{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T20:37:41Z","timestamp":1793392661979,"version":"4.5.0"},"reference-count":31,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec id=\"ab-zoi240486-4\"><jats:title>Importance<\/jats:title><jats:p>Traumatic brain injury (TBI) occurs at the highest rate in older adulthood and increases risk for cognitive impairment and dementia.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi240486-5\"><jats:title>Objectives<\/jats:title><jats:p>To update existing TBI surveillance data to capture nonhospital settings and to explore how social determinants of health (SDOH) are associated with TBI incidence among older adults.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi240486-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This nationally representative longitudinal cohort study assessed participants for 18 years, from August 2000 through December 2018, using data from the Health and Retirement Study (HRS) and linked Medicare claims dates. Analyses were completed August 9 through December 12, 2022. Participants were 65 years of age or older in the HRS with survey data linked to Medicare without a TBI prior to HRS enrollment. They were community dwelling at enrollment but were retained in HRS if they were later institutionalized.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi240486-7\"><jats:title>Exposures<\/jats:title><jats:p>Baseline demographic, cognitive, medical, and SDOH information from HRS.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi240486-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Incident TBI was defined using inpatient and outpatient <jats:italic>International Classification of Disease<\/jats:italic>s, <jats:italic>Ninth<\/jats:italic> or <jats:italic>Tenth Revision,<\/jats:italic> diagnosis codes received the same day or within 1 day as the emergency department (ED) visit code and the computed tomography (CT) or magnetic resonance imaging (MRI) code, after baseline HRS interview. A cohort with TBI codes but no ED visit or CT or MRI scan was derived to capture diagnoses in nonhospital settings. Descriptive statistics and bivariate associations of TBI with demographic and SDOH characteristics used sample weights. Fine-Gray regression models estimated associations between covariates and TBI, with death as a competing risk. Imputation considering outcome and complex survey design was performed by race and ethnicity, sex, education level, and Area Deprivation Index percentiles 1, 50, and 100. Other exposure variables were fixed at their weighted means.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi240486-9\"><jats:title>Results<\/jats:title><jats:p>Among 9239 eligible respondents, 5258 (57.7%) were female and 1210 (9.1%) were Black, 574 (4.7%) were Hispanic, and 7297 (84.4%) were White. Mean (SD) baseline age was 75.2 (8.0) years. During follow-up (18 years), 797 (8.9%) of respondents received an incident TBI diagnosis with an ED visit and a CT code within 1 day, 964 (10.2%) received an incident TBI diagnosis and an ED code, and 1148 (12.9%) received a TBI code with or without an ED visit and CT scan code. Compared with respondents without incident TBI, respondents with TBI were more likely to be female (absolute difference, 7.0 [95% CI, 3.3-10.8]; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt; .001) and White (absolute difference, 5.1 [95% CI, 2.8-7.4]; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001), have normal cognition (vs cognitive impairment or dementia; absolute difference, 6.1 [95% CI, 2.8-9.3]; <jats:italic>P<\/jats:italic>\u2009=\u2009.001), higher education (absolute difference, 3.8 [95% CI, 0.9-6.7]; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001), and wealth (absolute difference, 6.5 [95% CI, 2.3-10.7]; <jats:italic>P<\/jats:italic>\u2009=\u2009.01), and be without baseline lung disease (absolute difference, 5.1 [95% CI, 3.0-7.2]; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001) or functional impairment (absolute difference, 3.3 [95% CI, 0.4-6.1]; <jats:italic>P<\/jats:italic>\u2009=\u2009.03). In adjusted multivariate models, lower education (subdistribution hazard ratio [SHR], 0.73 [95% CI, 0.57-0.94]; <jats:italic>P<\/jats:italic>\u2009=\u2009.01), Black race (SHR, 0.61 [95% CI, 0.46-0.80]; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001), area deprivation index national rank (SHR 1.00 [95% CI 0.99-1.00]; <jats:italic>P<\/jats:italic>\u2009=\u2009.009), and male sex (SHR, 0.73 [95% CI, 0.56-0.94]; <jats:italic>P<\/jats:italic>\u2009=\u2009.02) were associated with membership in the group without TBI. Sensitivity analyses using a broader definition of TBI yielded similar results.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi240486-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In this longitudinal cohort study of older adults, almost 13% experienced incident TBI during the 18-year study period. For older adults who seek care for TBI, race and ethnicity, sex, and SDOH factors may be associated with incidence of TBI, seeking medical attention for TBI in older adulthood, or both.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.14223","type":"journal-article","created":{"date-parts":[[2024,5,31]],"date-time":"2024-05-31T15:33:01Z","timestamp":1717169581000},"page":"e2414223","source":"Crossref","is-referenced-by-count":25,"title":["Incidence of Traumatic Brain Injury in a Longitudinal Cohort of Older Adults"],"prefix":"10.1001","volume":"7","author":[{"given":"Erica","family":"Kornblith","sequence":"first","affiliation":[{"name":"San Francisco Veterans Affairs Health Care System, San Francisco, California"},{"name":"Department of Psychiatry, University of California San Francisco, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. 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John","family":"Boscardin","sequence":"additional","affiliation":[{"name":"San Francisco Veterans Affairs Health Care System, San Francisco, California"},{"name":"Department of Medicine, University of California, San Francisco, San Francisco"},{"name":"Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raquel C.","family":"Gardner","sequence":"additional","affiliation":[{"name":"Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2024,5,31]]},"reference":[{"issue":"10","key":"zoi240486r1","doi-asserted-by":"publisher","first-page":"1590","DOI":"10.1111\/jgs.2006.54.issue-10","article-title":"Traumatic brain injury in older adults: epidemiology, outcomes, and future implications.","volume":"54","author":"Thompson","year":"2006","journal-title":"J Am 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