-stratified analyses were conducted to examine relative risk of TBI diagnosis based on use of VA justice-related services. MAIN MEASURES Documented TBI diagnosis was the main outcome. Covariates included VA service use, age, race, and ethnicity. RESULTS Both male and female Veterans using VA justice-related services were more likely to have a documented TBI diagnosis in their electronic VA medical record. Associations were attenuated, yet maintained significance, in all adjusted and sensitivity models. CONCLUSIONS Given potential risk for TBI, enhancing and tailoring care for justice-involved Veterans may be critical to facilitating rehabilitation and reducing recidivism. Examination of existing services within justice-related settings and methods of augmenting care is an important next step.
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Affiliation(s)
- Ryan Holliday
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Aurora, Colorado (Drs Holliday, Kinney, Forster, Bahraini, Monteith, and Brenner and Ms Smith); Department of Psychiatry (Drs Holliday and Monteith), Department of Physical Medicine and Rehabilitation (Dr Forster), Departments of Physical Medicine and Rehabilitation, Psychiatry (Drs Bahraini), Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology (Dr Brenner), University of Colorado Anschutz Medical Campus, Aurora; and VA National Center on Homelessness Among Veterans, Washington, District of Columbia (Dr Holliday)
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Maldonado J, Huang JH, Childs EW, Tharakan B. Racial/Ethnic Differences in Traumatic Brain Injury: Pathophysiology, Outcomes, and Future Directions. J Neurotrauma 2023; 40:502-513. [PMID: 36029219 DOI: 10.1089/neu.2021.0455] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
Traumatic brain injury (TBI) is a major cause of death and disability in the United States, exacting a debilitating physical, social, and financial strain. Therefore, it is crucial to examine the impact of TBI on medically underserved communities in the U.S. The purpose of the current study was to review the literature on TBI for evidence of racial/ethnic differences in the U.S. Results of the review showed significant racial/ethnic disparities in TBI outcome and several notable differences in other TBI variables. American Indian/Alaska Natives have the highest rate and number of TBI-related deaths compared with all other racial/ethnic groups; Blacks/African Americans are significantly more likely to incur a TBI from violence when compared with Non-Hispanic Whites; and minorities are significantly more likely to have worse functional outcome compared with Non-Hispanic Whites, particularly among measures of community integration. We were unable to identify any studies that looked directly at underlying racial/ethnic biological variations associated with different TBI outcomes. In the absence of studies on racial/ethnic differences in TBI pathobiology, taking an indirect approach, we looked for studies examining racial/ethnic differences in oxidative stress and inflammation outside the scope of TBI as they are known to heavily influence TBI pathobiology. The literature indicates that Blacks/African Americans have greater inflammation and oxidative stress compared with Non-Hispanic Whites. We propose that future studies investigate the possibility of racial/ethnic differences in inflammation and oxidative stress within the context of TBI to determine whether there is any relationship or impact on TBI outcome.
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Affiliation(s)
- Justin Maldonado
- Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Jason H Huang
- Department of Neurosurgery, Baylor Scott and White Health and Texas A&M University College of Medicine, Temple, Texas, USA
| | - Ed W Childs
- Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Binu Tharakan
- Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia, USA
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Mukhtarzada MG, Monteith TS. Equity and Disparities in Diagnosis, Management, and Research of Post-Traumatic Headache. Curr Pain Headache Rep 2022; 26:555-566. [PMID: 35567660 DOI: 10.1007/s11916-022-01058-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW There are notable health disparities and inequities in individuals with traumatic brain injury (TBI) and concussion by race, ethnicity, gender, socioeconomic status, and geography. This review will evaluate these disparities and inequities and assess the social determinants of health that drive outcomes for post-traumatic headache. Interventions for achieving this are also discussed. RECENT FINDINGS Significant disparities and inequities exist in TBI and concussion among people of different races, socioeconomic status, and geographic locations. Migraine is a common symptom post-concussion, for which disparities and social determinants of health are also discussed. Overall, multi-level interventions to reduce these disparities and inequities are reviewed for post-traumatic headache but require further investigation. Interventions are needed to reduce disparities and inequities including public health initiatives, improvements in clinical care, diversity/inclusion training, and research efforts. As literature expands, we can form guidance to identify solutions for eliminating disparities in care of diverse populations.
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Affiliation(s)
- Mejgan G Mukhtarzada
- Department of Neurology-Headache Division, University of Miami, Miller School of Medicine, 1120 NW 14 Street #13th floor, Miami, FL, 33136, USA
| | - Teshamae S Monteith
- Department of Neurology-Headache Division, University of Miami, Miller School of Medicine, 1120 NW 14 Street #13th floor, Miami, FL, 33136, USA.
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Saleem GT, Champagne M, Haider MN, Leddy JJ, Willer B, Asante I, Kent A, Joseph T, Fitzpatrick JM. Prevalence and Risk Factors for Intimate Partner Physical Violence-Related Acquired Brain Injury Among Visitors to Justice Center in New York. J Head Trauma Rehabil 2022; 37:E10-E19. [PMID: 34985036 DOI: 10.1097/htr.0000000000000750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The recent United States Government Accountability Office report highlights the need for improved data on the prevalence of intimate partner violence (IPV)-related acquired brain injury (ABI) to help direct Health & Human Services public efforts. This article identifies the prevalence and risk factors for IPV-related ABI among survivors of IPV at a Justice Center in New York. SETTING Community Justice Center. PARTICIPANTS Forty survivors of IPV, aged 17 to 73 years (median 32, interquartile range: 25.25, 42) were assessed within 60 days of sustaining physical violence. DESIGN Retrospective chart review. MAIN MEASURES The HELPS and the Danger Assessment-Revised were used at the initial Center visit. RESULTS Of the 40 physical IPV survivors screened, all (100%) reported a prior history of partner-induced ABI within the past 60 days. Thirty-seven (92.5%) survivors also reported sustaining at least 1 potential hypoxic brain injury from strangulation. However, only 16 (40%) survivors screened positive on the HELPS for a history of IPV-related mild traumatic brain injury. Females (95%) and individuals with low income (67.5%) largely comprised our sample. Compared with the County's average, the proportion of African Americans/Blacks and refugees was 227% higher (42.5% vs 13%) and 650% higher (7.5% vs 1.09%), respectively. Refugee status (P = .017) also correlated with number of previous ABIs. On an exploratory binary logistic regression with stepwise selection, only balance difficulties (P = .023) and difficulty concentrating/remembering (P = .009) predicted a positive screen for mild traumatic brain injury. CONCLUSIONS Consistent with previous findings, our data indicate a high prevalence of IPV-related ABI among visitors to a New York Justice Center. An overrepresentation of African Americans/Blacks and refugees in our sample relative to the region signified a higher prevalence of IPV in these populations and warrants a provision of more trauma-informed ABI resources to these groups/communities. Intimate partner violence survivors visiting Justice Centers should be screened for motor/neurocognitive symptoms suggestive of mild traumatic brain injury. Further research to identify the prevalence and risk factors of IPV-related ABI statewide and nationwide is urgently needed to improve resource allocation and clinical management.
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Affiliation(s)
- Ghazala T Saleem
- Department of Rehabilitation Sciences, University at Buffalo, The State University of New York (Dr Saleem); Jacobs School of Medicine and Biomedical Sciences, The State University of New York, Buffalo (Mss Champagne, Kent, and Joseph); UBMD Department of Orthopaedics and Sports Medicine (Drs Haider and Leddy) and Department of Psychiatry (Willer), Jacobs School of Medicine and Biomedical Sciences, The State University of New York, Buffalo; Department of Public Health, School of Public Health and Health Professions, The State University of New York, Buffalo (Mr Asante); and Department of Social Work, The State University of New York, Buffalo State College (Dr Fitzpatrick)
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Stevens LF, Ketchum JM, Sander AM, Callender L, Dillahunt-Aspillaga C, Dreer LE, Finn JA, Gary KW, Graham KM, Juengst SB, Kajankova M, Kolakowsky-Hayner S, Lequerica AH, Rabinowitz AR. Race/Ethnicity and Community Participation Among Veterans and Service Members With Traumatic Brain Injury: A VA Traumatic Brain Injury Model Systems Study. J Head Trauma Rehabil 2021; 36:408-417. [PMID: 33656479 DOI: 10.1097/htr.0000000000000657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine racial/ethnic disparities in community participation among veterans and active duty service members with traumatic brain injury (TBI). SETTING Five Department of Veterans Affairs (VA) TBI Model Systems (TBIMS) Polytrauma Rehabilitation Centers (PRCs). Participants: Three hundred forty-two community-dwelling adults (251 White, 34 Black, and 57 Hispanic) with TBI enrolled in the VA TBIMS National Database who completed a 1-year follow-up interview. Mean age was 38.6 years (range, 19-84 years). DESIGN Cross-sectional analysis of a prospective observational cohort study. Main Measures: Community participation at 1 year postinjury assessed by 3 domains of the Participation Assessment with Recombined Tools-Objective (PART-O): Out & About, Productivity, and Social Relations. RESULTS Significant differences were observed among race/ethnicity groups in PART-O Productivity and Out & About domains without controlling for relevant participant characteristics; Productivity scores were significantly higher for non-Hispanic Black than for non-Hispanic White participants (t = 2.40, P = .0169). Out & About scores were significantly higher for Hispanic than for non-Hispanic White participants (t = 2.79, P = .0056). However, after controlling for demographic, injury severity, and 1-year follow-up characteristics, only differences in the Out & About domain remained statistically significant (t = 2.62, P = .0094), with scores being significantly higher for Hispanics than for non-Hispanic Whites. CONCLUSIONS The results, which differ from findings from studies conducted in non-VA healthcare settings where there are greater racial/ethnic disparities in participation outcomes, could reflect differences between military and civilian samples that may reduce disparities.
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Affiliation(s)
- Lillian Flores Stevens
- Departments of Psychology and Physical Medicine and Rehabilitation, Virginia Commonwealth University, and Defense and Veterans Brain Injury Center (DVBIC), Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia (Dr Stevens); Research Department, Craig Hospital, Englewood, Colorado (Dr Ketchum); Research Services, James A. Haley Veterans Hospital, Tampa, Florida (Drs Ketchum and Dillahunt-Aspillaga); H. Ben Taub Department of Physical Medicine & Rehabilitation, Baylor College of Medicine and Harris Health System, and Brain Injury Research Center, TIRR Memorial Herman, Houston, Texas (Dr Sander); Baylor Research Institute at Baylor Institute for Rehabilitation, Dallas, Texas (Ms Callender); Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, Texas (Dr Juengst); Rehabilitation and Mental Health Counseling Program, Department of Child and Family Studies, College of Family and Community Sciences, University of South Florida, Tampa (Dr Dillahunt-Aspillaga); Departments of Physical Medicine and Rehabilitation and Ophthalmology and Visual Sciences, University of Alabama at Birmingham (Dr Dreer); Minneapolis Veterans Affairs Health Care System, and Department of Psychiatry, University of Minnesota-Twin Cities, Minneapolis (Dr Finn); Department of Rehabilitation Counseling, Virginia Commonwealth University, Richmond (Dr Gary); Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York City, New York (Drs Kajankova and Kolakowsky-Hayner); Kessler Foundation, East Hanover, New Jersey (Dr Lequerica); Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark (Dr Lequerica); and Moss Rehabilitation Research Institute, Elkins, Pennsylvania (Dr Rabinowitz)
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Dismuke-Greer CE, Fakhry SM, Horner MD, Pogoda TK, Pugh MJ, Gebregziabher M, Hall CL, Taber D, Spain DA. Ethnicity/race and service-connected disability disparities in civilian traumatic brain injury mechanism of injury and VHA health services costs in military veterans: Evidence from a Level 1 Trauma Center and VA Medical Center. TRAUMA-ENGLAND 2021. [DOI: 10.1177/1460408620914436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction The objective of this study was to examine the association of military veteran socio-demographics and service-connected disability with civilian mechanism of traumatic brain injury and long-term Veterans Health Administration (VHA) costs. Methods We conducted a 17-year retrospective longitudinal cohort study of veterans with a civilian-related traumatic brain injury from a Level 1 Trauma Center between 1999 and 2013, with VHA follow-up through 2016. We merged trauma center VHA data, and used logit to model mechanism of injury, and generalized linear model to model VHA costs. Results African American race or Hispanic ethnicity veterans had a higher unadjusted rate of civilian assault/gun as mechanism of injury (15.38%) relative to non-Hispanic White (7.19%). African American race or Hispanic veterans who were discharged from the trauma center with traumatic brain injury and followed in VHA had more than twice the odds of assault/gun (OR 2.47; 95% CI 1.16:5.26), after adjusting for sex, age, and military service-connected disability. Veterans with service-connected disability ≥50% had more than twice the odds of assault/gun (OR 2.48; 95% CI 0.97:6.31). Assault/gun was associated with significantly higher annual VHA costs post-discharge ($16,807; 95% CI 672:32,941) among non-Hispanic White veterans. Military service-connected disability ≥50% was associated with higher VHA costs among both non-Hispanic White ($44,987; 95% CI $17,159:$72,816) and African American race or Hispanic ($37,901; 95% CI $4,543:$71,258) veterans. Conclusions We found that African American race or Hispanic veterans had higher adjusted likelihood of assault/gun mechanism of traumatic brain injury, and non-Hispanic White veterans had higher adjusted annual VHA resource costs associated with assault/gun, post trauma center discharge. Veterans with higher than 50% service-connected disability had higher likelihood of assault/gun and higher adjusted annual VHA resource costs. Assault/gun prevention efforts may be indicated within the VHA, especially in minority and service-connected disability veterans. More data from Level 1 Trauma Centers are needed to assess the generalizability of these findings.
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Affiliation(s)
- CE Dismuke-Greer
- Health Economics Resource Center (HERC), Ci2i, VA Palo Alto Health Care System, Palo Alto, USA
| | - SM Fakhry
- Center for Trauma and Acute Care Surgery Research, CSG, HCA Healthcare, Nashville, USA
| | - MD Horner
- Ralph H. Johnson VA Medical Center and Medical University of South Carolina, Charleston, USA
| | - TK Pogoda
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, USA
- Boston University School of Public Health, Boston, USA
| | - MJ Pugh
- Salt Lake City VA Health Care System and University of Utah Health Sciences, Salt Lake City, USA
| | - M Gebregziabher
- Ralph H. Johnson VA Medical Center and Medical University of South Carolina, Charleston, USA
| | - CL Hall
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson VAMC, Charleston, USA
| | - D Taber
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson VAMC, Charleston, USA
| | - DA Spain
- Department of Surgery, Stanford University, Stanford Healthcare, Stanford, USA
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10
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Sander AM, Ketchum JM, Lequerica AH, Pappadis MR, Bushnik T, Hammond FM, Sevigny M. Primary Language and Participation Outcomes in Hispanics With Traumatic Brain Injury: A Traumatic Brain Injury Model Systems Study. J Head Trauma Rehabil 2021; 36:E218-E225. [PMID: 33656477 PMCID: PMC8249338 DOI: 10.1097/htr.0000000000000655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the relationship between primary language and participation outcomes in English- and Spanish-speaking persons with complicated mild to severe traumatic brain injury (TBI) at 1 year post-injury. SETTING Community following discharge from inpatient rehabilitation. PARTICIPANTS A total of 998 Hispanic participants with outcomes available at year 1 follow-up; 492 (49%) indicated English as their primary language and 506 (51%) indicated Spanish as their primary language. DESIGN Prospective, multicenter, cross-sectional, observational cohort study. MAIN MEASURES Community participation at 1 year post-injury was assessed by 3 domains of the Participation Assessment with Recombined Tools-Objective (PART-O): Out and About, Productivity, and Social Relations. RESULTS Unadjusted group comparisons showed better participation outcomes for English versus Spanish speakers for all PART-O domains and for the Balanced Total score. After controlling for relevant covariates, English-speaking participants had significantly better PART-O Balanced Total scores and better scores on the Social Relations domain, although effect sizes were small. CONCLUSIONS Hispanic persons with TBI whose primary language is Spanish may require greater assistance integrating socially back into their communities after TBI. However, potential cultural differences in value placed on various social activities must be considered. Potential cultural bias inherent in existing measures of participation should be investigated in future studies.
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Affiliation(s)
- Angelle M Sander
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine and Harris Health System, Houston, Texas (Dr Sander); Brain Injury Research Center, TIRR Memorial Herman, Houston, Texas (Drs Sander and Pappadis); Research Department, Craig Hospital, Englewood, Colorado (Dr Ketchum and Mr Sevigny); Kessler Foundation, East Hanover, New Jersey, and Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, New Jersey (Dr Lequerica); Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch at Galveston, Galveston, Texas (Dr Pappadis); Rusk Rehabilitation and NYU Langone Health, New York, New York (Dr Bushnik); and Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana (Dr Hammond)
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11
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Ward RE, Nguyen XMT, Li Y, Lord EM, Lecky V, Song RJ, Casas JP, Cho K, Gaziano JM, Harrington KM, Whitbourne SB. Racial and Ethnic Disparities in U.S. Veteran Health Characteristics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052411. [PMID: 33801200 PMCID: PMC7967786 DOI: 10.3390/ijerph18052411] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/18/2021] [Accepted: 02/23/2021] [Indexed: 11/16/2022]
Abstract
Racial/ethnic health disparities persist among veterans despite comparable access and quality of care. We describe racial/ethnic differences in self-reported health characteristics among 437,413 men and women (mean age (SD) = 64.5 (12.6), 91% men, 79% White) within the Million Veteran Program. The Cochran-Mantel-Haenszel test and linear mixed models were used to compare age-standardized frequencies and means across race/ethnicity groups, stratified by gender. Black, Hispanic, and Other race men and women reported worse self-rated health, greater VA healthcare utilization, and more combat exposure than Whites. Compared to White men, Black and Other men reported more circulatory, musculoskeletal, mental health, and infectious disease conditions while Hispanic men reported fewer circulatory and more mental health, infectious disease, kidney, and neurological conditions. Compared to White women, Black women reported more circulatory and infectious disease conditions and Other women reported more infectious disease conditions. Smoking rates were higher among Black men, but lower for other minority groups compared to Whites. Minority groups were less likely to drink alcohol and had lower physical fitness than Whites. By identifying differences in burden of various health conditions and risk factors across different racial/ethnic groups, our findings can inform future studies and ultimately interventions addressing disparities.
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Affiliation(s)
- Rachel E. Ward
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
- New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA 02130, USA
- Correspondence:
| | - Xuan-Mai T. Nguyen
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
- Carle Illinois College of Medicine, University of Illinois, Champaign, IL 61820, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Yanping Li
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
| | - Emily M. Lord
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
| | - Vanessa Lecky
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
| | - Rebecca J. Song
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
| | - Juan P. Casas
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Kelly Cho
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - John Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Kelly M. Harrington
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA
| | - Stacey B. Whitbourne
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA
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12
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Pappadis MR, Sander AM, Struchen MA, Kurtz DM. Soy diferente: a qualitative study on the perceptions of recovery following traumatic brain injury among Spanish-speaking U.S. immigrants. Disabil Rehabil 2020; 44:2400-2409. [PMID: 33108224 DOI: 10.1080/09638288.2020.1836045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To explore the impact of traumatic brain injury (TBI) on the quality of life (QoL) and self-concept of Spanish-speaking U.S. Hispanic immigrants with TBI. MATERIALS AND METHODS A prospective, qualitative study conducted in a county level I trauma center and community. Semi-structured interviews on QoL and self-concept following TBI were conducted with 24 Spanish-speaking U.S. Hispanic immigrants with TBI living in the community at least 6 months following injury. RESULTS Perceived facilitators of QoL included faith, hopefulness in recovery, empathy for others, and support from others. Perceived barriers to QoL mentioned were symptoms/consequences of injury, employment/financial changes, loss of independence, fear/uncertainty, stigma/shame, lack of medical care, and decreased social integration. Participants described their self-concept after TBI as either a maintained self or loss of self. Those who viewed themselves differently reported physical and emotional changes, gender role conflict, loss of self-worth, and total loss due to the TBI. CONCLUSIONS Spanish-speaking U.S. Hispanic immigrants held a strong faith and positive outlook after TBI in spite of the significant barriers to recovery. A need exists for programs to support creatively the recovery of Spanish-speaking U.S. Hispanic immigrants with limited access to care and resources.IMPLICATIONS FOR REHABILITATIONSpanish-speaking U.S. Hispanic immigrants may experience significant barriers to care following traumatic brain injury (TBI), such as access to rehabilitation services and follow-up care.Rehabilitation professionals should consider the importance of faith and encourage positive thinking and social support when working with Spanish-speaking U.S. Hispanic immigrants on how to cope with TBI-related challenges.Access to Spanish-speaking rehabilitation professionals, translators and Spanish language educational materials could help reduce language-related barriers to recovery among Spanish-speaking U.S. immigrants with TBI.Rehabilitation facilities should develop partnerships with community-based organizations serving the uninsured or underinsured to address the access to rehabilitation and medical needs of Spanish-speaking U.S. immigrants with TBI.
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Affiliation(s)
- Monique R Pappadis
- Division of Rehabilitation Sciences and Sealy Center on Aging, University of Texas Medical Branch at Galveston, Galveston, TX, USA.,TIRR Memorial Hermann Brain Injury Research Center, Houston, TX, USA
| | - Angelle M Sander
- TIRR Memorial Hermann Brain Injury Research Center, Houston, TX, USA.,H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine and Harris Health System, Houston, TX, USA
| | - Margaret A Struchen
- TIRR Memorial Hermann Brain Injury Research Center, Houston, TX, USA.,Center for Rehabilitation Psychology and Neuropsychology, PC, Walnut Creek, CA, USA
| | - Diana M Kurtz
- TIRR Memorial Hermann Brain Injury Research Center, Houston, TX, USA.,Spring Branch Counseling Center, Houston, TX, USA
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Lequerica AH, Arango-Lasprilla JC, Krch D. Factor analysis of the Neurobehavioral Symptom Inventory among a sample of Spanish-speakers. Neuropsychol Rehabil 2020; 32:165-178. [PMID: 32867569 DOI: 10.1080/09602011.2020.1809464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ABSTRACTA study was conducted to examine the factor structure of the Neurobehavioral Symptom Inventory (NSI) among a large community sample of 729 Spanish-speakers from the Continental United States (n = 174, 23.9%), Latin America (n = 465, 63.8%), and Spain (n = 90, 12.3%) The sample was 62.1% female, had at least 10 years of formal education, and ranged in age from 18 to 65 years (M = 36.7, SD = 12.5). The sample was randomly split into two groups with comparable demographics for a sequential analysis that consisted of an exploratory factor analysis on the first subsample followed by a confirmatory factor analysis within a second validation subsample. Results demonstrated a high internal consistency reliability for the Spanish version of the NSI, and a three-factor solution was supported with somatic, affective, and cognitive factors. Findings were comparable to prior studies with the English version of the NSI providing preliminary support for the construct validity of this measure among a large sample of Spanish-speakers. Further study is needed to determine the criterion-related validity of the individual factors as separate subscales and to examine the appropriateness of this measure for individuals with lower levels of education.
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Affiliation(s)
- Anthony H Lequerica
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, USA.,Department of Physical Medicine and Rehabilitation, Rutgers - New Jersey Medical School, Newark, NJ, USA
| | - Juan Carlos Arango-Lasprilla
- BioCruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain.,IKERBASQUE, Basque Foundation for Science, Bilbao, Spain.,Department of Cell Biology and Histology, University of the Basque Country UPV/EHU, Leioa, Spain
| | - Denise Krch
- Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, NJ, USA.,Department of Physical Medicine and Rehabilitation, Rutgers - New Jersey Medical School, Newark, NJ, USA
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Ward RC, Egede L, Ramakrishnan V, Frey L, Axon RN, Dismuke CLE, Hunt KJ, Gebregziabher M. An improved comorbidity summary score for measuring disease burden and predicting mortality with applications to two national cohorts. COMMUN STAT-THEOR M 2019. [DOI: 10.1080/03610926.2018.1498896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Ralph C. Ward
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Leonard Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Lewis Frey
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Robert Neal Axon
- College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | | | - Kelly J. Hunt
- College of Medicine, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Mulugeta Gebregziabher
- College of Medicine, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
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15
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Agimi Y, Regasa LE, Stout KC. Incidence of Traumatic Brain Injury in the U.S. Military, 2010–2014. Mil Med 2018; 184:e233-e241. [DOI: 10.1093/milmed/usy313] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/15/2018] [Accepted: 10/24/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yll Agimi
- Defense and Veterans Brain Injury Center (DVBIC), Defense Health Agency (DHA), 1335 East West HWY 4-214E, Silver Spring, MD
- SalientCRGT, Inc., 4000 Legato Rd. Suite 600, Fairfax, VA
| | - Lemma Ebssa Regasa
- Defense and Veterans Brain Injury Center (DVBIC), Defense Health Agency (DHA), 1335 East West HWY 4-214E, Silver Spring, MD
- General Dynamics Information Technology (GDIT), 3211 Jermantown Road Fairfax, VA
| | - Katharine C Stout
- Defense and Veterans Brain Injury Center (DVBIC), Defense Health Agency (DHA), 1335 East West HWY 4-214E, Silver Spring, MD
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Dismuke-Greer CE, Gebregziabher M, Ritchwood T, Pugh MJ, Walker RJ, Uchendu US, Egede LE. Geographic Disparities in Mortality Risk Within a Racially Diverse Sample of U.S. Veterans with Traumatic Brain Injury. Health Equity 2018; 2:304-312. [PMID: 30374469 PMCID: PMC6203888 DOI: 10.1089/heq.2018.0047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Traumatic brain injury (TBI) is a signature injury among the U.S. veterans. Hispanic U.S. veterans diagnosed with TBI have been found to have higher risk-adjusted mortality. This study examined the adjusted association of geographic location with all-cause mortality in 114,593 veterans diagnosed with TBI between January 1, 2000 and December 31, 2010, and followed through December 31, 2014. Methods: National Veterans Health Administration (VHA) databases containing administrative data including International Classification of Diseases, 9th Revision (ICD-9) codes, sociodemographic characteristics, and survival were linked. TBI was identified based on ICD-9 codes. Cox proportional hazards regression methods were used to examine the association of time from first TBI ICD-9 code to death with geographic location, after adjustment for TBI severity, race/ethnicity, other sociodemographic characteristics, military factors, and Elixhauser comorbidities. Results: Relative to urban mainland veterans with a median survival of 76.4 months, veterans living in the U.S. territories had a median survival of 69.1 months, whereas rural mainland veterans had a median survival of 77.1 months, and highly rural mainland veterans had a mean survival of 77.6 months. The final model adjusted for race/ethnicity, TBI severity, sociodemographic, military, and comorbidity covariates showed that residing in the U.S. territories was associated with a higher risk of death (hazard ratios=1.24; 95% confidence interval 1.15-1.34) relative to residing on the U.S. mainland. The race/ethnicity disparity previously found for the U.S. veterans diagnosed with TBI seems to be accounted for by living in the U.S. territories. Conclusion: The study shows that among veterans with TBI, mortality rates were higher in those who reside in the U.S. territories, even after adjustment. Previous documented higher mortality among Hispanic veterans seems to be explained by residing in the U.S. territories. The VA has a mission of ensuring equitable treatment of all veterans, and should investigate targeted policies and interventions to improve the survival of the U.S. territory veterans diagnosed with TBI.
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Affiliation(s)
- Clara E Dismuke-Greer
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina.,Division of Internal Medicine, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Mulugeta Gebregziabher
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Tiarney Ritchwood
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Mary Jo Pugh
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah.,IDEAS Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah
| | - Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.,Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Uche S Uchendu
- Chief Officer for Health Equity, US Department of Veterans Affairs, Washington, DC.,Principal, Health Management Associates, Washington, DC
| | - Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.,Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, Wisconsin
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17
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Agimi Y, Regasa LE, Ivins B, Malik S, Helmick K, Marion D. Role of Department of Defense Policies in Identifying Traumatic Brain Injuries Among Deployed US Service Members, 2001-2016. Am J Public Health 2018; 108:683-688. [PMID: 29565670 DOI: 10.2105/ajph.2018.304347] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine the role of Department of Defense policies in identifying theater-sustained traumatic brain injuries (TBIs). METHODS We conducted a retrospective study of 48 172 US military service members who sustained their first lifetime TBIs between 2001 and 2016 while deployed to Afghanistan or Iraq. We used multivariable negative binomial models to examine the changes in TBI incidence rates following the introduction of Department of Defense policies. RESULTS Two Army policies encouraging TBI reporting were associated with an increase of 251% and 97% in TBIs identified following their implementation, respectively. Among airmen, the introduction of TBI-specific screening questions to the Post-Deployment Health Assessment was associated with a 78% increase in reported TBIs. The 2010 Department of Defense Directive Type Memorandum 09-033 was associated with another increase of 80% in the likelihood of being identified with a TBI among soldiers, a 51% increase among sailors, and a 124% increase among Marines. CONCLUSIONS Department of Defense and service-specific policies introduced between 2006 and 2013 significantly increased the number of battlefield TBIs identified, successfully improving the longstanding problem of underreporting of TBIs.
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Affiliation(s)
- Yll Agimi
- All of the authors are with the Defense and Veterans Brain Injury Center, Defense Health Agency, Silver Spring, MD. Yll Agimi is also with Salient CRGT, Springfield, VA. Lemma Ebssa Regasa, Brian Ivins, and Donald Marion are also with General Dynamics Information Technology, Fairfax, VA
| | - Lemma Ebssa Regasa
- All of the authors are with the Defense and Veterans Brain Injury Center, Defense Health Agency, Silver Spring, MD. Yll Agimi is also with Salient CRGT, Springfield, VA. Lemma Ebssa Regasa, Brian Ivins, and Donald Marion are also with General Dynamics Information Technology, Fairfax, VA
| | - Brian Ivins
- All of the authors are with the Defense and Veterans Brain Injury Center, Defense Health Agency, Silver Spring, MD. Yll Agimi is also with Salient CRGT, Springfield, VA. Lemma Ebssa Regasa, Brian Ivins, and Donald Marion are also with General Dynamics Information Technology, Fairfax, VA
| | - Saafan Malik
- All of the authors are with the Defense and Veterans Brain Injury Center, Defense Health Agency, Silver Spring, MD. Yll Agimi is also with Salient CRGT, Springfield, VA. Lemma Ebssa Regasa, Brian Ivins, and Donald Marion are also with General Dynamics Information Technology, Fairfax, VA
| | - Katherine Helmick
- All of the authors are with the Defense and Veterans Brain Injury Center, Defense Health Agency, Silver Spring, MD. Yll Agimi is also with Salient CRGT, Springfield, VA. Lemma Ebssa Regasa, Brian Ivins, and Donald Marion are also with General Dynamics Information Technology, Fairfax, VA
| | - Donald Marion
- All of the authors are with the Defense and Veterans Brain Injury Center, Defense Health Agency, Silver Spring, MD. Yll Agimi is also with Salient CRGT, Springfield, VA. Lemma Ebssa Regasa, Brian Ivins, and Donald Marion are also with General Dynamics Information Technology, Fairfax, VA
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18
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Equal Access Is Quality: an Update on the State of Disparities Research in Trauma. CURRENT TRAUMA REPORTS 2018. [DOI: 10.1007/s40719-018-0114-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Uchendu US, Omalu BI, Cifu DX, Egede LE. Repeated Concussions: Time to Spur Action Among Vulnerable Veterans. Am J Public Health 2016; 106:1366-8. [PMID: 27310350 DOI: 10.2105/ajph.2016.303293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Uchenna S Uchendu
- Uchenna S. Uchendu is with the United States Department of Veterans Affairs, Washington, DC. Bennet I. Omalu is with the Department of Pathology, University of California, Davis. David X. Cifu is with the Virginia Commonwealth University School of Medicine, Richmond, and the United States Department of Veterans Affairs Medical Center, Richmond. Leonard E. Egede is with the Medical University of South Carolina, Charleston, and the United States Department of Veterans Affairs Medical Center, Charleston
| | - Bennet I Omalu
- Uchenna S. Uchendu is with the United States Department of Veterans Affairs, Washington, DC. Bennet I. Omalu is with the Department of Pathology, University of California, Davis. David X. Cifu is with the Virginia Commonwealth University School of Medicine, Richmond, and the United States Department of Veterans Affairs Medical Center, Richmond. Leonard E. Egede is with the Medical University of South Carolina, Charleston, and the United States Department of Veterans Affairs Medical Center, Charleston
| | - David X Cifu
- Uchenna S. Uchendu is with the United States Department of Veterans Affairs, Washington, DC. Bennet I. Omalu is with the Department of Pathology, University of California, Davis. David X. Cifu is with the Virginia Commonwealth University School of Medicine, Richmond, and the United States Department of Veterans Affairs Medical Center, Richmond. Leonard E. Egede is with the Medical University of South Carolina, Charleston, and the United States Department of Veterans Affairs Medical Center, Charleston
| | - Leonard E Egede
- Uchenna S. Uchendu is with the United States Department of Veterans Affairs, Washington, DC. Bennet I. Omalu is with the Department of Pathology, University of California, Davis. David X. Cifu is with the Virginia Commonwealth University School of Medicine, Richmond, and the United States Department of Veterans Affairs Medical Center, Richmond. Leonard E. Egede is with the Medical University of South Carolina, Charleston, and the United States Department of Veterans Affairs Medical Center, Charleston
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