Population-Level Epidemiology of Traumatic Brain Injury Concurrent with Domestic Violence in Arizona, USA

Abstract

Background: Domestic violence (DV) is a chronic societal epidemic. When DV involves physical assault, the head, neck, and face are common targets, which increases the risk of traumatic brain injuries (TBIs). Population-level epidemiological data on TBIs in DV victims remain sparse. Methods: We performed a statewide, multi-institution, retrospective review of all medical records for patients diagnosed with a TBI at medical facilities in Arizona, USA, that were licensed by Arizona Department of Health Services (ADHS) during 2016-2018. De-identified records were extracted from discharge data reported to ADHS, which we decoded and transformed to spatiotemporal demographic data of patients who were diagnosed with TBI concurrent with DV. Findings: Among 72,307 TBI diagnoses, 940 were concurrent with DV. Most adults were discharged from general medical facilities, whereas most children were discharged from specialized facilities. Sixteen patients died as a result of TBI-DV injuries. Although females were most of the TBI-DV diagnoses, median ages for males and females were 1 and 32 years, respectively, demonstrating that males were predominantly child abuse victims. Whites and Hispanics were victims most diagnosed with TBI and DV, but Native Americans and Blacks comprised a much greater proportion of diagnoses compared with their population representations. Though likely underreported, approximately half of the cases were inflicted by intimate partners, which corresponded closely to marital status. Surprisingly, 61% of victims sought medical treatment for non-TBI injuries and then TBI was entered as a primary diagnosis. Interpretation: We provide the first population-level evaluation of TBI concurrent with DV. Health care disparities emerge that demand TBI screening in suspected DV patients. Funding Statement: RKR and JL were funded by Phoenix Children’s Hospital Mission Support Funds. SMM, HH, and JL were funded by a grant from the Kemper and Ethel Marley Foundation. Declaration of Interests: The authors have no conflicts of interest to report. Ethics Approval Statement: Approval from the Arizona Department of Health Services (ADHS) Human Subjects Review Board (#19-0025).