Health Services Utilization, Health Care Costs, and Diagnoses by Mild Traumatic Brain Injury Exposure: A Chronic Effects of Neurotrauma Consortium Study

• DOI: 10.1016/j.apmr.2020.06.008
• Publication Date: 2020-07-10T03:09:00Z
• Authors: Clara Dismuke-Greer; Shawn Hirsch; Kathleen Carlson; Terri Pogoda; Risa Nakase-Richa...; Saurabha Bhatnagar; Blessen Eapen; Maya Troyanskaya; Shannon Miles; Tracy Nolen; William C. Walker
• Keywords: Adult; Male; Trauma Severity Indices; Adolescent; Health Status; Health Services; Patient Acceptance of Health Care; United States; 3. Good health; Stress Disorders, Post-Traumatic; 03 medical and health sciences; Mental Health; Military Personnel; Sex Factors; 0302 clinical medicine; Socioeconomic Factors; Chronic Disease; Humans; Female; Prospective Studies; Health Expenditures; Iraq War, 2003-2011; Brain Concussion

To compare Veterans Health Administration (VHA) diagnoses, health services utilization, and costs by mild traumatic brain injury (mTBI) group (blast-related [BR] mTBI vs non-blast-related [NBR] mTBI vs no mTBI) among Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF)/Operation New Dawn (OND) veterans in the Chronic Effects of Neurotrauma Consortium multicenter observational study.Prospective cohort study.Four Veterans Affairs Medical Centers.OEF/OIF/OND veterans (N=472) who used Veterans Affairs Medical Centers services between 2002-2017.Not applicable. Lifetime mTBI history was assessed via semistructured interviews.VHA diagnoses, health services utilization, and costs.Relative to NBR mTBI and no mTBI, veterans with BR mTBI were more likely to be male, have greater combat, and have controlled and uncontrolled detonations exposures (median BR, 15.0 vs NBR, 3.0 vs no mTBI, 3.0). They also had higher prevalence of headache, posttraumatic stress disorder, and anxiety diagnoses. Veterans with BR had the highest site-adjusted mean annual VHA utilization (26.31 visits; 95% confidence interval [CI], 26.01-26.61) relative to NBR (20.43 visits; 95% CI, 20.15-20.71) and no mTBI (16.62 visits; 95% CI, 16.21-17.04) and highest site adjusted mean annual VHA outpatient costs ($6480; 95% CI, $5842-$7187) relative to NBR ($4901; 95% CI, $4392-$5468) and no mTBI ($4069; 95% CI, $3404-$4864).Veterans with BR mTBI had higher exposure to combat and detonation. BR was associated with greater prevalence of select diagnoses and higher health services utilization and costs relative to NBR and no mTBI. The role of health care needs from mTBI polytrauma, other deployment-related exposures, and VHA access warrants future research.