Abstract
BackgroundThe interplay of host, agent, and environment implicated in traumatic brain injury (TBI) events is difficult to account for in hypothesis-driven research. Data-driven analysis of injury data can enable insight into injury events in novel ways. This research dissected complex and multidimensional data at the time of the TBI event by exploiting data mining and information visualization methods.MethodsWe drew upon population-based decade-long health administrative data collected through the routine operation of the publicly funded health system in Ontario, Canada. We applied a computational approach to categorize health records of 235,003 patients with TBI versus the same number of reference patients without TBI, individually matched based on sex, age, place of residence, and neighbourhood income quantile. We adopted the basic concepts of the Haddon Matrix (host, agent, environment) to organize emerging factors significantly related to TBI versus non-TBI events. To explore sex differences, the data of male and female patients with TBI were plotted on heatmaps and clustered using hierarchical clustering algorithms.ResultsBased on detected similarities, the computational technique yielded 34 factors on which individual TBI-event codes were loaded, allowing observation of a set of definable patterns within the host, the agent, and the environment. Differences in the patterns of host, agent and environment were found between male and female patients with TBI, which are currently not identified based on data from injury surveillance databases. The results were internally validated.ConclusionsThe study outlines novel areas for research relevant to TBI and offers insight into how computational and visual techniques can be applied to advance the understanding of TBI event. Results highlight unique aspects of sex differences of the host and agent at the injury event, as well as differences in exposure to adverse social and environmental circumstances, which can be a function of gender, aiding in future studies of injury prevention and gender-transformative care.
Highlights
The interplay of host, agent, and environment implicated in traumatic brain injury (TBI) events is difficult to account for in hypothesis-driven research
We issued an exhaustive effort to describe unique aspects of sex differences of the host at the injury event, as well as differences in exposure to adverse social and environmental circumstances, which can be a function of gender, rooted in socially determined expectations and behaviors ascribed on the basis of biological sex [48]
While previous research on TBI severity focused on injury events assumed to be independent of the agent and environment, our results show that the Haddon Matrix designations are not independently contributing to TBI severity but are uniformly present at the injury event and correlate with one another in a sex-specific manner
Summary
The interplay of host, agent, and environment implicated in traumatic brain injury (TBI) events is difficult to account for in hypothesis-driven research. The presence of substance-use disorders, epilepsy, and medication effects can potentiate or modify the risks associated with adverse behaviors (e.g., assault and domestic abuse) or falls [3, 7,8,9], which may affect male and female patients differently and have different implications for an injury event with a TBI outcome. Adding to these risks, many known adverse social determinants of health (e.g., socioeconomic disparity, racial and gender inequality) have been implicated in vulnerability to injury and decreased help-seeking after injury due to depleted psychosocial reserves [10,11,12,13]. Relatively higher occurrence of injuries from sharp instruments and moving machinery and emergencies and adversities due to substance use within five years preceding TBI [8] highlight the links to a gender-based division of labour and high risk behaviours, which might be reflected in injuries as a result of being struck by or against an object and interpersonal violence; all of which have implications for clinical and prevention contexts, and TBI surveillance system overall [4, 5]
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