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2023 HSR&D/QUERI National Conference Abstract

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1197 — Racial/Ethnic and Geographic Disparities in Comorbid Traumatic Brain Injury (TBI)-Renal Failure (RF) in US Veterans and Associated VA Costs

Lead/Presenter: Clara Dismuke-Greer,  Resource Center - HERC
All Authors: Dismuke-Greer CE (Health Economics Resource Center, VA Palo Alto Health Care System), Esmaeili A (Health Economics Resource Center (HERC), VA Palo Alto Healthcare System) Ozieh M (Center for Advancing Population Science and Department of Medicine, Division of Nephrology, Medical College of Wisconsin, and Division of Nephrology, Clement J. Zablocki VA Medical Center, Milwaukee, WI) Gujral K (Health Economics Resource Center (HERC), VA Palo Alto Healthcare System) Garcia C (Health Economics Resource Center (HERC), VA Palo Alto Healthcare System) Davis B (Department of English Emerita, College of Liberal Arts & Sciences, The University of North Carolina at Charlotte, Charlotte, NC) Egede LE (Department of Medicine, Division of General Internal Medicine, and Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI)

Objectives:
Non-Hispanic Black (NHB) race, Hispanic/Latino (H/L) ethnicity, and US Territory (UST) residence have been found to be associated with higher severity and lower survival of US veterans diagnosed with traumatic brain injury (TBI). TBI has been shown to increase the risk of renal failure (RF). We examined race/ethnicity and urban/rural/UST residence with onset of RF in veterans with and without TBI. We also examined racial/ethnic and geographic disparities in Veterans Administration (VA) TBI+RF resource cost, 2000-2020.

Methods:
We estimated Cox Proportional Hazards models for risk of RF, and generalized estimating equations (XTGEE) for inpatient, outpatient, and pharmacy cost annually and time since TBI+RF diagnosis.

Results:
TBI only had the highest percentage of H/L veterans (8.6%), while the TBI+RF cohort had the highest percentage of NHB veterans (19.2%). NHB veterans had the highest race/ethnicity HR (1.41) for risk of RF, with the highest HR for those < 65 (1.49). UST veterans had the highest geographic HR (1.71) for RF, with the highest for those < 65 (1.65). NHB (-$5,171), H/L (-$3,158) and UST (-$3,185) veterans received significantly fewer annual VA resources for veterans < 65.

Implications:
TBI+RF had a higher prevalence in NHB and US territory veterans. While TBI+RF veterans had higher resource use than TBI alone, NHB, H/L and UST veterans < 65 received fewer resources. Prevention of RF in veterans with TBI, especially NHB and UST veterans, should be a priority. Whether lower VA resource use may be contributing to poorer clinical outcomes of NHB, H/L and UST veterans should be investigated.

Impacts:
Previous literature has identified veterans diagnosed with TBI living in US Territories to have higher mortality rates. Our study found that these veterans along with Non-Hispanic Black veterans have a higher risk of comorbid TBI and Renal Failure. Despite their higher risk, US Territory and non-Hispanic Black veterans along with Hispanic/Latino veterans < 65 receive fewer VA resources.