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Brain Inj. 2016;30(12):1481-1490.

A retrospective cohort study of comorbidity trajectories associated with traumatic brain injury in veterans of the Iraq and Afghanistan wars.

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a South Texas Veterans Health Care System , San Antonio , TX , USA.
b Department of Epidemiology and Biostatistics.
c Division of Hospital Medicine, Department of Medicine , University of Texas Health Science Center San Antonio , San Antonio , TX , USA.
d Center for Applied Health Research, Central Texas Veterans Health with Baylor Scott & White, Temple , TX , USA.
e Texas A&M Health Science Center, Department of Medicine , Bryan , TX , USA.
f University of North Carolina, School of Nursing, College of Health and Human Services , Charlotte , NC , USA.
g Division of General Internal Medicine, VA North Texas Health Care System , Dallas , TX , USA.
h Division of General Internal Medicine , University of Texas Southwestern Medical Center , Dallas , TX , USA.
i Department of Family and Community Medicine , University of Texas Health Science Center San Antonio , San Antonio , TX , USA.



To identify and validate trajectories of comorbidity associated with traumatic brain injury in male and female Iraq and Afghanistan war Veterans (IAV).


Derivation and validation cohorts were compiled of IAV who entered the Department of Veterans Affairs (VA) care and received 3 years of VA care between 2002-2011. Chronic disease and comorbidities associated with deployment including TBI were identified using diagnosis codes. A latent class analysis (LCA) of longitudinal comorbidity data was used to identify trajectories of comorbidity.


LCA revealed five trajectories that were similar for women and men: (1) Healthy, (2) Chronic Disease, (3) Mental Health, (4) Pain and (5) Polytrauma Clinical Triad (PCT: pain, mental health and TBI). Two additional classes found in men were 6) Minor Chronic and 7) PCT with chronic disease. Among these gender-stratified trajectories, it was found that women were more likely to experience headache (Pain trajectory) and depression (Mental Health trajectory), while men were more likely to experience lower back pain (Pain trajectory) and substance use disorder (Mental Health trajectory). The probability of TBI was highest in the PCT-related trajectories, with significantly lower probabilities in other trajectories.


It was found that TBI was most common in PCT-related trajectories, indicating that TBI is commonly comorbid with pain and mental health conditions for both men and women. The relatively young age of this cohort raises important questions regarding how disease burden, including the possibility of neurodegenerative sequelae, will accrue alongside normal age-related decline in individuals with TBI. Additional 'big data' methods and a longer observation period may allow the development of predictive models to identify individuals with TBI that are at-risk for adverse outcomes.


Comorbidity; Iraq and Afghanistan wars; Trajectories; brain injury; healthcare; veteran

[Indexed for MEDLINE]

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