Characterization of neuropsychiatric traumatic brain injury outcomes in individuals of Black racial identity using the All of Us Database

Introduction: Brain trauma(TBI) disproportionately impacts Black patients, who experience worse post-TBI outcomes versus White patients, yet Black patients are underrepresented in TBI research. Racial disparities in TBI may reflect structural racism, i.e., the propagation of systems that perpetuate racial discrimination and inequity in societies We investigated the epidemiology and neuropsychiatric outcomes of TBI in Black individuals using All of Us(AoU), a US-based research database aimed at collecting nationally representative health data.

Methods: TBI was defined using ICD-9/10 codes. Neuropsychiatric conditions (NPC) associated with TBI were captured using phecodes and grouped into nine categories. Demographic factors included race, age, gender, and social deprivation index(SDI) for 3-digit zip codes.

Results: Our cohort(N=8,811) was limited to Black(25.5%) or White(74.8%) patients. 31.8% of the cohort had severe injury by AIS score (no significant difference across race, p=0.3). Black individuals were younger at index TBI(45.1±15.2SD versus 50.2±18.6SD; p< 0.001). Most Black individuals were men(53%) while most White individuals were women(57%, p< 0.001). Black individuals reported living in areas of higher SDI(0.35±0.07) compared to White individuals(0.30±0.05, p< 0.001). The prevalences of post-TBI anxiety(p=0.003), dementia(p=0.006), and sleep disorders(p < 0.001) were higher in White individuals, while post-TBI headache(p < 0.001), schizophrenia(p < 0.001), seizures(p=0.01), and SUD (p < 0.001) were higher in Black individuals. NPC prevalence varied by SDI quartile, with significantly higher rates of post-TBI headache(p < 0.01), schizophrenia(p < 0.005), and SUD(p < 0.05) in Black individuals at high SDI versus White individuals. PTSD prevalence was higher in Black individuals at low SDI(p < 0.05) but comparable at higher SDI levels.

Conclusion : We observed stark differences in post-TBI prevalence of NPC in Black versus White patients. Stratifying by SDI impacted differences in the prevalence of outcome, demonstrating the intersectionality of race and socioeconomic factors that characterize structural racism. Further work is required to understand structural discrimination in TBI to advance health equity for all TBI patients.