TBI and Pre-Injury Incarceration: Level of Incarceration Involvement Demonstrates Statistically Significant Differences in Sociodemographic and Lifestyle Factors

Research Objectives: To investigate characteristics of individuals with a traumatic brain injury (TBI) with respect to pre-injury incarceration status.

Design: Survey within inception cohort

Setting: Acute inpatient rehabilitation

Participants: 255 individuals with moderate-to-severe TBI enrolled in the Rusk Rehabilitation TBI Model System. Sample: 82% male, average age 50 years (SD:19); Racial/Ethnic

Background: White (50%), Black (30%), Asian (11%), other (6%); Hispanic/Latino/Spanish origin (35%). Individuals were grouped based on pre-injury incarceration history: Jail only (J; n=43); Prison (P; n=24); No incarceration (N; n=188).

Interventions: N/A

Main Outcome Measures: N/A, secondary data analysis

Results: Individuals with a history of pre-injury incarceration were more likely to be younger (p=.009), male (p=.009), born in the U.S. (p=.006), have a history of learning/behavioral problems in school (p <.001), and less likely to achieve higher educational attainment (p=.013) or be competitively employed (p=.024).

History of incarceration was significantly associated (p < 0.05) with a pre-injury history of mental illness, psychiatric hospitalization, and suicide attempt. Formerly incarcerated individuals reported more pre-injury high-risk behaviors, including drug use (J: OR = 4.7, 95% CI [2.2, 10.1]; P: OR = 7.2 [2.8, 18.5]), daily cigarette use (J: OR = 4.7, [2.2, 10.1]; P: OR = 23.9, [8.5, 66.8]), and binge drinking (J: OR = 2.5, [1.3, 4.9]; P: OR = 3.7, [1.5, 8.8]). Both pre-injury incarcerated groups were more likely to have experienced homelessness in their lifetime (J: OR = 4.0, [1.9, 8.7]; P: OR = 15.1, [5.8, 39.3]). Individuals with a prison history were more likely to have a violent TBI etiology (p=.006).

Conclusions: Differentiating by pre-injury incarceration level reveals significant differences in vital sociodemographic and lifestyle characteristics; failure to do so may disregard the impact of intersectionality in a vulnerable population. Further inquiry is warranted.

Author(s) Disclosures: None