# COGNITIVE RESERVE AND DISPARITIES IN HEALTHCARE USAGE AFTER TRAUMATIC BRAIN INJURY AND STROKE: AN OBSERVATIONAL COHORT STUDY

## TL;DR

Higher education is linked to more healthcare use after brain injury, but this didn't improve return to work, though it was tied to better life satisfaction.

## Contribution

This study explores how cognitive reserve influences healthcare usage and long-term outcomes after brain injury, revealing new insights into disparities in care.

## Key findings

- Higher education correlated with increased healthcare usage in the year following injury.
- Healthcare usage was associated with better long-term life satisfaction but not with return to work.
- Differences in healthcare usage based on education were statistically significant during the injury year.

## 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.

People with higher education levels usually have better outcomes after brain injuries, which is often linked to cognitive reserve. However, they might also have better access to specialized care, influencing these outcomes. This study aimed to explore how healthcare usage varies with cognitive reserve and its impact on recovery after stroke and traumatic brain injury. We conducted an observational study with 83 participants, analysing healthcare usage from 3 years before to 4 years after their injury and interviewing them 5–15 years post-injury. Results showed that those with higher education used more healthcare services, especially in the year of the injury. This increased usage was linked to higher life satisfaction but not to the likelihood of returning to work. In conclusion, while more educated individuals received more healthcare, healthcare usage was not related to better long-term work outcomes, though possibly to life satisfaction.