Explaining Outcome Differences between Men and Women following Mild Traumatic Brain Injury

Ana Mikolic*, Joost Oude Groeniger, Marina Zeldovich, Lindsay Wilson, Jeanine Roeters Van Lennep, David Van Klaveren, Suzanne Polinder

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

16 Citations (Scopus)
18 Downloads (Pure)


Men and women differ in outcomes following mild traumatic brain injury (TBI). In the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, we previously found that women had worse 6-month functional outcome (Glasgow Outcome Score Extended [GOSE]), health-related quality of life (HRQoL), and mental health following mild TBI. The aim of this study was to investigate whether those differences were mediated by psychiatric history, gender-related sociodemographic variables, or by care pathways. We analyzed sex/gender differences in 6-month GOSE, generic and TBI-specific HRQoL, and post-concussion and mental health symptoms using three sets of mediators: Psychiatric history, sociodemographic variables (living alone, living with children, education and employment status/job category), and care-pathways (referral to study hospital and discharge destination after emergency department); while controlling for a substantial number of potential confounders (pre-injury health and injury-related characteristics). We included 1842 men and 1022 women (16+) with a Glasgow Coma Score 13-15, among whom 83% had GOSE available and about 60% other 6-month outcomes. We used natural effects models to decompose the total effect of sex/gender on the outcomes into indirect effects that passed through the specified mediators and the remaining direct effects. In our study population, women had worse outcomes and these were only partly explained by psychiatric history, and not considerably explained by sociodemographic variables nor by care pathways. Factors other than differences in specified variables seem to underlie observed differences between men and women in outcomes after mild TBI. Future studies should explore more aspects of gender roles and identity and biological factors underpinning sex and gender differences in TBI outcomes.

Original languageEnglish
Pages (from-to)3315-3331
Number of pages17
JournalJournal of Neurotrauma
Issue number23
Early online date23 Nov 2021
Publication statusPublished - Dec 2021

Bibliographical note

Funding Information:
This study was supported by The Netherlands Organization for Health Research and Development (ZonMw). The authors A. Mikolic, S. Polinder, L. Wilson and M. Zeldovich were supported by the European Union 7th Framework Programme (EC grant 602150). Additional support was obtained from the Hannelore Kohl Stiftung (Germany), OneMind (USA), Integra LifeScien-ces Corporation (USA), and Neurotrauma Sciences (USA).

Publisher Copyright:
© 2021 Ana Mikolic et al. Published by Mary Ann Liebert, Inc.


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