To examine the relationship between social determinants of health (SDOH) on patient-centered measures in TBI-clinic patients.

Traumatic brain injury (TBI) can lead to chronic physical, mental, and social disability, yet SDOH remains an understudied area in the context of TBI patient recovery. NIH-PROMIS (Patient-Reported Outcomes Measurement Information System) provides novel person-centered measures that evaluate quality of life, but its use in TBI is unknown. We hypothesize that certain SDOH are related to improved self-efficacy (confidence in performing tasks/behaviors) defined by the PROMIS General Self-Efficacy (GSE) measure post-TBI.

Retrospective cohort study of sequential TBI-clinic visits in the University of California Irvine-NTBIC database (9/2022-8/2024). Inclusion criteria: ≥18yo, self-reported TBI history per 2023-ACRM criteria. SDOH defined as: non-white race, Hispanic ethnicity, non-college educated, no insurance, median census tract 2022 income. Outcome: PROMIS-GSE dichotomized as below (“poor”) or above (“good”) 50th percentile T-score. Descriptive statistics, multivariable logistic regression, and Pearson correlation performed.

Among 50 patients studied (median age=50, 50% female, 76% mild TBI, 6 months from TBI-to-clinic), age, sex, race/ethnicity, education level, and insurance status did not differ between poor versus good PROMIS-GSE outcomes (p>.05). Median-area income was significantly higher for those with good PROMIS-GSE scores (median [IQR], $117,461 [$106,920-$128,839]) versus those with poor scores ($102,065 [$88,538-$116,104], p=.022). Median-area incomes above the California-household median income predicted good PROMIS-GSE outcomes on regression (OR=11.3, 95% CI: 2.33-89, p=.006). PROMIS-GSE scores were moderately correlated to Glasgow Outcome-Extended Scale (r=.369).

Our exploratory analysis suggests higher median area income is associated with higher general self-efficacy post-TBI. We demonstrate the feasibility of implementing a PROMIS measure to a predominantly subacute-chronic mild-TBI cohort. Future work will test other PROMIS batteries and longitudinally measure PROMIS scores.