Nearly 13% of older adults in the U.S. experienced a traumatic brain injury over an 18-year period, according to study results.
Published in JAMA Network Open, investigators of a large longitudinal study analyzed data from 9,239 participants aged ≥65 years in the nationally representative Health and Retirement Study. Participants were assessed from 2000 through 2018, with TBI cases identified through Medicare claims showing diagnosis codes along with emergency department visits and brain imaging scans.
During the follow-up period, 797 respondents (8.9%) received an incident TBI diagnosis accompanied by an emergency room visit and brain scan. When applying a broader definition, including TBI diagnoses without documented brain imaging, 1,148 respondents (12.9%) experienced an incident TBI.
Compared to those without TBI, respondents who sustained TBIs were more likely to be female, White, have normal cognition at baseline, higher education and wealth levels, and lack preexisting lung disease or functional impairments.
After adjusting for demographics and medical factors, lower education level, Black race, greater neighborhood deprivation, and male sex were associated with a decreased incidence of TBI diagnoses in the claims data.
"For older adults who seek care for TBI, race and ethnicity, sex, and social determinants of health factors may be associated with the incidence of TBI, seeking medical attention for TBI in older adulthood, or both," wrote the authors.
They also noted that while the findings could reflect real differences in TBI risk across groups, they may also stem from disparities in accessing healthcare or receiving comprehensive diagnoses after a head injury. Limitations of the study include the self-reported nature of some demographic variables and the use of diagnosis codes rather than standardized TBI assessments to identify cases.
Overall, the findings updated existing TBI surveillance data and suggest social factors may impact both TBI incidence and detection among older adults in the U.S. The authors emphasized the need for further research to clarify these factors and develop targeted prevention strategies.
Full conflict of interest disclosures are found in the study.
