Factors Associated with Cardiovascular Mortality After TBI

What is the study about?

Heart disease is the leading cause of death in the United States, and people who have experienced a traumatic brain injury (TBI) face a higher risk of cardiovascular disease (heart and blood vessel problems). However, little is known about which individuals with TBI are most at risk of dying from cardiovascular disease. This study examined a large group of individuals with TBI to identify factors—such as age, sex, employment, and insurance status—associated with higher or lower risk of cardiovascular death.

What did the study find?

Out of 15,370 people studied, 2,770 (about 18%) died during the study period. Of those deaths, more than 1 in 5 (about 21.5%) were caused by heart or blood vessel disease. The study found that certain factors made it more or less likely that someone would die from a cardiovascular reason.

Factors linked to a HIGHER risk of cardiovascular death:

• Older age at the time of injury
• Being male
• Being divorced at the time of injury
• Having more difficulty with physical tasks (like moving, dressing, or bathing) when leaving the rehabilitation hospital

Factors linked to a LOWER risk of cardiovascular death:

• Being employed (working) at the time of injury or at one year after injury
• Having private health insurance at time of injury
• Identifying as Asian or Pacific Islander
• Having a longer period of post-traumatic amnesia (am-NEE-zhuh) — a period after injury when the person is confused or unable to form new memories.

This is a measure of how severe a brain injury is. A longer period of post-traumatic amnesia indicates a more severe brain injury.

• Living in the Western United States 

Importantly, alcohol use, drug use, and education level were not significantly linked to cardiovascular death in this study.

Who participated in the study?

The study included 15,370 people who had been admitted to inpatient rehabilitation after TBI and were at least 16 years old. The average age at injury was 41 years. Most participants were male (73.5%) and identified as White (66.9%). About 74.5% had graduated from high school. Data were collected from 1987 through February 2020, and the cutoff of February 2020 was chosen to avoid the effects of the COVID-19 pandemic on the results.

How was the study conducted?

Researchers analyzed data from the TBI Model Systems (TBIMS) national database, which includes individuals hospitalized and admitted to inpatient rehabilitation after TBI across the United States. Participant information—such as demographics, employment, insurance, and functional ability—was collected during hospitalization and at follow‑ups at 1, 2, 5, and every 5 years thereafter. Causes of death were obtained from official death certificates. A competing risk statistical model was used to identify factors associated with cardiovascular death while accounting for deaths from other causes.

How can people use the results?

Individuals with TBI and families: TBI is a long‑term condition, and heart health is an important part of recovery. Individuals with TBI—particularly older men, those who are divorced, or those with physical limitations—should discuss cardiovascular risk with their healthcare providers and focus on healthy habits such as staying active, eating well, avoiding smoking, and attending regular check‑ups.

Clinicians: Findings emphasize the importance of early and ongoing cardiovascular risk screening in TBI patients, especially those who are older, male, divorced, or physically limited. Supporting return to work and access to quality health insurance may also improve long‑term health outcomes.

Researchers: Future studies should examine why certain groups have lower cardiovascular risk after TBI and evaluate whether targeted lifestyle interventions can reduce that risk. Longitudinal research tracking changes in employment, insurance, and physical function is needed.

Policymakers: The association between private insurance and lower cardiovascular mortality highlights the importance of access to quality healthcare. Policies that improve insurance access and support return‑to‑work programs may reduce heart‑related deaths among individuals with TBI.

Reference

Pinto, S. M., Thakur, B., Kumar, R. G., Venkatesan, U. M., Hicks, A. J., Driver, S., Ding, K., Watanabe, T. K., Bell, K., Walker, W. C., Katta-Charles, S., Zafonte, R., Rabinowitz, A., & Hammond, F. M. (2025). Factors associated with cardiovascular mortality after complicated mild to severe traumatic brain injury (TBI): A TBI Model Systems study. Journal of Head Trauma Rehabilitation. https://doi.org/10.1097/HTR.0000000000001087

Disclaimer

The contents of this quick review were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90DPKT0009). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this quick review do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government.

The content of this Quick Review was generated and edited using Claude and Microsoft Co-Pilot and was carefully reviewed and edited by experts to ensure accuracy.