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TBI: U.S. Territory Veterans Have Greater Mortality Risk Than Mainland Vets

MedicalResearch.com Interview with:
Clara E. Dismuke-Greer, PhD
Health Equity and Rural Outreach Innovation Center
Ralph H. Johnson Department of Veterans Affairs Medical Center
Charleston, SC 29401

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The background for this study is that previous research we had published had shown that Hispanic U.S. Veterans diagnosed with Traumatic Brain Injury (TBI) had higher risk of mortality than non-Hispanic White U.S. Veterans, even after accounting for the effects of comorbidities as well as socio-demographics. This study sought to investigate further this apparent racial/ethnic disparity.

Using a 10 year cohort followed for up to 14 years, and adjusting for TBI severity as well as comorbidities, socio-demographics and military factors, when we included location (urban vs. rural vs. highly rural vs. U.S. Territory (Puerto Rico, U.S. Virgin Islands, Guam, America Samoa and Mariana Islands), as well as race/ethnicity, we found that the racial/ethnic disparity disappeared, and that it was location which became statistically significant.

Our main findings were that Veterans diagnosed with TBI residing in U.S. Territories have lower survival and higher risk of mortality relative to Veterans residing on the U.S. Mainland , even after statistical adjustment for the factors listed above.

MedicalResearch.com: What should readers take away from your report?

Response: The U.S. Department of Veterans Affairs has a mission of providing equitable treatment for all Veterans. This equitable treatment involves targeting appropriate VA interventions and resources to specific groups of Veterans whose health outcomes are worse relative to other groups of Veterans. Therefore, it is a major concern if U.S. Territory Veterans diagnosed with TBI have lower survival and higher mortality risk than U.S. Mainland Veterans diagnosed with Traumatic Brain Injury. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: In this case, further investigation as to the reasons for higher mortality among U.S. Territory Veterans diagnosed with TBI needs to be conducted, and appropriate VA interventions and resources need to be targeted to close the gap between U.S. Mainland and  U.S. Territory survival and mortality risk for Veterans diagnosed with TBI.

MedicalResearch.com: Is there anything else you would like to add?

Response: I am a research health scientist with the U.S. Department of Veterans Affairs. My research is also supported by a VA/DoD grant, Chronic Effects of Neurotrauma Consortium (CENC).

Thank you so very much for your interest in Veterans, TBI, and our work. Thank you for the opportunity for this interview. We thank all Veterans for giving us this mission, as they have accomplished their mission.


Geographic Disparities in Mortality Risk Within a Racially Diverse Sample of U.S. Veterans with Traumatic Brain Injury
Clara E. Dismuke-Greer, Mulugeta Gebregziabher, Tiarney Ritchwood, Mary Jo Pugh, Rebekah J. Walker, Uche S. Uchendu, and Leonard E. Egede

Health Equity 2018 2:1, 304-312  

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Last Updated on November 8, 2018 by Marie Benz MD FAAD