Traumatic brain injury (TBI) is a serious public health problem that can significantly impact a person's quality of life, the healthcare system, and society as a whole. Health disparities in TBI refer to the unequal distribution of TBI-related morbidity (the state of having a specific illness) and mortality (the number of deaths due to a particular disease) across different populations. These disparities can be due to various factors, including socioeconomic status, race and ethnicity, and age. Understanding which groups are at greater risk of sustaining, dying from, or receiving inadequate care related to TBI is crucial to better health outcomes for ALL people.
Socioeconomic Status
Socioeconomic status plays a significant role in a person's higher likelihood of living in crowded and poorly maintained (exposure to lead paint and secondhand smoke, for example) housing situations, as well as living in areas with higher crime rates, which can lead to violence and falls. People from low-income households are at two-to-four times greater risk of suffering a TBI than those who have a higher income. People making a lower income are also more likely to work in dangerous jobs, such as construction and manufacturing, which can increase their risk for head injuries.
Socioeconomic status affects a person's ability to afford quality health care, health insurance, and access to quality health care providers within a "near enough" geographic area. Additionally, individuals struggling financially to afford basic daily living necessities (food, shelter, clothing, transportation) are also at an increased risk of not receiving adequate care if they have sustained a TBI. These factors can make getting necessary and sometimes life-saving care even more difficult after a TBI.
Race and Ethnicity
Racial disparities in sustaining a TBI tend to go hand-in-hand with those explained in the socioeconomic section above. A 2021 study published in Frontiers of Surgery indicated that people of color are more than twice as likely to die as white people after sustaining a traumatic brain injury. Non-Hispanic black and Hispanic people are also at an increased risk of sustaining a TBI and receiving inadequate rehabilitation and follow-up care after sustaining a TBI than other racial groups. These factors increase the likelihood of poorer physical, mental, and return-to-work-related outcomes for people of color after TBI than any other racial demographic group.
Age
Older adults, especially those over 75, have the highest rates of TBI-related hospitalization and death than younger people. Age-related changes in the brain can contribute to the brains of older people becoming more fragile and susceptible to injury. Older adults are also more likely to have medical conditions that can increase their risk of TBI – such as stroke, heart disease, or diabetes. With the increase in the number of medical diagnoses often comes an increase in prescribed medications, which can also increase fall risk for older adults.
The impact of TBI is significant. It can be even greater for people who are already marginalized. People from low-income households, people of color, and older adults may have less access to quality healthcare and may be less likely to receive the support they need to recover from a TBI.
Plenty can be done to address health disparities in TBI. These include increasing awareness of TBI among healthcare providers and the public, improving access to quality healthcare, providing support services for people who have experienced a TBI, and reducing the risk factors for TBI. By taking these steps, we can help to ensure that EVERYONE can reduce their TBI risk and has an equal opportunity to recover from TBI and live a healthy and productive life.
Sources:
https://www.cdc.gov/traumaticbraininjury/health-disparities-tbi.html
https://thejns.org/pediatrics/view/journals/j-neurosurg-pediatr/29/3/article-p335.xml
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5857393/
https://www.mdpi.com/journal/brainsci/special_issues/Health_Disparities_TBI