| ||||
|
| ||||
|
Traumatic Brain Injury in
the United States: Current Data on Traumatic Brain Injury Mortality and Morbidity Current information on TBI deaths comes from the National Center for Health Statistics for the years 1980-1994.21 In 1994, 51,350 persons died from traumatic brain injury; most of these deaths were related to firearms, transportation (injuries involving motor vehicle occupants, pedestrians, bicyclists, motorcyclists, and others), or falls. From 1980 through 1994, the TBI-associated death rate in the United States decreased 20 percent, from 24.7 per 100,000 population to 19.8 per 100,000 population (Figure 1). Most of the decrease resulted from a 38 percent decline in transportation-related deaths, from 11.1 per 100,000 population in 1980 to 6.9 per 100,000 in 1994. Rates of TBI-associated death due to falls and other causes also decreased during this period. However, firearm-related TBI deaths increased 11 percent during this period, from 7.6 per 100,000 in 1980 to 8.4 per 100,000 in 1994. Because of this increase, firearms-use surpassed transportation crashes as the leading cause of death from TBI in 1990.
Firearms use has been the leading cause of death from traumatic brain injury since 1990. In 1994, death rates among males were 3.3 times higher than among females (30.7 per 100,000 males compared with 9.3 per 100,000 females) (Figure 2). Rates were highest among persons aged 75 years and older (46.3 per 100,000), with a smaller peak among those aged 15-24 years (32.8 per 100,000).
Leading causes of TBI-associated death among males varied with age in 1994 (Figure 3). Firearm-related injuries were the leading cause of TBI-associated death among males aged 15-84 years, transportation-related injuries among those under 15 years of age, and falls among those 85 years of age and older. 
Brain injuries that kill boys and young men are often the result of shootings or motor vehicle crashes. For females, the leading causes of TBI-related deaths also varied with age. Transportation-related injuries were the leading cause of TBI among females from birth to 74 years of age, although death rates related to firearms and transportation were almost identical among women aged 30-54 years (Figure 4). As in the older male population, falls were the leading cause of TBI-associated death among women 75 years of age and older.
TBI-associated death rates in 1994 differed by race as well (Figure 5): 25.5 per 100,000 for African Americans; 19.0 per 100,000 for whites; and 15.3 per 100,000 for all other racial groups combined. Among African Americans, firearm-use was the leading cause of TBI-associated death, with a rate of 13.6 per 100,000. This rate was more than two times higher than the rate for the next leading cause, transportation. Firearm-related injuries were also the leading cause of TBI-associated death among whites, with a rate of 7.9 deaths per 100,000--just slightly higher than the transportation-related rate (7.3 per 100,000). Transportation was the leading cause of TBI-associated death among all other racial groups (6.1 per 100,000).
Fatal and Nonfatal Injuries in Seven States, 1994 With financial and technical support from CDC for statewide TBI surveillance systems, seven States (Arizona, Colorado, Minnesota, Missouri, New York [excluding New York City], Oklahoma, and South Carolina) compiled data for TBI-related hospitalizations and deaths that occurred in 1994. As a result, these States have been able to provide more complete descriptions of the incidence, severity, causes, and outcomes of TBI currently occurring among their residents. During 1994, the seven States had 32,112 reported cases of TBI collectively; among persons with these injuries, 5,442 (16.9 percent of all reported TBIs) died without being admitted to a hospital, while 26,670 (83.0 percent) were admitted. Among those who were hospitalized, 1,802 (5.6 percent of all TBIs) died while receiving acute care. Thus, a total of 7,244 TBIs (22.6 percent of all reported TBIs) were fatal. The annual unadjusted incidence rate of TBI for all seven States combined was 90.9 per 100,000 population (91.8 per 100,000, age-adjusted to the 1990 U.S. population). The crude rate of hospitalizations for TBI in the seven States combined was 75.5 per 100,000. The overall TBI-related death rate was 20.7 per 100,000 (Figure 6). In an assessment of State-specific rates of TBI, serious nonfatal injuries requiring hospitalization were far more common than injuries resulting in death in all seven States. The median age at the time of injury was 32 years. The incidence rate of TBI was highest among persons 75 years of age and older (191.1 per 100,000) and among persons 15-24 years (145.1 per 100,000) (Figure 7). Most TBIs (21,423 or 66.7 percent) occurred among males, with the rate among males (124.1 per 100,000) being about twice the rate among females (59.1 per 100,000).
Teenagers, young adults, and people over 75 are far more likely than others to sustain a traumatic brain injury, primarily because of motor vehicle crashes and violence among youths, and falls among the elderly. Transportation-related crashes (involving motor vehicles, bicycles, pedestrians, and recreational vehicles) accounted for 49 percent of all TBIs; falls accounted for an additional 26 percent (Figure 8). Firearm-use accounted for 10 percent of all TBIs in the seven States, and assaults not involving firearms accounted for 8 percent of reported injuries. Nearly two-thirds of firearm-related TBIs (66.5 percent) were classified as suicidal in intent (Figure 9).
The majority of firearm-related traumatic brain injury represent suicides or suicide attempts, although more than a fourth are the result of assaults by others. The leading causes of TBI varied by age in the seven States. Falls were by far the leading cause of TBI among persons aged 75 years and older (at a rate of 126.6 per 100,000), whereas transportation led the list for persons aged 15-24 years (97.9 per 100,000) (Figure 10). Analysis also revealed that the severity of injury and the outcome varied depending on the cause. For example, 90.4 percent of firearm-related TBIs resulted in death, but only 10.2 percent of fall-related TBI proved fatal (Figure 11).
People injured in motor vehicle crashes, falls, or assaults without a firearm have a much greater chance of surviving than do those injured in a shooting. The consistency of findings in these seven States, located in different regions of the United States, suggests that these data may be broadly representative of the Nation as a whole. The epidemiologic patterns of TBI described in this report also resemble those from an analysis of 1994 National Hospital Discharge Survey (NHDS) data, which obtained hospital discharge data from a sample of 478 participating hospitals located across the United States. The crude TBI-related hospitalization rate estimated in the NHDS was 94 per 100,000 population.2 The combined TBI-related hospitalization rate obtained from Arizona, Colorado, Minnesota, Missouri, New York State, Oklahoma, and South Carolina is approximately 20 percent lower than the corresponding rate estimated from the NHDS. Different sampling and other methods that may explain this rate difference have not yet been elucidated. The rates in this report are substantially lower than rates previously reported in studies conducted from 1974 to 1986 (approximately 200 cases per 100,000 population annually).7-16 In comparison, from 1979 to 1992, the TBI-associated death rate declined 22 percent, largely because of a decrease in TBI-related deaths associated with motor-vehicle crashes.3 The findings in this report and those from the NHDS suggest a decline of approximately 50 percent in combined morbidity and death during a corresponding interval, indicating a disproportionately large reduction in rates of nonfatal TBI resulting in hospitalization. This decrease may reflect successes in injury prevention efforts but may also be the result of recent changes in hospital admission policies that encourage outpatient care for less severe injuries. This evident shift away from inpatient care underscores the need for surveillance of TBI patients treated in emergency departments and other outpatient settings. The National Center for Health Statistics National Health Interview Survey (NHIS) has provided some information on the incidence of TBI treated on an outpatient basis.1 In 1991, an estimated 1.54 million non-institutionalized U.S. civilians sustained a brain injury that resulted in loss of consciousness but was not severe enough to cause death or long-term institutionalization, according to self-reported NHIS data collected with the 1991 Injury Supplement. Of these 1.54 million persons, 25 percent received no medical care for their TBI, 49 percent received care in an emergency department or other outpatient site, 9 percent received overnight hospital care, and 16 percent were admitted to a hospital for two or more days.
| ||||
|
This page last modified on 09/19/06. Privacy Notice - Accessibility Centers for Disease Control and
Prevention
| ||||
