The Interaction Between Race/Ethnicity and Sex on Societal Participation Among Individuals With Traumatic Brain Injury: A NIDILRR Model Systems Study

Objective: To examine the interaction of race/ethnicity and sex on societal participation (productivity and overall participation) among individuals with traumatic brain injury (TBI). Setting: Community. Participants: A total of 8861 individuals aged ≥16 who identified as non-Hispanic White (1750 females, 4270 males), non-Hispanic Black (315 females, 1147 males), or Hispanic (314 females, 1065 males), and who completed a 1-year postinjury follow-up interview in the TBI Model Systems National Database. Design: Secondary analysis of a longitudinal cohort study at 1-year postinjury. Main Measures: The Participation Assessment with Recombined Tools-Objective-17 (PART-O-17) Productivity items (ie, school, employment, and homemaking) and subscale, and total Summary scores were the primary outcomes used to assess societal participation. The covariates were age, years of education, and total score on the Functional Independence Measure (FIM). Results: A significant sex × race/ethnicity interaction with homemaking was identified (P =.047). Compared with Non-Hispanic White males, odds of not endorsing homemaking were 1.55 times greater for Non-Hispanic Black males and 1.71 times greater for Hispanic males. No significant sex × race/ethnicity interactions were found with employment (P=.221) or school items (P=.967). After adjusting for age, education, and FIM Total, a significant sex × race/ethnicity interaction on Productivity scores was found, F(28 852) = 10.3, P<.001, such that sex differences were observed for only Non-Hispanic Black and Hispanic participants compared to Non-Hispanic White participants. No significant interaction regarding sex differences across racial/ethnic groups was identified using the PART-O-17 Summary score. Conclusions: Compared with non-Hispanic White males, non-Hispanic Black and Hispanic males were less likely to report engaging in homemaking activities, resulting in greater sex differences among Non-Hispanic Black and Hispanic males and females on the Productivity subscale than were observed on this scale among non-Hispanic White individuals. Current community participation measures may not accurately capture the experiences of diverse populations with TBI.