Statement of Purpose To determine if location of living (rural vs. urban and Appalachian vs. non-Appalachian) moderates the relationship between lifetime history of traumatic brain injury (TBI) with loss of consciousness (LOC) and self-reported disability.
Methods/Approach Data on lifetime history of TBI with LOC, location of living, and sources of disability (auditory, visual, cognitive, mobility, self-care, and independent living impairments) were obtained from the Ohio Behavioral Risk Factor Surveillance Surveys (2016–2019). We conducted multivariable logistic regressions to determine the odds ratios for having any disability, number of disabilities, and each of the six disability sources between individuals living in Appalachian vs. non-Appalachian areas, rural vs. urban areas, and individuals with vs. without lifetime history of TBI with LOC.
Results Of 16,941 respondents included in the final sample, 52.1% were female, 81.2% were White, and 43.1% were aged 18 to 44. Living in an Appalachian or rural area increased the likelihood of having at least one type of impairment leading to disability compared to living in a non-Appalachian or urban area, respectively, after adjusting for lifetime history of TBI with LOC. Notably, living in an Appalachian area was associated with greater risk for all six sources of disability and reporting one, two, and three disabilities, while living in a rural area was only associated with increased mobility impairments and reporting two disabilities. Furthermore, irrespective of location of living, lifetime history of TBI with LOC was associated with increased risk for all sources of disability and reporting one, two, and three disabilities.
Conclusion This study highlighted health disparities in disability and lifetime history of TBI among Appalachian and rural populations. Future studies should examine access to care in these areas following TBI.
Significance Our results contribute to the further understanding of health disparities in TBI and disability among underserved Appalachian and rural populations.
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