Traumatic Brain Injury in
the United States:
CDC Estimates of Traumatic Brain Injury-Related Disability
The CDC's National Center for Injury Prevention and Control estimates that 5.3 million U.S. citizens (2 percent of the population) are living with disability as a result of a traumatic brain injury. This represents the prevalence of TBI disability, defined as the proportion of persons in the population at a given time who have disability resulting from a traumatic brain injury. To estimate the prevalence of disability from TBI in the United States, CDC developed a model incorporating data on the incidence of TBI, severity of injury, and likelihood of disability given a specific level of injury severity.22 Data come from several sources:
The model uses these data to estimate the number of persons alive in 1996 who had ever had a TBI that required hospitalization and resulted in long-term disability. It incorporates differences in rates across age groups, variations in injury severity, and changing patterns in hospital admissions related to severity. The model does not account for disability among people who visited emergency departments or outpatient clinics with a TBI but were not admitted to the hospital. Because of this, our estimate of 5.3 million U.S. citizens living with TBI-related disability may be low. Other restrictions in existing data and methods may also affect the accuracy of this estimate.23 Given these limitations, some variation in future estimates of the prevalence of TBI-related disability is expected.
According to NHDS data, the annual incidence rate of TBI hospitalizations has been declining since 1975, when it peaked at 234 per 100,000 population (500,000 cases). During 1990-1995, the mean annual incidence rate for persons hospitalized with TBI and survived was 99 per 100,000 population (260,000 cases). Hospitalization incidence patterns mirrored mortality rate patterns -- the highest rates were among persons 15-24 years of age and persons over age 65. Based on preliminary data from the Colorado TBI Registry and Follow-up System,25,26 we can estimate that each year, approximately 35 percent (80,500) of the 230,000 hospitalized survivors of TBI experience the onset of long-term disability. A small but unknown proportion of the more than 1 million persons with TBI who are not hospitalized may also experience long-term disability. If we assume this proportion is only 1 percent (existing data indicate it is probably greater), an additional 10,000 persons might have long-term disability. Thus, the estimated number of persons who become disabled each year from TBI is between 80,000 and 90,000.
The data in this report clearly demonstrate the importance of traumatic brain injury as a public health problem. Consequent to these injuries, each year more than 50,000 Americans die, nearly 230,000 are hospitalized and survive, and an estimated 80,000 to 90,000 experience the onset of long-term or lifelong disability. We have much work to do in these areas: primary prevention, acute care and rehabilitation, and improved data systems. This work requires that we better define groups with an increased risk of injury or adverse outcomes based on population characteristics, e.g., age, sex, and race or ethnicity.
Primary prevention of TBI is an important goal of public health efforts. Accomplishing this goal requires attention to each of the major external causes of these injuries: transportation, violence, and falls.
An effective public health response to TBI also requires concerted programs to minimize adverse outcomes among persons who do experience injury. We need research activities to improve the acute care and rehabilitation of persons with TBI, strategies to ensure they have access to appropriate care and services, and interventions to promote their independence and integration into the community for persons living with the effects of TBI.
Research to date indicates that the disabilities most often associated with TBI include cognitive, emotional, and--to a lesser extent--sensory and motor impairments. A traumatic brain injury may permanently alter a person's career or vocational aspirations and may also have profound effects on social and family relationships. In part, impairment of cognitive function may result in the loss of communication skills and memory, inability to organize tasks and solve problems, and decreased attention to detail. TBI may also cause emotional instability--especially impulsiveness--and changes in the ability to see, smell, and hear.
To help persons living with the effects of TBI, we need better information on the nature and scope of these disabilities, including who experiences TBIs, which rehabilitation treatment methods are most effective, and what services are useful and readily available.
In the near future, three important developments may increase our knowledge and promote the development of secondary and tertiary prevention programs.
Finally, more effective, targeted prevention requires better information on the occurrence of TBI and the circumstances surrounding those injuries (for example, the involvement of alcohol and other drugs or the use of personal protective equipment such as helmets). Expanded use of registries facilitates such data collection while also producing more precise information on the impact of these injuries. Standard measures for TBI outcomes need to be refined so that they will readily identify those adverse outcomes most amenable to prevention through rehabilitation and social support. A person's long-term outcome is related to the severity of the TBI. Better defining the relationship between the initial severity of an injury and a person's long-term outcome would help identify those persons who need ongoing medical care, rehabilitation, and other services. Such information also would also help health practitioners and policy makers ensure that these services are available in the community.
This page last reviewed December 04, 2006.