Virginia Commonwealth University, Richmond (Ms Ohayagha and Drs Arango-Lasprilla and Jones); University of Virginia, Charlottesville (Dr Perrin); and Central Virginia Veterans Affairs Health Care System, Richmond (Dr Perrin).
J Head Trauma Rehabil. 2023;38(6):E394-E403. doi: 10.1097/HTR.0000000000000858. Epub 2023 Feb 28.
Although racial/ethnic disparities have been documented in numerous outcomes after traumatic brain injury (TBI), research has yet to explore differences in rehabilitation outcomes based upon nativity (foreign-born vs US-born individuals). The purpose of this study was to compare the functional outcomes over the first 10 years after TBI for individuals born in the United States with those who were foreign-born.
SETTING/PARTICIPANTS: A sample of 10 695 individuals in the TBI Model Systems database with a coding for country of birth the United States ( n = 9435) versus other than the United States ( n = 1260) was used.
DESIGN/MAIN MEASURES: Outcome measures at 1, 2, 5, and 10 years after TBI included the Motor and Cognitive subscales of the Functional Independence Measure and the Supervision Rating Scale.
Foreign-born individuals exhibited lower motor functional independence trajectories than those born in the United States, even after controlling for demographic and injury-related covariates. However, foreign-born individuals generally showed a stronger upward quadratic trajectory in motor functional independence with the greatest gains between the 5- and 10-year time points, whereas those born in the United States improved more quickly but then plateaued between the 5- and 10-year time points; these differential effects over time dissipated with the addition of demographic and injury-related covariates. Foreign-born individuals also exhibited lower cognitive functional independence trajectories, as well as greater supervision needs trajectories, than those born in the United States, even after controlling for demographic and injury-related covariates.
These findings dovetail with literature suggesting that racially/ethnically diverse groups exhibit reduced functional independence after TBI. The findings may also suggest potential systematic barriers such as healthcare access and language barriers that may influence the frequency, rate, and quality of care received. The results highlight the importance of uncovering cultural distinctions and can aid in facilitating research examining foreign nativity-based disparities following TBI.
尽管在创伤性脑损伤（TBI）后的许多结果中都存在种族/民族差异，但尚未有研究根据出生地（外国出生与美国出生个体）来探究康复结果的差异。本研究的目的是比较在美国出生的个体与外国出生的个体在 TBI 后 10 年内的功能结果。
设置/参与者：使用 TBI 模型系统数据库中出生于美国（n=9435）与其他国家（n=1260）的个体编码，对 10695 例个体样本进行分析。
设计/主要措施：TBI 后 1、2、5 和 10 年的结果测量包括功能独立性测量的运动和认知分量表以及监督评分量表。
即使在控制了人口统计学和损伤相关的协变量后，外国出生的个体也表现出较低的运动功能独立性轨迹，而在美国出生的个体则表现出较高的运动功能独立性轨迹。然而，外国出生的个体通常在运动功能独立性的向上二次轨迹中表现出更强的趋势，最大的增益出现在 5 年至 10 年的时间点之间，而在美国出生的个体在 5 年至 10 年的时间点之间则表现出更快的改善，但随后达到平台期；随着人口统计学和损伤相关协变量的加入，这些随时间变化的差异效应逐渐消失。外国出生的个体也表现出较低的认知功能独立性轨迹，以及更高的监督需求轨迹，而在美国出生的个体则表现出较高的认知功能独立性轨迹，即使在控制了人口统计学和损伤相关的协变量后也是如此。
这些发现与文献一致，表明在 TBI 后，不同种族/民族的群体表现出较低的功能独立性。这些发现也可能表明存在系统障碍，如医疗保健的获取和语言障碍，这可能会影响接受护理的频率、速度和质量。研究结果强调了揭示文化差异的重要性，并有助于促进研究外国出生个体在 TBI 后的差异。
