| Research TBI Model Systems |
| Outcomes for African Americans and Whites: Similarities and Differences |
| The Question: How do preinjury characteristics and one-year outcomes compare for African Americans and Whites with traumatic brain injury? Are the differences in outcome due in part to unintended biases contained within outcome measurement techniques? Past Studies show that members of minority racial and ethnic groups are at the highest risk for traumatic brain injury. African Americans have the highest brain injury related death rates. Some studies state that following traumatic brain injury, members of minority groups have a more difficult time than whites in finding work and returning to social activities. Other studies disagree. Some researchers suggest that evaluation tools used by clinicians are to blame for the differences in scores. They suspect that the evaluation tools may be unintentionally biased against members of minority groups because they are written for and measure traits of the White culture. Researchers agree that it is important to obtain accurate information to clearly understand the ways in which race or ethnicity may be related to traumatic brain injury outcomes and the reasons for any observed differences. It is important that evaluation tools are culturally sensitive to all individuals to provide accurate information. By doing so, treatments and resources can be provided to all individuals with unmet needs. This study included 55 White and 39 African American individuals with moderate to severe traumatic brain injury. A biracial task force composed of White and African American professionals and family members reviewed the follow-up measures in this study. They identified questions and measures on which the two racial groups might differ for reasons unrelated to traumatic brain injury but related to cultural differences. The biracial task force added culturally sensitive questions to the standardized questionnaires to examine home and social activities. The researchers also obtained information about the individuals’ lives before their injuries from interviews and chart reviews. The purpose of this was to see if differences that existed before the injury would carry over to the outcome phase. The participants were contacted at one year after their injury dates and interviewed about the quality of their present lives and the things they were doing. The researchers compared the two groups’ preinjury and post-injury results. The researchers did not find differences in outcome due to biases contained within outcome measurement techniques. The two groups had similar preinjury characteristics and preinjury levels of productivity. At one year after their injury dates, the two groups reported mostly similar outcomes. Both groups reported an increase in depression symptoms, a decrease in employment, and a decrease in satisfaction with their lives. The biggest difference between the groups was in social and leisure time activities, even though they had been similar on this variable before their injuries. A year after injury, the African Americans reported having less contact with friends and less participation in leisure activities compared to Whites. African Americans were also more likely than Whites to change their living situation, such as moving in with different people, over the first year after injury. African Americans also seemed to lose more of their income after injury compared to Whites, although this needs to be confirmed in a study using more people. Who May Be Affected By These Findings: Individuals with traumatic brain injury, health care providers, researchers. Caveats: Although the African Americans in this study reported having less contact with friends and less participation in leisure activities, this doesn’t necessarily mean they had worse outcomes. Some of the participants, both African American and White, reported that they did not want to socialize with the people that they used to because those persons were “bad influences on them.” Changing neighborhoods and making a fresh start could account for some of these results. Further research is necessary to study cultural considerations in outcome studies. Bottom Line: Preinjury characteristics and one-year outcomes were generally similar for African Americans and Whites with traumatic brain injury who were all treated at the same Model System center. Although the groups did differ on level of social activity after injury, the researchers did not find evidence for biases contained within outcome measurement techniques. Find This Study: Hart, T., Whyte, J., Polansky, M., Kersey-Matusiak, G., & Fidler-Sheppard, R. (2005). Community outcomes following traumatic brain injury: Impact of race and preinjury status. Journal of Head Trauma Rehabilitation, 20, 158-172. |
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