Deaths From Fall-Related Traumatic Brain Injury — United States, 2008–2017

Alexis B. Peterson, PhD; Scott R. Kegler, PhD

Disclosures

Morbidity and Mortality Weekly Report. 2020;69(9):225-230. 

In This Article

Abstract and Introduction

Introduction

One in 10 U.S. residents aged ≥18 years reports falling each year.[1] Among all age groups, falls can cause serious injury and are the second leading cause of traumatic brain injury (TBI)–related deaths.[2] TBI is a head injury caused by a bump, blow, or jolt to the head or body or a penetrating head injury that results in disruption of normal brain function.* CDC estimated national and state-specific rates and trends for TBI-related deaths (TBI deaths) caused by unintentional falls (fall-related TBI deaths) among U.S. residents during 2008–2017, by selected decedent characteristics. The national age-adjusted rate of fall-related TBI deaths increased by 17% from 2008 to 2017. Rate trends at the national level increased significantly for nearly all decedent characteristics, with the most notable increases observed among persons living in noncore (i.e., most rural), nonmetropolitan counties and those aged ≥75 years. Analysis of state-specific rate trends determined that rates of fall-related TBI deaths increased significantly in 29 states over the 10-year study period. A fall can happen to anyone of any age, but falls are preventable. Health care providers and the public need to be aware of evidence-based strategies to prevent falls, given that rates of fall-related TBI deaths are increasing. Health care providers can educate patients on fall and TBI prevention, assess their risk for falls, and when needed, encourage participation in appropriate evidence-based fall prevention programs.

National Vital Statistics System multiple-cause-of-death database on death certificates filed in 50 states and the District of Columbia (DC) were analyzed to determine the incidence of fall-related TBI deaths among U.S residents by year, decedent characteristics (sex, age group, race/ethnicity, and urban/rural residence classification status§), and state of residence. To identify cases, an initial screen for International Classification of Diseases, Tenth Revision (ICD-10) underlying-cause-of-death codes in the range W00–W19 was performed, indicating an unintentional fall as the underlying cause of death. A fall-related death was further identified as a TBI death when any of the ICD-10 multiple-cause-of-death codes indicated a TBI-related diagnosis.[2] Study years 2008–2017 were selected to support estimation of 10-year national and state-specific trends.

Annual death rates and accompanying 95% confidence intervals (CIs) were calculated per 100,000 population by integrating the National Vital Statistics System data with U.S. bridged-race population estimates.** With the exception of age-group rates, death rates were age-adjusted to the U.S. year 2000 standard age distribution. National and state-specific rate trends of fall-related TBI deaths were modeled using Joinpoint regression software (version 4.6.0.0; National Cancer Institute) to estimate average annual percent changes (AAPCs) for the 10-year study period. AAPCs were considered statistically significant at α = 0.05.

During 2008–2017, the national age-adjusted rate of fall-related TBI deaths increased by 17%, from 3.86 per 100,000 persons to 4.52 (Table 1), representing 17,408 fall-related TBI deaths in 2017. State-specific age-adjusted rates ranged from 2.25 (Alabama) to 9.09 (South Dakota) during 2017 (Figure). Considering only the study endpoint years (2008 and 2017), the number of fall-related TBI deaths increased in 49 of 51 jurisdictions (50 states and DC), and corresponding age-adjusted rates increased in 45 of these 49 jurisdictions (Supplementary Table, https://stacks.cdc.gov/view/cdc/85245). The largest AAPCs in rates of fall-related TBI deaths occurred in Maine (6.5%), South Dakota (6.1%), and Oklahoma (5.2%). A significant increase in rates occurred in 29 states (Arkansas, California, Colorado, Connecticut, Florida, Indiana, Iowa, Kansas, Louisiana, Maine, Maryland, Massachusetts, Minnesota, Missouri, Nebraska, Nevada, New Hampshire, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Virginia, and Wisconsin). The remaining 21 states and DC experienced no significant change in rates.

Figure.

Age-adjusted* rate of traumatic brain injury–related deaths caused by unintentional falls, by state — United States, 2008 and 2017
*Age-adjusted to the 2000 U.S. standard population.
Forty-nine states; Alaska and the District of Columbia not shown because total case count was <20.

During 2017, national rates of fall-related TBI death were highest among persons aged ≥75 years (54.08 per 100,000) and males (6.31) (Table 2). Notably, the rate among persons aged ≥75 years was approximately eight times higher than that among those aged 55–74 years (6.24), and the rate among males was nearly double that of females (3.17). For the period 2008 to 2017, significantly increasing rate trends in fall-related TBI deaths were identified for both males and females, persons aged ≥55 years, non-Hispanic whites, non-Hispanic blacks, and Hispanics, and across all levels of urbanization. The largest modeled rate increases occurred among persons living in noncore nonmetropolitan counties (AAPC = 2.9%) and those aged ≥75 years (AAPC = 2.6%). The only significantly decreasing national rate trend identified was for persons aged 0–17 years (AAPC = −4.3%).

*https://www.cdc.gov/traumaticbraininjury/index.html.
https://www.cdc.gov/homeandrecreationalsafety/pdf/falls/cdc_falls_compendium-2015-a.pdf.
§ https://www.cdc.gov/nchs/data/series/sr_02/sr02_166.pdf.
TBI injury-related diagnosis codes identified by ICD-10 include S01.0–S01.5, S01.7–S01.9, S02.0–S02.1, S02.3, S02.7–S02.9, S04.0, S06.0–S06.9, S07.0–S07.1, S07.8–S07.9, S09.7–S09.9, T90.1–T90.2, T90.4–T90.5, T90.8–T90.9.
**https://www.cdc.gov/nchs/nvss/bridged_race.htm.

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