Investigating potential racial disparities and associated baseline comorbidities in patients admitted for post-traumatic epilepsy (PTE) following traumatic brain injury (TBI) in the unique, minority-majority population of the Hawaiian Islands.

Racial and ethnic minority groups in the United States experience a higher incidence of TBI and TBI-associated complications. Despite this, minority populations continue to remain underrepresented in TBI empirical studies. PTE is a common complication of TBI in both the acute and chronic setting and is defined as seizures occurring within one week following head trauma. Prior studies have shown that Black patients experience PTE at a higher rate than White patients following TBI. Whether such discrepancies exist among Asians, Native Hawaiians (NH), and Other Pacific Islanders (PI) remain unknown.

We conducted a retrospective cohort study using administrative claims data from all hospitals in Hawaii, identifying patients who were admitted for traumatic brain injury between 2005 and 2017. We then tracked these patients to determine if they had subsequent visits with a diagnosis of epilepsy. Sociodemographic information and baseline comorbid conditions were collected to account for potential cofounders. 

We identified 8217 total TBI cases across 8 different racial groups, among whom 157 (1.9%) developed PTE. Japanese patients faced the lowest odds of PTE [OR: 0.30; 95% CI: 0.30, 0.85; p=0.01]. Independent risk factors for PTE were Medicaid [OR: 2.49; 95% CI: 1.32, 4.73; p=0.01] and Medicare [OR: 2.26; 95% CI: 1.18, 4.35; p=0.01] recipients and a history of alcohol use disorder [OR: 1.68; 95% CI: 1.08, 2.61; p=0.02].

Relative to other races, Japanese patients faced the lowest odds of developing epilepsy following TBI. Other independent risk factors for PTE were Medicaid or Medicare recipients and those with a history of alcohol use disorder. More in-depth studies are necessary to explore the socioeconomic and healthcare elements potentially driving our findings.