Traumatic brain injury (TBI) affects the lives of millions of Americans each year
(
1
). To describe the trends in TBI-related deaths among different racial/ethnic groups
and by sex, CDC analyzed death data from the National Vital Statistics System (NVSS)
over an 18-year period (2000–2017). Injuries were also categorized by intent, and
unintentional injuries were further categorized by mechanism of injury. In 2017, TBI
contributed to 61,131 deaths in the United States, representing 2.2% of approximately
2.8 million deaths that year. From 2015 to 2017, 44% of TBI-related deaths were categorized
as intentional injuries (i.e., homicides or suicides). The leading category of TBI-related
death varied over time and by race/ethnicity. For example, during the last 10 years
of the study period, suicide surpassed unintentional motor vehicle crashes as the
leading category of TBI-related death. This shift was in part driven by a 32% increase
in TBI-related suicide deaths among non-Hispanic whites. Firearm injury was the underlying
mechanism of injury in nearly all (97%) TBI-related suicides among all groups. An
analysis of TBI-related death rates by sex and race/ethnicity found that TBI-related
deaths were significantly higher among males and persons who were American Indians/Alaska
Natives (AI/ANs) than among all other groups across all years. Other leading categories
of TBI-related deaths included unintentional motor vehicle crashes, unintentional
falls, and homicide. Understanding the leading contributors to TBI-related death and
identifying groups at increased risk is important in preventing this injury. Broader
implementation of evidence-based TBI prevention efforts for the leading categories
of injury, such as those aimed at stemming the significant increase in TBI-related
deaths from suicide, are warranted.
Data from CDC’s NVSS multiple-cause-of-death files were analyzed for 2000–2017. NVSS
collects data for all deaths among U.S. residents. TBI-related deaths were classified
using codes from the International Classification of Diseases, Tenth Revision (ICD-10)
using an established surveillance definition (
2
). Deaths were classified as TBI-related if any multiple codes for causes of deaths
listed in the death record indicated a TBI-related diagnosis, and the single underlying
cause of death was listed as an injury. This methodology represents a change in the
calculation of estimates from previous CDC reports (
1
,
2
), which did not require that an injury be listed as an underlying cause of death.
†
Data on TBI-related deaths were stratified by year, race/ethnicity, sex, and principal
mechanism of injury. Racial/ethnic groups included non-Hispanic white (white), non-Hispanic
black (black), non-Hispanic American Indian/Alaska Native (AI/AN), non-Hispanic Asian/Pacific
Islander (Asian/PI), Hispanic, and other. Injuries were categorized first by intent
(intentional, unintentional, and undetermined intent). Intentional injuries were further
categorized as suicide or homicide. Unintentional injuries were further categorized
by mechanism of injury (motor vehicle crashes, falls, being struck by or against an
object, or unspecified). Principal mechanism of injury was categorized based on the
CDC-recommended external cause of injury mortality matrix for ICD-10 (
3
) and are presented as the pooled average of 3-year groupings.
Each rate and its corresponding 95% confidence interval were based on U.S. bridged-race
population estimates of the resident population (
4
). U.S. census population estimates for the year 2000 were used as the standard for
age-adjusted rates by direct method (
5
). T-tests were used to analyze between-group differences for rates of TBI-related
deaths. Only selected comparisons were tested for statistical significance. Differences
with p-values <0.05 were considered statistically significant. JoinPoint regression
software (version 4.7.0.0; National Cancer Institute) was used to calculate the average
annual percent changes of TBI-related death rates from 2000 to 2017 for each race
and Hispanic origin group to illustrate trends over time. Average annual percent changes
were considered significantly different from zero for p-values <0.05. SAS (version
9.4; SAS Institute, Inc.) was used for all statistical analyses.
The overall rate of TBI-related deaths remained constant from 2000 to 2005, followed
by a statistically significant decrease in the overall rate from 2005 to 2010 and
then a flattening out from 2010 to 2014. From 2014 to 2017, a small but statistically
significant increase in the overall rate of TBI-related deaths occurred (Figure).
TBI-related death rates were significantly higher among males of all races than among
females throughout the study period (p<0.001) (Table 1), and age-adjusted rates were
significantly higher among AI/AN persons than among other racial/ethnic groups (p<0.001).
From 2001 to 2006, the death rates of whites and blacks were similar (p>0.05), but
since 2007, the rate of TBI-related deaths has been significantly higher among whites
(p<0.001).
FIGURE
Age-adjusted rates* of traumatic brain injury–related deaths, by year and race/ethnicity
†
— United States, 2000–2017
Abbreviations: AI/AN = American Indian/Alaska Native; A/PI = Asian/Pacific Islander.
* Per 100,000 population.
† Whites, Blacks, AI/AN, A/PI were non-Hispanic; Hispanic persons could be of any
race.
The figure is a line graph showing the age-adjusted rates of traumatic brain injury–related
deaths, by year and race/ethnicity, in the United States during 2000–2017.
TABLE 1
Estimated number* and age-adjusted rates
†
of traumatic brain injury (TBI)–related deaths,
§
by year, sex, and race/ethnicity
¶
— United States, 2000–2017**
Year/Sex
Race/Ethnicity
Total
White
Black
American Indian/Alaska Native
Asian/Pacific Islander
Hispanic
Other
No.
Rate (95% CI)
No.
Rate (95% CI)
No.
Rate (95% CI)
No.
Rate (95% CI)
No.
Rate (95% CI)
No.
No.
Rate (95% CI)
2000
Male
26,497
27.6 (27.3–28.0)
4,832
30.5 (29.6–31.4)
412
38.5 (34.3–42.6)
599
13.0 (11.9–14.2)
3,593
22.5 (21.6–23.4)
164
36,097
27.3 (27.0–27.6)
Female
9,982
9.0 (8.8–9.2)
1,436
8.0 (7.5–8.4)
169
14.4 (12.2–16.7)
291
6.0 (5.3–6.7)
912
6.3 (5.8–6.8)
40
12,830
8.5 (8.4–8.7)
Total
36,479
17.7 (17.5–17.9)
6,268
18.3 (17.8–18.8)
581
25.8 (23.6–28.1)
890
9.3 (8.6–9.9)
4,505
14.3 (13.8–14.8)
204
48,927
17.4 (17.2–17.5)
2001
Male
27,747
28.6 (28.3–29.0)
4,915
30.8 (29.9–31.7)
429
39.4 (35.2–43.6)
648
13.8 (12.6–15.0)
3,865
22.7 (21.8–23.6)
166
37,770
28.2 (28.0–28.5)
Female
10,307
9.1 (8.9–9.3)
1,410
7.9 (7.4–8.3)
184
16.0 (13.5–18.4)
306
5.9 (5.2–6.6)
961
6.4 (6.0–6.9)
43
13,211
8.7 (8.5–8.8)
Total
38,054
18.3 (18.1–18.5)
6,325
18.4 (17.9–18.8)
613
27.2 (24.9–29.5)
954
9.5 (8.8–10.1)
4,826
14.5 (14.0–15.0)
209
50,981
17.9 (17.7–18.0)
2002
Male
27,771
28.4 (28.1–28.7)
4,811
30.0 (29.1–30.9)
480
42.2 (38.1–46.4)
652
13.6 (12.4–14.7)
3,908
22.5 (21.6–23.4)
186
37,808
27.9 (27.6–28.2)
Female
10,400
9.1 (9.0–9.3)
1,402
7.6 (7.2–8.0)
171
14.7 (12.4–17.0)
334
6.4 (5.7–7.2)
973
6.1 (5.7–6.5)
31
13,311
8.6 (8.5–8.8)
Total
38,171
18.2 (18.0–18.4)
6,213
17.8 (17.3–18.2)
651
28.0 (25.7–30.3)
986
9.7 (9.1–10.4)
4,881
14.2 (13.7–14.6)
217
51,119
17.7 (17.6–17.9)
2003
Male
27,631
28.0 (27.7–28.4)
4,923
30.0 (29.1–30.9)
491
44.1 (39.8–48.4)
671
13.3 (12.2–14.4)
3,977
22.1 (21.3–23.0)
119
37,812
27.6 (27.3–27.9)
Female
10,439
9.0 (8.8–9.2)
1,472
8.0 (7.6–8.4)
162
14.2 (11.9–16.5)
338
6.1 (5.4–6.8)
1,038
6.4 (6.0–6.9)
40
13,489
8.6 (8.5–8.8)
Total
38,070
18.0 (17.8–18.2)
6,395
18.1 (17.7–18.6)
653
28.6 (26.2–30.9)
1,009
9.4 (8.8–10.0)
5,015
14.2 (13.8–14.7)
159
51,301
17.6 (17.4–17.7)
2004
Male
27,799
27.9 (27.6–28.3)
4,842
29.7 (28.8–30.6)
435
37.9 (34.0–41.8)
604
11.7 (10.7–12.7)
3,938
20.9 (20.1–21.7)
117
37,735
27.2 (26.9–27.5)
Female
10,921
9.4 (9.2–9.6)
1,466
7.9 (7.5–8.3)
163
13.2 (11.1–15.3)
366
6.2 (5.6–6.9)
1,012
6.1 (5.7–6.5)
40
13,968
8.8 (8.7–9.0)
Total
38,720
18.1 (18.0–18.3)
6,308
17.8 (17.4–18.3)
598
25.0 (22.9–27.1)
970
8.7 (8.1–9.3)
4,950
13.5 (13.1–14.0)
157
51,703
17.5 (17.3–17.6)
2005
Male
28,771
28.6 (28.3–29.0)
5,126
30.5 (29.6–31.4)
471
39.0 (35.2–42.7)
741
13.9 (12.9–15.0)
4,261
22.4 (21.5–23.2)
122
39,492
28.0 (27.8–28.3)
Female
10,852
9.2 (9.0–9.4)
1,462
7.9 (7.5–8.3)
157
12.9 (10.8–15.0)
352
5.8 (5.2–6.4)
1,068
6.1 (5.7–6.5)
25
13,916
8.6 (8.5–8.8)
Total
39,623
18.4 (18.2–18.6)
6,588
18.3 (17.9–18.8)
628
25.6 (23.5–27.6)
1,093
9.5 (8.9–10.1)
5,329
14.2 (13.8–14.6)
147
53,408
17.8 (17.7–18.0)
2006
Male
28,336
27.9 (27.5–28.2)
5,205
30.4 (29.5–31.3)
453
37.8 (34.1–41.5)
703
12.6 (11.7–13.6)
4,254
21.3 (20.5–22.1)
105
39,056
27.3 (27.0–27.6)
Female
10,905
9.2 (9.0–9.3)
1,401
7.4 (7.0–7.7)
152
12.1 (10.1–14.0)
355
5.7 (5.1–6.3)
1,025
5.7 (5.3–6.1)
29
13,867
8.5 (8.4–8.6)
Total
39,241
18.0 (17.9–18.2)
6,606
18.0 (17.5–18.4)
605
24.5 (22.4–26.5)
1,058
8.9 (8.3–9.4)
5,279
13.5 (13.1–13.9)
134
52,923
17.4 (17.3–17.6)
2007
Male
28,849
28.1 (27.8–28.4)
4,980
28.2 (27.4–29.0)
422
35.6 (31.9–39.2)
752
12.9 (11.9–13.9)
4,141
20.6 (19.9–21.4)
104
39,248
27.1 (26.8–27.4)
Female
11,003
9.1 (8.9–9.2)
1,395
7.2 (6.8–7.6)
141
11.4 (9.4–13.3)
373
5.8 (5.2–6.4)
1,056
5.7 (5.3–6.1)
29
13,997
8.4 (8.3–8.6)
Total
39,852
18.1 (17.9–18.3)
6,375
17.0 (16.6–17.4)
563
23.1 (21.1–25.1)
1,125
9.1 (8.5–9.6)
5,197
13.1 (12.7–13.5)
133
53,245
17.3 (17.2–17.5)
2008
Male
29,211
28.1 (27.8–28.5)
4,670
26.4 (25.6–27.2)
430
35.2 (31.7–38.8)
703
11.9 (11.0–12.8)
3,810
19.0 (18.3–19.7)
84
38,908
26.5 (26.3–26.8)
Female
10,807
8.7 (8.6–8.9)
1,253
6.4 (6.0–6.7)
139
11.1 (9.2–13.0)
327
4.8 (4.3–5.4)
968
5.2 (4.8–5.6)
32
13,526
8.0 (7.8–8.1)
Total
40,018
18.0 (17.8–18.2)
5,923
15.7 (15.3–16.1)
569
22.7 (20.8–24.7)
1,030
8.1 (7.6–8.6)
4,778
12 (11.6–12.4)
116
52,434
16.8 (16.7–17.0)
2009
Male
28,236
26.9 (26.6–27.2)
4,346
24.5 (23.7–25.3)
411
33.2 (29.8–36.5)
711
11.6 (10.7–12.5)
3,789
18.3 (17.6–18.9)
154
37,647
25.4 (25.1–25.6)
Female
10,610
8.5 (8.3–8.6)
1,298
6.5 (6.1–6.9)
169
13.2 (11.2–15.3)
362
5.2 (4.7–5.7)
1,034
5.4 (5.1–5.8)
43
13,516
7.9 (7.7–8.0)
Total
38,846
17.2 (17.1–17.4)
5,644
14.8 (14.4–15.2)
580
23.0 (21.1–25.0)
1,073
8.1 (7.6–8.6)
4,823
11.8 (11.4–12.2)
197
51,163
16.2 (16.0–16.3)
2010
Male
28,678
27.5 (27.2–27.8)
4,303
24.0 (23.2–24.7)
401
34.4 (30.8–38.1)
749
11.8 (10.9–12.7)
3,381
16.3 (15.6–16.9)
144
37,656
25.3 (25.0–25.5)
Female
10,948
8.7 (8.5–8.8)
1,168
5.8 (5.5–6.2)
150
12.5 (10.4–14.5)
327
4.4 (3.9–4.9)
975
4.9 (4.5–5.2)
40
13,608
7.8 (7.6–7.9)
Total
39,626
17.6 (17.4–17.8)
5,471
14.2 (13.9–14.6)
551
22.9 (20.9–24.9)
1,076
7.7 (7.2–8.2)
4,356
10.4 (10.0–10.7)
184
51,264
16.0 (15.9–16.2)
2011
Male
29,067
27.6 (27.3–27.9)
4,420
24.3 (23.5–25.0)
462
39.3 (35.4–43.1)
798
12.4 (11.4–13.3)
3,581
16.8 (16.1–17.4)
114
38,442
25.4 (25.2–25.7)
Female
11,086
8.8 (8.6–8.9)
1,237
6.0 (5.7–6.4)
166
13.3 (11.2–15.4)
384
5.1 (4.5–5.6)
937
4.6 (4.3–4.9)
36
13,846
7.8 (7.7–7.9)
Total
40,153
17.8 (17.6–17.9)
5,657
14.4 (14.1–14.8)
628
25.7 (23.6–27.9)
1,182
8.3 (7.8–8.8)
4,518
10.5 (10.1–10.8)
150
52,288
16.2 (16.0–16.3)
2012
Male
29,678
27.9 (27.6–28.2)
4,549
24.5 (23.7–25.2)
495
40.3 (36.5–44.0)
797
11.7 (10.8–12.5)
3,700
17.3 (16.6–17.9)
137
39,356
25.7 (25.4–25.9)
Female
11,402
8.9 (8.8–9.1)
1,187
5.7 (5.4–6.0)
144
11.1 (9.2–12.9)
422
5.3 (4.8–5.8)
1,045
5.0 (4.7–5.3)
38
14,238
7.9 (7.8–8.1)
Total
41,080
18.0 (17.8–18.2)
5,736
14.4 (14.0–14.8)
639
25.1 (23.1–27.1)
1,219
8.1 (7.6–8.6)
4,745
10.9 (10.5–11.2)
175
53,594
16.3 (16.2–16.5)
2013
Male
30,118
28.0 (27.7–28.4)
4,525
24.0 (23.3–24.8)
461
38.7 (34.9–42.4)
841
11.5 (10.7–12.3)
3,605
16.4 (15.8–17.0)
120
39,670
25.5 (25.3–25.8)
Female
11,588
9.0 (8.8–9.1)
1,257
5.9 (5.6–6.3)
160
12.7 (10.6–14.7)
424
5.0 (4.5–5.5)
1,044
4.8 (4.5–5.1)
35
14,508
7.9 (7.8–8.1)
Total
41,706
18.1 (17.9–18.3)
5,782
14.4 (14.0–14.7)
621
25.1 (23.1–27.2)
1,265
7.9 (7.5–8.4)
4,649
10.4 (10.0–10.7)
155
54,178
16.3 (16.1–16.4)
2014
Male
30,432
28.0 (27.6–28.3)
4,501
23.6 (22.8–24.3)
486
39.6 (35.9–43.4)
888
11.6 (10.8–12.4)
3,738
16.5 (15.9–17.1)
152
40,197
25.5 (25.2–25.7)
Female
11,714
9.0 (8.8–9.2)
1,242
5.9 (5.6–6.2)
158
12.4 (10.4–14.4)
442
4.9 (4.5–5.4)
1,139
5.1 (4.8–5.4)
49
14,744
8.0 (7.8–8.1)
Total
42,146
18 (17.9–18.2)
5,743
14.1 (13.7–14.5)
644
25.4 (23.4–27.5)
1,330
8.0 (7.5–8.4)
4,877
10.6 (10.3–10.9)
201
54,941
16.3 (16.1–16.4)
2015
Male
31,353
28.8 (28.5–29.1)
5,007
25.8 (25.1–26.6)
490
39.2 (35.5–42.8)
902
11.2 (10.4–11.9)
3,970
16.8 (16.2–17.4)
166
41,888
26.3 (26.0–26.5)
Female
12,070
9.2 (9.1–9.4)
1,359
6.3 (6.0–6.6)
195
14.8 (12.7–16.9)
478
5.0 (4.6–5.5)
1,203
5.2 (4.9–5.5)
53
15,358
8.2 (8.1–8.3)
Total
43,423
18.6 (18.4–18.8)
6,366
15.4 (15.0–15.8)
685
26.5 (24.5–28.5)
1,380
7.8 (7.4–8.2)
5,173
10.8 (10.5–11.1)
219
57,246
16.8 (16.6–16.9)
2016
Male
32,241
29.4 (29.1–29.8)
5,359
27.3 (26.5–28.0)
486
38.2 (34.7–41.8)
988
11.6 (10.9–12.3)
4,310
17.5 (16.9–18.1)
141
43,525
26.9 (26.6–27.2)
Female
12,501
9.5 (9.4–9.7)
1,498
6.8 (6.5–7.2)
166
12.4 (10.4–14.3)
540
5.3 (4.9–5.8)
1,275
5.2 (4.9–5.5)
29
16,009
8.5 (8.3–8.6)
Total
44,742
19.1 (18.9–19.3)
6,857
16.4 (16.0–16.8)
652
24.8 (22.9–26.8)
1,528
8.2 (7.8–8.6)
5,585
11.2 (10.9–11.5)
170
59,534
17.3 (17.1–17.4)
2017
Male
33,209
30.0 (29.6–30.3)
5,577
27.8 (27.0–28.5)
542
42.2 (38.5–45.9)
1,041
11.9 (11.1–12.6)
4,463
17.9 (17.3–18.4)
129
44,961
27.4 (27.2–27.7)
Female
12,688
9.6 (9.4–9.8)
1,473
6.6 (6.3–7.0)
210
15.5 (13.3–17.6)
512
4.8 (4.4–5.3)
1,254
5.1 (4.8–5.4)
33
16,170
8.4 (8.3–8.6)
Total
45,897
19.4 (19.2–19.6)
7,050
16.6 (16.2–17.0)
752
28.3 (26.2–30.4)
1,553
8.0 (7.6–8.4)
5,717
11.3 (10.9–11.6)
162
61,131
17.5 (17.3–17.6)
Abbreviation: CI = confidence interval.
* Death estimates obtained from CDC’s National Vital Statistics System. Visits with
missing age or sex were excluded; numbers subject to rounding error.
† Per 100,000 population, age-adjusted to the 2000 U.S. standard population, using
12 age groups: 0–4, 5–9, 10–14, 15–19, 20–24, 25–34, 35–44, 45–54, 55–64, 65–74, 74–84,
and ≥85 years.
§ Record-axis condition codes were used (usually included both part I and part II
of entity-axis condition codes). https://www.cdc.gov/nchs/data/datalinkage/underlying_and_multiple_causes_of_death557_2011.pdf.
¶ Persons who were white, black, American Indian/Alaska Native, Asian/ Pacific Islander,
or Other were non-Hispanic; Hispanics could be of any race.
** Differences in any two rates were considered statistically significant if their
CIs were not overlapping.
Unintentional TBIs combined across mechanism of injury were responsible for a higher
number and rate of deaths than were suicide and homicide across all study years (p<0.001)
(Table 2). Unintentional motor vehicle crashes led to the highest number and rate
of all TBI-related deaths from 2000–2002 to 2006–2008 (p<0.05). Beginning in 2009–2011
and continuing through 2015–2017, suicide was responsible for the most TBI-related
deaths (p<0.001). Across all data years, firearm-related injuries were responsible
for approximately 97% of all TBI-related suicides. The leading category of TBI-related
injury death varied by race/ethnicity and changed for some groups during the study
period. For example, from 2000–2002 to 2003–2005, unintentional motor vehicle crashes
accounted for the highest rate of TBI-related deaths for whites (p<0.001). Beginning
in 2006–2008 and continuing through 2015–2017, suicide accounted for the highest rate
of TBI-related deaths for this group (p<0.002). Among blacks, homicide was responsible
for the highest rate of TBI-related deaths from 2000–2002 to 2015–2017 (p<0.001).
Across the study period, the highest rate of TBI-related deaths among AI/AN was attributed
to unintentional motor vehicle crashes (p<0.05). Among Hispanics, unintentional motor
vehicle crashes were the most common cause of TBI-related deaths from 2000–2002 to
2006–2008 (p<0.001). During 2009–2011, the rates of TBI-related death from unintentional
motor vehicle crashes and unintentional falls were similar (p = 0.16) in Hispanics;
beginning in 2012–2014 and through 2015–2017, unintentional falls were the most common
cause of TBI-related deaths among Hispanics (p<0.001).
TABLE 2
Estimated average annual number* and age-adjusted rates
†
per 100,000 population of traumatic brain injury (TBI)–related deaths
§
by year, intent, mechanism of injury, and race/ethnicity
¶
— United States, 2007–2017**
3-year interval/mechanism of injury
Race/Ethnicity
Total
White
Black
American Indian/Alaska Native
Asian/Pacific Islander
Hispanic
Other
No.
Rate (95% CI)
No.
Rate (95% CI)
No.
Rate (95% CI)
No.
Rate (95% CI)
No.
Rate (95% CI)
No.
No.
Rate (95% CI)
2000–2002
Total unintentional TBI-related deaths
22,908
11.0 (10.9–11.1)
2,914
8.9 (8.7–9.1)
414
18.5 (17.4–19.6)
622
6.8 (6.5–7.2)
2,940
9.3 (9.1–9.6)
103
29,902
10.5 (10.4–10.6)
Unintentional motor vehicle crashes
12,416
6.3 (6.2–6.4)
1,919
5.4 (5.2–5.5)
311
12.8 (12.0–13.7)
343
3.0 (2.8–3.2)
2,014
5.3 (5.1–5.4)
52
17,055
6.0 (5.9–6.0)
Unintentional falls††
6,496
2.8 (2.8–2.8)
477
1.8 (1.7–1.9)
53
3.4 (2.8–4.0)
194
2.8 (2.6–3.1)
484
2.5 (2.4–2.7)
30
7,734
2.7 (2.7–2.8)
Unintentionally struck by/against an object
304
0.1 (0.1–0.2)
34
0.1 (0.1–0.1)
2§§
0.1(0.0–0.2)
5§§
0.0 (0.0–0.1)§§
46
0.1 (0.1–0.2)
2§§
393
0.1 (0.1–0.1)
Other unintentional injury, mechanism unspecified¶¶
3,692
1.7 (1.7–1.8)
484
1.6 (1.5–1.7)
48
2.2 (1.8–2.6)
81
0.9 (0.8–1.1)
396
1.4 (1.3–1.5)
19§§
4,719
1.7 (1.6–1.7)
Total intentional TBI-related deaths
14,312
6.9 (6.9–7.0)
3,258
9.0 (8.8–9.1)
188
7.9 (7.3–8.6)
307
2.6 (2.4–2.7)
1,718
4.8 (4.6–4.9)
98
19,882
7.0 (6.9–7.0)
Suicide
11,909
5.7 (5.7–5.8)
883
2.5 (2.4–2.6)
102
4.4 (3.9–4.9)
164
1.4 (1.2–1.5)
728
2.3 (2.2–2.4)
46
13,833
4.8 (4.8–4.9)
Homicide
2,403
1.2 (1.2–1.2)
2,375
6.4 (6.3–6.6)
86
3.6 (3.1–4.0)
143
1.2 (1.1–1.3)
990
2.5 (2.4–2.6)
51
6,049
2.1 (2.1–2.1)
Other (no intent or mechanism specified)***
348
0.2 (0.2–0.2)
96
0.3 (0.3–0.3)
13§§
0.6 (0.4–0.8)§§
14§§
0.1 (0.1–0.2)§§
79
0.2 (0.2–0.3)
9§§
559
0.2 (0.2–0.2)
Total
37,568
18.1 (18.0–18.2)
6,269
18.2 (17.9–18.4)
615
27.0 (25.7–28.3)
943
9.5 (9.1–9.9)
4,737
14.3 (14.1–14.6)
210
50,342
17.6 (17.6–17.7)
2003–2005
Total unintentional TBI-related deaths
23,940
11.1 (11.0–11.2)
3,009
9.0 (8.8–9.2)
406
17.5 (16.4–18.5)
709
6.9 (6.6–7.2)
3,181
9.3 (9.0–9.5)
81
31,326
10.6 (10.5–10.7)
Unintentional motor vehicle crashes
11,827
5.9 (5.9–6.0)
1,873
5.1 (5.0–5.3)
276
10.8 (10.0–11.5)
349
2.8 (2.6–2.9)
2,146
5.1 (5.0–5.2)
46
16,516
5.6 (5.6–5.7)
Unintentional falls††
8,325
3.4 (3.4–3.5)
570
2.1 (2.0–2.2)
65
3.8 (3.2–4.4)
272
3.3 (3.0–3.5)
609
3.0 (2.8–3.1)
22
9,863
3.3 (3.3–3.4)
Unintentionally struck by/against an object
286
0.1 (0.1–0.1)
33
0.1 (0.1–0.1)
5§§
0.2(0.1–0.4)§§
7
0.1 (0.0–0.1)§§
50
0.1 (0.1–0.2)
1§§
381
0.1 (0.1–0.1)
Other unintentional injury, mechanism unspecified¶¶
3,502
1.6 (1.6–1.7)
534
1.7 (1.6–1.8)
61
2.7 (2.3–3.1)
82
0.8 (0.7–0.9)
376
1.1 (1.0–1.1)
13§§
4,566
1.5 (1.5–1.6)
Total intentional TBI-related deaths
14,482
6.9 (6.8–6.9)
3,286
8.7 (8.5–8.9)
205
8.2 (7.6–8.9)
302
2.2 (2.1–2.4)
1,823
4.5 (4.3–4.6)
69
20,168
6.8 (6.8–6.9)
Suicide
12,305
5.8 (5.7–5.8)
851
2.4 (2.3–2.4)
112
4.6 (4.1–5.1)
168
1.3 (1.1–1.4)
754
2.1 (2.0–2.1)
36
14,225
4.8 (4.8–4.8)
Homicide
2,177
1.1 (1.1–1.1)
2,436
6.3 (6.2–6.5)
93
3.6 (3.2–4.1)
135
1.0 (0.9–1.1)
1,069
2.4 (2.3–2.5)
34
5,943
2.0 (2.0–2.0)
Other (no intent or mechanism specified)***
382
0.2 (0.2–0.2)
135
0.4 (0.3–0.4)
15§§
0.6 (0.5–0.9)§§
12
0.1 (0.1–0.1)§§
95
0.2 (0.2–0.3)
4§§
643
0.2 (0.2–0.2)
Total
38,804
18.2 (18.1–18.3)
6,430
18.1 (17.8–18.3)
626
26.3 (25.1–27.6)
1,024
9.2 (8.9–9.6)
5,098
14.0 (13.7–14.2)
154
52,137
17.6 (17.5–17.7)
2006–2008
Total unintentional TBI-related deaths
24,156
10.8 (10.7–10.9)
2,829
8.1 (7.9–8.2)
372
15.4 (14.4–16.3)
750
6.4 (6.2–6.7)
3,133
8.4 (8.2–8.6)
68
31,308
10.1 (10.1–10.2)
Unintentional motor vehicle crashes
10,662
5.3 (5.2–5.3)
1,724
4.5 (4.4–4.6)
243
9.2 (8.5–9.9)
329
2.4 (2.3–2.6)
1,952
4.2 (4.1–4.3)
33
14,943
4.9 (4.9–5.0)
Unintentional falls††
9,920
3.9 (3.9–3.9)
591
2.1 (2.0–2.2)
74
4.0 (3.4–4.5)
345
3.4 (3.2–3.6)
741
3.1 (2.9–3.2)
23
11,694
3.7 (3.7–3.8)
Unintentionally struck by/against an object
283
0.1 (0.1–0.1)
33
0.1 (0.1–0.1)
3§§
0.1 (0.1–0.2)§§
7
0.1 (0.0–0.1)§§
55
0.1 (0.1–0.1)
0§§
381
0.1 (0.1–0.1)
Other unintentional injury, mechanism unspecified¶¶
3,291
1.5 (1.5–1.5)
481
1.4 (1.3–1.5)
52
2.1 (1.8–2.5)
70
0.6 (0.5–0.7)
385
1.0 (0.9–1.1)
12§§
4,290
1.4 (1.4–1.4)
Total intentional TBI-related deaths
15,125
7.0 (7.0–7.1)
3,339
8.4 (8.3–8.6)
189
7.3 (6.7–7.9)
301
2.1 (1.9–2.2)
1,844
4.2 (4.0–4.3)
55
20,854
6.8 (6.8–6.9)
Suicide
12,913
5.9 (5.9–6.0)
876
2.3 (2.2–2.4)
107
4.2 (3.7–4.6)
176
1.2 (1.1–1.3)
795
2.0 (1.9–2.1)
36
14,903
4.8 (4.8–4.9)
Homicide
2,212
1.1 (1.1–1.1)
2,463
6.1 (6.0–6.3)
82
3.1 (2.7–3.5)
125
0.9 (0.8–1.0)
1,049
2.2 (2.1–2.2)
20§§
5,950
2.0 (1.9–2.0)
Other (no intent or mechanism specified)***
422
0.2 (0.2–0.2)
134
0.4 (0.3–0.4)
18§§
0.8 (0.6–1.0)§§
20
0.1 (0.1–0.2)§§
108
0.3 (0.2–0.3)
4§§
706
0.2 (0.2–0.2)
Total
39,704
18.0 (17.9–18.2)
6,301
16.9 (16.6–17.1)
579
23.4 (22.3–24.6)
1,071
8.7 (8.4–9.0)
5,085
12.9 (12.6–13.1)
128
52,867
17.2 (17.1–17.3)
2009–2011
Total unintentional TBI-related deaths
22,629
9.7 (9.6–9.8)
2,444
6.7 (6.6–6.9)
347
14.7 (13.7–15.6)
773
6.0 (5.7–6.2)
2,695
7.0 (6.8–7.1)
81
28,969
9.0 (8.9–9.1)
Unintentional motor vehicle crashes
8,112
4.0 (3.9–4.0)
1,365
3.4 (3.3–3.5)
202
7.6 (7.0–8.2)
270
1.7 (1.6–1.9)
1,498
3.0 (2.9–3.1)
35
11,482
3.7 (3.6–3.7)
Unintentional falls††
11,281
4.3 (4.2–4.3)
675
2.2 (2.1–2.3)
87
4.7 (4.1–5.3)
415
3.6 (3.4–3.8)
810
3.1 (3.0–3.2)
32
13,301
4.0 (4.0–4.0)
Unintentionally struck by/against an object
276
0.1 (0.1–0.1)
31
0.1 (0.1–0.1)
2§§
0.1 (0.0–0.2)§§
8
0.1 (0.0–0.1)§§
43
0.1 (0.1–0.1)
0§§
360
0.1 (0.1–0.1)
Other unintentional injury, mechanism unspecified¶¶
2,960
1.3 (1.3–1.4)
373
1.0 (1.0–1.1)
56
2.2 (1.9–2.6)
80
0.6 (0.5–0.6)
343
0.8 (0.8–0.9)
14§§
3,826
1.2 (1.2–1.2)
Total intentional TBI-related deaths
16,465
7.6 (7.5–7.7)
3,016
7.4 (7.3–7.6)
216
8.3 (7.6–8.9)
321
2.0 (1.8–2.1)
1,768
3.7 (3.6–3.8)
90
21,877
6.9 (6.9–7.0)
Suicide
14,416
6.6 (6.5–6.7)
908
2.3 (2.2–2.4)
130
5.0 (4.5–5.5)
204
1.2 (1.1–1.3)
867
2.0 (1.9–2.0)
55
16,580
5.2 (5.1–5.2)
Homicide
2,049
1.0 (1.0–1.0)
2,109
5.1 (5.0–5.2)
86
3.3 (2.9–3.7)
117
0.7 (0.6–0.8)
901
1.7 (1.6–1.8)
35
5,297
1.7 (1.7–1.7)
Other (no intent or mechanism specified)***
448
0.2 (0.2–0.2)
130
0.3 (0.3–0.4)
23
0.9 (0.7–1.1)
16§§
0.1 (0.1–0.1)§§
103
0.2 (0.2–0.3)
6§§
726
0.2 (0.2–0.2)
Total
39,542
17.5 (17.4–17.6)
5,591
14.5 (14.3–14.7)
586
23.9 (22.7–25.0)
1,110
8.0 (7.7–8.3)
4,566
10.9 (10.7–11.1)
177
51,572
16.1 (16.0–16.2)
2012–2014
Total unintentional TBI-related deaths
23,486
9.7 (9.6–9.8)
2,530
6.6 (6.5–6.8)
373
15.2 (14.2–16.1)
888
5.9 (5.7–6.2)
2,895
7.0 (6.9–7.2)
87
30,260
9.0 (8.9–9.0)
Unintentional motor vehicle crashes
7,566
3.7 (3.7–3.8)
1,370
3.3 (3.2–3.4)
212
7.8 (7.2–8.4)
257
1.5 (1.4–1.6)
1,482
2.8 (2.7–2.8)
29
10,916
3.4 (3.4–3.4)
Unintentional falls††
12,677
4.6 (4.5–4.6)
746
2.2 (2.1–2.3)
104
5.1 (4.5–5.7)
527
3.8 (3.6–4.0)
1,006
3.4 (3.2–3.5)
46
15,107
4.3 (4.2–4.3)
Unintentionally struck by/against an object
276
0.1 (0.1–0.1)
28
0.1 (0.1–0.1)
4§§
0.2 (0.1–0.3)§§
10
0.1 (0.0–0.1)§§
48
0.1 (0.1–0.1)
0§§
367
0.1 (0.1–0.1)
Other unintentional injury, mechanism unspecified¶¶
2,967
1.3 (1.3–1.3)
386
1.0 (0.9–1.1)
53
2.1 (1.8–2.4)
94
0.6 (0.5–0.6)
359
0.8 (0.7–0.8)
11§§
3,870
1.2 (1.1–1.2)
Total intentional TBI-related deaths
17,692
8.1 (8.0–8.2)
3,100
7.4 (7.2–7.5)
239
9.2 (8.5–9.9)
363
2.0 (1.8–2.1)
1,750
3.4 (3.3–3.5)
83
23,227
7.1 (7.1–7.2)
Suicide
15,755
7.1 (7.1–7.2)
966
2.4 (2.3–2.5)
155
6.0 (5.4–6.5)
242
1.3 (1.2–1.4)
959
1.9 (1.9–2.0)
60
18,138
5.5 (5.4–5.5)
Homicide
1,937
1.0 (0.9–1.0)
2,134
5.0 (4.9–5.1)
84
3.2 (2.8–3.6)
121
0.7 (0.6–0.7)
791
1.4 (1.4–1.5)
23
5,089
1.6 (1.6–1.6)
Other (no intent or mechanism specified)***
465
0.2 (0.2–0.2)
123
0.3 (0.3–0.3)
23
0.9 (0.7–1.1)
20
0.1 (0.1–0.1)
112
0.2 (0.2–0.3)
7§§
751
0.2 (0.2–0.2)
Total
41,644
18.0 (17.9–18.1)
5,754
14.3 (14.1–14.5)
635
25.2 (24.0–26.4)
1,271
8.0 (7.7–8.3)
4,757
10.6 (10.4–10.8)
177
54,238
16.3 (16.2–16.4)
2015–2017
Total unintentional TBI-related deaths
24,843
9.9 (9.8–10.0)
2,919
7.3 (7.1–7.4)
391
15.3 (14.4–16.2)
1,018
5.7 (5.5–5.9)
3,273
7.2 (7.0–7.3)
102
32,547
9.2 (9.1–9.2)
Unintentional motor vehicle crashes
7,508
3.7 (3.6–3.7)
1,579
3.7 (3.6–3.8)
211
7.7 (7.1–8.3)
279
1.4 (1.3–1.5)
1,627
2.8 (2.8–2.9)
32
11,236
3.4 (3.4–3.5)
Unintentional falls††
13,977
4.8 (4.8–4.9)
859
2.4 (2.3–2.5)
109
4.8 (4.3–5.3)
626
3.7 (3.6–3.9)
1,203
3.4 (3.3–3.6)
54
16,828
4.5 (4.4–4.5)
Unintentionally struck by/against an object
257
0.1 (0.1–0.1)
24
0.1 (0.0–0.1)
4§§
0.1 (0.1–0.2)§§
6
0.0 (0.0–0.0)§§
47
0.1 (0.1–0.1)
1§§
339
0.1 (0.1–0.1)
Other unintentional injury, mechanism unspecified¶¶
3,100
1.3 (1.3–1.3)
457
1.1 (1.1–1.2)
67
2.6 (2.2–3.0)
108
0.6 (0.5–0.6)
396
0.8 (0.8–0.9)
16§§
4,144
1.2 (1.2–1.2)
Total intentional TBI-related deaths
19,367
8.9 (8.8–9.0)
3,701
8.5 (8.4–8.7)
275
10.1 (9.4–10.9)
445
2.2 (2.0–2.3)
2,101
3.7 (3.6–3.8)
75
25,965
7.8 (7.7–7.8)
Suicide
17,236
7.8 (7.7–7.9)
1,187
2.8 (2.7–2.9)
184
6.9 (6.3–7.5)
323
1.6 (1.5–1.7)
1,200
2.2 (2.1–2.3)
55
20,186
5.9 (5.9–6.0)
Homicide
2,131
1.1 (1.0–1.1)
2,514
5.7 (5.6–5.9)
90
3.3 (2.9–3.7)
122
0.6 (0.5–0.7)
901
1.5 (1.5–1.6)
20
5,779
1.8 (1.8–1.8)
Other (no intent or mechanism specified)***
477
0.2 (0.2–0.2)
137
0.3 (0.3–0.4)
31
1.2 (0.9–1.4)
23
0.1 (0.1–0.1)
118
0.2 (0.2–0.2)
6§§
792
0.2 (0.2–0.2)
Abbreviation: CI = confidence interval.
* Death estimates obtained from CDC’s National Vital Statistics System. Visits with
missing age were excluded; numbers subject to rounding error.
† Per 100,000 population, age-adjusted to the 2000 U.S. standard population, using
12 age groups: 0–4, 5–9, 10–14, 15–19, 20–24, 25–34, 35–44, 45–54, 55–64, 65–74, 74–84,
and ≥85 years.
§ Record-axis condition codes were used (usually included both part I and part II
of entity-axis condition codes). https://www.cdc.gov/nchs/data/datalinkage/underlying_and_multiple_causes_of_death557_2011.pdf.
¶ Persons who were white, black, American Indian/Alaska Native, Asian/ Pacific Islander,
or Other were non-Hispanic; Hispanics could be of any race.
** Differences in any two rates were considered statistically significant if their
CIs were not overlapping.
†† Includes falls of undetermined intent to maintain consistency with past data releases.
§§ Rates based on ≤20 deaths might be unstable and should be interpreted with caution.
¶¶ External cause of injury codes specify that the injury was unintentional but do
not specify the actual mechanism of injury.
*** Includes TBIs for which the intent was not determined as well as those caused
by legal intervention or war. Includes TBIs in which no mechanism was specified in
the record. Does not include falls of undetermined intent.
Discussion
Over the 18-year study period, approximately 960,000 TBI-related deaths occurred in
the United States; however, the patterns differed over time and among racial/ethnic
groups. Whereas the rates of TBI-related deaths among whites and blacks were similar
from 2001 to 2006, the rates among whites subsequently exceeded those among blacks,
presumably related to a 32% increase in TBI-related suicide deaths among whites, from
5.9 per 100,000 during 2006–2008 to 7.8 during 2015–2017. Previous data have documented
an increasing prevalence of suicide among whites and AI/ANs (
6
). These findings suggest that tailored prevention efforts might be needed to help
reduce the prevalence of TBI among different groups at risk for injury.
This analysis corroborated findings in a 2017 study of TBI-related emergency department
visits, hospitalizations, and deaths (
1
) that identified a shift in the leading category of TBI-related deaths in the United
States during the last 10 years from unintentional motor vehicle crashes to suicide.
That shift was driven by a significant increase in TBI-related suicide deaths as well
as an overall decrease in motor vehicle crash deaths during the last decade (
7
). CDC supports suicide prevention efforts by encouraging the use of strategies that
reflect the best available evidence, including strengthening access and delivery of
suicide care, creating protective environments, teaching coping and problem-solving
skills, and identifying and supporting persons at risk (
8
). Firearm injury was the underlying mechanism of injury in nearly all TBI-related
suicides among all groups. Reducing access to lethal means among persons at risk for
suicide is an important approach to creating protective environments (
8
).
Also consistent with previous research, AI/ANs consistently had the highest age-adjusted
rates of TBI-related deaths across the study period, and unintentional motor vehicle
crashes contributed the highest number and accounted for the highest rate of these
TBI-related deaths in all years (
9
). Lower rates of seat belt use and higher rates of alcohol-related motor vehicle
crash deaths among AI/ANs compared with other groups might be contributing factors
(
9
). Expansion of evidence-based strategies for reducing the likelihood of injury once
a motor vehicle crash has occurred, for example enactment of universal motorcycle
helmet laws and enforcement of existing seat belt and child restraint/booster laws,
might be beneficial.
§
TBI-related homicides disproportionately affected blacks compared with all other groups.
CDC’s National Center for Injury Prevention and Control has created technical packages
that outline the best available evidence-based strategies for preventing violence
¶
; the strategies are intended to work together and to be used in combination in a
multilevel, multisector effort to prevent violence. Implementation might help stop
violence before it starts and decrease the rates of TBI-related homicides.
Falls are the second-leading cause of TBI-related deaths and have been increasing
in number and rate, particularly among older adults (
1
). Health care providers can play an important role in in the prevention of older
adult falls. CDC’s STEADI** (Stopping Elderly Accidents Deaths and Injuries) initiative
can help providers address patient fall risk through the identification of modifiable
risk factors and implementation of effective interventions (e.g., strength and balance
exercises and medication management).
The findings in this report are subject to at least two limitations. First, misclassification
of race and Hispanic origin is a common problem on death certificates, especially
for AI/AN, Asian/PI, and Hispanic populations (
10
). Therefore, for these groups, mortality estimates are most likely underestimates.
Second, incomplete reporting or misclassification of cause of death on death certificates
might bias estimates of TBI-related deaths.
Understanding the leading contributors to TBI-related death and identifying groups
at increased risk is important in preventing this injury. Health care providers can
play an important role in assessing patients at increased risk, such as those at risk
for suicide, unintentional motor vehicle crashes, or unintentional falls, and provide
referrals or tailored interventions.
Summary
What is already known about this topic?
Traumatic brain injuries (TBIs) contribute to a substantial number of deaths each
year.
What is added by this report?
In 2017, approximately 61,000 TBI-related deaths occurred in the United States. Suicide
surpassed motor vehicle crashes as the leading category of TBI-related deaths during
2009–2011 and through 2015–2017. Males and American Indians/Alaska Natives experienced
the highest rates of TBI-related death.
What are the implications for public health practice?
Broader implementation of evidence-based prevention strategies for the leading categories
of TBI-related death, particularly those aimed at stemming the significant increase
in suicide, are warranted. Health care providers can play an important role in assessing
patients at increased risk for suicide and providing appropriate interventions.