Risk of hospitalization with neurodegenerative disease after moderate-to-severe traumatic brain injury in the working- age population : A retrospective cohort study using the Finnish national health registries

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dc.contributor.author Raj, Rahul
dc.contributor.author Kaprio, Jaakko
dc.contributor.author Korja, Miikka
dc.contributor.author Mikkonen, Era D.
dc.contributor.author Jousilahti, Pekka
dc.contributor.author Siironen, Jari
dc.date.accessioned 2017-08-21T07:39:00Z
dc.date.available 2017-08-21T07:39:00Z
dc.date.issued 2017-07
dc.identifier.citation Raj , R , Kaprio , J , Korja , M , Mikkonen , E D , Jousilahti , P & Siironen , J 2017 , ' Risk of hospitalization with neurodegenerative disease after moderate-to-severe traumatic brain injury in the working- age population : A retrospective cohort study using the Finnish national health registries ' , PLoS Medicine , vol. 14 , no. 7 , 1002316 . https://doi.org/10.1371/journal.pmed.1002316
dc.identifier.other PURE: 88585697
dc.identifier.other PURE UUID: aeddb91b-509d-440d-ae6e-363532d3ee55
dc.identifier.other WOS: 000406611200003
dc.identifier.other Scopus: 85024365187
dc.identifier.other ORCID: /0000-0002-4463-6954/work/58742424
dc.identifier.uri http://hdl.handle.net/10138/214064
dc.description.abstract Background Previous epidemiological studies suggest that working-aged persons with a history of moderate-to-severe traumatic brain injury (TBI) may have an increased risk for developing neurodegenerative disease (NDD) while persons with a history of mild TBI do not. In this comprehensive nationwide study in Finland, we assessed the risk of NDD and history of moderate-to-severe TBI in the working-age population. Methods and findings We performed a population-based follow-up study using the Finnish Care Register for Health Care to identify all persons between the ages of 18 and 65 years hospitalized during 1987-2014 due to TBI who did not have a baseline NDD diagnosis. We compared the risk of hospitalization with NDD between persons hospitalized due to moderate-to-severe TBI (intracranial lesions) and persons hospitalized due to mild TBI (no intracranial lesions). Follow-up NDD diagnoses were recorded from 1 year following the TBI to the end of 2014. NDD diagnoses included dementia, Parkinson disease, and amyotrophic lateral sclerosis. We used a Cox proportional hazards model, adjusting for age, sex, education, and socioeconomic group, to assess the association between TBI and NDD. In total, 19,936 and 20,703 persons with a history of moderate-to-severe TBI and mild TBI, respectively, were included. The overall time at risk was 453,079 person-years (median 10 years per person). In total, 3.5% (N = 696) persons in the moderate-to-severe TBI group developed NDD compared to 1.6% (N = 326) in the mild TBI group. After adjusting for covariates, moderate-to-severe TBI was associated with an increased risk for NDD, with a hazard ratio (HR) of 1.8 (95% CI 1.6-2.1) compared to mild TBI. Of the NDD subtypes, only moderate-to-severe TBI was associated with an increased risk for dementia (HR 1.9, 95% CI 1.6-2.2). Yet, this large-scale epidemiological study does not prove that there is a causal relationship between moderate-to-severe TBI and NDD. Further, the Care Register for Health Care includes only hospitalized persons; thus, patients diagnosed with NDD in the outpatient setting may have been missed. Additional limitations include the potential for miscoding and unmeasured confounds. Conclusions In working-aged persons, a history of moderate-to-severe TBI is associated with an increased risk for future dementia but not for Parkinson disease or amyotrophic lateral sclerosis. en
dc.format.extent 16
dc.language.iso eng
dc.relation.ispartof PLoS Medicine
dc.rights cc_by
dc.rights.uri info:eu-repo/semantics/openAccess
dc.subject HEAD-INJURY
dc.subject ALZHEIMERS-DISEASE
dc.subject PARKINSON DISEASE
dc.subject COGNITIVE FUNCTION
dc.subject DEMENTIA RISK
dc.subject METAANALYSIS
dc.subject PROGESTERONE
dc.subject EPIDEMIOLOGY
dc.subject ESTROGEN
dc.subject EUROPE
dc.subject 3112 Neurosciences
dc.subject 3124 Neurology and psychiatry
dc.subject 3126 Surgery, anesthesiology, intensive care, radiology
dc.subject 3142 Public health care science, environmental and occupational health
dc.title Risk of hospitalization with neurodegenerative disease after moderate-to-severe traumatic brain injury in the working- age population : A retrospective cohort study using the Finnish national health registries en
dc.type Article
dc.contributor.organization Neurokirurgian yksikkö
dc.contributor.organization University of Helsinki
dc.contributor.organization Clinicum
dc.contributor.organization Institute for Molecular Medicine Finland
dc.contributor.organization Department of Public Health
dc.contributor.organization Department of Neurosciences
dc.contributor.organization HUS Neurocenter
dc.contributor.organization Genetic Epidemiology
dc.description.reviewstatus Peer reviewed
dc.relation.doi https://doi.org/10.1371/journal.pmed.1002316
dc.relation.issn 1549-1676
dc.rights.accesslevel openAccess
dc.type.version publishedVersion

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