Chan Vincy, Wirianto Clarissa Serafine, Balogh Robert, Haarbauer-Krupa Juliet, Escobar Michael David
KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.
Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada.
PLoS One. 2025 Jun 12;20(6):e0323902. doi: 10.1371/journal.pone.0323902. eCollection 2025.
Traumatic brain injury is a major cause of death and disability worldwide, with almost half of new cases occurring in children, adolescents, and young adults. However, data on injury characteristics stratified by social determinants of health are scarce. This study explores severity, intent, and mechanism of traumatic brain injury sustained during childhood, adolescence, and young adulthood by social determinants of health.
This study utilizes a population-based birth cohort of births in publicly funded hospitals in Ontario, Canada, between April 1, 1992 and March 31, 2020 (n = 3,648,760). Individuals experiencing a traumatic brain injury requiring medical attention to the emergency department or acute care between April 1, 2002 and November 20, 2020 (n = 94,514) were identified using International Classification of Diseases Version 10 diagnosis codes. Social determinants of health variables included age, sex, rurality of residence, neighbourhood income quintile, and the following Ontario Marginalization Index variables: households and dwellings, material resources, and racialized and newcomer populations. The primary outcome was percentage of injuries falling under each mechanism, intent, and severity of injury category, stratified by social determinants of health variables.
Approximately 50% of injuries were mild and 96.2% of injuries were unintentional. Injury severity and intent of injury significantly varied by social determinants of health; for example, the proportion of traumatic brain injury-related healthcare visits for moderate/severe and intentional injuries was highest in areas with the lowest income quintile (13.3% and 6.1%, respectively), lowest households and dwellings stability (12.2% and 5.7%, respectively), lowest material resources (12.8% and 6.0% respectively), and highest racialized and newcomer populations (13.5% and 4.5% respectively). The percentage of traumatic brain injury-related healthcare visits for a sports-related injury significantly varied by social determinants of health; for example, the proportion of traumatic brain injury-related healthcare visits for sports-related injuries was highest among males (45.5%), those living rural areas (44.0%), and those living in areas with the highest income (47.2%), highest households and dwellings stability (44.0%), highest material resources (45.8%), and lowest racialized and newcomer populations (43.4%).
Characteristics of traumatic brain injury-related healthcare visits vary based on social determinants of health. Targeted prevention of traumatic brain injury beyond the sports settings, including fall prevention among young children, are encouraged, and guidelines to identify and address traumatic brain injury outside of the sports setting must be developed to support early intervention of traumatic brain injury across social determinants of health.
创伤性脑损伤是全球死亡和残疾的主要原因，近一半的新病例发生在儿童、青少年和青年成人中。然而，按健康的社会决定因素分层的损伤特征数据稀缺。本研究通过健康的社会决定因素探讨儿童期、青少年期和青年成人期创伤性脑损伤的严重程度、意图和机制。
本研究利用了1992年4月1日至2020年3月31日期间加拿大安大略省公立医院基于人群的出生队列（n = 3,648,760）。使用国际疾病分类第10版诊断代码识别2002年4月1日至2020年11月20日期间因创伤性脑损伤需要到急诊科或接受急性护理的个体（n = 94,514）。健康的社会决定因素变量包括年龄、性别、居住农村地区、邻里收入五分位数以及以下安大略省边缘化指数变量：家庭和住所、物质资源以及种族化和新移民人口。主要结局是按健康的社会决定因素变量分层的每种机制、意图和损伤严重程度类别下的损伤百分比。
约50%的损伤为轻度，96.2%的损伤为非故意伤害。损伤严重程度和损伤意图因健康的社会决定因素而有显著差异；例如，中度/重度和故意伤害导致的创伤性脑损伤相关医疗就诊比例在收入五分位数最低的地区最高（分别为13.3%和6.1%），家庭和住所稳定性最低的地区（分别为12.2%和5.7%），物质资源最低的地区（分别为12.8%和6.0%），以及种族化和新移民人口比例最高的地区（分别为13.5%和4.5%）。与运动相关的创伤性脑损伤相关医疗就诊百分比因健康的社会决定因素而有显著差异；例如，与运动相关的创伤性脑损伤相关医疗就诊比例在男性中最高（45.5%），居住在农村地区的人群中（44.0%），以及居住在收入最高地区的人群中（47.2%），家庭和住所稳定性最高的地区（44.0%），物质资源最高的地区（45.8%），以及种族化和新移民人口比例最低的地区（43.4%）。
创伤性脑损伤相关医疗就诊的特征因健康的社会决定因素而异。鼓励在运动环境之外有针对性地预防创伤性脑损伤，包括预防幼儿跌倒，并且必须制定指南以识别和处理运动环境之外的创伤性脑损伤以支持跨健康的社会决定因素对创伤性脑损伤进行早期干预。
