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Racial/Ethnic Differences in Combat- and Non-Combat-Associated Traumatic Brain Injury Severity in the Veterans Health
Clara E Dismuke1, Mulugeta Gebregziabher1, Derik Yeager1
1Clara E. Dismuke, Mulugeta Gebregziabher, Derik Yeager, and Leonard E. Egede are with the Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC. Clara E. Dismuke and Leonard E. Egede are also with the Center for Health Disparities Research and Division of General Internal Medicine & Geriatrics, Medical University of South Carolina, Charleston. Mulugeta Gebregziabher is also with the Department of Public Health Sciences, Medical University of South Carolina, Charleston.
Objectives:
We examined the association between traumatic brain injury (TBI) severity and combat exposure by race/ethnicity.
Methods:
We estimated logit models of the fully adjusted association of combat exposure with TBI severity in separate race/ethnicity models for a national cohort of 132 995 veterans with TBI between 2004 and 2010.
Results:
Of veterans with TBI, 25.8% had served in a combat zone. Mild TBI increased from 11.5% to 40.3%, whereas moderate or severe TBI decreased from 88.5% to 59.7%. Moderate or severe TBI was higher in non-Hispanic Blacks (80.0%) and Hispanics (89.4%) than in non-Hispanic Whites (71.9%). In the fully adjusted all-race/ethnicity model, non-Hispanic Blacks (1.44; 95% confidence interval [CI] = 1.37, 1.52) and Hispanics (1.47; 95% CI = 1.26, 1.72) had higher odds of moderate or severe TBI than did non-Hispanic Whites. However, combat exposure was associated with higher odds of mild TBI in non-Hispanic Blacks (2.48; 95% CI = 2.22, 2.76) and Hispanics (3.42; 95% CI = 1.84, 6.35) than in non-Hispanic Whites (2.17; 95% CI = 2.09, 2.26).
Conclusions:
Research is needed to understand racial differences in the effect of combat exposure on mild TBI and on interventions to prevent TBI across severity levels.
