Exploring Racial/Ethnic Disparities in Rehabilitation Outcomes after TBI: A Veterans Affairs Model Systems Study

Abstract: Objectives: To examine racial/ethnic differences in 5-year functional independence and life satisfaction trajectories among SMVs who had undergone acute rehabilitation at one of five VA TBI Model Systems (TBIMS) Polytrauma Rehabilitation Centers (PRCs). Design: Retrospective cohort analysis. Data collected at 1, 2, and 5 year post injury. Setting: Veterans Affairs. Participants: White (n=663), Black (n=89) and Hispanic/Latine (n=124). Interventions: Acute rehabilitation services. Main Outcome Measures" Functional Independence Measure (FIM) Motor, FIM Cognitive, and Satisfaction with Life Scale (SWLS) scores were collected. Racial/ethnic comparisons in these outcome trajectories were made using hierarchical linear modeling. Results: Black SMVs were less likely than White and Hispanic/Latine SMVs to have been deployed to a combat zone; there were no other racial/ethnic differences in any demographic or injury-related variable assessed. In terms of outcomes, no racial/ethnic differences emerged in FIM Motor, FIM cognitive, or SWLS trajectories. Conclusions: The absence of observable racial/ethnic differences in 5-year outcome trajectories after TBI among SMVs from VA TBIMS PRCs contrasts sharply with previous research identifying disparities in these same outcomes and throughout the larger VA health care system. Individuals enrolled in VA PRCs are likely homogenized on key social determinants of health that would otherwise contribute to racial/ethnic disparities in outcome trajectories.

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