Departments of Epidemiology and Public Health (Drs Chauhan, Guralnik, and Albrecht) and Neurology (Dr Badjatia), University of Maryland School of Medicine, Baltimore; Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore (Dr dosReis); Baltimore VA Geriatric Research, Education and Clinical Center (Dr Sorkin); and Department of Medicine, Division of Gerontology and Geriatrics, University of Maryland School of Medicine, Baltimore (Dr Sorkin).
J Head Trauma Rehabil. 2022;37(4):E242-E248. doi: 10.1097/HTR.0000000000000719. Epub 2021 Jul 26.
To determine the incidence of and assess risk factors for repetitive traumatic brain injury (TBI) among older adults in the United States.
Retrospective cohort study.
Administrative claims data obtained from the Centers for Medicare & Medicaid Services' Chronic Conditions Data Warehouse.
Individuals 65 years or older and diagnosed with TBI between July 2008 and September 2012 drawn from a 5% random sample of US Medicare beneficiaries.
Repetitive TBI was identified as a second TBI occurring at least 90 days after the first occurrence of TBI following an 18-month TBI-free period. We identified factors associated with repetitive TBI using a log-binomial model.
A total of 38 064 older Medicare beneficiaries experienced a TBI. Of these, 4562 (12%) beneficiaries sustained at least one subsequent TBI over up to 5 years of follow-up. The unadjusted incidence rate of repetitive TBI was 3022 (95% CI, 2935-3111) per 100 000 person-years. Epilepsy was the strongest predictor of repetitive TBI (relative risk [RR] = 1.44; 95% CI, 1.25-1.56), followed by Alzheimer disease and related dementias (RR = 1.32; 95% CI 1.20-1.45), and depression (RR = 1.30; 95% CI, 1.21-1.38).
Injury prevention and fall-reduction interventions could be targeted to identify groups of older adults at an increased risk of repetitive head injury. Future work should focus on injury-reduction initiatives to reduce the risk of repetitive TBI as well as assessment of outcomes related to repetitive TBI.
在美国，确定老年人群中重复性创伤性脑损伤（TBI）的发生率，并评估其危险因素。
回顾性队列研究。
从美国医疗保险和医疗补助服务中心的慢性病数据仓库中获得的行政索赔数据。
2008 年 7 月至 2012 年 9 月期间，年龄在 65 岁或以上，被诊断患有 TBI 的个体，从美国 Medicare 受益人的 5%随机样本中抽取。
重复性 TBI 被定义为在首次 TBI 后至少 90 天，在 18 个月的 TBI 无发作期后发生的第二次 TBI。我们使用对数二项式模型确定与重复性 TBI 相关的因素。
共有 38064 名老年 Medicare 受益人经历了 TBI。其中，在长达 5 年的随访期间，有 4562 名（12%）受益人至少发生了一次后续 TBI。未调整的重复性 TBI 发生率为 3022 例（95%CI，2935-3111）/100000 人年。癫痫是重复性 TBI 的最强预测因素（相对风险 [RR] = 1.44；95%CI，1.25-1.56），其次是阿尔茨海默病和相关痴呆症（RR = 1.32；95%CI，1.20-1.45）和抑郁症（RR = 1.30；95%CI，1.21-1.38）。
可以针对伤害预防和跌倒减少干预措施，以确定具有较高重复性头部损伤风险的老年人群。未来的工作应重点关注减少重复性 TBI 风险的干预措施，并评估与重复性 TBI 相关的结果。
