{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T04:53:02Z","timestamp":1789275182564,"version":"build-2803163510"},"reference-count":65,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Neurosurg Rev"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Traumatic brain injury (TBI) represents a significant public health burden, particularly among American Indian and Alaska Native (AI\/AN) populations in the United States, and particularly in the State of Alaska. This systematic review aims to evaluate the incidence, risk factors, outcomes, and healthcare disparities associated with TBI in this population and to identify strategies for prevention and improved management.\u00a0Following PRISMA guidelines, we conducted a systematic review of Medline\/PubMed, Google Scholar, Web of Science, Scopus, and Embase through May 2025. Inclusion criteria targeted studies involving AI\/AN populations in the United States that reported on epidemiology, causes of injury, hospitalization, and mortality rates, as well as healthcare access. Data were extracted and synthesized qualitatively as we summarized, compared, and interpreted findings narratively based on common patterns and themes. The NIH Quality Assessment Tool was used to evaluate the quality of the included studies.\u00a0Fourteen studies met the inclusion criteria. AI\/ANs exhibited significantly higher TBI-related emergency visits (1,026 per 100,000), hospitalizations (186.7 per 100,000), and mortality rates (up to 65.9 per 100,000) compared to other racial groups. Leading causes included motor vehicle accidents, falls, and self-harm. Geographic isolation, limited neurosurgical infrastructure, and mistrust towards non-Native healthcare providers exacerbated disparities. Interventions like telemedicine, community health training, and culturally sensitive healthcare were identified as potential solutions.\u00a0AI\/AN populations, particularly those residing in the state of Alaska, face significantly higher incidence and worse outcomes from TBI due to systemic healthcare barriers and regional challenges. These disparities necessitate a multifaceted, culturally informed approach that encompasses enhanced access to care, preventive strategies, and collaboration with tribal health organizations to mitigate the burden of TBI and improve long-term outcomes.<\/jats:p>","DOI":"10.1007\/s10143-025-03817-2","type":"journal-article","created":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T01:59:50Z","timestamp":1759283990000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Traumatic brain injury among American indians\/alaska natives in the united states: a comprehensive systematic review of the literature"],"prefix":"10.1007","volume":"48","author":[{"given":"Laurel A.","family":"Seltzer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed A.","family":"Fouda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan C.","family":"Pannullo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,1]]},"reference":[{"key":"3817_CR1","unstructured":"(2011) Brain Injury Association of America. BIAA Adopts New TBI Definition. 2011. https:\/\/www.biausa.org\/public-affairs\/public-awareness\/news\/biaa-adopts-new-tbi-definition"},{"key":"3817_CR2","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1007\/s11011-015-9651-7","volume":"30","author":"H Alluri","year":"2015","unstructured":"Alluri H, Wiggins-Dohlvik K, Davis ML, Huang JH, Tharakan B (2015) Blood\u2013brain barrier dysfunction following traumatic brain injury. Metab Brain Dis 30:1093\u20131104","journal-title":"Metab Brain Dis"},{"key":"3817_CR3","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1089\/neu.2021.0455","volume":"40","author":"J Maldonado","year":"2023","unstructured":"Maldonado J, Huang JH, Childs EW, Tharakan B (2023) Racial\/ethnic differences in traumatic brain injury: pathophysiology, outcomes, and future directions. J Neurotrauma 40:502\u2013513","journal-title":"J Neurotrauma"},{"key":"3817_CR4","doi-asserted-by":"crossref","first-page":"1834","DOI":"10.1089\/neu.2014.3352","volume":"32","author":"HM Bramlett","year":"2015","unstructured":"Bramlett HM, Dietrich WD (2015) Long-term consequences of traumatic brain injury: current status of potential mechanisms of injury and neurological outcomes. J Neurotrauma 32:1834\u20131848","journal-title":"J Neurotrauma"},{"key":"3817_CR5","doi-asserted-by":"crossref","first-page":"e0174847","DOI":"10.1371\/journal.pone.0174847","volume":"12","author":"K McInnes","year":"2017","unstructured":"McInnes K, Friesen CL, MacKenzie DE, Westwood DA, Boe SG (2017) Mild traumatic brain injury (mTBI) and chronic cognitive impairment: a scoping review. PLoS ONE 12:e0174847","journal-title":"PLoS ONE"},{"key":"3817_CR6","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.3171\/2017.10.JNS17352","volume":"130","author":"MC Dewan","year":"2019","unstructured":"Dewan MC, Rattani A, Gupta S, Baticulon RE, Hung YC, Punchak M, Agrawal A, Adeleye AO, Shrime MG, Rubiano AM, Rosenfeld JV, Park KB (2019) Estimating the global incidence of traumatic brain injury. J Neurosurg 130:1080\u20131097","journal-title":"J Neurosurg"},{"key":"3817_CR7","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1016\/j.injury.2014.12.023","volume":"46","author":"JC Lee","year":"2015","unstructured":"Lee JC, Rittenhouse K, Bupp K, Gross B, Rogers A, Rogers FB, Horst M, Estrella L, Thurmond J (2015) An analysis of Brain Trauma Foundation traumatic brain injury guideline compliance and patient outcome. Injury 46:854\u2013858","journal-title":"Injury"},{"key":"3817_CR8","doi-asserted-by":"crossref","unstructured":"Newell K, Parrish J, McLaughlin J (2025) Traumatic Brain Injury, Alaska, 2016\u20132021. Public Health Reports\u00ae: 00333549241309802","DOI":"10.1177\/00333549241309802"},{"key":"3817_CR9","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/j.jsr.2019.09.017","volume":"71","author":"AB Peterson","year":"2019","unstructured":"Peterson AB, Sarmiento K, Xu L, Haileyesus T (2019) Traumatic brain injury-related hospitalizations and deaths among American Indians and Alaska natives\u2014United states, 2008\u20132014. J Saf Res 71:315\u2013318","journal-title":"J Saf Res"},{"key":"3817_CR10","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1016\/j.jsr.2022.10.001","volume":"83","author":"AB Peterson","year":"2022","unstructured":"Peterson AB, Zhou H, Thomas KE (2022) Disparities in traumatic brain injury-related deaths\u2014United States, 2020. J Saf Res 83:419\u2013426","journal-title":"J Saf Res"},{"key":"3817_CR11","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1146\/annurev-publhealth-032315-021439","volume":"37","author":"K Fiscella","year":"2016","unstructured":"Fiscella K, Sanders MR (2016) Racial and ethnic disparities in the quality of health care. Annu Rev Public Health 37:375\u2013394","journal-title":"Annu Rev Public Health"},{"key":"3817_CR12","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1080\/02699050410001720158","volume":"19","author":"JJ Bazarian","year":"2005","unstructured":"Bazarian JJ, Mcclung J, Shah MN, Ting Cheng Y, Flesher W, Kraus J (2005) Mild traumatic brain injury in the United States, 1998\u20132000. Brain Inj 19:85\u201391","journal-title":"Brain Inj"},{"key":"3817_CR13","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.15585\/mmwr.mm6846a2","volume":"68","author":"J Daugherty","year":"2019","unstructured":"Daugherty J, Waltzman D, Sarmiento K, Xu L (2019) Traumatic brain injury-related deaths by race\/ethnicity, sex, intent, and mechanism of injury - United states, 2000\u20132017. MMWR Morb Mortal Wkly Rep 68:1050\u20131056","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"3817_CR14","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/00001199-200505000-00004","volume":"20","author":"W Rutland-Brown","year":"2005","unstructured":"Rutland-Brown W, Wallace LD, Faul MD, Langlois JA (2005) Traumatic brain injury hospitalizations among American Indians\/Alaska Natives. J Head Trauma Rehabil 20:205\u2013214","journal-title":"J Head Trauma Rehabil"},{"key":"3817_CR15","doi-asserted-by":"crossref","first-page":"2057","DOI":"10.1089\/neu.2013.3091","volume":"30","author":"AO Asemota","year":"2013","unstructured":"Asemota AO, George BP, Cumpsty-Fowler CJ, Haider AH, Schneider EB (2013) Race and insurance disparities in discharge to rehabilitation for patients with traumatic brain injury. J Neurotrauma 30:2057\u20132065","journal-title":"J Neurotrauma"},{"key":"3817_CR16","doi-asserted-by":"crossref","first-page":"260","DOI":"10.5539\/gjhs.v8n2p260","volume":"8","author":"CE Dismuke","year":"2015","unstructured":"Dismuke CE, Gebregziabher M, Egede LE (2015) Racial\/ethnic disparities in VA services utilization as a partial pathway to mortality differentials among veterans diagnosed with TBI. Glob J Health Sci 8:260\u2013272","journal-title":"Glob J Health Sci"},{"key":"3817_CR17","doi-asserted-by":"crossref","first-page":"595","DOI":"10.3171\/2014.10.JNS14187","volume":"122","author":"AD Meagher","year":"2015","unstructured":"Meagher AD, Beadles CA, Doorey J, Charles AG (2015) Racial and ethnic disparities in discharge to rehabilitation following traumatic brain injury. J Neurosurg 122:595\u2013601","journal-title":"J Neurosurg"},{"key":"3817_CR18","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1055\/s-0034-1543958","volume":"76","author":"M Schiraldi","year":"2015","unstructured":"Schiraldi M, Patil CG, Mukherjee D, Ugiliweneza B, Nu\u00f1o M, Lad SP, Boakye M (2015) Effect of insurance and racial disparities on outcomes in traumatic brain injury. J Neurol Surg Cent Eur Neurosurg 76:224\u2013232","journal-title":"J Neurol Surg Cent Eur Neurosurg"},{"key":"3817_CR19","first-page":"1138","volume":"63","author":"S Shafi","year":"2007","unstructured":"Shafi S, de la Plata CM, Diaz-Arrastia R, Bransky A, Frankel H, Elliott AC, Parks J, Gentilello LM (2007) Ethnic disparities exist in trauma care. J Trauma 63:1138\u20131142","journal-title":"J Trauma"},{"key":"3817_CR20","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1055\/s-0039-3402581","volume":"11","author":"JK Yue","year":"2020","unstructured":"Yue JK, Upadhyayula PS, Avalos LN, Phelps RR, Suen CG, Cage TA (2020) Concussion and mild-traumatic brain injury in rural settings: epidemiology and specific health care considerations. J Neurosciences Rural Pract 11:23","journal-title":"J Neurosciences Rural Pract"},{"key":"3817_CR21","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7041a3","author":"J Daugherty","year":"2021","unstructured":"Daugherty J (2021) Differences in state traumatic brain injury\u2013related deaths, by principal mechanism of injury, intent, and percentage of population living in rural areas\u2014United states, 2016\u20132018. MMWR Morb Mortal Wkly Rep. https:\/\/doi.org\/10.15585\/mmwr.mm7041a3","journal-title":"MMWR; Morbidity and Mortality Weekly Report"},{"key":"3817_CR22","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.109-5563","author":"Y Fedyanova","year":"2018","unstructured":"Fedyanova Y (2018) Incentivizing young doctors to practise in underserved areas. CMAJ. https:\/\/doi.org\/10.1503\/cmaj.109-5563","journal-title":"CMAJ"},{"key":"3817_CR23","first-page":"715","volume":"62","author":"AB Valadka","year":"2008","unstructured":"Valadka AB (2008) Neurosurgical emergency transfers to academic centers in cook county: a prospective multicenter study-Commentary. Neurosurgery 62:715","journal-title":"Neurosurgery"},{"key":"3817_CR24","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1016\/j.annemergmed.2021.09.433","volume":"79","author":"J Daugherty","year":"2022","unstructured":"Daugherty J, Sarmiento K, Waltzman D, Xu L (2022) Traumatic brain injury\u2013related hospitalizations and deaths in urban and rural counties\u20142017. Ann Emerg Med 79:288\u2013296 e281","journal-title":"Ann Emerg Med"},{"key":"3817_CR25","first-page":"58","volume":"46","author":"F Sacco","year":"2004","unstructured":"Sacco F, Zafren K, Brown K, Cohen T, Coopes B, Godersky J, Hudson D, Hyams S, Ingraham D, Levy M (2004) Guidelines for the management of head injuries in remote and rural Alaska. Alaska Med 46:58\u201362","journal-title":"Alaska Med"},{"key":"3817_CR26","doi-asserted-by":"crossref","unstructured":"Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. bmj 372","DOI":"10.1136\/bmj.n71"},{"key":"3817_CR27","unstructured":"National Heart L, Institute B (2014) Study Quality Assessment Tools. U.S. Department of Health and Human Services, National Institutes of Health. https:\/\/www.nhlbi.nih.gov\/health-topics\/study-quality-assessment-tools. Accessed Date Accessed 2014 Accessed"},{"key":"3817_CR28","first-page":"1","volume":"51","author":"N Adekoya","year":"2002","unstructured":"Adekoya N, Thurman DJ, White DD, Webb KW (2002) Surveillance for traumatic brain injury deaths\u2013United states, 1989\u20131998. MMWR Surveill Summ 51:1\u201314","journal-title":"MMWR Surveill Summ"},{"key":"3817_CR29","first-page":"1","volume":"60","author":"VG Coronado","year":"2011","unstructured":"Coronado VG, Xu L, Basavaraju SV, McGuire LC, Wald MM, Faul MD, Guzman BR, Hemphill JD (2011) Surveillance for traumatic brain injury-related deaths\u2013United states, 1997\u20132007. MMWR Surveill Summ 60:1\u201332","journal-title":"MMWR Surveill Summ"},{"key":"3817_CR30","first-page":"1","volume":"52","author":"JA Langlois","year":"2003","unstructured":"Langlois JA, Kegler SR, Butler JA, Gotsch KE, Johnson RL, Reichard AA, Webb KW, Coronado VG, Selassie AW, Thurman DJ (2003) Traumatic brain injury-related hospital discharges. Results from a 14-state surveillance system, 1997. MMWR Surveill Summ 52:1\u201320","journal-title":"MMWR Surveill Summ"},{"key":"3817_CR31","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1097\/MLR.0b013e31803dcdf3","volume":"45","author":"SM Bowman","year":"2007","unstructured":"Bowman SM, Martin DP, Sharar SR, Zimmerman FJ (2007) Racial disparities in outcomes of persons with moderate to severe traumatic brain injury. Med Care 45:686\u2013690","journal-title":"Med Care"},{"key":"3817_CR32","unstructured":"(2002) Centers for disease control prevention. Traumatic brain injury among American indians\/alaska Natives\u2013United states, 1992\u20131996. MMWR: Morbidity Mortal Wkly Rep 51: 303\u2013305"},{"key":"3817_CR33","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1136\/injuryprev-2014-041419","volume":"21","author":"MJ Hoopes","year":"2015","unstructured":"Hoopes MJ, Dankovchik J, Weiser T, Cheng T, Bigback K, Knaster ES, Sugerman DE (2015) Uncovering a missing demographic in trauma registries: epidemiology of trauma among American Indians and Alaska natives in Washington state. Inj Prev 21:335\u2013343","journal-title":"Inj Prev"},{"key":"3817_CR34","doi-asserted-by":"crossref","first-page":"639","DOI":"10.3109\/02699052.2014.989406","volume":"29","author":"KF Linton","year":"2015","unstructured":"Linton KF (2015) Interpersonal violence and traumatic brain injuries among Native Americans and women. Brain Inj 29:639\u2013643","journal-title":"Brain Inj"},{"key":"3817_CR35","doi-asserted-by":"crossref","first-page":"E441","DOI":"10.1097\/HTR.0000000000000570","volume":"35","author":"K Sarmiento","year":"2020","unstructured":"Sarmiento K, Kennedy J, Daugherty J, Peterson AB, Evans ME, Haberling DL, Billie H (2020) Traumatic brain injury-related emergency department visits among American Indian and Alaska native persons\u2014national patient information reporting system, 2005\u20132014. J Head Trauma Rehabil 35:E441\u2013E449","journal-title":"J Head Trauma Rehabil"},{"key":"3817_CR36","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.1093\/geront\/gny101","volume":"59","author":"YA Johnston","year":"2019","unstructured":"Johnston YA, Bergen G, Bauer M, Parker EM, Wentworth L, McFadden M, Reome C, Garnett M (2019) Implementation of the stopping elderly accidents, deaths, and injuries initiative in primary care: an outcome evaluation. Gerontologist 59:1182\u20131191","journal-title":"Gerontologist"},{"key":"3817_CR37","unstructured":"Helmets On Heads. Safety info: focal points (2024) https:\/\/www.helmetsonheads.com\/safetyinfo"},{"key":"3817_CR38","unstructured":"Alaska Native Tribal Health Consortium. Helmets on (2024). https:\/\/www.anthc.org\/whatwedo\/wellness\/helmetson"},{"key":"3817_CR39","unstructured":"Alaska Native Tribal Health Consortium. Helmets On part 2: ATV safety course and injury prevention in New Stuyahok follow near-fatal crash (2024) https:\/\/www.anthc.org\/news\/helmets-on-part-2-atv-safetycourse-and-injury-prevention-in-new-stuyahok-follow-nearfatal-crash"},{"key":"3817_CR40","unstructured":"Alaska Native Tribal Health Consortium. Alaska Native Injury Atlas: An Update (2014) http:\/\/anthctoday.org\/epicenter\/publications\/InjuryAtlas\/Alaska%20Native%20Injury%20Atlas%20-%20Full_101314.pdf"},{"key":"3817_CR41","unstructured":"Alaska Department of Health (2024) Alaska fall-related injury prevention. https:\/\/health.alaska.gov\/dph\/Chronic\/Pages\/InjuryPrevention\/falls\/default.aspx"},{"key":"3817_CR42","unstructured":"Alaska Department of Health (2022) Alaska senior fall prevention. https:\/\/health.alaska.gov\/acoa\/pages\/falls\/default.aspx"},{"key":"3817_CR43","unstructured":"Alaska Native Tribal Health Consortium. Behavioral health aide program (2022) https:\/\/www.anthc.org\/behavioral-health-aide-program"},{"key":"3817_CR44","unstructured":"Substance Abuse and Mental Health Services Administration. SAMHSA native connections (2022) https:\/\/www.samhsa.gov\/native-connections"},{"key":"3817_CR45","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1007\/s10464-014-9651-5","volume":"54","author":"SM Rasmus","year":"2014","unstructured":"Rasmus SM, Charles B, Mohatt GV (2014) Creating Qungasvik (a yup\u2019ik intervention toolbox): case examples from a community-developed and culturally-driven intervention. Am J Community Psychol 54:140\u2013152","journal-title":"Am J Community Psychol"},{"key":"3817_CR46","unstructured":"Statewide Suicide Prevention Council (2023) Messages of hope: promoting wellness to prevent suicide in alaska, 2023\u20132027 statewide suicide prevention plan. https:\/\/health.alaska.gov\/SuicidePrevention\/Documents\/230301_StatePlan_SuicidePrevention.pdf"},{"key":"3817_CR47","unstructured":"Alaska Native Tribal Health Consortium. Suicide prevention (2024) https:\/\/www.anthc.org\/what-we-do\/behavioral-health\/suicide-prevention"},{"key":"3817_CR48","unstructured":"Alaska Native Tribal Health Consortium. Behavioral health wellness clinic (2024) https:\/\/www.anthc.org\/departments\/behavioral-health-wellnessclinic\/welcome"},{"key":"3817_CR49","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1080\/19371918.2015.1087920","volume":"31","author":"KF Linton","year":"2016","unstructured":"Linton KF, Jung Kim B (2016) The moderation of blood alcohol levels on higher odds of survival among American Indians with violent, blunt-force traumatic brain injuries. Soc Work Public Health 31:168\u2013174","journal-title":"Soc Work Public Health"},{"key":"3817_CR50","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.3109\/02699052.2014.901558","volume":"28","author":"KF Linton","year":"2014","unstructured":"Linton KF, Kim BJ (2014) Traumatic brain injury as a result of violence in Native American and Black communities spanning from childhood to older adulthood. Brain Inj 28:1076\u20131081","journal-title":"Brain Inj"},{"key":"3817_CR51","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1053\/apmr.2003.50096","volume":"84","author":"RA Hanks","year":"2003","unstructured":"Hanks RA, Wood DL, Millis S, Harrison-Felix C, Pierce CA, Rosenthal M, Bushnik T, High WM Jr, Kreutzer J (2003) Violent traumatic brain injury: occurrence, patient characteristics, and risk factors from the traumatic brain injury model systems project. Arch Phys Med Rehabil 84:249\u2013254","journal-title":"Arch Phys Med Rehabil"},{"key":"3817_CR52","unstructured":"Faul M, Wald MM, Xu L, Coronado VG (2010) Traumatic brain injury in the United States: Emergency department visits, hospitalizations, and deaths, 2002\u20132006"},{"key":"3817_CR53","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1023\/B:AIBE.0000017524.40093.6b","volume":"8","author":"JM Simoni","year":"2004","unstructured":"Simoni JM, Sehgal S, Walters KL (2004) Triangle of risk: urban American Indian women\u2019s sexual trauma, injection drug use, and HIV sexual risk behaviors. AIDS Behav 8:33\u201345","journal-title":"AIDS Behav"},{"key":"3817_CR54","doi-asserted-by":"crossref","first-page":"1515","DOI":"10.2105\/AJPH.88.10.1515","volume":"88","author":"DG Fairchild","year":"1998","unstructured":"Fairchild DG, Fairchild MW, Stoner S (1998) Prevalence of adult domestic violence among women seeking routine care in a Native American health care facility. Am J Public Health 88:1515\u20131517","journal-title":"Am J Public Health"},{"key":"3817_CR55","unstructured":"DeVoe JF, Darling-Churchill KE (2008) Status and trends in the education of American Indians and Alaska natives: 2008. NCES 2008-084. National Center for Education Statistics"},{"key":"3817_CR56","unstructured":"Ogunwole SU (2006) We the people: American Indians and Alaska natives in the United States. US Department of Commerce, Economics and Statistics Administration, US &#8230"},{"key":"3817_CR57","doi-asserted-by":"crossref","first-page":"10","DOI":"10.4103\/jnrp.jnrp_310_18","volume":"10","author":"JB Brown","year":"2019","unstructured":"Brown JB, Kheng M, Carney NA, Rubiano AM, Puyana JC (2019) Geographical disparity and traumatic brain injury in America: rural areas suffer poorer outcomes. J Neurosciences Rural Pract 10:10","journal-title":"J Neurosciences Rural Pract"},{"key":"3817_CR58","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1097\/HTR.0b013e3181d36ca3","volume":"25","author":"JC Arango-Lasprilla","year":"2010","unstructured":"Arango-Lasprilla JC, Kreutzer JS (2010) Racial and ethnic disparities in functional, psychosocial, and neurobehavioral outcomes after brain injury. J Head Trauma Rehabil 25:128\u2013136","journal-title":"J Head Trauma Rehabil"},{"key":"3817_CR59","first-page":"133","volume":"9","author":"MM Fuentes","year":"2016","unstructured":"Fuentes MM, Jimenez N, Apkon SD, Rivara FP (2016) Functional outcomes during inpatient rehabilitation for American Indian and Alaska Native children with traumatic brain injury. J Pediatr Rehabil Med 9:133\u2013141","journal-title":"J Pediatr Rehabil Med"},{"key":"3817_CR60","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1093\/aje\/154.11.1037","volume":"154","author":"DM Bensyl","year":"2001","unstructured":"Bensyl DM, Moran K, Conway GA (2001) Factors associated with pilot fatality in work-related aircraft crashes, Alaska, 1990\u20131999. Am J Epidemiol 154:1037\u20131042","journal-title":"Am J Epidemiol"},{"key":"3817_CR61","first-page":"434","volume":"21","author":"A-K Ahmed","year":"2018","unstructured":"Ahmed A-K, Duhaime A-C, Smith TR (2018) Geographic proximity to specialized pediatric neurosurgical care in the contiguous united States. J Neurosurgery: Pediatr 21:434\u2013438","journal-title":"J Neurosurgery: Pediatr"},{"key":"3817_CR62","doi-asserted-by":"crossref","first-page":"1162","DOI":"10.1227\/NEU.0b013e3182245989","volume":"69","author":"KM Fargen","year":"2011","unstructured":"Fargen KM, Chakraborty A, Friedman WA (2011) Results of a national neurosurgery resident survey on duty hour regulations. Neurosurgery 69:1162\u20131170","journal-title":"Neurosurgery"},{"key":"3817_CR63","doi-asserted-by":"crossref","first-page":"e305","DOI":"10.1016\/j.wneu.2021.02.127","volume":"150","author":"PJ Gabriel","year":"2021","unstructured":"Gabriel PJ, Alexander J, K\u0101rkli\u0146a A (2021) Diversity in neurosurgery: trends in gender and racial\/ethnic representation among applicants and residents from US neurological surgery residency programs. World Neurosurg 150:e305\u2013e315","journal-title":"World Neurosurg"},{"key":"3817_CR64","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2020.24583","volume":"3","author":"J Takeshita","year":"2020","unstructured":"Takeshita J, Wang S, Loren AW, Mitra N, Shults J, Shin DB, Sawinski DL (2020) Association of racial\/ethnic and gender concordance between patients and physicians with patient experience ratings. JAMA Netw Open 3:e2024583\u2013e2024583","journal-title":"JAMA Netw Open"},{"key":"3817_CR65","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1353\/hpu.2020.0012","volume":"31","author":"E Idan","year":"2020","unstructured":"Idan E, Xing A, Ivory J, Alsan M (2020) Sociodemographic correlates of medical mistrust among African American men living in the East Bay. J Health Care Poor Underserved 31:115\u2013127","journal-title":"J Health Care Poor Underserved"}],"container-title":["Neurosurgical Review"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10143-025-03817-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10143-025-03817-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10143-025-03817-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T04:14:54Z","timestamp":1772079294000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10143-025-03817-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,1]]},"references-count":65,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["3817"],"URL":"https:\/\/doi.org\/10.1007\/s10143-025-03817-2","relation":{},"ISSN":["1437-2320"],"issn-type":[{"value":"1437-2320","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,1]]},"assertion":[{"value":"20 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 August 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 August 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 October 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"674"}}