Surveillance for Traumatic Brain Injury Deaths ? United States, 1989?1998

Nelson Adekoya, Dr.P.H. (1)
David J. Thurman, M.D. (2)
Dionne D. White, M.P.S. (3)
Kevin W. Webb (3)

(1) Division of Disability, Outcomes, and Programs National Center for Injury Prevention and Control
(2) Division of Adult and Community Health National Center for Chronic Disease Prevention and Health Promotion
(3) Office of Statistics and Programming National Center for Injury Prevention and Control

Abstract

Problem/Condition: Data indicate that approximately 50,000 U.S. residents die as a result of traumatic brain injury (TBI) annually. Survivors of TBI are often left with neuropsychologic impairments that result in disabilities affecting work or social activity. During 1979?1992, TBI-related death rates declined 22%, from 24.6 to 19.3 deaths/100,000 population. This report describes the epidemiology and trends in TBI-related mortality during 1989?1998.

Reporting Period: January 1, 1989?December 31, 1998. Description of Systems: The National Center for Health Statistics (NCHS) Multiple Cause of Death public use data were analyzed for this study.

Results: During 1989?1998, an annual average of 53,288 deaths (range: 51,848?54,501) among U.S. residents were associated with TBI. TBI-related death rates declined 11.4%, from 21.9 to 19.4/100,000 population. The major causes of TBI-related deaths were firearm-related (40%), motor-vehicle?related (34%), and fall-related (10%). The leading causes of TBI-related deaths differed among age groups. Among youths aged 0?19 years, motor-vehicle?related TBIs were the leading cause; among persons aged 20?74 years, firearm-related TBIs were the leading cause; and among persons aged >75 years, fall-related TBIs were the leading cause. Comparing rates in 1989 with rates in 1998, motor-vehicle? related causes declined by 22%; the majority of this decline occurred during the first 5 years of the period. During 1989?1998, firearm-related TBI-related deaths declined by 14%; approximately all of this decline occurred during the last 5 years of the period. In contrast, fall-related TBI-related death rates increased by 25% during the period.

Conclusion: This analysis of mortality data identifies recent trends in TBI-related deaths occurring during 1989? 1998. Fall-related TBI death rates have increased throughout the period. Firearm-related TBI death rates, which were increasing in the early 1990s, declined. Motor-vehicle?related TBI death rates, which were decreasing until the mid-1990s, have since demonstrated only a limited change. Public Health Action: More current population-based epidemiologic studies of TBI are needed to assess recent trends of etiologic factors, provide additional guidance for public policy, and evaluate prevention strategies. Despite the decline in fatal TBI incidence, TBI morbidity and mortality remains a public health challenge. Public health, law enforcement, and transportation safety professionals can address these challenges by implementing effective interven-tions based on a thorough assessment of the factors that influence health-related behaviors.

Introduction

Traumatic brain injury (TBI) is a major cause of morbidity and mortality in the United States (1?18). Each year, approxi-mately 50,000 deaths in the United States are associated with TBI (19), representing >33% of all injury-related deaths. Among survivors of TBI, neuropsychologic and other disabilities (20) are common and often require extensive rehabilitation services and sometimes long-term care. TBI results in substantial loss to persons, their families, and soci-ety (21?23); in 1995, the total direct and indirect financial costs of these injuries were estimated at $56 billion (23). In 1989, the Federal Interagency Head Injury Task Force identified traumatic brain injury as a critical public health problem (24). Since 1989, CDC has published analyses of trends in TBI mortality (1,5,19); the most recent of these indicated that TBI mortality rates decreased from 24.6 to 19.3

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