Race/Ethnicity and Traumatic Brain Injury: Are There Disparities in Positive Screenings and Diagnoses Among Service Members Returning From Afghanistan and Iraq?

• Author: Sarah Mustillo,Ashleigh Kysar-Moon
• Published date: 01 January 2019
• DOI: 10.1177/0095327X18761852
• Date: 01 January 2019
• Subject Matter: Articles

Article

Race/Ethnicity and

Traumatic Brain Injury:

Are There Disparities in

Positive Screenings and

Diagnoses Among Service

Members Returning From

Afghanistan and Iraq?

Ashleigh Kysar-Moon

1

and Sarah Mustillo

2

Abstract

The authors examine racial/ethnic differences in screening positive for traumatic

brain injury (TBI) and in diagnosis among service members upon returning from war

in Afghanistan and Iraq. Using data from the Post-Deployment Health Assessment

and Re-Assessment, and military health-care encounters from 2008 to 2009, they

estimate logistic regressions in a sample of 46,488 service members. Hispanic and

Asian service members do not differ from White service members in screening

positive for TBI but have 19% and 33% lower odds of diagnosis, respectively.

Compared to White service members, Black service members are less likely to

screen positive for TBI immediately after deployment and about as likely 3–6 months

later, yet have 27% lower odds of diagnosis. Further, racial/ethnic minority service

members have a lower probability of TBI diagnosis than White service members at

all self-reported symptom levels, suggesting there is a discrepancy between symp-

toms and diagnosis related to race/ethnicity.

1

Department of Sociol ogy, Anthropology , and Criminology, Uni versity of Northern Io wa, Cedar

Falls, IA, USA

2

Department of Sociology, University of Notre Dame, Notre Dame, IN, USA

Corresponding Author:

Ashleigh Kysar-Moon, Department of Sociology, Anthropology, and Criminology, University of Northern

Iowa, Bartlett 1126, Cedar Falls, IA 50614-0513, USA.

Email: ashleigh.kysar-moon@uni.edu

Armed Forces & Society

2019, Vol. 45(1) 155-176

ªThe Author(s) 2018

Article reuse guidelines:

sagepub.com/journals-permissions

DOI: 10.1177/0095327X18761852

journals.sagepub.com/home/afs

Keywords

traumatic brain injury, race and ethnicity, health disparities, military

Introduction

The wars in Afghanistan, Operation Enduring Freedom, and Iraq, Operation Iraqi

Freedom, lasted from October 2001 to December 2014 and March 2003 to Decem-

ber 2011, respectively. Approximately 2.5 million service men and women served

(The White House, 2013), and over 52,000 of those service members were wounded

in action (Fischer, 2015). Traumatic brain injuries are described as the “signature

wound” of the Afghanistan and Iraq wars (Egede, Dismuke, & Echols, 2012), and

since 2000, the Department of Defense (2016) reports that among the diagnosed

traumatic brain injuries, 82.3%are mild, 9%moderate, 2.4%severe or penetrating,

and 6.2%are not classifiable. A traumatic brain injury (TBI) is an open or closed

head wound that results from “blunt force, penetration of the skull, or acceleration/

deceleration of the brain” (Fabrizio & Keltner, 2010, p. 570).

The chances for a TBI in the combat theater is especially high due to the risk of

falls, motor vehicle accidents, improvised explosive devices (or roadside bombs),

mortars, artillery, and rocket-propelled grenades (Fabrizio & Keltner, 2010). Studies

find that among veterans with combat-related trauma, such as TBI due to blasts or

explosions, the risk for developing other comorbid conditions like posttraumatic

stress disorder is high (Carlson et al., 2010; Evans et al., 2013).

The consequences of TBI can vary widely from person to person; some service

members experience altered sleeping patterns, persistent headaches, greater sensi-

tivity to stress (Ashman, Gordon, Cantor, & Hibbard, 2006; Clarke, Genat, &

Anderson, 2012; Griesbach, Hoyda, Tio, & Taylor, 2011), and higher mortality risk,

especially among minority service members (Egede et al., 2012). Research addi-

tionally shows a link between multiple traumatic brai n injuries and Parkinson’s

disease, Alzheimer’s disease, and chronic traumatic encephalopathy (a degenerative

brain disease; McKee & Robinson, 2014).

Diagnosis and Treatment for TBI

Early identification and treatment for TBI can reduce the risk of future health

problems (Maguen, Lau, Madden, & Seal, 2012). The Department of Veterans

Affairs (VA) began mandatory screening for TBI among all Afghanistan and Iraq

war veterans following deployment (Scholten, Sayer, Vanderploeg, Bidelspach, &

Cifu, 2012) and designed specific measures to assess TBI that reflect the unique

combat style seen in conflicts post-September 11th, 2001 (Fabrizio & Keltner,

2010). The initial screening is performed by a physician, nurse, or other health-

care professional in a VA medical center or community-based outpatient facility (see

Dismuke, Gebregziabher, Yeager, & Egede, 2015; Fabrizio & Keltner, 2010).

156 Armed Forces & Society 45(1)