We examined, among those persons working preinjury, the risk of
unemployment 1 year after traumatic brain injury (TBI) relative to
expected risk of unemployment for the sample under a validated
risk-adjusted econometric model of employment in the U.S. population.
Results indicate that 42% of TBI cases were unemployed versus 9%
expected, relative risk (RR) = 4.5, 95% confidence interval (CI) (4.12,
4.95). The relative risk for unemployment was higher among males, those
with higher education, persons with more severe injuries, and more
impaired early neuropsychological or functional status. Difference in
unemployment rates gave similar results for gender, severity of injury,
and early neuropsychological and functional status. However, for
education, the excess was smaller among those more highly educated, but
the unemployment rate in the more highly educated in the general
population was sufficiently small to yield a larger relative risk. In
conclusion, after accounting for underlying risk of unemployment in the
general population, unemployment is substantially higher after TBI for
people who were employed when they were injured. The differential
employment status varies depending on demographics, severity of brain
injury, early functional outcome, and neurobehavioral indicators. For
characteristics such as education, associated with rates of unemployment
in the general population, different methods used to compare the rates may
yield different results. (JINS, 2005, 11,
747–752.)