Effect of Race and Nativity on Functional Outcomes Following Traumatic Brain Injury Among Asian, Hispanic, and Non-Hispanic White Survivors in the United States: A NIDILRR TBI Model Systems Study

Abstract

Objective: To compare the racial/ethnic differences in traumatic brain injury (TBI) recovery among Asians, Hispanics, and Whites, and explore the effect of nativity in the recovery process. Setting: Six Traumatic Brain Injury Model Systems (TBIMS) centers. Participants: In total, 7953 patients who had at least 1 severe TBI between 2000 and 2016 were admitted to one of the TBIMS centers. Design: Secondary data analysis. Main Measures: Functional Independent Measure (FIM instrument) ratings. Results: Asians had the lowest injury severity at admission, but they failed to make the improvements made by the Hispanics and the Whites between the rehabilitation discharge and the 1-year follow-up. The magnitude of improvement made by the foreign-born Asians was less than that made by their native-born counterparts. Both Asian and the Hispanic groups had lower functional outcomes at the 1-year follow-up, and the differences in functional outcomes between the Asian and Hispanic groups were not statistically significant. The above racial/ethnic disparities in functional outcomes were not fully explained by differences in sociodemographic status, injury characteristics, and immigration-related factors. The effect of nativity was mediated by covariates. Conclusions: This study reveals racial/ethnic disparities post-TBI functional recovery. Despite lower injury severity and apparent financial resource advantages, Asians did not experience better functional outcomes. Although the effect of nativity was not established in this study, contextual factors related to ethnicity and immigration experiences should be further investigated.

Exercise and Recovery Following Mild-to-Moderate Traumatic Brain Injury in the Community Setting

“…These disparities were similarly reflected in our study. Although further studies with a larger sample size would be beneficial to significantly verify such trends, the current results were consistent with existing literature that explores racial and ethnic disparities across the United States, particularly in Asian and Hispanic groups [ 16 ]. Perhaps the most meaningful component of this lack of resource access was the inability to accommodate an appropriate treatment plan when factoring in social and economic considerations.…”

Impact of English proficiency on use of Glasgow Coma Scale in geriatric patients with traumatic brain injury

“…Several large studies have explored racial/ethnic disparities in TBI outcomes. Kuerban and Dams-O’Connor 27 analyzed 7953 patients from a national TBI database, categorizing them into Asian, white, and Hispanic. They used the Functional Independence Measure (FIM) assessment tool to evaluate differences in functional outcomes after inpatient rehabilitation discharge and 1-year functional status.…”

Trajectories of Cognitive and Motor Functional Independence in Hispanic Individuals During the 10 Years After Traumatic Brain Injury

“…This study included only Hispanic participants, and as such, results should not be generalized to other groups. Future studies should include other racial/ethnic groups to compare and contrast recovery trajectories in light of the history of outcome disparities in TBI among groups 32 . Given the influence of education in this study on the recovery trajectory, and noting that almost half of the sample had less than a high school education, further investigation into the influence of sociodemographic contextual factors and social determinants of health is recommended so that findings can inform approaches toward reducing racial/ethnic disparities in a more comprehensive way as opposed to simply identifying their existence.…”

“…Future studies should include other racial/ethnic groups to compare and contrast recovery trajectories in light of the history of outcome disparities in TBI among groups. 32 Given the influence of education in this study on the recovery trajectory, and noting that almost half of the sample had less than a high school education, further investigation into the influence of sociodemographic contextual factors and social determinants of health is recommended so that findings can inform approaches toward reducing racial/ethnic disparities in a more comprehensive way as opposed to simply identifying their existence. Another limitation of this study is that the FIM Motor scale has been phased out of the TBIMS rehabilitation inpatient data collection in favor of the Continuity and Record Evaluation tool.…”