Open AccessExplaining Outcome Differences between Men and Women following Mild Traumatic Brain Injury
Author(s) -
Ana Mikolić,
Joost Oude Groeniger,
Marina Zeldovich,
Lindsay Wilson,
Jeanine Roeters van Lennep,
David van Klaveren,
Suzanne Polinder,
Cecilia Åkerlund,
Krisztina Amrein,
Lasse Andreassen,
Audny Anke,
Anna Antoni,
Gérard Audibert,
Philippe Azouvi,
Maria Luisa Azzolini,
Ronald Bartels,
Pál Barzó,
Romuald Beauvais,
Ronny Beer,
BoMichael Bellander,
Antonio Belli,
Habib Benali,
Maurizio Berardino,
Luigi Beretta,
Morten Blaabjerg,
Peter Bragge,
Alexandra Bražinová,
Vibeke Brinck,
Joanne Brooker,
Camilla Brorsson,
András Büki,
Monika Bullinger,
Manuel Cabeleira,
Alessio Caccioppola,
Emiliana Calappi,
Maria Rosa Calvi,
Peter Cameron,
Guillermo Carbayo Lozano,
Marco Carbonara,
Ana M. CastañoLeón,
Simona Cavallo,
Giorgio Chevallard,
Arturo Chieregato,
Giuseppe Citerio,
Iris Ceyisakar,
Hans Clusmann,
Mark Coburn,
Jonathan P. Coles,
Jamie D. Cooper,
Marta Correia,
Amra Čović,
Nicola Curry,
Endre Czeiter,
Marek Czosnyka,
Claire DahyotFizelier,
Paul Dark,
Helen Dawes,
Véronique De Keyser,
Vincent Degos,
Francesco Della Corte,
Hugo den Boogert,
Bart Depreitere,
Đula Đilvesi,
Abhishek Dixit,
Emma Donoghue,
Jens P. Dreier,
GuyLoup Dulière,
Ari Ercole,
Patrick Esser,
Erzsébet Ezer,
Martin Fabricius,
Valery Feigin,
Kelly Foks,
Shirin Frisvold,
Alex Furmanov,
Pablo Gagliardo,
Damien Galanaud,
Dashiell Gantner,
Guoyi Gao,
Pradeep George,
Alexandre Ghuysen,
Lelde Giga,
Ben Glocker,
Jagoš Golubović,
Pedro A. Gómez,
Johannes Gratz,
Benjamin Gravesteijn,
Francesca Grossi,
Russell L. Gruen,
Deepak Gupta,
Juanita A. Haagsma,
Iain Haitsma,
Raimund Helbok,
Eirik Helseth,
Lindsay Horton,
Jilske Huijben,
Peter J. Hutchinson,
Bram Jacobs,
Stefan Jankowski,
Mike Jarrett,
Jiyao Jiang,
Faye Johnson,
Kelly Jones,
Mladen Karan,
Angelos Kolias,
Erwin J. O. Kompanje,
Daniel Kondziella,
Evgenios Koraropoulos,
LarsOwe D. Koskinen,
Noémi Kovács,
Ana Kowark,
Alfonso Lagares,
Linda Lanyon,
Steven Laureys,
Fiona Lecky,
Didier Ledoux,
Rolf Lefering,
Valérie Legrand,
Aurélie Lejeune,
Leon Levi,
Roger Lightfoot,
Hester F. Lingsma,
Andrew I.R. Maas,
Marc Maegele,
Marek Majdán,
Alex Manara,
Geoffrey T. Manley,
Costanza Martino M.,
Hugues Maréchal,
Julia Mattern,
Catherine McMahon,
Béla Melegh,
David Me,
Tomas Menovsky,
Ana Mikolić,
Michel Benoît,
Visakh Muraleedharan,
Lynnette Murray,
Ancuța Negru,
David Nelson,
Virginia Newcombe,
Daan Nieboer,
József Nyirádi,
Otesile Olubukola,
Matej Orešič,
Fabrizio Ortolano,
Aarno Palotie,
Paul M. Parizel,
JeanFrançois Payen,
Natascha Perera,
Vincent Perlbarg,
Hopitaux de Paris,
Paolo Persona,
Wilco C. Peul,
Matti Pirinen,
Horia Pleș,
Suzanne Polinder,
Iñigo Pomposo,
Jussi P. Posti,
Louis Puybasset,
Andreea Rădoi,
Arminas Ragauskas,
Malinka Rambadagalla,
Jonathan R. Rhodes,
Sylvia Richardson,
Sophie Richter,
Samuli Ripatti,
Saulius Ročka,
Cecilie Røe,
Olav Røise,
Jonathan Rosand,
Christina Rosenlund,
Guy Rosenthal,
Rolf Rossaint,
Sandra Rossi,
Daniel Rueckert,
Martin Rusňák,
Juan Sahuquillo,
Oliver Sakowitz,
Renán Sánchez-Porras,
János Sándor,
Nadine Schäfer,
Silke Schmidt,
Herbert Schöechl,
Guus Schoonman,
Rico Frederik Schou,
Elisabeth Schwendenwein,
Charlie Sewalt,
Toril Skandsen,
Peter Smielewski,
Abayomi Sorinola,
Emmanuel Stamatakis,
Simon Stanworth,
Robert Stevens,
William Α. Stewart,
Ewout W. Steyerberg,
Nino Stocchetti,
Nina Sundström,
Anneliese Synnot,
Riikka Takala,
Viktória Tamás,
Tomas Tamošuitis,
Mark Taylor,
Braden Te Ao,
Olli Tenovuo,
Alice Theadom,
Matt Thomas,
Dick Tibboel,
Marjolein Timmers,
Christos M. Tolias,
Tony Trapani,
Cristina Maria Tudora,
Peter Vajkoczy,
Shirley Vallance,
Egils Valeinis,
Zoltán Vámos,
Mathieu van der Jagt,
Gregory Van der Steen,
Joukje van der Naalt,
Jeroen T.J.M. van Dijck,
Thomas A. van Essen,
Wim Van Hecke,
Caroline van Heugten,
Dominique Van Praag,
Thijs Vande Vyvere,
Roel P. J. van Wijk,
Alessia Vargiolu,
Emmanuel Vega,
Kimberley Velt,
Jan Verheyden,
Paul Vespa,
Anne Vik,
Rimantas Vilcinis,
Victor Volovici,
Nicole von Steinbüchel,
Daphne Voormolen,
Petar Vuleković,
Kevin Wang,
Eveline Wiegers,
Guy Williams,
Lindsay Wilson,
Stefan Winzeck,
Stefan Wolf,
Zhihui Yang,
Peter Ylén,
Alexander Younsi,
Frederick A. Zeiler,
Veronika Zelinkova,
Agate Ziverte,
Tommaso Zoerle
Publication year - 2021
Publication title -
journal of neurotrauma
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.653
H-Index - 149
eISSN - 1557-9042
pISSN - 0897-7151
DOI - 10.1089/neu.2021.0116
Subject(s) - traumatic brain injury , medicine , confounding , mental health , referral , poison control , injury prevention , population , glasgow coma scale , emergency department , psychiatry , clinical psychology , emergency medicine , family medicine , environmental health
Men and women differ in outcomes following mild traumatic brain injury (TBI). In the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, we previously found that women had worse 6-month functional outcome (Glasgow Outcome Score Extended [GOSE]), health-related quality of life (HRQoL), and mental health following mild TBI. The aim of this study was to investigate whether those differences were mediated by psychiatric history, gender-related sociodemographic variables, or by care pathways. We analyzed sex/gender differences in 6-month GOSE, generic and TBI-specific HRQoL, and post-concussion and mental health symptoms using three sets of mediators: psychiatric history, sociodemographic variables (living alone, living with children, education and employment status/job category), and care-pathways (referral to study hospital and discharge destination after emergency department); while controlling for a substantial number of potential confounders (pre-injury health and injury-related characteristics). We included 1842 men and 1022 women (16+) with a Glasgow Coma Score 13-15, among whom 83% had GOSE available and about 60% other 6-month outcomes. We used natural effects models to decompose the total effect of sex/gender on the outcomes into indirect effects that passed through the specified mediators and the remaining direct effects. In our study population, women had worse outcomes and these were only partly explained by psychiatric history, and not considerably explained by sociodemographic variables nor by care pathways. Factors other than differences in specified variables seem to underlie observed differences between men and women in outcomes after mild TBI. Future studies should explore more aspects of gender roles and identity and biological factors underpinning sex and gender differences in TBI outcomes.