Corrigan John D, Vuolo Mike, Shankman Rebecca, Bogner Jennifer, Beaulieu Cynthia L, Botticello Amanda L, Hyzak Kathryn A, Juengst Shannon, Kumar Raj G, Mengo Cecilia
The Ohio State University, Columbus, OH, USA.
Kessler Foundation, Center for Outcomes and Assessment Research, West Orange, NJ, USA.
SSM Popul Health. 2025 Apr 2;30:101795. doi: 10.1016/j.ssmph.2025.101795. eCollection 2025 Jun.
Social Determinants of Health (SDoH) are a significant factor in health outcomes for both acute and chronic health conditions, but systematic research related to outcomes from traumatic brain injury (TBI) has been limited. This study explores the relationship between individual and neighborhood-level SDoH and TBI outcomes to understand the extent of their influence on long-term recovery. Hybrid panel models that decompose time-varying predictors into between- and within-person effects were used to examine the relationships between SDoH and participation in the community, life satisfaction, and global functioning for persons with moderate to severe TBI one to 30 years post-injury. Participants were 9263 persons, distributed nationally, who received inpatient rehabilitation for TBI and enrolled in the TBI Model Systems longitudinal study. Individual-level SDoH included sex, race/ethnicity, education, employment, insurance, primary means of transportation, and rurality. The Social Vulnerability Index (SVI) was used as an indicator of neighborhood disadvantage. Results indicated that neighborhood-level SDoH accounted for differences in outcomes between individuals but not due to change in a given individual's neighborhood. These findings were robust to the inclusion of numerous individual-level SDoH, which were also associated with the outcomes. Individual-level SDoH accounted for differences in outcomes both between individuals and with change in a given individual's status. Among four thematic subscales constituting the SVI, the socio-economic status subscale was consistently associated with all three outcomes.
健康的社会决定因素（SDoH）是急性和慢性健康状况下健康结果的一个重要因素，但与创伤性脑损伤（TBI）结果相关的系统研究一直有限。本研究探讨个体层面和社区层面的SDoH与TBI结果之间的关系，以了解它们对长期康复的影响程度。使用混合面板模型将随时间变化的预测因素分解为个体间效应和个体内效应，以检验SDoH与中度至重度TBI患者伤后1至30年的社区参与、生活满意度和整体功能之间的关系。参与者为9263人，分布在全国范围内，他们因TBI接受了住院康复治疗，并参加了TBI模型系统纵向研究。个体层面的SDoH包括性别、种族/民族、教育程度、就业情况、保险、主要交通方式和农村地区。社会脆弱性指数（SVI）被用作社区劣势的指标。结果表明社区层面的SDoH解释了个体间结果的差异，但不是由于特定个体所在社区的变化。这些发现对于纳入众多个体层面的SDoH来说是稳健的，这些个体层面的SDoH也与结果相关。个体层面的SDoH既解释了个体间结果的差异，也解释了特定个体状态变化带来的差异。在构成SVI的四个主题子量表中，社会经济地位子量表始终与所有三个结果相关。
