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2023 HSR&D/QUERI National Conference Abstract

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1142 — Social Determinants of Service Connected TBI and VA Compensation

Lead/Presenter: Clara Dismuke-Greer,  Resource Center - HERC
All Authors: Dismuke-Greer CE (Health Economics Resource Center (HERC), VA Palo Alto Health Care System), Esmaeili A (Health Economics Resource Center (HERC),VA Palo Alto Health Care System, Palo Alto, CA ) Amuan M (IDEAS Center VA Salt Lake City, Salt Lake City, UT) DePalma R (Office of Research and Development, US Department of Veterans Affairs; Department of Surgery, Uniform Services University of the Health Sciences, Washington DC) Cifu D (Department of Physical Rehabilitation, Virginia Commonwealth University; US Department of Veterans Affairs, Richmond VA) Pugh MJ (IDEAS Center VA Salt Lake City, Salt Lake City, UT)

Objectives:
To examine social determinants of service-connected-disability (SCD) Traumatic Brain Injury (TBI) and Veterans Administration (VA) compensation in a cohort of 1.5 million veterans with and without TBI. We compared the most recent VA compensation for Veterans with TBI SCD compared with veterans without SCD TBI.

Methods:
Our retrospective observational cohort study used administrative data from electronic health records of VHA using veterans since the first TBI diagnosis in VA or DoD post 9/11. Veteran demographic and military characteristics were identified using VINCI CDW databases, and SCD compensation in 2022 using VETSNET databases. We used logit models to examine the association of veteran demographics and military characteristics with the likelihood of SCD TBI and generalized linear models to identify the association of SCD TBI, veteran demographics, and military characteristics with monthly SCD compensation in 2022.

Results:
In this cohort of 1,207,751 without SCD TBI and 92,637 with SCD TBI Post-9/11 era Veterans, mean (median) unadjusted monthly compensation for veterans without SCD TBI was $1,940 ($1,778) vs $2,281 ($2,035) for those with SCD TBI. The highest monthly comensation was $10,411 for non-TBI and $10,248 for those with TBI. Asian American Pacific Islanders (AAPI) (OR 1.17, 95% CI 1.14:1.20) and Native Americans (NA) (OR 1.08, 95% CI 1.02:1.13) had the highest odds of TBI SCD relative to non-Hispanic White (NHW) veterans. Veterans residing in US Territories (UST) (OR 1.22, 95% CI 1.01:1.48) had the highest odds for TBI SCD relative to veterans living in urban mainland (UM) areas, while those who lived in the Mountain Region of the US had the highest odds (OR 1.06, 95% CI 1.02:1.11) relative to New England. Veterans who were high school educated or less, deployed, had combat exposure, enlisted, and had Army service had the highest odds for TBI SCD. Veterans with SCD TBI were compensated approximately $481 higher per month in fully adjusted models. Each non-TBI SCD condition contributed an extra $99 per month in compensation. AAPI and NA had a lower adjusted SCD compensation than Black Hispanic (BH), Black Non-Hispanic (BNH), and White Hispanic (WH) race/ethnicity. Rural and highly rural had significantly higher compensation than US Territory. Mountain areas also had significantly lower compensation. Less than high school education was associated with the highest compensation, relative to those with a college education.

Implications:
TBI SCD is associated with a higher SCD compensation in a cohort of 1.5 million veterans with and without SCD TBI. Despite having the highest risk of TBI SCD, AAPI and NA veterans had lower adjusted compensation relative to other race/ethnicity minority groups. Despite having the highest risk of TBI SCD, UST and Mountain veterans had the lowest compensation.

Impacts:
Our team is investigating methods to identify NA veterans living on Native American Lands/Reservations in order to estimate the geographic as well as race/ethnicity effect on risk of SCD TBI as well as SCD compensation. Since high school and less educated veterans have the highest risk of SCD TBI, education as part of TBI care could be an important factor.