Traumatic Brain Injury in Veterans: Social Determinants, Survival and Costs

Abstract BACKGROUND: Traumatic Brain Injury (TBI) is a signature injury from the Iraq and Afghanistan conflicts as well as an important contributor to morbidity and mortality in the United States. Using a cohort of over 400,000 veterans with and without TBI, odds of TBI diagnosis by socio-demographics and clinical factors, along with the association of a TBI diagnosis with veteran survival were estimated for 15 years. Annual Veterans Health Administration (VHA) costs associated with a TBI diagnosis over a 14-year period were estimated per veteran. METHODS: 291,015 veterans without TBI and 181,521 veterans with TBI were followed from FY 2000 through FY2015 for comorbidities and survival. Veterans were followed through FY2014 for costs and adjusted to 2019 for inflation. Logit models were estimated to examine the association of veteran socio-demographics and clinical factors with the odds of a TBI diagnosis. Cox proportional hazard model was estimated to examine the covariate-adjusted association of TBI with survival. Generalized linear and seemingly unrelated regression models were used to estimate the association of TBI with annual per veteran VHA costs. RESULTS: Non-Hispanic Blacks (OR 1.85; 95% CI 1.81:1.88), Hispanic (OR 1.94; 95% CI 1.88:2.00)), and veterans with high numbers of mental (OR 5.83; 95% CI 5.68:5.98) and physical comorbidities (OR 2.47; 95% CI 2.42:2.52) had higher likelihood of having TBI. Veterans with TBI were 1.2 times more likely to die and had higher total annual costs by $19,808 (95% CI $13,900: $25,715), with a similar pattern for all component cost categories. CONCLUSIONS: Racial/Ethnic minorities have a higher likelihood of TBI. TBI is associated with increased death and annual health care costs. These results will inform decision-making by military leaders and policymakers regarding the harmful health impacts and higher health care services burden of TBI that may affect a large portion of military personnel.