Risk of hospitalization due to motor vehicle crashes among Iraq and Afghanistan war veterans diagnosed with traumatic brain injury

BACKGROUND: Traumatic brain injury (TBI) was deemed the 'signature injury' of the Iraq and Afghanistan Wars (OEF/OIF/OND). Civilians with severe TBI have increased risks of motor vehicle crashes (MVCs). Little is known about MVC risk among Veterans with TBI, many of whom incurred TBIs that were mild in severity. OBJECTIVE: To examine associations between TBI and MVC-related hospitalizations among OEF/OIF/OND Veterans who use Veterans Health Administration (VA) healthcare. METHODS: Using national VA data, we identified 277,330 Veterans who enrolled in VA within one year of deployment. MVC, TBI, and other diagnoses were identified using ICD-9-CM codes. We estimated risk of subsequent MVC hospitalization for those with, versus without, TBI using time-to-event analyses. Time-varying Cox proportional hazards models were used to compute hazard ratios (HR) and 95% confidence intervals (CI) while controlling for potential confounders, including psychiatric diagnoses. RESULTS: There were 28,551 Veterans diagnosed with TBI; 130 were subsequently hospitalized for MVC. In adjusted models, those with TBI were four times more likely to be hospitalized for MVC than those without (HR = 4.2; CI = 3.3-5.3). CONCLUSION: Veterans with TBI had substantially greater risk of MVC-related hospitalizations. These Veterans may benefit from enhanced driving safety interventions to reduce risk.