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Updated: Jun 17, 2025
Systems Analysis of the Neuroinflammatory and Hemodynamic Response to Traumatic Brain Injury
Published on: May 27, 2022
The TBI Model Systems Neighborhood Socioeconomic Disadvantage Index (TBIMS-NSDI): Development and Comparison to
Raj G Kumar1, Andrew Delgado, John D Corrigan
1Author Affiliations: Department of Rehabilitation and Human Performance (Drs Kumar and Dams-O'Connor), Department of Population Health Science & Policy (Dr Delgado), Department of Emergency Medicine (Dr Taylor), Department of Neurology (Dr Dams-O'Connor), Icahn School of Medicine at Mount Sinai, New York, New York; Department of Physical Medicine and Rehabilitation (Drs Corrigan and Bogner), College of Medicine, The Ohio State University; Research Department, Craig Hospital, Englewood, Colorado(Drs Eagye and Whiteneck); Brain Injury Research Center, TIRR Memorial Hermann (Dr Juengst), Houston, Texas; Department of Physical Medicine and Rehabilitation (Dr Juengst), UT Health Sciences Center at Houston, Houston, Texas; Baylor Scott and White Institute for Rehabilitation (Dr Callender), Dallas, Texas; Department of Physical Medicine and Rehabilitation (Dr Pinto), University of Texas Southwestern Medical Center, Dallas, Texas; Moss Rehabilitation Research Institute (Drs Rabinowitz and Venkatesan), Elkins Park, Pennsylvania; Department of Rehabilitation Medicine (Drs Rabinowitz and Venkatesan), Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; Central Virginia Veterans Affairs Health Care System (Dr Perrin), Richmond, Virginia; School of Data Science and Department of Psychology (Dr Perrin), University of Virginia, Charlottesville, Virginia; Kessler Foundation (Drs Botticello and Lequerica), East Hanover, New Jersey; Rutgers-New Jersey Medical School (Drs Botticello and Lequerica), Newark, New Jersey; Department of Physical Medicine and Rehabilitation (Dr Zafonte), Harvard Medical School, Boston, Massachusetts; Spaulding Rehabilitation Hospital (Dr Zafonte), Boston, Massachusetts; Massachusetts General Hospital (Dr Zafonte), Boston, Massachusetts; Brigham and Women's Hospital (Dr Zafonte), Boston, Massachusetts.
Objective:
To create a census-based composite neighborhood socioeconomic deprivation index (NSDI) from geocoded residential addresses and to quantify how NSDI aligns with individual-level socioeconomic factors among people with traumatic brain injury (TBI).
Setting:
Community.
Participants:
People enrolled in the TBI Model Systems National Database (TBIMS NDB).
Design:
Secondary analysis of a longitudinal cohort study.
Main Measures:
The TBIMS-NSDI was calculated at the census tract level for the United States population based on a principal components analysis of eight census tract-level variables from the American Community Survey. Individual socioeconomic characteristics from the TBIMS NDB were personal household income, education (years), and unemployment status. Neighborhood:Individual NSDI residuals represent the difference between predicted neighborhood disadvantage based on individual socioeconomic characteristics versus observed neighborhood disadvantage based on the TBIMS-NSDI .
Results:
A single principal component was found to encompass the eight socioeconomic neighborhood-level variables. It was normally distributed across follow-up years 2, 5, and 10 post-injury in the TBIMS NDB. In all years, the TBIMS-NDSI was significantly associated with individual-level measures of household income and education but not unemployment status. Males, persons of Black and Hispanic background, Medicaid recipients, persons with TBI caused by violence, and those living in urban areas, as well as in the Northeast or Southern regions of the United States, were more likely to have greater neighborhood disadvantage than predicted based on their individual socioeconomic characteristics.
Conclusions:
The TBIMS-NSDI provides a neighborhood-level indicator of socioeconomic disadvantage, an important social determinant of outcomes from TBI. The Neighborhood:Individual NSDI residual adds another dimension to the TBIMS-NSDI by summarizing how a person's socioeconomic status aligns with their neighborhood socioeconomics. Future studies should evaluate how both measures affect TBI recovery and life quality. Research studying neighborhood socioeconomic disadvantage may improve our understanding of how systemic adversity influences outcomes after TBI.
