DOI: 10.15154/1528795
title: Differences in social determinants of health in youth with lifetime history and new incidence of traumatic brain injury

description: Background/Rationale: According to the CDC, children are most often injured during vehicle crashes, falls, and assault rendering them susceptible to traumatic brain injury (TBI). Each year, 1 million US children seek care for concussion and more severe TBI with an estimated $5,000 in health care costs per pediatric TBI patient. Concussed children experience the burden of greater academic and social problems as well as physical, cognitive, and emotional symptoms. However, little is known about sociocultural factors that might predispose children to head injuries.

Main Objective: To examine the hypothesis that a greater proportion of adolescents with more social disadvantages will experience TBI. 

Design: Secondary data analysis of a nationwide prospective cohort study. 

Setting: Twenty-one research centers recruiting from schools across the US.

Participants: 11,869 children ages 8-11 years enrolled in the Adolescent Brain Cognitive Development study (excluded 9 participants with unknown TBI history). 

Main Outcome Measures: Parents completed in English or Spanish the Ohio State University TBI Identification Method, a survey of TBI history in their child. To be considered a TBI, head injuries had to have altered mental status (loss of consciousness or amnesia). Social determinants of health (SDoH) were sex, household income (<, =, or > $50,000–75,000), primary caregiver education (<, =, or > high school), lack of access to basic needs (food, phone, utilities, doctor, dentist, rent), and eviction. Associations among dichotomized TBI variables and SDoH (8 binomial and 2 ordinal variables) were evaluated using chi-square tests. TBI variables included (1) history of TBI reported at enrollment (TBI+/TBI-), (2) TBI+ with vs. without hospital visit, and (3) history of new TBI reported at 1-year follow-up.

Results: For those with a lifetime history of TBI at enrollment (389/11,869, 3%), there was a greater presence of males (p = .002), higher parent educational attainment (p = .001), and greater income (p < .001). A greater proportion of those with TBI treatment in the hospital had household incomes of $50,000–75,000 than those with TBI never treated in the hospital, and a lesser proportion of TBI+ treated in the hospital had incomes >$75,000 (p = .020). For those sustaining a new TBI in the ensuing year (n = 118), there was a greater prevalence of higher parent educational attainment (p = .006) and greater income (p = .030).

Conclusions/Future Directions: Utilizing a nationwide study of nearly 12,000 adolescent-caregiver dyads revealed a paradoxical socioeconomic risk pattern for TBI. Parents with greater educational attainment and income more commonly report that their child had TBI both retrospectively at enrollment and prospectively at 1-year follow-up. Findings also hint at socioeconomic factors that may contribute to presenting to an ED for a child’s TBI, although this should be further investigated. Future research should examine the factors that drive ED admission for pediatric TBI and whether increased parent awareness might improve TBI identification in children. Additional studies of SDoH would aid in clarifying these relationships.