Traumatic Brain Injuries in Massachusetts

1. Traumatic Brain Injuries in Massachusetts Injury Surveillance Program Center for Health Statistics, Information, Research and Evaluation Massachusetts Department of Public Health August 2004

2. 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

3. 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

4. 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.

5. 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.

6. Magnitude of Traumatic Brain Injury in Massachusetts

7. Traumatic Brain Injury Fatalities MA Residents, 1995-2002 (N=4,395) • 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

8. 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. Source: MA Hospital Discharge Database, MA Division of Health Care Finance and Policy. Prepared by: The Injury Surveillance Program, MA Department of Public Health

9. 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 Policy Prepared by: The Injury Surveillance Program, MA Department of Public Health Includes all discharge dispositions, including death in ED

10. Leading Causes of Traumatic Brain Injury in Massachusetts

11. Causes of Fatal Traumatic Brain Injury MA Residents, 2002 (N=530) -- 67% were unintentional; 18% were suicide; 11% were homicide Source: Registry of Vital Records and Statistics, MA Department of Public Health Prepared by: The Injury Surveillance Program, MA Department of Public Health

12. Leading Causes of TBI Fatalities MA Residents, 1995-2002 • 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 Health Prepared by: The Injury Surveillance Program, MA Department of Public Health

13. 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 Health Prepared by: The Injury Surveillance Program, MA Department of Public Health

14. Causes of Nonfatal TBI HospitalizationsMA 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 “Other” includes unknown, unspecified, or other specified causes

15. Number of Nonfatal TBI Hospitalizations By Selected Causes and Age Groups, MA Residents, FY 2002 Source: MA Hospital Discharge Database, MA Division of Health Care Finance and Policy. Prepared by: The Injury Surveillance Program, MA Department of Public Health

16. 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 Policy Prepared 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

17. Annual Number of ED Visits for TBI By Selected Causes and Age Groups, MA Residents, FY 2002 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 deaths in ED

18. Risk Factors for Traumatic Brain Injury in Massachusetts

19. Average Annual TBI Death Rates By Sex and Age Group, MA Residents, 2001-2002 (N=1,133) Source: Registry of Vital Records and Statistics, MA Department of Public Health Prepared by: The Injury Surveillance Program, MA Department of Public Health

20. 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

21. Emergency Department Visit Rates for TBIBy Sex and Age Group, MA Residents, FY 2002 (N=33,073) 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

22. Traumatic Brain Injury Death Rates By Race and Ethnicity, MA Residents, 2002 (N=528) N=35 N=443 N=33 N=17 Source: Registry of Vital Records and Statistics, MA Department of Public Health Prepared 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.

23. Acute Care Hospitalization Rates for Nonfatal TBIBy Race and Ethnicity1, MA Residents, FY 2002 (N=4,032) N=241 N= 3,452 N=274 N=33 N=17 N=65 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.

24. Traumatic Brain InjuriesMassachusetts Residents, 2002 1 Death For every: 8 Hospital Discharges ~62 Emergency Department Visits 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 Policy Prepared by: The Injury Surveillance Program, MA Department of Public Health

25. 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.

26. 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!

27. 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