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Mortality and Associated Morbidities Following Traumatic Brain Injury in Older Medicare Statin Users

Khokhar, Bilal, PhD; Simoni-Wastila, Linda, PhD; Slejko, Julia F., PhD; Perfetto, Eleanor, PhD; Zhan, Min, PhD; Smith, Gordon S., MBChB, MPH

The Journal of Head Trauma Rehabilitation: November/December 2018 - Volume 33 - Issue 6 - p E68–E76
doi: 10.1097/HTR.0000000000000369
Focus on Clinical Research and Practice

Objective: To assess the relationship between posttraumatic brain injury statin use and (1) mortality and (2) the incidence of associated morbidities, including stroke, depression, and Alzheimer's disease and related dementias following injury.

Setting and Participants: Nested cohort of all Medicare beneficiaries 65 years of age and older who survived a traumatic brain injury (TBI) hospitalization during 2006 through 2010. The final sample comprised 100 515 beneficiaries.

Design: Retrospective cohort study of older Medicare beneficiaries. Relative risks (RR) and 95% confidence interval (CI) were obtained using discrete time analysis and generalized estimating equations.

Measures: The exposure of interest included monthly atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, and simvastatin use. Outcomes of interest included mortality, stroke, depression, and Alzheimer's disease and related dementias.

Results: Statin use of any kind was associated with decreased mortality following TBI hospitalization discharge. Any statin use was also associated with a decrease in any stroke (RR, 0.86; 95% confidence intervals (CI), 0.81-0.91), depression (RR, 0.85; 95% CI, 0.79-0.90), and Alzheimer's disease and related dementias (RR, 0.77; 95% CI, 0.73-0.81).

Conclusion: These findings provide valuable information for clinicians treating older adults with TBI as clinicians can consider, when appropriate, atorvastatin and simvastatin to older adults with TBI in order to decrease mortality and associated morbidities.

General Dynamics Information Technology, Defense and Veterans Brain Injury Center, Fairfax, Virginia (Dr Khokhar); Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore (Drs Slejko, Perfetto, and Simoni-Wastila); National Health Council, Washington, District of Columbia (Dr Perfetto); Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore (Dr Zhan and Mr Smith); and West Virginia University School of Public Health, Morgantown (Mr Smith).

Corresponding Author: Bilal Khokhar, PhD, General Dynamics Information Technology, Defense and Veterans Brain Injury Center, 1335 East West Highway, Silver Spring, MD 20910 (Bilal.khokhar@gdit.com).

Dr Khokhar was supported by National Institutes of Health grant T32AG000262-14 (Magaziner, PI) and Dr Smith was supported by National Institutes of Health grant R01AA18707. For the remaining authors none were declared.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.headtraumarehab.com).

The authors declare no conflicts of interest.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.