Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. Defined as an injury to the head that disrupts normal function of the brain, TBI affects millions each year. In the United States alone, 2.85 million Americans sustain a TBI annually, underscoring the magnitude of this public health issue.

Whether mild (commonly called a concussion) or severe, TBI impacts the whole person, often leading to complex and long-term challenges. Research shows that 51.5 percent of people experience chronic pain, and 70 percent of people experience sleep problems (fatigue, insomnia, sleep apnea) after TBI. Up to 50 percent of people with TBI face mental health challenges, including anxiety, depression, and PTS(D). The risk of suicide for those with TBI is four times more likely than for people without TBI. Additionally, the often invisible nature of brain injury results in a lack of awareness and understanding in society, which leads to increased stigma, unemployment, and social isolation, underscoring the need to improve equity in brain injury care.

The lack of a gold standard in treatment makes it among the most expensive public health problems globally, often leaving people to navigate complex challenges without sufficient care.

Systemic Barriers to Equity in Brain Injury Care

Despite the significant health challenges following a brain injury, accessing long-term, holistic healthcare necessary to support wellbeing and quality of life remains difficult due to several systemic barriers.

For example, up to 56 percent of TBIs are not diagnosed in the ER. Only 13 to 25 percent of patients receive interdisciplinary rehabilitation—including physical, occupational, and speech therapies, and other necessary interventions—due to cost barriers, institutional racism, and insurance limits.

For those who are diagnosed, inpatient and outpatient care for TBI are costly, with lifetime healthcare expenses estimated to reach up to $3 million per individual. Yet patients are often discharged without comprehensive therapies to address the long-term implications.

Identity factors—including race, age, gender, and socioeconomic status—shape one’s risk of TBI and one’s experience within the medical system. According to the CDC:

  • American Indian/Alaska Native people and older adults (age 75 and older) have the highest rates of TBI-related hospitalization and death.
  • Men, disproportionately Black and Indigenous, have the highest risk of sustaining a brain injury.
  • Black and Latinx people are significantly more likely to be discharged home and receive less physical therapy (PT) and occupational therapy (OT) treatment than White people.
  • People with low incomes, no health insurance, or those far from hospitals often go without care.

Read the full article about equitable brain injury care by Rachel Petri, Laurel Crosby, and Kyla Pearce at Nonprofit Quarterly.