Traumatic Brain Injury among Native Hawaiian and Pacific Islander Veterans accessing Veterans Health Administration Homeless Services: A Preliminary Examination

Veterans experiencing homelessness have elevated rates of traumatic brain injury (TBI) diagnoses. There remains limited research on subsets of homeless Veterans, including Native Hawaiian and Pacific Islander (NHPI) Veterans. Department of Veterans Affairs (VA) electronic medical records of 724 752 Veterans who accessed Veterans Health Administration (VHA) homeless services from January 2005-December 2018 were examined. Of the total sample, 1177 identified as NHPI, with comparator samples of non-NHPI (n=723 575) and White (n=418 085) Veterans also generated. Rates of TBI were compared between NHPI Veterans relative to non-NHPI Veterans, as well as between NHPI and White Veterans (a subset of the non-NHPI Veteran sample). NHPI homeless Veterans were more likely to have a documented TBI diagnosis relative to non-NHPI homeless Veterans (AOR=1.82, 95% CI: 1.57-2.11), including the White homeless Veteran subgroup specifically (AOR=1.51, 95% CI: 1.30-1.75). This persisted in the presence of several covariates, including sex, ethnicity, rurality, VA service-connected disability, posttraumatic stress disorder, depression, and VHA mental health and general service use. NHPI homeless Veterans were also significantly less likely to utilize VHA services, suggesting an important gap in health service delivery. Results support potentially heightened risk for TBI among NHPI homeless Veterans, and a need to elucidate if such injuries occur during or outside of military service. Alternatively, given potential sociocultural differences, understanding the experience and expression of TBI sequelae among NHPI homeless Veterans is essential. Further research is requisite to understand how to optimally engage homeless NHPI Veterans in care to ensure TBI-related sequelae are adequately identified and addressed.