# Health Literacy and Access to Care among Patients with and Without Traumatic Brain Injury: An All of Us Analysis

## TL;DR

People with traumatic brain injury face greater challenges with health literacy and accessing care, especially those from underserved communities.

## Contribution

This study identifies disparities in health literacy and access to care among TBI patients using the All of Us Research Program.

## Key findings

- TBI patients reported more difficulty understanding medical forms and affording emergency care.
- Underserved racial/ethnic and income groups with TBI experienced greater health literacy and financial barriers.
- TBI did not consistently amplify the effects of race/ethnicity or income on health outcomes.

## Abstract

Health literacy, which enables patients to effectively navigate the healthcare system, is associated with improved patient outcomes. Patients with traumatic brain injury (TBI) may be uniquely susceptible to gaps in health literacy and access to care, particularly for those of vulnerable socioeconomic status.

Using the National Institutes of Health's (NIH) All of Us Research Program, we analyzed survey responses among matched participants with and without TBI (N = 2,330 and N = 11,562, respectively) via nearest-neighbor propensity score matching. Chi-squared tests compared responses between racial/ethnic and income groups among those with TBI. Multivariable binary and logistic regression compared responses between matched participants with and without TBI.

Respondents with TBI were more likely to report issues related to health literacy and financial barriers to care. Multivariable analyses revealed participants with TBI reported increased difficulty understanding medical forms (OR 1.31, 95% CI 1.18-1.45, P < 0.001) and difficulty affording emergency care (OR 1.55, 95% CI 1.26–1.90, P < 0.001) when compared to those without TBI.

Respondents with history of TBI, per electronic health records, are more likely to report issues pertaining to health literacy and access to care. Among those with TBI, historically underserved populations are also more likely to report issues relating to health literacy and financial barriers to care, though TBI did not consistently modify the effects of race/ethnicity or income. Multidisciplinary efforts to address these limitations are necessary.