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