Burden of Racial Disparities in Pediatric Traumatic Brain Injury Among American Indian/Alaska Native Children: A Scoping Review of the Literature.

BACKGROUND: Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children worldwide. In the United States, and in the state of Alaska in particular, American Indian/Alaska Native (AI/AN) children experience a disproportionate burden of healthcare disparities. Understanding the epidemiology, mechanisms of injury, access to care, and long-term clinical outcomes in this vulnerable population is crucial for guiding management strategies and prevention initiatives. OBJECTIVES: This scoping review aimed to characterize the epidemiology of pediatric TBI among AI/AN children in the United States; examine mechanisms of injury, hospitalization, and mortality patterns; assess disparities in diagnostic evaluation, insurance status, inpatient and post-discharge care; evaluate current prevention and intervention strategies; and and propose future directions to reduce healthcare inequities among AI/AN children. METHODS: we systematically searched PubMed/MEDLINE, Embase, Scopus, Web of Science, and Google Scholar for English-language, peer-reviewed studies examining TBI in AI/AN children (<18 years). Eligible studies reported epidemiology, clinical outcomes, healthcare disparities, or interventions. Data extraction and quality assessment were conducted independently by multiple reviewers, with methodological rigor assessed using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. RESULTS: AI/AN children demonstrated the highest TBI-related hospitalization and mortality rates nationally, with the burden most pronounced in children < 4 years and in adolescents. Motor vehicle accidents were the leading cause of TBI-related hospitalization and mortality, often associated with alcohol involvement and low utilization of protective equipment. Violence, including blunt trauma and firearm injuries, accounted for disproportionately higher mortality rates, with firearm-related TBI deaths up to three-fold higher compared to that among white children. Disparities extended beyond the mechanism of injury, as AI/AN children were less likely to undergo advanced imaging and experienced longer hospital stays. Additionally, AI/AN children had the lowest rates of private insurance coverage and the highest reliance on Medicaid/Medicare, contributing to the limited access to rehabilitation services and post-discharge healthcare services. CONCLUSION: AI/AN children with TBI bear a substantial burden of healthcare disparities. The limited healthcare infrastructure, insurance disparities, and cultural barriers, in addition to the geographical isolation of those who live in the state of Alaska amplify the burden of healthcare disparities faced by these children. Addressing these disparities requires a multi-faceted approach, including improved surveillance, standardized case definitions, expansion of preventive initiatives, telemedicine, workforce development and diversification, and culturally sensitive care models.