Structural Inequities in Brain Trauma Outcome Prevalences Reported in the All of Us Database.

Abstract

Traumatic brain injury (TBI) is a major public health concern affecting millions of people yearly. Disparities in TBI outcomes based on social determinants of health (SDoH), such as race and socioeconomic position, highlight the need to explore the causative structural inequities. We employed a socio-epidemiological approach, with particular focus on the putative role of structural racism, to investigate the prevalence, sociodemographic patterns, and neuropsychiatric outcomes of TBI in the All of Us database. This study included 11,286 individuals with a documented TBI diagnosis, determined based on a curated phenotype definition using the International Statistical Classification of Diseases Clinical Modification criteria. Outcome measures included TBI prevalence and sociodemographic distribution; TBI severity; and neuropsychiatric diagnoses related to TBI. Nearly equivalent TBI prevalences were observed across racial categories. Black participants with TBI had higher socioeconomic deprivation indices and higher prevalence of certain neuropsychiatric conditions, such as substance use disorders and headache disorders, compared to White participants. This study underscores the importance of considering SDoH, particularly race and socioeconomic position, in TBI research. These findings highlight the need for efforts to address structural inequities that impact disparities in TBI and call for future research investigating how healthcare practices relate to disparities in TBI outcomes.