The Importance of Social Determinants of Health in Predicting Healthcare Access After Traumatic Brain Injury

Research Objectives: To examine how social determinants of health account for variance in healthcare access and quality above and beyond demographics such as race/ethnicity.

Design: Cross-sectional

Setting: Online survey.

Participants: 311 individuals with a history of traumatic brain injury involving a loss of consciousness were recruited from the three largest racial ethnic groups in the U.S. The sample included Non-Hispanic White (34.7%), Non-Hispanic Black (35.4%), and Hispanic (29.9%) participants. Females made up 39.9% of the sample.

Interventions: Not Applicable.

Main Outcome Measures: The Barriers to Care Questionnaire for Adult Self-Report (BCQ-ASR), a measure of healthcare access and quality was completed along with the Patient Reported Outcome Measurement Information System 4-item short forms for instrumental, emotional, and informational social support. Food and housing insecurity was assessed using two questions from the Behavioral Risk Factor Surveillance System (BRFSS) as a proxy for financial instability.

Results: A hierarchical linear regression model included the BCQ-ASR as the dependent variable. Demographics entered on Step 1 accounted for 14.4% of the variance [F(5,305)=10.3, p< 0.001] with significant effects for age (p < 0.001), race/ethnicity (p < 0.001), and TBI severity (p < 0.028). The effect of sex was not significant (p=0.946). When social determinants of health were added on Step 2, they accounted for an additional 11.3% of the variance [Fchange(5,300)=9.2, p< 0.001]. A composite of the three social support measures (β=0.12, p=0.021) and food or housing insecurity (β=-0.56, p< 0.001) were significantly associated with scores on the BCQ-ASR. In addition, the differences between Non-Hispanic Whites compared with Hispanic (p=0.097) and Non-Hispanic Black (p=0.075) individuals became non-significant.

Conclusions: Social support and especially financial instability predicted healthcare access and quality, accounting for significant variance over and above sociodemographic characteristics such as race/ethnicity. It is important to account for social determinants of health to better understand the mechanisms that perpetuate racial/ethnic health disparities after TBI.

Author(s) Disclosures: Authors have no conflicts of interest to disclose.