traumatic brain injuries in massachusetts injury surveillance program center for health statistics,...
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Traumatic Brain Injuries in Massachusetts
Injury Surveillance ProgramCenter for Health Statistics, Information, Research and Evaluation
Massachusetts Department of Public Health
August 2004
What is a Traumatic Brain Injury (TBI)?
• An injury to the head resulting from blunt, penetrating, and/or acceleration/deceleration forces, and resulting in any of the following:
– Decreased level of consciousness– Amnesia (memory loss)– Skull fracture– Intracranial lesions (bleeding)– Other neurologic or neuropsychologic
abnormalities
• Concussions are a type of TBI
Source: State and Territorial Injury Prevention Directors Association (STIPDA), 1999
Importance of Traumatic Brain Injury:
• Nationally, an estimated 1.5 million people sustain a
TBI each year.
– Approximately 50,000 of these are fatal.
• At least 5.3 million Americans (2%) of population
currently live with disabilities resulting from TBI.
Source: Centers for Disease Control and Prevention, Traumatic Brain Injury Fact Sheet
Consequences and Costs of Traumatic Brain Injury:
• TBI may lead to problems with cognition, concentration, mood,
movement, balance, sensation and vision, emotional instability, and
seizure disorders.
• In the U.S. in 1995, the direct and indirect costs of TBI totaled and
estimated $56.3 billion.
• In MA, in FY2003, the acute care hospital charges for TBI-related
hospitalizations alone were over $151 million. Nearly half of these
charges were to a public payer source*.
Sources: Centers for Disease Control and Prevention, Traumatic Brain Injury Fact Sheet
MA Hospital Discharge Database, MA Division of Health Care Finance and Policy
*Includes Medicare, Medicaid, and free care.
Massachusetts Data Sources • Death Data
– Registry of Vital Records and Statistics, MA Department of Public Health
• Acute Care Hospital Discharge Data– MA Hospital Discharge Database MA Division of Health Care Finance and Policy
• Emergency Department (ED) Data– MA Emergency Department Database MA Division of Health Care Finance and Policy- The 2002 ED data presented here includes deaths occurring
at an Emergency Department. It does not include those individuals hospitalized through the ED.
Magnitude of Traumatic Brain Injury
in Massachusetts
Traumatic Brain Injury FatalitiesMA Residents, 1995-2002 (N=4,395)
603
530551562561
536525527
0
150
300
450
600
750
1995 1996 1997 1998 1999 2000 2001 2002
Year
TB
I F
ata
liti
es
• The MA crude TBI-related death rate in 2002 was 8.3 per 100,000 residents.
• Traumatic brain injuries occurred in 20% of all injury deaths in 2002. Source: Registry of Vital Records and Statistics, MA Department of Public Health
Prepared by: The Injury Surveillance Program, MA Department of Public Health
Acute Care Hospitalizations for Nonfatal TBI MA Residents, FY 1995-2003
• The MA crude hospital discharge rate for non-fatal TBI was 73 per 100,000 in 2003.
• Between 1995 and 2003 there was a 24% increase in acute care hospitalizations for TBI. Most of the increase was due to increases in fall-related traumatic brain injuries.
3,728
4,605
0
1,000
2,000
3,000
4,000
5,000
1995 1996 1997 1998 1999 2000 2001 2002 2003
Year
TB
I Ho
spit
aliz
atio
ns
Source: MA Hospital Discharge Database, MA Division of Health Care Finance and Policy.
Prepared by: The Injury Surveillance Program, MA Department of Public Health
Massachusetts Emergency Department Visits for Traumatic Brain Injuries, FY 2002
• 33,073 ED visits for TBI
• The crude ED visit rate for TBI is 520.9 per 100,000
Source: MA Emergency Department Discharge Database, MA Division of Health Care Finance and PolicyPrepared by: The Injury Surveillance Program, MA Department of Public HealthIncludes all discharge dispositions, including death in ED
Leading Causes of Traumatic Brain Injury in
Massachusetts
Causes of Fatal Traumatic Brain Injury MA Residents, 2002 (N=530)
Other or Unspec.
20% (N=108)
Struck By4% (N=21)
MVOccupant
21% (N=113)
Firearm23%
(N=120)
Fall32%
(N=168)
-- 67% were unintentional; 18% were suicide; 11% were homicide
Source: Registry of Vital Records and Statistics, MA Department of Public HealthPrepared by: The Injury Surveillance Program, MA Department of Public Health
Leading Causes of TBI Fatalities MA Residents, 1995-2002
120158
168
95113
77
0
50
100
150
200
Year
TB
I F
ata
litie
sFirearm Fall MV-Occup.
• Between 1995 and 2002:
77% increase in fall-related TBI deaths; 46% increase in MV occupant -related TBI deaths; 24% decrease in firearm-related TBI deaths
Source: Registry of Vital Records and Statistics, MA Department of Public HealthPrepared by: The Injury Surveillance Program, MA Department of Public Health
Average Annual Number of TBI Deaths By Selected Causes and Age Groups, MA Residents, 2000-2002
Source: Registry of Vital Records and Statistics, MA Department of Public HealthPrepared by: The Injury Surveillance Program, MA Department of Public Health
0
10
20
30
40
50
60
Age Group (Years)
Nu
mb
er
of D
ea
ths
Falls
Motor Vehicle Occupant
Firearms
Causes of Nonfatal TBI HospitalizationsMA Residents, FY 2002 (N=4,258)
Falls50%
Pedal Cyclist3%
Other10%
Pedestrian5%
Struck By/Against
7%
MV Occupant25%
Source: MA Hospital Discharge Database, MA Division of Health Care Finance and Policy. Prepared by: The Injury Surveillance Program, MA Department of Public Health
“Other” includes unknown, unspecified, or other specified causes
Number of Nonfatal TBI Hospitalizations By Selected Causes and Age Groups, MA Residents, FY 2002
0
100
200
300
400
500
600
<1 1 to 14
15 to 24
25 to 34
35 to 44
45 to 54
55 to 64
65 to 74
75 to 84
85 and overAge Group (Years)
Nu
mb
er o
f H
osp
ital
izat
ion
s
FallsMotor Vehicle OccupantStruck by
Source: MA Hospital Discharge Database, MA Division of Health Care Finance and Policy. Prepared by: The Injury Surveillance Program, MA Department of Public Health
Causes of Emergency Department Visits for TBIMA Residents, FY2002 (N=33,073)
Source: MA Emergency Department Discharge Database, MA Division of Health Care Finance and PolicyPrepared by: The Injury Surveillance Program, MA Department of Public Health
1 “Other” includes unknown, unspecified, or other specified causes. Includes all discharge dispositions, including deaths in ED
Fall39%
Other16%
MV-
Occupant18%
Struck by27%
Annual Number of ED Visits for TBI By Selected Causes and Age Groups, MA Residents, FY 2002
0
2,000
4,000
6,000
Age Group (Years)
Num
ber
of
ED
Vis
its
MV-Occupant
Struck by
Fall
Source: MA Emergency Department Discharge Database, MA Division of Health Care Finance and PolicyPrepared by: The Injury Surveillance Program, MA Department of Public Health
Includes all discharge dispositions, including deaths in ED
Risk Factors for Traumatic Brain Injury in Massachusetts
Average Annual TBI Death Rates By Sex and Age Group, MA Residents, 2001-2002 (N=1,133)
0.0
30.0
60.0
90.0
120.0
150.0
0 to 14
15 to 24
25 to 44
45 to 64
65 to 84
85 and overAge Group (Years)
Ra
te p
er
10
0,0
00
Males Females
Source: Registry of Vital Records and Statistics, MA Department of Public HealthPrepared by: The Injury Surveillance Program, MA Department of Public Health
Hospitalization Rates for Nonfatal TBI By Sex and Age Group, MA Residents, FY 2002 (N=4,258)
Source: MA Hospital Discharge Database, MA Division of Health Care Finance and Policy. Prepared by: The Injury Surveillance Program, MA Department of Public Health
0.0
100.0
200.0
300.0
400.0
500.0
600.0
<1 1 to 1415 to 24
25 to 44
45 to 64
65 to 84
85+
Age Group (Years)
Ra
te p
er
10
0,0
00 Males Females
Emergency Department Visit Rates for TBIBy Sex and Age Group, MA Residents, FY 2002 (N=33,073)
0.0
400.0
800.0
1,200.0
1,600.0
2,000.0
<1 1 to 14
15 to 24
25 to 44
45 to 64
65 to 84
85 and over
Age Group (Years)
Ra
te p
er
10
0,0
00 Males
Females
Source: MA Emergency Department Discharge Database, MA Division of Health Care Finance and Policy
Prepared by: The Injury Surveillance Program, MA Department of Public Health
Includes all discharge dispositions, including death in ED
Traumatic Brain Injury Death Rates By Race and Ethnicity, MA Residents, 2002 (N=528)
0.0
2.0
4.0
6.0
8.0
10.0
12.0
White, NH Black, NH Asian, NH Hispanic
Race/Ethnicity
Rate
pe
r 1
00,0
00 N=443
N=35
N=17N=33
Source: Registry of Vital Records and Statistics, MA Department of Public HealthPrepared by: The Injury Surveillance Program, MA Department of Public Health
All other race/ethnicity = 2, not depicted in the graphic. Rates based on numbers less than 20 may be unstable.
Acute Care Hospitalization Rates for Nonfatal TBIBy Race and Ethnicity1, MA Residents, FY 2002 (N=4,032)
N=17N=33
Source: MA Hospital Discharge Database, MA Division of Health Care Finance and Policy
Prepared by: The Injury Surveillance Program, MA Department of Public Health
1 “Other race/ethnicity” = 226, and not depicted in the graphic.
0.0
20.0
40.0
60.0
80.0
White Black Asian Hispanic
Race/Ethnicity
Rat
e p
er 1
00,0
00
N= 3,452N=241
N=65
N=274
Traumatic Brain InjuriesMassachusetts Residents, 2002
1 Death
~62 Emergency Department Visits
8 Hospital Discharges
For every:
Sources: Registry of Vital Records and Statistics, MA Department of Public Health; MA Hospital Discharge Database and MA Emergency Department Database, MA Division of Health Care Finance and PolicyPrepared by: The Injury Surveillance Program, MA Department of Public Health
Traumatic Brain Injury Prevention Tips: • Always wear a seat belt when you drive or ride in a motor vehicle. Never drive
under the influence of alcohol or drugs. Always buckle your child into a child safety seat, child booster seat or seat belt (according to the child’s weight, height and age) in the car.
• Always wear a helmet – when riding a motorcycle, bicycle, scooter or ATV; playing a contact sport;
batting and running bases; skiing or snowboarding; inline skating or riding a skateboard; riding a horse.
• Avoid falls by: – Installing handrails; removing tripping hazards; maintaining a regular exercise
program to improve strength, balance, and coordination; seeing an eye doctor regularly; installing window guards; using nonslip mats and installing grab bars in tubs and showers.
• Keep firearms stored unloaded in a locked cabinet or safe. Store bullets in a separate location.
• Make sure the surface of playgrounds are made of shock absorbing materials.
Source: The Centers for Disease Control and the Brain Injury Association of America. http://www.cdc.gov/node.do/id/0900f3ec8000dbdc/aspectId/A0400033, accessed 8/21/04.
Conclusions:
• Traumatic brain injuries are an important public health concern in Massachusetts
• Falls are the leading cause of TBI death, hospitalization and ED visits in Massachusetts
• Individuals 85 and over have the highest rates of TBI death and hospitalization. Infants under 1 year have the highest rates of ED visits for TBI.
• TBI’s ARE PREVENTABLE!
Selected Resources for Traumatic Brain Injuries in MA:
• MA Department of Public Health– Injury Prevention and Control Program: 617-624-5070– Injury Surveillance Program: 617-988-3318– Office of Elder Health: 617-624-5070
• MA Rehabilitation Commission– Statewide Head Injury Program: 617-204-3600
• MA Brain Injury Association: 508-795-0244
Brain Injury Information Hotline: 800-242-0300