Abstract:
Objective: To investigate the contribution of pre-injury differences and potential biases in outcome measurement in explaining outcome differences between white and African-American persons with moderate
and severe traumatic brain injury (TBI).

Design: Prospective, two group longitudinal study with retrospective self-assessment of pre-injury status.

Setting: Inpatient and outpatient TBI rehabilitation program.

Participants: 94 persons with moderate and severe TBI (55 white, 39
African-American) who provided data on both pre-injury status and 1-year outcome.

Measures: Community Integration Questionnaire, Aggression and Depression subscales of Neurobehavioral Functioning Inventory-Revised,
Satisfaction With Life Scale, other questions on demographic and social
status; all measures were selected by a bi-racial focus group.

Results: Whites and African-Americans did not differ significantly on demographic factors except gender; nor on retrospective, self-reported pre-injury status on any of the outcome measures. At 1 year post TBI, African-Americans reported significantly lower Social Integration subscale scores than whites. African-Americans may also have lost more income than whites. All other outcome measures were comparable between groups and showed declines in community productivity, increases in depression symptoms, and lower satisfaction with life for both whites and African-Americans compared to pre-injury. A higher rate of change in living situation post TBI may partially account for lower levels of social integration for African-Americans. Conclusion: Whites and African Americans who are comparable prior to injury may experience generally similar outcomes, but differences in social and financial outcomes require further investigation.