Sociodemographic and Injury Characteristics Contribute to Ethnoracial Differences in Societal Participation After TBI

Research Objectives: This study sought to investigate contextual factors that may contribute to ethnoracial differences in societal participation following traumatic brain injury (TBI), which is a common neurological condition and has varied symptom presentations. Participation captures re-integration into ones community and meaningful social roles. Prior literature indicated worse functional outcomes among Black and Hispanic individuals relative to White individuals.

Design: This project was a secondary analysis of a de-identified archival dataset (Sherer et al., 2015).

Setting: The sample consisted of people with TBI recruited from the general community.

Participants: The sample included 222 non-Hispanic White, 188 non-Hispanic Black, and 76 Hispanic participants with chronic TBI. The original study recruited its sample from TBI Model Systems (TBIMS) study sites in Texas, Michigan, and Alabama.

Interventions: N/A

Main Outcome Measures: The primary outcome was societal participation as measure by the Participation Assessment with Recombined Tools-Objective (PART-O) Total score.

Results: There were significant group differences across sociodemographic and clinical characteristics (age, education years, marital status, pre-injury employment, pre-injury income, and time since injury), which were used as covariates in the evaluation of ethnoracial differences in PART-O Total score. There was a consistent, larger proportion of males relative to females across ethnoracial groups. There was a statistically significant difference in unadjusted PART-O Total between racial/ethnic groups as determined by one-way ANOVA (F(2,483) = 13.780, p < 0.0001). When considering covariates, race was not a significant contributor to PART-O Total score (p = 0.357). Age, education, and marital status were significant contributors (ps < .001) in the adjusted model. Pre-injury employment and income along with time since injury were not significant in the model.

Conclusions: Apparent ethnoracial differences in societal participation among people with TBI are at least partially driven by sociodemographic and injury characteristics. More specifically, baseline characteristics of age, education, and marital status are meaningful contributors to differences in participation, greater than race/ethnicity. Societal participation, and its potential drivers, require further investigation among ethnoracial minoritized groups to promote health equity in TBI outcomes.

Author(s) Disclosures: Dr. Williams discloses grant funding from the National Institute on Disability, Independent Living, and Rehabilitation Research.