Sociodemographic and individual risk factors for traumatic brain injury in UK Biobank (N=500,035)

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Importance: Much research investigates sequelae arising from traumatic brain injury (TBI), however few studies investigate risk factors for TBI in the first instance. This could have implications for representativeness, risk mitigation and prevention. Objectives: Test for associations between multiple sociodemographic and individual difference variables, and their interaction with sex, on risk of subsequent incident TBI.Design, setting and participants: General population prospective cohort, UK Biobank. Main outcomes and measures: Baseline lifestyle, cognitive, personality and sociodemographic variables versus risk of later TBI, ascertained via ICD-10 codes. We used Cox regressions, and tested 11 predictors individually, then adjusted for baseline age and sex, then combined in one multivariable model. Results: After exclusions, 5764/500,035 (1.15%) participants recorded a TBI over median 14 years follow-up. Most predictors were individually associated with increased risk of TBI in expected directions. The largest associations were for male sex (versus female; hazard ratio [HR] = 1.56, 95% confidence intervals [CIs] = 1.48-1.65) and self-reported ‘risk-taker’ status (HR = 1.28, 95 CIs = 1.21-1.36). These remained significant in multivariable regressions. There was significant interaction between educational attainment and sex, where degree possession (versus not) was protective in males only (HR = 0.76, 95% CIs = 0.70-0.82, all P <0.001).Conclusion and relevance: Prominent risk factors for TBI include male sex and identifying as a ‘risk-taker’. Higher educational attainment was protective in males. Studies comparing TBI cases versus controls routinely underestimate premorbid group differences. These findings represent targetable opportunities for public health intervention.

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