Sex Differences in Profiles and Outcomes of Patients with Traumatic Brain Injury in a National Rehabilitation Sample Dr. Angela Colantonio PhD, OT Reg. (Ont), FACRM CIHR Research Chair in Gender, Work and Health Vincy Chan MPH, PhD Candidate Tatyana Mollayeva PhD 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

Methods Sample:  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)

Methods Key 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 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 & Cognitive Rating at Discharge

Comorbid Health Condition at Admission 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 Statistics Significance: *p<.05, **p<.01, ***p<.001

Proportion with Mental Health Conditions at Admission Statistics Significance: *p<.05, **p<.01, ***p<.001

Comorbid Health Condition at Discharge 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

Summary  There 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 ) Support for Vincy Chan: CIHR, Ontario Neurotrauma Foundation, Brain Canada, Pediatric Oncology Group of Ontario, CIBC Support for Tatyana Mollayeva: CIHR Acknowledgements