Traumatic Brain Injury and Risk of Incident Comorbidities.

IF 10.5 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Cathra Halabi, Saef Izzy, Anthony M DiGiorgio, Hunter Mills, Farid Radmanesh, John K Yue, Habibeh Ashouri Choshali, Gundolf Schenk, Sharat Israni, Ross Zafonte, Geoffrey T Manley
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引用次数: 0

Abstract

Importance: Traumatic brain injury (TBI) is associated with chronic medical conditions. Evidence from diverse clinical administrative datasets may improve care delivery.

Objective: To characterize post-TBI risk of incident neuropsychiatric and medical conditions in a California health care system administrative database and validate findings from a Massachusetts dataset.

Design, setting, and participants: In this cohort study, prospective longitudinal cohorts using data from 5 University of California health care settings between 2013 and 2022 were studied. Patients aged 18 years and older with mild (mTBI) or moderate to severe TBI (msTBI) were included. Unexposed individuals were propensity matched by age, race and ethnicity, sex, University of California site, insurance coverage, area deprivation index (ADI) score, and duration from index date to most recent clinical encounter. Patients with study comorbidities of interest before the index date were excluded. Data were analyzed August to October 2024.

Exposure: TBI.

Main outcomes and measures: International Classification of Diseases, Ninth Revision (ICD-9) and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes were used to identify patients with TBI and patients with up to 22 comorbidities within neurological, psychiatric, cardiovascular, and endocrine umbrella groupings. Cox proportional hazard models were used to generate yearly hazard ratios (HRs) from 6 months up to 10 years after a TBI. Models were further stratified by age and ADI score.

Results: The study consisted of 20 400 patients (9264 female [45.4%]; 1576 Black [7.7%], 3944 Latinx [19.3%], and 10 480 White [51.4%]), including 5100 patients with mTBI (median [IQR] age, 36.0 [25.0-51.0] years), 5100 patients with msTBI (median [IQR age, 35.0 [25.0-52.0] years), and 10 200 matched patients in the control group (median [IQR] age, 36.0 [25.0-51.0] years). By ADI score quintile, there were 2757 unexposed patients (27.0%), 1561 patients with mTBI (30.6%), and 1550 patients with msTBI (30.4%) in the lowest (1-2) quintiles and 1523 unexposed patients (14.9%), 769 patients with mTBI (15.1%), and 804 patients with msTBI (15.8%) in the highest quintiles (9-10). TBI of any severity was associated with increased risk of nearly all conditions (mTBI HRs ranged from 1.30; 95% CI, 1.07-1.57 for hypothyroidism to 4.06; 95% CI, 3.06-5.39 for dementia, and msTBI HRs ranged from 1.35; 95% CI, 1.12-1.62 for hypothyroidism to 3.45; 95% CI, 2.73-4.35 for seizure disorder). Separate age and ADI stratifications revealed patient populations at increased risk, including middle-age adults (ages 41-60 years), with increased risk of suicidality (mTBI: HR, 4.84; 95% CI, 3.01-7.78; msTBI: HR, 4.08; 95% CI, 2.51-6.62). Suicidality risk persisted for patients with mTBI in the high ADI subgroup (HR, 2.23; 95% CI, 1.36-3.66).

Conclusions and relevance: In this cohort study, TBI was a risk factor associated with treatable incident neuropsychiatric and other medical conditions, validating similar findings from a Massachusetts dataset. Additional exploratory findings suggested varying demographic and regional risk patterns, which may generate causal hypotheses for further research and inform clinical surveillance strategies.

外伤性脑损伤和突发合并症的风险。
重要性:创伤性脑损伤(TBI)与慢性疾病有关。来自不同临床管理数据集的证据可能会改善护理服务。目的:在加州卫生保健系统管理数据库中描述脑外伤后突发神经精神和医疗状况的风险,并验证马萨诸塞州数据集的发现。设计、环境和参与者:在这项队列研究中,使用2013年至2022年间来自加州大学5所卫生保健机构的数据进行前瞻性纵向队列研究。年龄在18岁及以上的轻度(mTBI)或中重度TBI (msTBI)患者被纳入研究对象。未暴露个体的年龄、种族和民族、性别、加州大学所在地、保险覆盖范围、区域剥夺指数(ADI)评分以及从指数日期到最近一次临床就诊的持续时间倾向匹配。在索引日期之前有研究合并症的患者被排除在外。数据分析于2024年8月至10月进行。曝光:创伤性脑损伤。主要结局和措施:国际疾病分类第九版(ICD-9)和国际疾病统计分类第十版临床修改(ICD-10-CM)代码用于识别TBI患者和神经、精神、心血管和内分泌总分组中多达22种合并症的患者。Cox比例风险模型用于生成TBI后6个月至10年的年度风险比(hr)。模型进一步按年龄和ADI评分分层。结果:共纳入20 400例患者,其中女性9264例,占45.4%;1576名黑人[7.7%],3944名拉丁裔[19.3%],10名 480名白人[51.4%]),其中5100名mTBI患者(中位[IQR]年龄36.0[25.0-51.0]岁),5100名msTBI患者(中位[IQR]年龄35.0[25.0-52.0]岁),10名 200名对照组匹配患者(中位[IQR]年龄36.0[25.0-51.0]岁)。根据ADI评分,最低(1-2)分位数中有2757例未暴露患者(27.0%)、1561例mTBI患者(30.6%)和1550例msTBI患者(30.4%);最高(9-10)分位数中有1523例未暴露患者(14.9%)、769例mTBI患者(15.1%)和804例msTBI患者(15.8%)。任何严重程度的脑外伤都与几乎所有疾病的风险增加相关(mTBI hr范围从1.30;甲状腺功能减退症的95% CI为1.07-1.57至4.06;痴呆的95% CI为3.06-5.39,msTBI hr为1.35;甲状腺功能减退的95% CI为1.12-1.62至3.45;癫痫发作障碍95% CI为2.73-4.35)。单独的年龄和ADI分层显示,患者人群的自杀风险增加,包括中年成年人(41-60岁),自杀风险增加(mTBI: HR, 4.84;95% ci, 3.01-7.78;msTBI: HR, 4.08;95% ci, 2.51-6.62)。高ADI亚组mTBI患者的自杀风险持续存在(HR, 2.23;95% ci, 1.36-3.66)。结论和相关性:在这项队列研究中,TBI是与可治疗的神经精神事件和其他医疗状况相关的风险因素,验证了马萨诸塞州数据集的类似发现。其他探索性发现表明不同的人口和区域风险模式,可能为进一步研究产生因果假设,并为临床监测策略提供信息。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
JAMA Network Open
JAMA Network Open Medicine-General Medicine
CiteScore
16.00
自引率
2.90%
发文量
2126
审稿时长
16 weeks
期刊介绍: JAMA Network Open, a member of the esteemed JAMA Network, stands as an international, peer-reviewed, open-access general medical journal.The publication is dedicated to disseminating research across various health disciplines and countries, encompassing clinical care, innovation in health care, health policy, and global health. JAMA Network Open caters to clinicians, investigators, and policymakers, providing a platform for valuable insights and advancements in the medical field. As part of the JAMA Network, a consortium of peer-reviewed general medical and specialty publications, JAMA Network Open contributes to the collective knowledge and understanding within the medical community.
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