Long-Term Outcomes Associated with Traumatic Brain Injury in Childhood and Adolescence: A Nationwide Swedish Cohort Study of a Wide Range of Medical and Social Outcomes

Traumatic brain injury (TBI) is the leading cause of disability and mortality in children and young adults worldwide. It remains unclear, however, how TBI in childhood and adolescence is associated with adult mortality, psychiatric morbidity, and social outcomes. In a Swedish birth cohort between 19...

Full description

Saved in:
Bibliographic Details
Published in:PLoS medicine 2016-08, Vol.13 (8), p.e1002103
Main Authors: Sariaslan, Amir, Sharp, David J, D'Onofrio, Brian M, Larsson, Henrik, Fazel, Seena
Format: Article
Language:English
Subjects:
Adolescent
Adult
Age Factors
Analysis
Brain injuries
Brain Injuries, Traumatic - epidemiology
Brain Injuries, Traumatic - mortality
Brain Injuries, Traumatic - therapy
Care and treatment
Child
Child, Preschool
Children
Cohort Studies
Complications and side effects
Disabled Persons - statistics & numerical data
Female
Health aspects
Hospitalization - statistics & numerical data
Humans
Infant
Infant, Newborn
Injuries
Male
Medicin och hälsovetenskap
Medicine and Health Sciences
Mental disorders
Mental Disorders - epidemiology
Mental Disorders - etiology
Mortality
Patient outcomes
People and Places
Registries
Risk Factors
Siblings
Social Sciences
Socioeconomic Factors
Studies
Sweden
Sweden - epidemiology
Traumatic brain injury
Treatment Outcome
Young Adult
Youth
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Traumatic brain injury (TBI) is the leading cause of disability and mortality in children and young adults worldwide. It remains unclear, however, how TBI in childhood and adolescence is associated with adult mortality, psychiatric morbidity, and social outcomes. In a Swedish birth cohort between 1973 and 1985 of 1,143,470 individuals, we identified all those who had sustained at least one TBI (n = 104,290 or 9.1%) up to age 25 y and their unaffected siblings (n = 68,268) using patient registers. We subsequently assessed these individuals for the following outcomes using multiple national registries: disability pension, specialist diagnoses of psychiatric disorders and psychiatric inpatient hospitalisation, premature mortality (before age 41 y), low educational attainment (not having achieved secondary school qualifications), and receiving means-tested welfare benefits. We used logistic and Cox regression models to quantify the association between TBI and specified adverse outcomes on the individual level. We further estimated population attributable fractions (PAF) for each outcome measure. We also compared differentially exposed siblings to account for unobserved genetic and environmental confounding. In addition to relative risk estimates, we examined absolute risks by calculating prevalence and Kaplan-Meier estimates. In complementary analyses, we tested whether the findings were moderated by injury severity, recurrence, and age at first injury (ages 0-4, 5-9, 6-10, 15-19, and 20-24 y). TBI exposure was associated with elevated risks of impaired adult functioning across all outcome measures. After a median follow-up period of 8 y from age 26 y, we found that TBI contributed to absolute risks of over 10% for specialist diagnoses of psychiatric disorders and low educational attainment, approximately 5% for disability pension, and 2% for premature mortality. The highest relative risks, adjusted for sex, birth year, and birth order, were found for psychiatric inpatient hospitalisation (adjusted relative risk [aRR] = 2.0; 95% CI: 1.9-2.0; 6,632 versus 37,095 events), disability pension (aRR = 1.8; 95% CI: 1.7-1.8; 4,691 versus 29,778 events), and premature mortality (aRR = 1.7; 95% CI: 1.6-1.9; 799 versus 4,695 events). These risks were only marginally attenuated when the comparisons were made with their unaffected siblings, which implies that the effects of TBI were consistent with a causal inference. A dose-response relationship was observed with injury s
ISSN:1549-1676
1549-1277
1549-1676
DOI:10.1371/journal.pmed.1002103