446 Traumatic Brain Injury in Relation to Health Literacy and Access to Care: An All of Us Analysis

INTRODUCTION: Health literacy enables patients to effectively navigate the healthcare system and be active participants in their own care. Low health literacy is associated with poor clinical outcomes and higher costs across a host of conditions. Despite the vulnerability of traumatic brain injury (TBI) patients, who have higher care complexity and potential cognitive challenges, little is known about the health literacy in this population, particularly how these measures vary among socioeconomic and demographic groups. METHODS: Using of the NIH’s All of Us Research Program, we analyzed survey responses among matched TBI (N = 6,036) and non-TBI patients (N = 259,930). Chi-squared tests compared responses between different racial, ethnic, and income groups among unmatched TBI patients (N = 6,112). Binary and logistic regression compared responses between the matched TBI and non-TBI patients. RESULTS: Patients with TBI consistently reported lower health literacy (3/3 questions, P < 0.01) and limited access to care (4/15 questions, P < 0.05). Multivariable analyses revealed increased difficulty understanding medical forms (OR 2.00, 95% CI 1.73–2.30, P < 0.01) and affording emergency care (OR 1.69, 95% CI 1.12–2.55, P = 0.01). Black, Hispanic, and low-income patients reported more difficulty navigating medical forms. The lowest and second-lowest income groups reported more difficulty navigating medical forms and accessing care. CONCLUSIONS: Health literacy and access to care are limited in patients with a self-reported history of TBI. These disparities are magnified in historically underserved populations and in lower socioeconomic groups. Multidisciplinary efforts to address these limitations are necessary.