(Research Hub Theater) Sociodemographic/Health Characteristics Profile of Veterans with Traumatic Brain Injury Residing in Rural Areas of US Territories and Its Association to Increased Mortality: A Rehabilitation Challenge

Background and/or Objectives: Studies on Veterans with Traumatic Brain Injury (TBI) showed that residing in U.S. territories are associated with higher mortality, even after adjusting for race/ethnicity, severity, sociodemographic, military, and comorbidity covariates. The goal of this study is to create a sociodemographic/health characteristics profile of Veterans with TBI, residing in rural areas of U.S territories, and its association with mortality rates.

Design: Retrospective cohort study.

Setting: Hispanic Veterans in USA Territories that are not incorporated as states. TBI Veterans receiving care in US Virgin Islands, Guam, Northern Mariana Islands, and American Samoa. To serve as control, data from TBI Veterans residing in Hawaii and Alaska.

Participants: Veterans older than 21 years of age, with a diagnosis of TBI between the years 2000-2015. Data will be collected from selected VA Healthcare Systems through Computerized Patient Record System (CPRS) and Joint Legacy Viewer (JLV) record review in a cohort of TBI Veterans residing in rural areas and receiving care at the U.S. territories.

Interventions: Record review using VA Informatics Computing Infrastructure (VINCI) of 168,336 Veterans with an International Classification of Diseases Ninth Revision (ICD-9) diagnosis of TBI from 2000 to 2015. Data will be used to create the sociodemographic and health characteristic profile and projected for survival.

Main Outcome Measures: Mortality rates with demographic adjustments.

Results: Data adjusted for age/gender/race and comorbidities, showed that mortality rate in territories is 1.18 times higher than mainland (Cox HR 1.18, 95% CI: 1.06:1.31). Mortality rates in Hawaii/Alaska drop 22% when compared to mainland and territories (Cox HR 0.779, 95% CI: 0.707: 0.859). Mortality rates are similar in mainland when comparing VAs with high Hispanic population and those with no-high Hispanic population (Cox HR 0.999, 95% CI: 0.943:1.06).

Conclusions: Preliminary analysis of data adjusted for age, gender, race, and comorbidities has demonstrated that the mortality rate in the territories is higher than that in the mainland.