TBI and risk of death in military veterans over 14 years: Injury severity, timing, and cause of death

Amy L Byers; Yixia Li; Deborah E Barnes; W John Boscardin; Carrie B Peltz; Kristine Yaffe

doi:10.1016/j.jpsychires.2022.09.035

TBI and risk of death in military veterans over 14 years: Injury severity, timing, and cause of death

J Psychiatr Res. 2022 Dec:156:200-205. doi: 10.1016/j.jpsychires.2022.09.035. Epub 2022 Sep 25.

Authors

Amy L Byers¹, Yixia Li², Deborah E Barnes³, W John Boscardin⁴, Carrie B Peltz², Kristine Yaffe⁵

Affiliations

¹ San Francisco VA Health Care System, San Francisco, CA, USA; Department of Psychiatry & Behavioral Sciences, University of California, San Francisco, USA; Department of Medicine, Division of Geriatrics, University of California, San Francisco, USA. Electronic address: Amy.Byers@ucsf.edu.
² San Francisco VA Health Care System, San Francisco, CA, USA; Northern California Institute for Research and Education, San Francisco, CA, USA.
³ San Francisco VA Health Care System, San Francisco, CA, USA; Department of Psychiatry & Behavioral Sciences, University of California, San Francisco, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, USA.
⁴ San Francisco VA Health Care System, San Francisco, CA, USA; Department of Medicine, Division of Geriatrics, University of California, San Francisco, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, USA.
⁵ San Francisco VA Health Care System, San Francisco, CA, USA; Department of Psychiatry & Behavioral Sciences, University of California, San Francisco, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, USA; Department of Neurology, University of California, San Francisco, USA.

PMID: 36257114
DOI: 10.1016/j.jpsychires.2022.09.035

Abstract

The objective of this study was to determine the association of traumatic brain injury (TBI) with mortality in military veterans and whether this association differs as a function of TBI severity, timing, and cause of death. This national cohort study used U.S. Department of Veterans Affairs' (VA) data of patients 18 years and older with TBI diagnoses (N = 213,290) and 1:1 propensity-matched comparison random sample of patients without TBI (N = 213,290). The main outcome measure was mortality within 6 months of TBI diagnosis and longer-term (after 6 months). Cox proportional hazards models were used to examine risk of all-cause mortality according to TBI severity and Fine-Gray proportional hazards regression to examine time to cause-specific mortality, accounting for competing risk of other deaths. For patients with moderate-to-severe TBI (compared with no TBI), hazard ratios (HRs) for mortality were highest within first 6 months of injury (fully-adjusted HR: 2.42, 95% CI: 2.32-2.53); for mild TBIs, HRs for mortality were lower and relatively constant over time (fully-adjusted HR within first 6 months: 1.33, 95% CI: 1.26-1.39). Veterans with mild and moderate-to-severe TBI had higher risk of future death over short term for 9 out 10 of the U.S. leading causes of death, with only unintentional injury, stroke, and suicide showing differences by TBI severity. Associations attenuated significantly from within to after 6 months TBI diagnosis. These findings indicate that adults with TBI are at increased risk of majority of leading causes of death, with differential risk by TBI severity and timing of death.

Keywords: Injury severity; Mortality; TBI.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Brain Injuries, Traumatic*
Cause of Death
Cohort Studies
Humans
United States / epidemiology