Prevalence of Comorbidities in Active and Reserve Service Members Pre and Post Traumatic Brain Injury, 2017-2019

Abstract

Objective To understand the prevalence of comorbidities associated with traumatic brain injury (TBI) patients among active and reserve service members in the U.S. Military. Methods Active and reserve SMs diagnosed with an incident TBI from January 2017 to October 2019 were selected. Nineteen comorbidities associated with TBI as identified in the literature and by clinical subject matter experts were described in this article. Each patient’s medical encounters were evaluated from 6 months before to 2 years following the initial TBI diagnoses date in the Military Data Repository, if data were available. Time-to-event analyses were conducted to assess the cumulative prevalence over time of each comorbidity to the incident TBI diagnosis. Results We identified 47,299 TBI patients, of which most were mild (88.8%), followed by moderate (10.5%), severe (0.5%), and of penetrating (0.2%) TBI severity. Two years from the initial TBI diagnoses, the top five comorbidities within our cohort were cognitive disorders (51.9%), sleep disorders (45.0%), post-traumatic stress disorder (PTSD; 36.0%), emotional disorders (22.7%), and anxiety disorders (22.6%) across severity groups. Cognitive, sleep, PTSD, and emotional disorders were the top comorbidities seen within each TBI severity group. Comorbidities increased pre-TBI to post-TBI; the more severe the TBI, the greater the prevalence of associated comorbidities. Conclusion A large proportion of our TBI patients are afflicted with comorbidities, particularly post-TBI, indicating many have a complex profile. The military health system should continue tracking comorbidities associated with TBI within the U.S. Military and devise clinical practices that acknowledge the complexity of the TBI patient.

Clusters of conditions among US service members diagnosed with mild TBI from 2017 through 2019

“…This study examined clusters among the 29,860 mTBI patients who had at least one of our selected conditions within one year of the initial TBI diagnoses date. Additional details on our study methods are published elsewhere ( 6 ).…”

“…MTBI patients may exhibit a wide range of symptoms and comorbidities, presenting a complex patient profile. For example, some mTBI patients may experience a sleep disorder, cognitive sequelae, or hearing impairments at the time of injury (3)(4)(5)(6)(7), or months following their injury (6,8,9). These patients may experience multiple conditions simultaneously (7,10).…”

“…The presentation of these conditions was not clinically consistent and varied across individual TBI patients ( 11 , 12 ). Some symptoms and comorbidities were more prevalent in the acute stages of the injury, while others become more apparent during the chronic phases ( 6 , 13 ). Due to the heterogeneity of conditions presented among mTBI patients, clinicians were often perplexed on how to create treatment plans and health administrators faced challenges in allocating clinical resources ( 14 , 15 ).…”