Exploring the Social Determinants of Health and Health Disparities in Traumatic Brain Injury: A Scoping Review

Abstract

Traumatic brain injury (TBI) is a global health concern, that can leave lasting physical, cognitive, and/or behavioral changes for many who sustain this type of injury. Because of the heterogeneity of this population, development of appropriate intervention tools can be difficult. Social determinants of health (SDoH) are factors that may impact TBI incidence, recovery, and outcome. The purpose of this study is to describe and analyze the existing literature regarding the prevailing SDoH and health disparities (HDs) associated with TBI in adults. A scoping review, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework was used to explore three electronic databases—PubMed, Medline, and CINAHL. Searches identified peer-reviewed empirical literature addressing aspects of SDoH and HDs related to TBI. A total of 123 records were identified and reduced to 27 studies based on inclusion criteria. Results revealed race/ethnicity was the most commonly reported SDoH impacting TBI, followed by an individual’s insurance status. Health disparities were noted to occur across the continuum of TBI, including TBI risk, acute hospitalization, rehabilitation, and recovery. The most frequently reported HD was that Whites are more likely to be discharged to inpatient rehabilitation compared to racial/ethnic minorities. Health disparities associated with TBI are most commonly associated with the race/ethnicity SDoH, though insurance status and socioeconomic status commonly influence health inequities as well. The additional need for evidence related to the impact of other, lesser researched, SDoH is discussed, as well as clinical implications that can be used to target intervention for at-risk groups using an individual’s known SDoH.

Machine Learning Identifies Variation in Timing of Palliative Care Consultations Among Traumatic Brain Injury Patients

“…Beyond standardized triggers, enhancing detection of palliative needs warrants policy efforts expanding access and reducing existing disparities. 39 Current lack of adherence to the palliative care guidelines established by the American College of Surgeons Trauma Quality Improvement Program (TQIP) underscores the need for more effective implementation strategies and highlights the importance of tailoring these guidelines to address the diverse needs of TBI patients. 40 , 41 Explicitly integrating social determinants of health frameworks into TBI management guidelines could mitigate biases and barriers to equitable care.…”

Applying the Common-Sense Self-Regulation Model to Understand Illness Representations of Mild Traumatic Brain Injury in College Students

“…However, these have been researched as factors in younger populations 69,70. It is important to consider how social determinants of health can influence health-seeking behaviors in addition to access to healthcare after mTBI 71,72…”

Traumatic Brain Injury, Psychological Trauma Exposure, and Anxious and Depressive Symptoms in a Clinical Population

“…Mild traumatic brain injury (TBI) is a significant public health concern, with 4.8 million people in the United States evaluated for TBI in an emergency department annually (National Academies of Sciences, 2022). While most individuals who sustain a TBI will recover, some suffer long-term neurologic deficits and functional impairments in daily living due to the underlying brain damage and social, economic, and cultural factors that impact health and well-being (Johnson & Diaz, 2023). Critically, individuals who sustain a TBI are at least twice as likely as those without a TBI to develop PTSD (Vasterling et al, 2018).…”