A-9 Representing the Underrepresented: An Examination of Racial/Ethnic Differences in TBI-Related Outcomes in U.S. Veterans Enrolled in the Million Veteran Program

Abstract

Abstract Objective Traumatic brain injury (TBI) research in Veterans is based primarily on non-Hispanic White samples, which does not reflect the diversity of the current military population. We examined the relationship between race/ethnicity and clinical outcomes in a large sample of Iraq/Afghanistan-era Veterans within the Million Veteran Program. Method Primary outcomes included injury characteristics, neurobehavioral-related symptoms, and employment status gleaned from the Comprehensive TBI Evaluation (CTBIE) for 7006 Veterans with a clinician-confirmed history of TBI. Logistic regressions adjusting for age, sex, and education examined the effect of race/ethnicity on CTBIE outcomes. Results Racial/ethnic groups included non-Hispanic White (n = 4203), Hispanic (¬n = 1302), non-Hispanic Black (n = 951), Asian (¬n = 205), Multiracial (¬n = 157), Native Hawaiian/Pacific Islander (−n = 91), and American Indian/Alaska Native (¬n = 79). Race/ethnicity was significantly associated with 5/10 CTBIE variables after applying Bonferroni-correction: blast exposure, loss of consciousness, post-traumatic amnesia (PTA), affective neurobehavioral symptoms, and unemployment (p’s < 0.0001). Relative to non-Hispanic Whites, Veterans self-identifying as Asian, non-Hispanic Black, and Hispanic were less likely to experience certain injury-related characteristics (e.g., blast exposure, PTA). Additionally, Asian and Native Hawaiian/Pacific Islander groups were less likely to endorse severe affective symptoms compared to White Veterans, whereas Black Veterans were more likely to endorse severe affective symptoms. Conclusions Results highlight that certain TBI outcomes—particularly those related to injury characteristics and affective symptoms—vary by race/ethnicity. An enhanced understanding of how outcomes are modified by race/ethnicity is vital so that clinical care can be appropriately tailored to the unique needs of racially and ethnically diverse Veterans. Future studies should further elucidate the relationship between race/ethnicity and TBI outcomes.