Racial and Ethnic Differences in Deaths by Suicide, Drug Overdose, and Opioid-Related Overdose in a National Sample of Military Members With Mild Traumatic Brain Injury, 1999-2019

Abstract

Objective: To examine racial and ethnic differences in suicide and drug and opioid-related overdose deaths among a population-based cohort of military service members who were diagnosed with a mild traumatic brain injury (mTBI) during military service. Design: Retrospective cohort. Setting: Military personnel receiving care within the Military Health System between 1999 and 2019. Participants: In total, 356 514 military members aged 18 to 64 years, who received an mTBI diagnosis as their index TBI between 1999 and 2019, while on active duty or activated. Main Measures: Death by suicide, death by drug overdose, and death by opioid overdose were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes within the National Death Index. Race and ethnicity were captured from the Military Health System Data Repository. Results: Overall crude rates were 38.67 per 100 000 person-years for suicide; 31.01 per 100 000 person-years for drug overdose death; and 20.82 per 100 000 person-years for opioid overdose death. Crude and age-specific rates for military members who self-identified as Other were higher than all other racial/ethnic groups for all 3 mortality outcomes. Adjusting for age, suicide rates for those classified as Other were up to 5 times that of other racial/ethnic groups for suicide, and up to 11 and 3.5 times that of other race/ethnicity groups for drug and opioid overdose death, respectively. Conclusion: Findings extend previous knowledge regarding risk for suicide and deaths by drug overdose among those with mTBI and highlight new important areas for understanding the impact of race and ethnicity on mortality. Methodological limitations regarding classification of race and ethnicity must be addressed to ensure that future research provides a better understanding of racial and ethnic disparities in suicide and drug overdose mortality among military members with TBI.

Social Determinants of Health and Traumatic Brain Injury: Implications for Rehabilitation Service Delivery and Outcomes

“…Although findings presented add to evidence of disparities in TBI care and outcomes across SDoH, what continues to be urgently needed is empirical support for purported theories explaining such disparities—many of which were advanced by authors of studies included in this issue. For example, several studies revealed racial disparities in TBI care and outcomes 7,8,10,11. However, race and ethnicity are socially constructed categories that serve as surrogate measures of historical and structural marginalization that may shape TBI care and recovery in myriad, dynamic, and mutually reinforcing ways 20.…”

“…Several studies in this issue document disparities in TBI care and outcomes among members of marginalized racial and ethnic groups. Bahraini et al 7 conducted a population-based study of military members with mild traumatic brain injury (mTBI) to examine potential racial and ethnic disparities in mortality risk. Their data indicated that risk for death by suicide, drug overdose, and opioid overdose was substantially higher among military members who self-identified as "other," a racial category that may reflect minoritized individuals whose self-conception of racial identity is outside the bounds of standard categories (eg, multiracial).…”

“…For example, several studies revealed racial disparities in TBI care and outcomes. 7,8,10,11 However, race and ethnicity are socially constructed categories that serve as surrogate measures of historical and structural marginalization that may shape TBI care and recovery in myriad, dynamic, and mutually reinforcing ways. 20 As such, including indicators of race and ethnicity alone may be necessary, yet insufficient, for understanding the specific mechanisms underlying disparities in TBI service delivery and recovery.…”