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Transcript of Sex Differences in Profiles and Outcomes of Patients with Traumatic Brain Injury in a National...
Sex Differences in Profiles and Outcomes of Patients with Traumatic Brain Injury in a
National Rehabilitation Sample
Dr. Angela ColantonioPhD, OT Reg. (Ont),
FACRMCIHR Research Chair in
Gender, Work and Health
Vincy ChanMPH, PhD Candidate
Tatyana MollayevaPhD Candidate
University of Toronto&
Toronto Rehabilitation Institute, University Health Network
Background and Significance
Traumatic brain injury (TBI): Damage to brain after birth by traumatic events
Leading cause of death, disability worldwide Cost of TBI is considerable, indirect costs
expected to increase significantly
Background and Significance
Sex differences in TBI population outcomes: Women more likely than men to be discharged to
care facilities Well-established association between TBI and
depression, anxiety, substance use Comorbidities influence discharge destination
However: Paucity of research on TBI outcomes considering
sex differences Scarce population-based information on range of
health conditions affecting TBI rehabilitation patient outcomes by sex
Specific Aims Examine sex differences in profiles and outcomes of
patients with TBI patients in a population-based province-wide rehabilitation sample
Investigate the presence of medical comorbidities at admission as well as comorbidities that develop during the rehabilitation stay
MethodsSample: All patients in inpatient rehabilitation with TBI
diagnostic code between 2004/05 and 2007/08 Only the first inpatient rehabilitation admission for
each patient was considered
Data sources: National Rehabilitation Reporting System (NRS) Mandatory reporting in Ontario = population-
based
National Rehabilitation Reporting System
Clinical outcomes, characteristics of rehabilitation activities
Data from every inpatient rehabilitation bed within acute care or free standing rehab hospitals in Ontario, Canada
Cases grouped by conditions Rehabilitation Client Groupings (RCG)
Inclusion in study: RCG 2.2, 2.21, 2.22 (TBI)
MethodsKey Variables: Demographic:
Age, sex, language, geographic location of residence
Clinical: pre-admit and post-admit comorbid health
conditions, length of stay, total function score and motor and cognitive ratings from the FIM™ Instrument
Environmental: Informal support, living setting/arrangement at
admission and discharge
Results
Demographic Characteristics
N = 1,257 Majority males (70%)
Younger adults ~80% Older adults ~60%
Females significantly older than males (60 vs. 50 years)
Results
Clinical Characteristics
Average Length of Stay
Overall <65 65+0
10
20
30
40
50
60
Male Female
Age Groups
Avera
ge N
um
ber
of
Days
Statistics Significance: *p<.05, **p<.01, ***p<.001
Total Function Score, Motor & Cognitive Rating at Admission
Statistics Significance: *p<.05, **p<.01, ***p<.001
Total Function Score ***
Motor Rating *** Cognitive Rating0
10
20
30
40
50
60
70
80
90Male Female
Avera
ge Tota
l Fu
ncti
on
S
core
Statistics Significance: *p<.05, **p<.01, ***p<.001
Total Function Score *
Motor Rating * Cognitive Rating 0
20
40
60
80
100
120Male Female
Avera
ge Tota
l Fu
ncti
on
S
core
Total Function Score, Motor & Cognitive Rating at Discharge
Comorbid Health Condition at Admission
Overall *** <65 65+ **70%
75%
80%
85%
90%
95%
100%Male Female
Age Groups
Statistics Significance: *p<.05, **p<.01, ***p<.001
Most Common Comorbid Health Conditions at Admission
Overall: Circulatory System (M=31%, F=45%) Mental Health (M=28%, F=27%) Nervous System (M=26%, F=30%)
<65 Years: Mental Health (M=30%, F=24%) Nervous System (N=25%, F=31%)
65+ Years: Circulatory System (M=64%, F=69%) Nervous System (N=29%, F=30%)
Type of Comorbid Health Condition at Admission
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%Male Female
Comorbid Health Conditions
Statistics Significance: *p<.05, **p<.01, ***p<.001
Proportion with Mental Health Conditions at Admission
Overall <65 65+ **0%
5%
10%
15%
20%
25%
30%
35%Male Female
Age Groups
Statistics Significance: *p<.05, **p<.01, ***p<.001
Comorbid Health Condition at Discharge
Overall *** <65 65+ **0%
5%
10%
15%
20%
25%
Male Female
Age Groups
Statistics Significance: *p<.05, **p<.01, ***p<.001
Most Common Comorbid Health Conditions at Discharge
Overall: Mental Health (M=4%, F=5%) Circulatory System (M=3%, F=5%) Nervous System (M=4%, F=5%)
<65 Years: Mental Health (M=4%, F=5%) Nervous System (N=4%, F=3%)
65+ Years: Mental Health (M=5%, F=6%) Nervous System (N=3%, F=7%)
Type of Comorbid Health Condition at Discharge
Overall A significantly higher proportion of females (p<.05) had
symptoms, signs, and ill-defined conditions <65 Years
A significantly higher proportion of females (p<.05) had infectious and parasitic conditions and symptoms, signs, and ill-defined conditions
65+ Years A significantly higher proportion of females (p<.05) had
conditions of the blood and blood-forming organs
Results
Environmental Characteristics At admission:
Significantly higher proportion of females living alone
At admission and at discharge: Significantly higher proportion of males living at
home Significantly higher proportion of females living
at home with support and in residential care No significant sex differences in informal support
at discharge
SummaryThere are significant sex differences, in particular, in functional outcomes, comorbidities, and living setting
A significantly higher proportion of females had a comorbid health condition at admission and at discharge
Types of comorbid health conditions differed significantly by sex
Limitations
Extensive validation not done on all variables Not all desired variables available Sample limited to patients coded as having a
TBI in the NRS Some patients may be coded under other health
conditions (e.g., stroke)
Implications
Importance in understanding influence of comorbidities on rehabilitation outcomes by sex:
Inform planning of rehabilitation services Preparation of community support and services for
population at discharge
Future Plans Additional research will adjust for age in order
to determine the influence of age on the demographic and clinical variables
Disclosure: This study was supported in part by the National Institutes of Health - National Center for Medical Rehabilitation Research (NICHD), National Institute on Neurological Disorders and Stroke, and National Institute on Aging (Grant#R24HD065702)
Support for Dr. Colantonio:Saunderson Family Chair, Toronto Rehabilitation Institute, Canadian Institutes for Health Research (CIHR) Chair in Gender, Work and Health (#CGW-126580)
Support for Vincy Chan: CIHR, Ontario Neurotrauma Foundation, Brain Canada, Pediatric Oncology Group of Ontario, CIBC
Support for Tatyana Mollayeva: CIHR
Acknowledgements