Perceived discrimination and blood pressure in individuals aging with traumatic brain injury.

Abstract

Purpose/Objective: Older adults with a history of traumatic brain injury (TBI) remain an understudied population, resulting in a paucity of geriatric-specific guidelines. Given an increased vascular risk among older adults with TBI, we aimed to examine distal predictors of vascular health in this population. Specifically, we sought to compare levels of perceived discrimination in Black and White older adults with a history of complicated mild, moderate, or severe TBI, and to examine the relationship between levels of discrimination and pulse pressure, a measure of vascular health. Research Method/ Design: Self-report measures of everyday discrimination (ED) and major experiences of discrimination (MED) were completed by 106 individuals aging with TBI (27 identified as Black, 79 identified as White). Resting blood pressure was collected during the assessment. Results: MED, but not ED, was significantly higher among Black individuals versus White individuals aging with TBI. Greater MED was significantly associated with higher pulse pressure independent of race and antihypertensive medication status. There was a marginally significant race by MED interaction, where the association between MED and pulse pressure was observed in Black individuals but not White individuals. Injury severity was not associated with pulse pressure, nor were there significant severity by discrimination interactions on pulse pressure. Conclusions/Implications: Discrimination, which may arise from multiple sources of bias (e.g., related to race, disability), is associated with vascular burden. These findings suggest that patients' experiences of discrimination should be addressed as a factor that contributes to health and well-being in brain injury rehabilitation. Impact and ImplicationsWe aimed to examine perceived major and everyday experiences of discrimination in a sample of Black and White individuals aging with traumatic brain injury (TBI) and its potential link with vascular health. We found that Black individuals aging with TBI reported higher levels of major experiences of discrimination compared to White individuals, and that level of major experiences of discrimination was associated with pulse pressure, a measure of vascular health, independent of race and antihypertensive medication use. These findings highlight the importance of considering the experience of discrimination of individuals aging with TBI as a factor that may impact patient cardiovascular health.

Effects of Perceived Discrimination on Behavioral Health Outcomes in People Aging With Traumatic Brain Injury

“…The present study builds on our previous findings in older individuals with chronic moderate-to-severe TBI (>1 year postinjury) 21 by expanding the investigation of MED and EED to behavioral health. Our principal research questions were as follows: (1) "What are the relationships between perceived discrimination and behavioral health outcomes in older PwTBI?"…”

“…The present study builds on our previous findings in older individuals with chronic moderate-to-severe TBI (>1 year postinjury)21 by expanding the investigation of MED and EED to behavioral health. Our principal research questions were as follows: (1) “What are the relationships between perceived discrimination and behavioral health outcomes in older PwTBI?” and (2) “Are these relationships independent of demographic and clinical factors?” On the basis of literature in non-TBI samples, we hypothesized that greater perceived discrimination would be related to poorer patient-reported behavioral outcomes and cognitive performance and that these relationships would be independent of age, sex, race, education level, injury severity, and time postinjury (ie, injury chronicity).…”

“…Examining correlates of social anxiety in PwTBI, Curvis et al20 found that perceived discrimination was associated with increased levels of anxiety beyond demographic and clinical variables. Recently, we demonstrated that a greater number of lifetime MED were associated with higher pulse pressure, an objective indicator of compromised vascular health, in older PwTBI 21. Notably, this relationship was independent of demographic and clinical factors, including race, injury severity, and antihypertensive medication status.…”

“…Descriptive statistics for MED and EED were reported in Bernier et al 21 for a subset of the current study sample; these data have been updated in Table 2. This table also details relationships of MED and EED to individual demographic and injury-related variables.…”

How Subjective and Objective Factors in Research and Practice May Perpetuate Health Disparities amongst Patients with Traumatic Brain Injury

“…A study showed that racial/ethnic minority patients had poorer communication experiences pertaining to their health care 52 . Lack of awareness of one’s own biases (particularly related to race/ethnicity) among healthcare providers, as well as lack of strategies to overcome these biases, can negatively impact decision making related to TBI, directly influencing decisions on discharge destinations, treatments, and referrals and indirectly influencing mortality and other outcomes 53 . To close the gap in the literature on existing health disparities in the TBI population, the purpose of this analysis and perspective is to provide recommendations for further examination of subjective factors in research and practice that would help identify strategies to improve clinical practice with the overarching goal of reducing TBI-related disparities.…”