Relationships Between Neighborhood Disadvantage, Race/Ethnicity, and Neurobehavioral Symptoms Among Veterans With Mild Traumatic Brain Injury.

IF 2.4 3区 医学 Q2 CLINICAL NEUROLOGY
Journal of Head Trauma Rehabilitation Pub Date : 2025-03-01 Epub Date: 2025-02-07 DOI:10.1097/HTR.0000000000001016
Adam R Kinney, Nazanin H Bahraini, Alexandra L Schneider, Xiang-Dong Yan, Jeri E Forster, Ryan Holliday, Lisa A Brenner
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引用次数: 0

Abstract

Objective: To examine the relationship between neighborhood disadvantage and severity of vestibular, sensory, mood-behavioral, and cognitive neurobehavioral symptoms among Veterans with a mild traumatic brain injury (mTBI); and whether Veterans in underrepresented racial/ethnic groups with high neighborhood disadvantage experience the most severe symptoms.

Setting: Outpatient Veterans Health Administration (VHA).

Participants: Veterans with the following data available in the electronic health record (2014-2020): (1) clinician-confirmed mTBI and complete neurobehavioral symptom inventory (NSI) as part of their comprehensive traumatic brain injury evaluation (CTBIE) and (2) area deprivation index (ADI) scores assessing neighborhood disadvantage from the same quarter as their CTBIE.

Design: Retrospective cohort study. Latent variable regression was used to examine unique and interactive relationships between neighborhood disadvantage, race/ethnicity, and neurobehavioral symptoms.

Main measures: NSI and ADI national percentile rank.

Results: The study included 58 698 eligible Veterans. Relative to Veterans in the first quintile of ADI national percentile rank, representing those with the least neighborhood disadvantage, Veterans in the ADI quintiles indicating greater neighborhood disadvantage reported more severe vestibular, sensory, mood-behavioral, and cognitive symptoms. The strongest associations between neighborhood disadvantage and neurobehavioral symptoms were observed within the sensory ( β = 0.07-0.16) and mood-behavioral domains ( β = 0.06-0.15). Statistical interactions indicated that the association between underrepresented racial/ethnic group status (vs. identifying as white, non-Hispanic) and the severity of neurobehavioral symptoms did not differ among those with severe neighborhood disadvantage versus those without.

Conclusion: Veterans with mTBI living in more disadvantaged neighborhoods reported more severe neurobehavioral symptoms relative to those in the most advantaged neighborhoods, with the strongest relationships detected within the sensory and mood-behavioral domains. While neighborhood disadvantage and underrepresented race/ethnicity were both independently associated with symptoms, these factors did not interact to produce more severe symptoms. Findings suggest that addressing factors driving socioeconomic disadvantage may assist in mitigating symptoms in this population.

轻度创伤性脑损伤退伍军人的社区劣势、种族/民族与神经行为症状的关系
目的:探讨退伍军人轻度创伤性脑损伤(mTBI)患者前庭、感觉、情绪行为和认知神经行为症状严重程度与邻里不利的关系;以及代表性不足、社区弱势程度高的种族/族裔群体的退伍军人是否会出现最严重的症状。设置:门诊退伍军人健康管理局(VHA)。参与者:电子健康记录(2014-2020)中具有以下数据的退伍军人:(1)临床证实的mTBI和完整的神经行为症状量表(NSI)作为其综合创伤性脑损伤评估(CTBIE)的一部分;(2)区域剥夺指数(ADI)评分评估邻里不利,来自同一季度的CTBIE。设计:回顾性队列研究。使用潜变量回归来检验邻里劣势、种族/民族和神经行为症状之间独特的互动关系。主要指标:NSI和ADI全国百分位排名。结果:本研究纳入58 698名符合条件的退伍军人。相对于处于ADI全国百分位排名前五分位数的退伍军人(代表那些社区劣势最小的退伍军人),处于ADI社区劣势较大的五分位数的退伍军人报告了更严重的前庭、感觉、情绪行为和认知症状。在感觉(β = 0.07-0.16)和情绪-行为领域(β = 0.06-0.15)观察到邻里不利与神经行为症状之间最强的关联。统计相互作用表明,未被充分代表的种族/族裔群体地位(相对于白人、非西班牙裔)与神经行为症状严重程度之间的关联,在邻里关系严重不利的人群与邻里关系不严重的人群之间没有差异。结论:生活在弱势社区的mTBI退伍军人比生活在优势社区的mTBI退伍军人报告的神经行为症状更严重,在感觉和情绪-行为领域检测到最强的关系。虽然社区劣势和代表性不足的种族/族裔都与症状独立相关,但这些因素并不相互作用而产生更严重的症状。研究结果表明,解决导致社会经济劣势的因素可能有助于减轻这一人群的症状。
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来源期刊
CiteScore
4.80
自引率
4.20%
发文量
153
审稿时长
6-12 weeks
期刊介绍: The Journal of Head Trauma Rehabilitation is a leading, peer-reviewed resource that provides up-to-date information on the clinical management and rehabilitation of persons with traumatic brain injuries. Six issues each year aspire to the vision of “knowledge informing care” and include a wide range of articles, topical issues, commentaries and special features. It is the official journal of the Brain Injury Association of America (BIAA).
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