Analysis highlights high TBI death rates among older adults and men

A new analysis of U.S. mortality data reveals the disproportionate impact of traumatic brain injuries (TBI) on older adults, males and certain racial and ethnic groups.

The study, published in the peer-reviewed journal Brain Injury, provides a comprehensive analysis of TBI-related deaths across different population groups across the U.S. in 2021.

The findings indicate that suicides remain the most common cause of TBI-related deaths, followed by unintentional falls, and specific groups are disproportionately affected by these tragedies.

Men, in particular, were found to be most likely to die from a TBI – more than three times the rate of women (30.5 versus 9.4). The reasons observed were multifactorial and could reflect differences in injury severity following a fall or motor vehicle crash, to the interaction of sex and age – with TBI outcomes in men worsening with age, while postmenopausal women fare better than men of similar age.

While anyone is at risk for getting a TBI, some groups have a higher chance than others of dying from one. We identified specific populations who are most affected. In addition to men, older adults are especially at risk, with unintentional falls being a major cause of TBI-related death. American Indian or Alaska Native people also have higher rates of these fatal injuries."

Alexis Peterson PhD., lead author of the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention

"These findings highlight the importance of tailored prevention strategies to reach groups who may be at higher risk and the role healthcare providers can play in reducing TBI-related deaths through early intervention and culturally sensitive care."

TBI remains a leading cause of injury-related death in the U.S. In 2020, TBIs were associated with around a quarter of all injury-related deaths. These injuries can result from a bump, blow, or jolt to the head that disrupts normal brain function, whether unintentional (such as motor vehicle crashes or accidental falls), self-inflicted harm, or related to an assault.

Using data from the National Vital Statistics System, the new analysis identified 69,473 TBI-related deaths among U.S. residents during 2021 - an average of 190 deaths per day. The age-adjusted TBI-related mortality rate was 19.5 per 100,000, representing an 8.8% increase from 2020.

Through statistical modeling, the researchers examined the simultaneous effect of multiple factors such as geographic region, sex, race and ethnicity, and age, on TBI-related mortality.

Key findings include:

• Older adults (75+) had the highest rates of TBI-related deaths, with unintentional falls being the most common cause in this age group.
• Non-Hispanic American Indian/Alaska Native individuals experienced the highest TBI-related death rate (31.5) compared to other racial and ethnic groups.
• There were 37,635 TBI-related deaths categorized as unintentional injuries (i.e., motor vehicle crashes, unintentional falls, unintentionally struck by or against an object, other).
• 30,801 were categorized as intentional injuries (i.e., all mechanisms of suicide and homicide).
• Children aged from birth to 17 years accounted for around 4% of TBI-related deaths (2,977).

The authors emphasize the critical role of healthcare providers in preventing TBI-related deaths, particularly with groups at higher risk. "By assessing patients who may be at higher risk for TBI, especially due to falls or mental health challenges, healthcare providers can make timely referrals and recommend culturally tailored interventions to prevent further injury or death," says Dr Peterson.

Public health efforts should focus on addressing the underlying causes of TBI-related deaths, such as unintentional falls and mental health crises, to help prevent further loss of life. "TBIs remain a significant public health concern, especially among older adults, men, and certain racial and ethnic groups," says Peterson. "CDC has proven resources that healthcare providers can use to not only reduce health disparities that increase the risk for TBI but also improve care for anyone affected by a TBI."

The authors note the COVID-19 pandemic could have influenced TBI-related death trends in 2021. They also acknowledge several limitations of this analysis, including potential misclassification or incomplete documentation of causes on death certificates, which may lead to inaccuracies in estimating TBI-related deaths.