Garduño-Ortega Olga, Li Huihui, Smith Michelle, Yao Lanqiu, Wilson Judith, Zarate Alejandro, Bushnik Tamara
Research Department, Rusk Rehabilitation, Grossman School of Medicine, NYU Langone Health, New York, NY, United States.
Department of Population Health, Grossman School of Medicine, NYU Langone Health, New York, NY, United States.
Front Neurol. 2022 Aug 26;13:942001. doi: 10.3389/fneur.2022.942001. eCollection 2022.
The aim of this study is to examine the effect of eight distinct marginalized group memberships and explore their compounding effect on injury severity, recovery, discharge location, and employment outcomes 1-year after traumatic brain injury (TBI).
Individuals with medically confirmed, complicated mild-severe TBI (N = 300) requiring inpatient rehabilitation care between the ages of 18 and 65 were recruited at two urban (public and private) health systems between 2013 and 2019. Data were collected from self-report and medical record abstraction. Marginalized group membership (MGM) includes racial and ethnic minority status, less than a high school diploma/GED, limited English proficiency, substance abuse, homelessness, psychiatric hospitalizations, psychiatric disorders, and incarceration history. Membership in four or more of these groups signifies high MGM. In addition, these factors were explored individually. Unadjusted and adjusted linear and logistic regressions and Kruskal-Wallis tests were used to assess the associations of interest in RStudio.
After adjusting for age, sex, and cause of injury, compared to TBI patients with low MGM, those with high MGM experience significantly longer post-traumatic amnesia (95% CI = 2.70, 16.50; = 0.007) and are significantly more likely to have a severe TBI (per the Glasgow-Coma Scale) (95% CI = 1.70, 6.10; ≤ 0.001) than a complicated mild-moderate injury. Individuals with high MGM also are significantly less likely to be engaged in competitive paid employment 1 year after injury (95% CI = 2.40, 23.40; = 0.001). Patients with high MGM are less likely to be discharged to the community compared to patients with low MGM, but this association was not significant (95% CI = 0.36, 1.16; = 0.141). However, when assessing MGMs in isolation, certain associations were not significant in unadjusted or adjusted models.
This exploratory study's findings reveal that when four or more marginalization factors intersect, there is a compounding negative association with TBI severity, recovery, and employment outcomes. No significant association was found between high MGM and discharge location. When studied separately, individual MGMs had varying effects. Studying marginalization factors affecting individuals with TBI has critical clinical and social implications. These findings underline the importance of addressing multidimensional factors concurrent with TBI recovery, as the long-term effects of TBI can place additional burdens on individuals and their economic stability.
本研究旨在探讨八种不同的边缘化群体身份的影响，并探究其对创伤性脑损伤（TBI）后1年的损伤严重程度、恢复情况、出院地点和就业结果的复合影响。
2013年至2019年期间，在两个城市（公立和私立）卫生系统招募了年龄在18至65岁之间、经医学确认患有复杂轻至重度TBI（N = 300）且需要住院康复护理的个体。数据通过自我报告和病历摘要收集。边缘化群体身份（MGM）包括种族和族裔少数群体身份、高中文凭/普通教育发展证书以下、英语水平有限、药物滥用、无家可归、精神病住院史、精神疾病和监禁史。属于四个或更多这些群体表示高MGM。此外，还对这些因素进行了单独探究。在RStudio中使用未调整和调整后的线性及逻辑回归以及Kruskal-Wallis检验来评估感兴趣的关联。
在调整年龄、性别和损伤原因后，与低MGM的TBI患者相比，高MGM的患者创伤后遗忘时间显著更长（95%置信区间 = 2.70，16.50；P = 0.007），并且与复杂的轻至中度损伤相比，更有可能患有重度TBI（根据格拉斯哥昏迷量表）（95%置信区间 = 1.70，6.10；P ≤ 0.001）。高MGM的个体在受伤1年后从事有竞争力的带薪工作的可能性也显著更低（95%置信区间 = 2.40，23.40；P = 0.001）。与低MGM的患者相比，高MGM的患者出院回到社区的可能性更低，但这种关联不显著（95%置信区间 = 0.36，1.16；P = 0.141）。然而，在单独评估MGM时，某些关联在未调整或调整后的模型中并不显著。
这项探索性研究的结果表明，当四个或更多边缘化因素相互交织时，与TBI严重程度、恢复情况和就业结果存在复合负相关。未发现高MGM与出院地点之间存在显著关联。单独研究时，个体MGM的影响各不相同。研究影响TBI患者的边缘化因素具有关键的临床和社会意义。这些发现强调了在TBI恢复过程中同时解决多维度因素的重要性，因为TBI的长期影响可能给个体及其经济稳定性带来额外负担。
