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Unemployment in the United States After Traumatic Brain Injury for Working-Age Individuals: Prevalence and Associated Factors 2 Years Postinjury

Cuthbert, Jeffrey P. PhD, MPH, MS; Harrison-Felix, Cynthia PhD; Corrigan, John D. PhD; Bell, Jeneita M. MD, MPH; Haarbauer-Krupa, Juliet K. PhD; Miller, A. Cate PhD

Section Editor(s): Bell, Jeneita M. MD, MPH; Taylor, Christopher A. PhD; Breiding, Matthew J. PhD

The Journal of Head Trauma Rehabilitation: May/June 2015 - Volume 30 - Issue 3 - p 160–174
doi: 10.1097/HTR.0000000000000090
Original Articles

Objective: To estimate the prevalence of unemployment and part-time employment in the United States for working-age individuals completing rehabilitation for a primary diagnosis of traumatic brain injury (TBI) between 2001 and 2010.

Design: Secondary data analysis.

Setting: Acute inpatient rehabilitation facilities.

Participants: Patients aged 16 to 60 years at injury who completed inpatient rehabilitation for TBI between 2001 and 2010.

Main Outcome Measures: Unemployment; Part-time employment.

Results: The prevalence of unemployment for persons in the selected cohort was 60.4% at 2-year postinjury. Prevalence of unemployment at 2-year postinjury was significantly associated with the majority of categories of age group, race, gender, marital status, primary inpatient rehabilitation payment source, education, preinjury vocational status, length of stay, and Disability Rating Scale. The direction of association for the majority of these variables complement previous research in this area, with only Hispanic ethnicity and the FIM Cognitive subscale demonstrating disparate findings. For those employed at 2-year postinjury, the prevalence of part-time employment was 35.0%. The model of prevalence for part-time employment at 2-year postinjury was less robust, with significant relationships with some categorical components of age group, gender, marital status, primary payment source, preinjury vocational status, and Disability Rating Scale.

Conclusions: The prevalence of unemployment for patients completing inpatient rehabilitation for TBI was substantial (60.4%). The majority of factors found to associate with 2 years' unemployment were complementary of previously published research; however, these were often smaller in magnitude than previous reports. The prevalence of part-time employment was also an issue for this cohort and included 35.0% of all employed individuals. In regard to the determination of factors associated with part-time employment, additional analyses that include more fine-grained factors associated with employment, including physical and psychosocial functioning, are recommended.

Research Department, Craig Hospital, Englewood, Colorado (Drs Cuthbert and Harrison-Felix); Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus (Dr Corrigan); National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Bell and Haarbauer-Krupa); and National Institute on Disability and Rehabilitation Research, Department of Education, Washington, District of Columbia (Dr Miller).

Corresponding Author: Jeffrey P. Cuthbert, PhD, MPH, MS, Research Department, Craig Hospital, 3425 S. Clarkson St, Englewood, CO 80113 (

This research was supported by an interagency agreement between the US Department of Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC), and the US Department of Education, Office of Special Education and Rehabilitative Services, National Institute on Disability and Rehabilitation Research (NIDRR), with supplemental funding to the NIDRR-funded Traumatic Brain Injury (TBI) Model Systems National Data and Statistical Center (grant no. H133A110006). It was also supported by a TBI Model Systems Centers grant from the NIDRR to Ohio State University (grant no. H133A070029). This article does not reflect the official policy or opinions of the CDC or HHS and does not constitute an endorsement of the individuals or their programs—by the CDC, HHS, or other components of the federal government—and none should be inferred. No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated. The TBI Model Systems National Database is supported by the NIDRR and created and maintained by the TBI Model Systems Centers Program. This article is intended to promote the exchange of ideas among researchers and policy makers. The views expressed in it are part of ongoing research and analysis and do not necessarily reflect the position of the US Department of Education.

The authors declare no conflicts of interest.

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