Spousal Traumatic Brain Injury and Risk of Mortality, Dementia, and Cardiovascular Events.

Incident spousal TBI was associated with a higher risk of all-cause mortality in the uninjured partner.

• Hazard ratio (HR), 1.24 (95% CI, 1.07-1.43; P = .004).
• Analysis used Cox proportional hazards shared frailty models with spousal TBI as a time-varying exposure.
• Models were adjusted for demographic, clinical, and behavioral characteristics.
• Analysis included 3281 married pairs (6562 participants).

Spousal TBI was not significantly associated with dementia risk in the uninjured partner.

• HR, 1.17 (95% CI, 0.88-1.56; P = .28).
• Dementia analyses included 3281 married pairs.
• The confidence interval included the null, so the estimate was imprecise.

Spousal TBI was not significantly associated with major adverse cardiovascular events (MACE) in the uninjured partner.

• HR, 1.15 (95% CI, 0.84-1.57; P = .40).
• MACE analyses included 2740 of the 3281 pairs.

Associations between spousal TBI and outcomes were similar in males and females.

• Sex-stratified analyses found similar associations among males and females.
• The cohort comprised 3281 female and 3281 male spouses.

When spousal death was incorporated, mortality risk was higher in all groups compared with those whose spouse was alive without a TBI.

• Spouse alive with TBI: HR, 1.22 (95% CI, 1.05-1.41; P = .008).
• Spouse deceased without TBI: HR, 1.48 (95% CI, 1.36-1.61; P < .001).
• Spouse deceased with TBI: HR, 1.27 (95% CI, 1.07-1.52; P = .006).
• Reference group was spouse alive without TBI; a 4-category exposure was used.

Results for dementia and MACE in models incorporating spousal death were similar in direction to mortality results but less precise.

• The abstract describes these results as 'similar, but less precise'.
• Overall, findings for dementia and MACE were less consistent than for mortality.

The study cohort was a community-based sample of married couples followed for a median of about 19.5 years.

• Drawn from ARIC at 4 US centers (North Carolina, Mississippi, Minnesota, Maryland); 4506 baseline pairs, 3281 retained for mortality and dementia analyses.
• Mean (SD) baseline age was 54.5 (5.5) years.
• Median follow-up was 19.5 years (IQR, 10.6-29.0); baseline 1987-1989, administrative censoring December 31, 2022.
• Spousal TBI was ascertained from self-report, hospitalization surveillance, and linked CMS data; follow-up ended with outcome, death, loss to follow-up, divorce/separation, or censoring.

The authors conclude that TBI consequences may extend beyond injured individuals, supporting family- and care partner-centered care.

• The mortality increase was described as 'modest but significantly higher'.
• Observational design; findings for dementia and MACE were less consistent.