American Indians Are More Likely to Survive Violent Traumatic Brain Injuries

American Indians (OR = 3.13) are more likely to experience traumatic brain injuries (TBIs) due to violence. Other research has also illustrated relationships between violence and TBIs among American Indians (Evans-Campbell, Lindhorst, Huang, & Walters, 2006). Research has found that patients’ race and substance use impacted their outcomes (Phelan et al., 2008). For example O’Dell and colleagues (2011) found that a history of alcoholism was associated with worse outcomes of TBI for whites and blacks, but more favorable outcomes for Hispanics. This study assessed the impact of American Indian race and substance use on outcomes among patients with violent TBIs.

Methods:A secondary data analysis of the Arizona Trauma Database 2008 - 2010 of patients with violent TBI was conducted (N = 3,551). Demographic variables were self-reported.  TBI etiology, blood-alcohol level above the legal limit (BAC+), and positive toxicology at the time of injury results were reported by medical professionals in emergency rooms. There were 652 (19.45%) American Indian, 188 (9.8%) black, and 1907 (56.9%) white patients. Other race patients were not included in analyses due to sample size samples. Most of the sample were males (83%, n = 2,780). Most of the patients were adults 18 - 65 (n= 2614; 78%).

Descriptive statistics, chi-squares, and t-tests were conducted. Demographic and substance use variables that were statistically significantly associated with survival were used in an initial logistic regression analyses. An interaction variable (BAC+_American Indian race) was added as a covariate in a second logistic regression model. All analyses were performed with PASW Statistics 18.

Results:Chi-square statistics indicated statistically significant differences between survival of those who used benzodiazepines (x² = 4.01; p = .04), BAC+ (t = -5.71; p = .000), and a history of alcoholism (x² = 8.58; p = .000). The initial logistic regression model indicated that those who were American Indian (OR = 1.76; p = .03), insured (OR = 2.75; p = .000), and had BAC+ (OR = 1.82; p = .001) had higher odds of in-hospital survival. Patients with higher injury severity (OR = 0.79; p = .000) and older patients were slightly less likely to survive (OR = 0.99; p = .031). The second logistic regression model, which included a statistically significant interaction between American Indian race and BAC+ (OR = 0.23; p = .007), had very similar results to the initial model with the exception of an increase of the OR between American Indian race and survival (OR = 3.89; p= .001).

Conclusions and Implications: This study found that American Indians had a higher odds of survival from violent TBIs which doubled when they did not have BAC+. BAC+ was protective against in-hospital mortality for whites and blacks, but not for American Indians. This study demonstrates the resilience of American Indians with violent TBIs indicating the importance of social workers to identify American Indian survivors of TBI due to violence. Social workers should educate American Indian clients about the repercussions of alcohol use to prevent worse outcomes.