VA San Diego Healthcare System (VASDHS), San Diego, California, USA.
Department of Psychiatry, University of California San Diego, La Jolla, California, USA.
J Neurotrauma. 2024 Mar;41(5-6):623-634. doi: 10.1089/neu.2023.0174. Epub 2023 Aug 25.
Epidemiological studies of medical comorbidities and possible gender differences associated with traumatic brain injury (TBI) are limited, especially among military veterans. The purpose of this study was to examine relationships between TBI history and a wide range of medical conditions in a large, national sample of veterans, and to explore interactions with gender. Participants of this cross-sectional epidemiological study included 491,604 veterans (9.9% TBI cases; 8.3% women) who enrolled in the VA Million Veteran Program (MVP). Outcomes of interest were medical comorbidities (i.e., neurological, mental health, circulatory, and other medical conditions) assessed using the MVP Baseline Survey, a self-report questionnaire. Logistic regression models adjusting for age and gender showed that veterans with TBI history consistently had significantly higher rates of medical comorbidities than controls, with the greatest differences observed across mental health (odds ratios [ORs] = 2.10-3.61) and neurological (ORs = 1.57-6.08) conditions. Similar patterns were found when evaluating men and women separately. Additionally, significant TBI-by-gender interactions were observed, particularly for mental health and neurological comorbidities, such that men with a history of TBI had greater odds of having several of these conditions than women with a history of TBI. These findings highlight the array of medical comorbidities experienced by veterans with a history of TBI, and illustrate that clinical outcomes differ for men and women with TBI history. Although these results are clinically informative, more research is needed to better understand the role of gender on health conditions in the context of TBI and how gender interacts with other social and cultural factors to influence clinical trajectories following TBI. Ultimately, understanding the biological, psychological, and social mechanisms underlying these comorbidities may help with tailoring TBI treatment by gender and improve quality of life for veterans with TBI history.
医学共病的流行病学研究以及与创伤性脑损伤（TBI）相关的可能性别差异在军事退伍军人中尤为有限。本研究的目的是在退伍军人的大型全国样本中检查 TBI 病史与广泛的医疗状况之间的关系，并探索与性别之间的相互作用。这项横断面流行病学研究的参与者包括 491,604 名退伍军人（9.9%为 TBI 病例；8.3%为女性），他们参加了退伍军人事务部百万退伍军人计划（MVP）。本研究使用 MVP 基线调查（一份自我报告问卷）评估了感兴趣的医疗合并症（即神经、心理健康、循环和其他医疗状况）。调整年龄和性别后，有 TBI 病史的退伍军人的医疗合并症发生率明显高于对照组，在心理健康（优势比[ORs] = 2.10-3.61）和神经（ORs = 1.57-6.08）方面差异最大。分别评估男性和女性时也发现了相似的模式。此外，还观察到 TBI-性别显著相互作用，尤其是在心理健康和神经共病方面，即有 TBI 病史的男性比有 TBI 病史的女性更有可能患有几种此类疾病。这些发现强调了有 TBI 病史的退伍军人所经历的一系列医疗合并症，并表明有 TBI 病史的男性和女性的临床结果不同。尽管这些结果具有临床意义，但需要更多的研究来更好地了解性别在 TBI 背景下对健康状况的作用，以及性别如何与其他社会和文化因素相互作用影响 TBI 后的临床轨迹。最终，了解这些合并症的生物学、心理学和社会机制可能有助于根据性别调整 TBI 治疗，并提高有 TBI 病史的退伍军人的生活质量。
