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CC BY-NC-ND 4.0 · Asian J Neurosurg 2025; 20(01): 020-033
DOI: 10.1055/s-0044-1800952
Review Article

Trends of Mortality due to Traumatic Brain Injury in the USA: A Comprehensive Analysis of CDC WONDER Data from 1999 to 2020

Muhammad Ashir Shafique
1   Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
,
Muhammad Saqlain Mustafa
1   Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
,
Aashish Kumar
2   Department of Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, Pakistan
,
Javed Iqbal
3   Department of Neurosurgery, University of Chicago, Chicago, Illinois, United States
,
Abdul Haseeb
1   Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
,
Hafsah Alim Ur Rahman
4   Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
,
Abdullah Mussarat
1   Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
,
Burhanuddin Sohail Rangwala
1   Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
,
Hussain Sohail Rangwala
1   Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
,
Syed Muhammad Sinaan Ali
5   Department of Medicine, Liaquat National Hospital and Medical College, Karachi, Pakistan
,
Mohammad Ashraf 
6   Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
7   Department of Neurosurgery, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom
› Author Affiliations Funding None.
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Abstract

Traumatic brain injury (TBI) poses a significant public health challenge in the United States, with diverse causes and outcomes. Understanding the trends in TBI-related mortality is crucial for effective prevention and intervention strategies. This comprehensive analysis utilized data from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database, covering the period from 1999 to 2020. Cause-of-death records were examined using the 10th Edition of the International Classification of Diseases and Related Health Problems diagnostic code S06 for TBI-related fatalities. Mortality rates were calculated per 100,000 individuals, adjusted for age and urban/rural status. Joinpoint Regression analysis was employed to identify significant trends over time. Between 1999 and 2020, 1,218,667 TBI-related deaths occurred, with varying mortality rates across demographic groups and geographic regions. Within the overall population, the highest annual average mortality rates were observed in the non-Hispanic (NH) American Indian or Alaska Native cohort, followed by NH white, NH black or African American, Hispanic or Latino, and NH Asian or Pacific Islander groups. Overall, there was an initial decrease in mortality rate from 1999 to 2012, followed by a subsequent significant increase. Males consistently exhibited higher mortality rates than females across all age groups. Disparities were also observed based on race/ethnicity, with NH American Indian or Alaska Native populations showing the highest mortality rates. Regional variations were evident, with the southern region consistently exhibiting the highest mortality rates. Evolving trends in TBI-related mortality in the United States highlight the need for targeted interventions, particularly in high-risk demographic groups and regions.

Keywords

traumatic brain injury - mortality trends - CDC WONDER database - demographic disparities - regional variations.

Authors' Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and have agreed to be held accountable for all aspects of the work.


Supplementary Material



Publication History

Article published online:
12 December 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Dams-O'Connor K, Juengst SB, Bogner J. et al. Traumatic brain injury as a chronic disease: insights from the United States Traumatic Brain Injury Model Systems Research Program. Lancet Neurol 2023; 22 (06) 517-528
    CrossrefPubMedSearch in Google Scholar
  • 2 Lo J, Chan L, Flynn S. A systematic review of the incidence, prevalence, costs, and activity and work limitations of amputation, osteoarthritis, rheumatoid arthritis, back pain, multiple sclerosis, spinal cord injury, stroke, and traumatic brain injury in the United States: a 2019 update. Arch Phys Med Rehabil 2021; 102 (01) 115-131
    CrossrefPubMedSearch in Google Scholar
  • 3 Peterson AB, Kegler SR. Deaths from fall-related traumatic brain injury - United States, 2008-2017. MMWR Morb Mortal Wkly Rep 2020; 69 (09) 225-230
    CrossrefPubMedSearch in Google Scholar
  • 4 Brett BL, Gardner RC, Godbout J, Dams-O'Connor K, Keene CD. Traumatic brain injury and risk of neurodegenerative disorder. Biol Psychiatry 2022; 91 (05) 498-507
    CrossrefPubMedSearch in Google Scholar
  • 5 Howlett JR, Nelson LD, Stein MB. Mental health consequences of traumatic brain injury. Biol Psychiatry 2022; 91 (05) 413-420
    CrossrefPubMedSearch in Google Scholar
  • 6 Posti JP, Cajanus K, Tornio A. et al. Causes of fatal traumatic brain injury in Finland. J Neurosurg 2023; 139 (06) 1506-1513
    CrossrefPubMedSearch in Google Scholar
  • 7 Taylor CA, Bell JM, Breiding MJ, Xu L. Traumatic brain injury-related emergency department visits, hospitalizations, and deaths - United States, 2007 and 2013. MMWR Surveill Summ 2017; 66 (09) 1-16
    CrossrefPubMedSearch in Google Scholar
  • 8 VanItallie TB. Traumatic brain injury (TBI) in collision sports: possible mechanisms of transformation into chronic traumatic encephalopathy (CTE). Metabolism 2019; 100S: 153943
    CrossrefPubMedSearch in Google Scholar
  • 9 Hu J, Wang X, Chen X. et al. Hydroxychloroquine attenuates neuroinflammation following traumatic brain injury by regulating the TLR4/NF-κB signaling pathway. J Neuroinflammation 2022; 19 (01) 71
    CrossrefPubMedSearch in Google Scholar
  • 10 Kalra S, Malik R, Singh G. et al. Pathogenesis and management of traumatic brain injury (TBI): role of neuroinflammation and anti-inflammatory drugs. Inflammopharmacology 2022; 30 (04) 1153-1166
    CrossrefPubMedSearch in Google Scholar
  • 11 Scarboro M, McQuillan KA. Traumatic brain injury update. AACN Adv Crit Care 2021; 32 (01) 29-50
    CrossrefPubMedSearch in Google Scholar
  • 12 Sharma HS, Muresanu DF, Nozari A. et al. Neuroprotective effects of nanowired delivery of cerebrolysin with mesenchymal stem cells and monoclonal antibodies to neuronal nitric oxide synthase in brain pathology following Alzheimer's disease exacerbated by concussive head injury. Adv Neurobiol 2023; 32: 139-192
    CrossrefPubMedSearch in Google Scholar
  • 13 Slovis JC, Gupta N, Li NY, Kernie SG, Miles DK. Assessment of recovery following pediatric traumatic brain injury. Pediatr Crit Care Med 2018; 19 (04) 353-360
    CrossrefPubMedSearch in Google Scholar
  • 14 Corps KN, Roth TL, McGavern DB. Inflammation and neuroprotection in traumatic brain injury. JAMA Neurol 2015; 72 (03) 355-362
    CrossrefPubMedSearch in Google Scholar
  • 15 Sulhan S, Lyon KA, Shapiro LA, Huang JH. Neuroinflammation and blood-brain barrier disruption following traumatic brain injury: pathophysiology and potential therapeutic targets. J Neurosci Res 2020; 98 (01) 19-28
    CrossrefPubMedSearch in Google Scholar
  • 16 Thapa K, Khan H, Singh TG, Kaur A. Traumatic brain injury: mechanistic insight on pathophysiology and potential therapeutic targets. J Mol Neurosci 2021; 71 (09) 1725-1742
    CrossrefPubMedSearch in Google Scholar
  • 17 Guan B, Anderson DB, Chen L, Feng S, Zhou H. Global, regional and national burden of traumatic brain injury and spinal cord injury, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. BMJ Open 2023; 13 (10) e075049
    CrossrefPubMedSearch in Google Scholar
  • 18 Guan L, Tan J, Qi B. et al. The bibliometric and altmetric analysis of chronic traumatic encephalopathy research: how great is the impact?. Front Neurol 2024; 15: 1294125
    CrossrefPubMedSearch in Google Scholar
  • 19 Hoffman SW, Harrison C. The interaction between psychological health and traumatic brain injury: a neuroscience perspective. Clin Neuropsychol 2009; 23 (08) 1400-1415
    CrossrefPubMedSearch in Google Scholar
  • 20 Wang KK, Yang Z, Zhu T. et al. An update on diagnostic and prognostic biomarkers for traumatic brain injury. Expert Rev Mol Diagn 2018; 18 (02) 165-180
    CrossrefPubMedSearch in Google Scholar
  • 21 Aita SL, Muchintala R, Suresh A, Patel S, Schuler B, Lichtenstein JD. Association of use of a mobile tackling dummy during college football practice with reduced sport-related concussion: results of a pilot investigation. Orthop J Sports Med 2024; 12 (02) 23 259671241228316
    CrossrefPubMedSearch in Google Scholar
  • 22 McCrea MA, Shah A, Duma S. et al. Opportunities for prevention of concussion and repetitive head impact exposure in college football players: a Concussion Assessment, Research, and Education (CARE) Consortium study. JAMA Neurol 2021; 78 (03) 346-350
    CrossrefPubMedSearch in Google Scholar
  • 23 McCrory P, Meeuwisse WH, Aubry M. et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med 2013; 47 (05) 250-258
    CrossrefPubMedSearch in Google Scholar
  • 24 Tajima T, Ota O, Nagayama M. et al. Head injury assessment in the Elite Level Rugby Union in Japan: review of 3 seasons. Int J Sports Med 2022; 43 (10) 889-894
    Thieme ConnectPubMedSearch in Google Scholar
  • 25 Faul M, Coronado V. Chapter 1 - Epidemiology of traumatic brain injury. In: Grafman J, Salazar AM. eds. Handbook of Clinical Neurology. Elsevier; 2015: 3-13
    Search in Google Scholar
  • 26 Tang CY, Eaves E, Dams-O'Connor K. et al. Diffuse disconnectivity in TBI: a resting state fMRI and DTI study. Transl Neurosci 2012; 3 (01) 9-14
    CrossrefPubMedSearch in Google Scholar
  • 27 Blennow K, Brody DL, Kochanek PM. et al. Traumatic brain injuries. Nat Rev Dis Primers 2016; 2 (01) 16084
    CrossrefPubMedSearch in Google Scholar
  • 28 Peek-Asa C, Coman MA, Zorn A. et al. Association of traumatic brain injury severity and time to definitive care in three low-middle-income European countries. Inj Prev 2022; 28 (01) 54-60
    CrossrefPubMedSearch in Google Scholar
  • 29 Steyerberg EW, Wiegers E, Sewalt C. et al; CENTER-TBI Participants and Investigators. Case-mix, care pathways, and outcomes in patients with traumatic brain injury in CENTER-TBI: a European prospective, multicentre, longitudinal, cohort study. Lancet Neurol 2019; 18 (10) 923-934
    CrossrefPubMedSearch in Google Scholar
  • 30 Vella MA, Crandall ML, Patel MB. Acute management of traumatic brain injury. Surg Clin North Am 2017; 97 (05) 1015-1030
    CrossrefPubMedSearch in Google Scholar
  • 31 McGinn MJ, Povlishock JT. Pathophysiology of traumatic brain injury. Neurosurg Clin N Am 2016; 27 (04) 397-407
    CrossrefPubMedSearch in Google Scholar
  • 32 Yang Y, Lu D, Wang M. et al. Endoplasmic reticulum stress and the unfolded protein response: emerging regulators in progression of traumatic brain injury. Cell Death Dis 2024; 15 (02) 156
    CrossrefPubMedSearch in Google Scholar
  • 33 Jeremitsky E, Omert L, Dunham CM, Protetch J, Rodriguez A. Harbingers of poor outcome the day after severe brain injury: hypothermia, hypoxia, and hypoperfusion. J Trauma 2003; 54 (02) 312-319
    CrossrefPubMedSearch in Google Scholar
  • 34 Babikian T, Merkley T, Savage RC, Giza CC, Levin H. Chronic aspects of pediatric traumatic brain injury: review of the literature. J Neurotrauma 2015; 32 (23) 1849-1860
    CrossrefPubMedSearch in Google Scholar
  • 35 Berry JG, Bloom S, Foley S, Palfrey JS. Health inequity in children and youth with chronic health conditions. Pediatrics 2010; 126 (Suppl. 03) S111-S119
    CrossrefPubMedSearch in Google Scholar
  • 36 Haarbauer-Krupa J, Taylor CA, Yue JK. et al. Screening for post-traumatic stress disorder in a civilian emergency department population with traumatic brain injury. J Neurotrauma 2017; 34 (01) 50-58
    CrossrefPubMedSearch in Google Scholar
  • 37 Zahniser E, Temkin NR, Machamer J. et al; TRACK-TBI Investigators. The functional status examination in mild traumatic brain injury: a TRACK-TBI sub-study. Arch Clin Neuropsychol 2019; 34 (07) 1165-1174
    CrossrefPubMedSearch in Google Scholar
  • 38 Yue JK, Winkler EA, Sharma S. et al; the TRACK-TBI Investigators. Temporal profile of care following mild traumatic brain injury: predictors of hospital admission, follow-up referral and six-month outcome. Brain Inj 2017; 31 (13-14): 1820-1829
    CrossrefPubMedSearch in Google Scholar
  • 39 Anderson VA, Catroppa C, Dudgeon P, Morse SA, Haritou F, Rosenfeld JV. Understanding predictors of functional recovery and outcome 30 months following early childhood head injury. Neuropsychology 2006; 20 (01) 42-57
    CrossrefPubMedSearch in Google Scholar
  • 40 Nishijima DK, Offerman SR, Ballard DW. et al; Clinical Research in Emergency Services and Treatment (CREST) Network. Immediate and delayed traumatic intracranial hemorrhage in patients with head trauma and preinjury warfarin or clopidogrel use. Ann Emerg Med 2012; 59 (06) 460-8.e1 , 7
    CrossrefPubMedSearch in Google Scholar