Traumatic Brain Injury in Those With Preexisting Disability: Prevalence, Characteristics, and Psychosocial Function

Objective: – To identify the prevalence of incident traumatic brain injury with loss of consciousness (traumatic brain injury [TBI] with loss of consciousness [LOC]) among a cohort of individuals with preexisting disabilities. To examine age at first TBI with LOC and number of TBI with LOC. To identify whether TBI with LOC was associated with type of preexisting primary disability and age of disability onset. We also compared psychosocial function between those with and without TBI with LOC. Setting: – 2023/2024 National Survey on Health and Disability (NSHD). Participants: – Adults aged ≥18 years, living in the US, with self-reported preexisting disabilities. Our analyses included 235 participants who reported TBI with LOC after the onset of their primary disability, and 1 211 participants who did not experience TBI with LOC. Design: – Cross-sectional observational online survey. Main Measures: – NSHD survey and abbreviated Brain Injury Screening Questionnaire. Results: – A total of 235 individuals sustained TBI after disability onset. The average age of first TBI with LOC was 20.3 years, and 34.1% of participants incurred multiple TBIs with LOC. In fully adjusted models, relative to a primary physical/mobility disability, having a primary mental illness/psychiatric disability was associated with higher odds of incident TBI with LOC. Younger age at disability onset was associated with a 5% greater odds of reporting incident TBI with LOC. Finally, those with TBI with LOC were more likely to report poor physical and mental health days, and greater levels of loneliness, but did not have higher odds of unemployment compared to those without TBI. Conclusion: – TBI with LOC in those living with preexisting disability is common, associated with younger age at disability onset, greater likelihood of poor physical and mental health days, and greater loneliness. Screening for TBI in those living with all-cause disability is warranted, alongside care coordination to meet care needs of this vulnerable but historically overlooked group.