Disparities between Native Americans and Whites in trajectories of functional independence and life satisfaction over the 5 years after traumatic brain injury.

Abstract

Purpose: Traumatic brain injury (TBI) can lead to impairments in motor and cognitive function and reduced life satisfaction. TBI is one of the leading causes of death and disability worldwide and disproportionately affects Native Americans, who have the highest rates of TBI among all races in the United States and elevated likelihood for fatality and severe complications. This study investigated whether disparities in functional and life satisfaction outcomes exist longitudinally over the 5 years after complicated mild, moderate, or severe TBI between Native Americans and White individuals; it further explored which demographic and injury-related covariates account for them.

Research method: The current study used a subsample of the national TBI Model Systems Database of 80 demographically and injury-severity matched Native American and White pairs (total n = 160).

Results: A series of longitudinal hierarchical linear models found that Native Americans experienced significantly lower Functional Independence Measure Cognitive and Motor trajectories than Whites; however, life satisfaction was comparable. Native Americans had declining cognitive function over time relative to a slight increase in White individuals. This differential movement dissipated with the addition of employment status at the time of injury and type of health insurance.

Conclusions: These results demonstrate a profound need to further investigate the cultural and contextual variables unique to Native Americans that underlie these differences and highlight the importance of culturally responsive treatment and rehabilitation in bridging the gap in recovery. (PsycInfo Database Record (c) 2025 APA, all rights reserved).