Cognitive reserve and disparities in healthcare usage after traumatic brain injury and stroke: an observational cohort study.

Abstract

Individuals with more education commonly have better outcome after brain injury, often attributed to cognitive reserve. However, evidence suggests that individuals with more education have better access to specialized care, potentially affecting outcomes. To investigate differences in healthcare usage based on cognitive reserve and examine the relationship between healthcare usage and outcomes after stroke and traumatic brain injury. An observational cohort study with healthcare usage data from 3 years before to 4 years after injury, interviewing patients 5-15 years after injury. A total of 83 participants suffering a stroke or traumatic brain injury. Healthcare usage over time varied based on educational level (repeated measures ANOVA, F(2, 227) = 4.17, p = 0.008). The differences in healthcare usage between educational levels was significant during the injury year (F(81) = -5.47, p = 0.022). Higher education implied more healthcare usage. Linear regression, controlling for possible confounders, confirmed the relationship between education and healthcare usage, (β = 4.3, p = 0.022). Healthcare usage was significantly related to long-term life satisfaction, but not to return to work. Individuals with more education received more healthcare in the year after traumatic brain injury or stroke. However, this was not related to long-term outcome regarding return to work, but we found a relationship between healthcare usage and life satisfaction.