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Research Letter: Characterizing Lifetime Mild TBI Exposure Among Female and Male Military Service Members and
Samuel R Walton1, Jessie R Oldham, Rosemay A Remigio-Baker
1Author Affiliations: Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine and Richmond Veterans Affairs Medical Center, Central Virginia VA Health Care System, Richmond (Dr Walton); Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond (Dr Oldham); Brain Injury Center of Excellence, Silver Spring; Compass Government Solutions, Annapolis (Dr Remigio-Baker); Department of Neurosurgery, Medical College of Wisconsin, Milwaukee (Dr Brett); San Diego VA Healthcare System, San Diego (Dr Austin); San Diego VA Healthcare System, San Diego (Ms Cetin); Department of Neurology, University of Utah School of Medicine and George E. Wahlen VA Medical Center, Salt Lake City (Dr Wilde); Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond (Dr Lempke); Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City (Ms Ou); Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City (Dr Kamineni); W. G. (Bill) Hefner VA Healthcare System, Salisbury and Department of Translational Neuroscience, Wake Forest School of Medicine, Winston-Salem (Dr Martindale); VA Portland Health Care System Oregon Health and Science University, Portland (Dr O'Neil); Department of Medicine, VA Salt Lake City, Salt Lake City, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City (Dr Pugh); Physical Medicine & Rehabilitation, Perelman School of Medicine, University of Pennsylvania and Rehabilitation Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia (Dr Swanson); Department of Population Health and Health Disparities, School of Public and Population Health, the University of Texas Medical Branch at Galveston, Galveston(Dr Pappadis); Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine and Richmond Veterans Affairs Medical Center, Central Virginia VA Health Care System, Richmond (Dr Cifu); and Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine and Richmond Veterans Affairs Medical Center, Central Virginia VA Health Care System, Richmond (Dr Walker).
Objective:
To (1) characterize lifetime mild traumatic brain injury (TBI) exposures among male and female US military service members and Veterans (SMVs) and (2) evaluate sex-related differences in mild TBI exposures.
Setting:
Clinical research laboratory.
Participants:
Participants were enrolled in the ongoing Long-term Impact of Military-relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC) Prospective Longitudinal Study.
Design:
Cross-sectional.
Main Measures:
Lifetime history of mild TBI was measured via structured interview. All mild TBI characteristics were collected as part of this interview, including total lifetime number; environment (deployment vs. non-deployment); timing of injury (relative to military service and age); and mechanism of injury (blast-related vs. non-blast).
Results:
Most participants ( n = 2323; 87.5% male; 79.6% Veteran) reported ≥1 lifetime mild TBI ( n = 1912; 82%), among whom, many reported ≥2 lifetime mild TBIs. Female SMVs reported fewer total lifetime mild TBIs than male participants ( P < 0.001), including fewer deployment-related ( P < 0.001) and non-deployment ( P < 0.001) mild TBIs. There were significant sex differences for total number of mild TBIs sustained before ( P = 0.005) and during ( P < 0.001) military service but not after separation from military service ( P = 0.99). Among participants with a lifetime history of mild TBI, female SMVs were less likely to report ≥2 mTBIs ( P = 0.003); however, male SMVs were more likely to report a mild TBI during military service ( P = 0.03), including combat-related mild TBI ( P < 0.001) and mild TBI involving blast ( P < 0.001).
Conclusions:
These findings inform clinical and research efforts related to mild TBI in US military SMVs. It may not be sufficient to simply measure the total number of mild TBIs when seeking to compare clinical outcomes related to mild TBI between sexes; rather, it is important to measure and account for the timing, environment, and mechanisms associated with mild TBIs sustained by female and male SMVs.
