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J Head Trauma Rehabil. 2018 Jan/Feb;33(1):15-24. doi: 10.1097/HTR.0000000000000273.

Epidemiology of Comorbid Conditions Among Adults 50 Years and Older With Traumatic Brain Injury.

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University of Pittsburgh Department of Physical Medicine and Rehabilitation, Pittsburgh, Pennsylvania (Messrs Kumar and Wang and Drs Juengst, Arenth, and Wagner); University of Pittsburgh Department of Epidemiology, Pittsburgh, Pennsylvania (Messrs Kumar and Wang); Icahn School of Medicine at Mount Sinai, New York, NY (Dr Dams-O'Connor); University of Washington Department of Rehabilitation Medicine, Seattle (Dr Dikmen); Northeastern University Department of Communication Sciences and Disorders, Boston, Massachusetts (Dr O'Neil-Pirozzi); Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts (Dr O'Neil-Pirozzi); Baylor Scott & White Health Medical Center - Plano, TX; Baylor Institute for Rehabilitation, Dallas, TX (Dr Dahdah); Indiana University School of Medicine Department of Physical Medicine and Rehabilitation, Indianapolis, Indiana (Dr Hammond); University of Miami Department of Physical Medicine and Rehabilitation, Miami, Florida (Dr Felix); and University of Pittsburgh Center for Neuroscience, University of Pittsburgh Safar Center for Resuscitation Research, and University of Pittsburgh Department of Neuroscience, Pittsburgh, Pennsylvania (Dr Wagner).



Aging individuals with traumatic brain injury (TBI) experience multiple comorbidities that can affect recovery from injury. The objective of this study was to describe the most commonly co-occurring comorbid conditions among adults 50 years and older with TBI.


Level I Trauma centers.


Adults 50 years and older with moderate/severe TBI enrolled in the TBI-Model Systems (TBI-MS) from 2007 to 2014 (n = 2134).


A TBI-MS prospective cohort study.


International Classification of Disease-9th Revision codes collapsed into 45 comorbidity categories. Comorbidity prevalence estimates and trend analyses were conducted by age strata (50-54, 55-64, 65-74, 75-84, ≥85 years). A dimension reduction method, Treelet Transform, classified clusters of comorbidities that tended to co-occur.


The 3 most commonly occurring comorbid categories were hypertensive disease (52.6/100 persons), other diseases of the respiratory system (51.8/100 persons), and fluid component imbalances (43.7/100 persons). Treelet Transform classified 3 clusters of comorbid codes, broadly classified as (1) acute medical diseases/infections, (2) chronic conditions, and (3) substance abuse disorders.


This study provides valuable insight into comorbid conditions that co-occur among adults 50 years and older with TBI and provides a foundation for future studies to explore how specific comorbidities affect TBI recovery.

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