SURVEILLANCE 

REPORT 

Traumatic Brain 

Injury-related Deaths 

by Age Group, Sex, and 

Mechanism of Injury 

UNITED STATES 2018 AND 2019 
 

 

TBI SURVEILLANCE REPORT // UNITED STATES 2018 AND 2019 

ACKNOWLEDGEMENTS 

This surveillance report on fatal traumatic brain injury (TBI) was prepared by staff from the 

Division of Injury Prevention (DIP), 

National Center for Injury Prevention and Control (NCIPC), 

Centers for Disease Control and Prevention (CDC), 

U.S. Department of Health and Human Services, Atlanta, Georgia. 

Contributors to this report included 

Alexis B. Peterson, PhD1 

Karen E. Thomas, MPH2 

Hong Zhou, MS, MPH2 

Corresponding Author 

Alexis B. Peterson 

Apeterson4@cdc.gov 

This report describes the incidence of TBI-related deaths obtained from the 

National Vital Statistics System’s 2018 and 2019 multiple-cause-of-death files. 

All material appearing in this report is in the public domain and may be reproduced 

or copied without permission; citation as to source, however, is appreciated. 

SUGGESTED CITATION: Centers for Disease Control and Prevention (2022). Surveillance Report of Traumatic Brain 

Injury-related Deaths by Age Group, Sex, and Mechanism of Injury—United States, 2018 and 2019. 

Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. 

DISCLAIMER 

The findings and conclusions in this report are those of the authors and do not necessarily represent 

the official position of the Centers for Disease Control and Prevention. 

1

Applied Science Branch, DIP, NCIPC, CDC 

2

Data Analytics Branch, DIP, NCIPC, CDC 

2 
 

TBI SURVEILLANCE REPORT // UNITED STATES 2018 AND 2019 

OVERVIEW 

Traumatic brain injury (TBI) is caused by bump, blow, or jolt to the head or a penetrating head injury that 

results in the disruption of normal brain function.1

 TBI is a preventable injury. It results in death and disability 

for thousands of people each year and remains a serious public health concern. TBIs were identified in 25% 

(N=60,134) of all injury-related deaths that occurred during 20172

 in the United States. 

This surveillance report describes the national numbers and rates of TBI-related deaths by socio-demographic 

characteristics during 2018 and 2019. To assess TBI-related deaths by age group, sex, principal mechanism 

of injury (MOI), and injury intent, we report the average annual numbers and rates during 2018 and 2019. 

TBI-related deaths were obtained from the National Vital Statistics System (NVSS), which captures data for 

all deaths registered in the 50 U.S. states and the District of Columbia.3 

METHODS 

TBI-related deaths were obtained from the 2018 and 2019 NVSS multiple-cause-of-death files. NVSS is a 

partnership between the National Center for Health Statistics and state/local jurisdictions that results in 

the compilation of records of all deaths in the United States.3

 Deaths were included if the record included 

an injury-related International Classification of Diseases 10th Revision (ICD–10)4

 underlying cause of 

death code (V01–Y36, Y85–Y87, Y89, U01–U03) and a TBI-related ICD–10 code in one of the 20 multiplecause-of-death fields. The following TBI-related ICD–10 codes correspond to the established TBI death 

surveillance definition:2

 S01, S02.0, S02.1, S02.3, S02.7–S02.9, S04.0, S06, S07.0, S07.1, S07.8, S07.9, 

S09.7–S09.9, T90.1, T90.2, T90.4, T90.5, T90.8, T90.9. The mechanism/intent of injury categories of 

interest were unintentional motor vehicle traffic crashes, unintentional falls, unintentionally struck by or 

against an object, other or unspecified unintentional injury, suicide, homicide, and other/unknown for 

this analysis. The underlying cause of death fields were searched for the codes listed in the table below to 

identify the cause of injury. These codes are consistent with the ICD–10 external cause of injury matrix.5

 The 

public-use multiple-cause-of-death files were used for most of the analysis.6

 Deaths were obtained from the 

multiple-cause-of-death files available through CDC WONDER for the analysis stratified by region of 

decedents’ residence.7 

Mechanism/Intent of Injury ICD-10 Codes 

Unintentional motor 

vehicle crashes 

[V02–V04](.1,.9), V09.2, [V12–V14](.3–.9), V19(.4–.6), 

[V20–V28](.3–.9), [V29–V79](.4–.9), V80(.3–.5), V81.1, 

V82.1, [V83–V86](.0–.3), V87(.0–.8), V89.2 

Unintentional falls W00–W19 

Unintentional struck 

by/against 

W20–W22, W50–W52 

Unintentional, other All the other codes in the V01–X59, Y85–Y86 ranges 

Suicide U03, X60–X84, Y87.0 

Homicide U01–U02, X85–Y09, Y87.1 

Other/unknown Y10–Y34, Y87.2, Y89.9, Y35–Y36, Y89(.0,.1) 

3 
 

TBI SURVEILLANCE REPORT // UNITED STATES 2018 AND 2019 

Regional analysis of TBI-related deaths focuses on the U.S. census region of the decedent’s residence. 

U.S. Census Region States Included 

Northeast Connecticut, Maine, Massachusetts, New Hampshire, 

Rhode Island, Vermont, New Jersey, New York, Pennsylvania 

Midwest Indiana, Illinois, Michigan, Ohio, Wisconsin, Iowa, 

Kansas, Minnesota, Missouri, Nebraska, North Dakota, 

and South Dakota 

South Delaware, District of Columbia, Florida, Georgia, Maryland, 

North Carolina, South Carolina, Virginia, West Virginia, 

Alabama, Kentucky, Mississippi, Tennessee, Arkansas, 

Louisiana, Oklahoma, Texas 

West Arizona, Colorado, Idaho, New Mexico, Montana, Utah, Nevada, 

Wyoming, Alaska, California, Hawaii, Oregon, and Washington 

For suicide data, deaths among children <10 years were not presented because determining suicidal intent 

in younger children is difficult and case counts were <20 indicating unstable rates.8

 Rates for deaths due 

to suicide were age-adjusted to the population 10 years and older. Suicide deaths in the birth to 9 years 

age group were moved to the “other/unknown” cause category so that the sum of causes equals the total 

number of TBI-related deaths. 

Rates were calculated using bridged race population estimates obtained from National Center for Health 

Statistics (NCHS) as the denominator.9

 Age-adjusted rates were calculated by the direct method of age 

adjusting using the 2000 U.S. Census population.10 While deaths are a complete census of all occurrences, 

confidence intervals were presented to account for random variation.11 Z-tests or nonoverlapping 

confidence intervals were used to analyze differences of TBI-related death rates between males and females 

by mechanism of injury when appropriate. 

4 
RESULTS 

Traumatic Brain Injury-related 

Deaths by Age Group, Sex, 

and Mechanism of Injury 

UNITED STATES 2018 AND 2019 
TBI SURVEILLANCE REPORT // UNITED STATES 2018 AND 2019 

LIST OF TABLES 

TABLE 1 

Annual number and rate per 100,000 of traumatic brain injury-related deaths by selected sociodemographic characteristics — National Vital Statistics System, United States, 2018 and 2019 

TABLE 2 

Average annual number and rate per 100,000 of traumatic brain injury-related deaths by age group 

and mechanism of injury — National Vital Statistics System, United States, 2018 and 2019 

TABLE 3 

Average annual number and rate per 100,000 of traumatic brain injury-related deaths by sex and 

mechanism of injury — National Vital Statistics System, United States, 2018 and 2019 

6 
 

 

 

TBI SURVEILLANCE REPORT // UNITED STATES 2018 AND 2019 

TABLE 1 – Annual number and rate per 100,000 of traumatic brain injury-related deaths† by selected 

socio-demographic characteristics — National Vital Statistics System, United States, 2018 and 2019 

Socio-Demographic 

Characteristic 

2018 

Number 

2018 Rate* 

(95% CI) 

2019 

Number 

2019 Rate* 

(95% CI) 

Age (Years) 

Birth-17 2,493 3.4 (3.3-3.5) 2,476 3.4 (3.3-3.5) 

Birth-4 659 3.3 (3.1-3.6) 612 3.1 (2.9-3.4) 

5-9 248 1.2 (1.1-1.4) 270 1.3 (1.2-1.5) 

10-14 456 2.2 (2.0-2.4) 497 2.4 (2.2-2.6) 

15-24 6,688 15.6 (15.2-16.0) 6,417 15.0 (14.7-15.4) 

25-34 7,376 16.2 (15.8-16.5) 7,251 15.8 (15.4-16.1) 

35-44 6,041 14.7 (14.3-15.0) 6,110 14.7 (14.3-15.0) 

45-54 6,780 16.3 (15.9-16.7) 6,536 16.0 (15.6-16.4) 

55-64 8,250 19.5 (19.1-20.0) 8,057 19.0 (18.6-19.4) 

65-74 7,473 24.5 (24.0-25.1) 7,542 24.0 (23.4-24.5) 

75+ 16,591 75.7 (74.5-76.8) 17,314 76.7 (75.6-77.8) 

Sex 

Male 

Crude§ 44,496 27.7 (27.4-27.9) 44,610 27.6 (27.3-27.9) 

Adjusted¶ 26.8 (26.6-27.1) 26.6 (26.4-26.9) 

Female 

Crude§ 16,069 9.7 (9.5-9.8) 16,001 9.6 (9.5-9.8) 

Adjusted¶ 8.2 (8.1-8.4) 8.1 (8.0-8.2) 

Race/Ethnicity** 

White, Non-Hispanic persons 

Crude§ 45,402 22.6 (22.4-22.8) 45,160 22.5 (22.3-22.7) 

Adjusted¶ 19.0 (18.8-19.2) 18.7 (18.5-18.9) 

Black or African American, 

Non-Hispanic persons 

Crude§ 6,983 16.3 (15.9-16.7) 7,135 16.5 (16.1-16.9) 

Adjusted¶ 16.4 (16.0-16.8) 16.6 (16.2-17.0) 

Hispanic persons 

Crude§ 5,761 9.7 (9.4-9.9) 5,937 9.8 (9.6-10.1) 

Adjusted¶ 11.1 (10.8-11.4) 11.3 (11.0-11.6) 

American Indian or Alaska 

Native, Non-Hispanic persons 

Crude§ 656 23.9 (22.0-25.7) 611 22.1 (20.3-23.8) 

Adjusted¶ 24.5 (22.5-26.4) 23.1 (21.3-25.0) 

Asian or Pacific Islander, 

Non-Hispanic persons 

Crude§ 1,619 8.0 (7.6-8.3) 1,649 7.9 (7.6-8.3) 

Adjusted¶ 8.2 (7.8-8.6) 8.0 (7.6-8.4) 

U.S. Census Region of 

Decedent’s Residence 

Northeast 

Crude§ 8,306 14.8 (14.5-15.1) 8,092 14.5 (14.1-14.8) 

Adjusted¶ 12.8 (12.5-13.1) 12.3 (12.0-12.6) 

Midwest 

Crude§ 13,478 19.8 (19.4-20.1) 13,335 19.5 (19.2-19.8) 

Adjusted¶ 18.0 (17.7-18.3) 17.7 (17.4-18.0) 

South 

Crude§ 25,179 20.2 (20.0-20.5) 25,323 20.2 (19.9-20.4) 

Adjusted¶ 19.0 (18.8-19.2) 18.9 (18.6-19.1) 

West 

Crude§ 13,602 17.5 (17.2-17.8) 13,861 17.7 (17.4-18.0) 

Adjusted¶ 16.4 (16.2-16.7) 16.5 (16.3-16.8) 

Total Crude§ 60,565 18.5 (18.4-18.7) 60,611 18.5 (18.3-18.6) 

Adjusted¶ 17.1 (17.0-17.2) 16.9 (16.8-17.1) 

7 
 

TBI SURVEILLANCE REPORT // UNITED STATES 2018 AND 2019 

TABLE 1 (cont’d) 

Annual number and rate per 100,000 of traumatic brain injury-related deaths† by selected socio-demographic 

characteristics — National Vital Statistics System, United States, 2018 and 2019 

Key Findings 

• Nationally 60,565 TBI-related deaths occurred during 2018 and 60,611 during 2019. 

• Children from birth to 17 years accounted for approximately 4.1% (data not shown) of TBI-related 

deaths during both 2018 and 2019. 

• Rates of TBI-related deaths per 100,000 population were highest among adults aged ≥75 years 

(75.7 in 2018 and 76.7 in 2019), those aged 65-74 years (24.5 in 2018 and 24.0 in 2019), and 

individuals aged 55-64 years (19.5 in 2018 and 19.0 in 2019). 

• The age-adjusted rate of TBI-related deaths per 100,000 population in males (26.8 in 2018 and 26.6 

in 2019) was more than three times the rate of females (8.2 in 2018 and 8.1 in 2019). 

• During 2018 and 2019, American Indian or Alaska Native, Non-Hispanic persons had the highest average 

annual age-adjusted rate (24.5 per 100,000 population in 2018 and 23.1 in 2019) of TBI-related deaths 

when compared to other racial and ethnic groups. 

• Age-adjusted rates of TBI-related deaths per 100,000 population were highest among persons residing 

in the South (19.0 in 2018 and 18.9 in 2019), followed by persons residing in the Midwest (18.0 in 2018 

and 17.7 in 2019), West (16.4 in 2018 and 16.5 in 2019), and Northeast (12.8 in 2018 and 12.3 in 2019). 

Abbreviations: CI = confidence interval 

§

Deaths with missing age were included. 

¶

Deaths with missing age were excluded (3 deaths in 2018 and 5 deaths in 2019). Rates were age-adjusted by the direct method to the 

2000 U.S. Census population. 

**Deaths in persons with an unknown Hispanic origin were excluded from the distribution by race/ethnicity (144 deaths in 2018 and 

119 deaths in 2019). 

8 
TABLE 2 – Average annual number and rate per 100,000 of traumatic brain injury-related deaths† 

 by age group and mechanism of injury — United States, 2018 and 2019 

AGE 

GROUP 

(YRS) 

Unintentional Motor 

Vehicle Traffic Crash Unintentional Falls§ 

Unintentionally Struck 

by or Against an Object 

Other or Unspecified 

Unintentional Injury Suicide¶ Homicide Other** 

NO. RATE (95% CI) NO. RATE (95% CI) NO. RATE (95% CI) NO. RATE (95% CI) NO. RATE (95% CI) NO. RATE (95% CI) NO. RATE (95% CI) 

Birth-17 755 1.0 (1.0-1.1) 37 0.1 (0.0-0.1) 28 0.0 (0.0-0.0) 258 0.4 (0.3-0.4) ¶ ¶ 662 0.9 (0.9-1.0) 75 0.1 (0.1-0.1) 

Birth-4 166 0.8 (0.8-0.9) 17 0.1 (0.1-0.1) 12 0.1 (0.0-0.1) 111 0.6 (0.5-0.6) ¶ ¶ 292 1.5 (1.4-1.6) 39 0.2 (0.2-0.2) 

5-9 135 0.7 (0.6-0.7) †† †† †† †† 37 0.2 (0.1-0.2) ¶ ¶ 64 0.3 (0.3-0.4) †† †† 

10-14 139 0.7 (0.6-0.7) †† †† †† †† 50 0.2 (0.2-0.3) 183 0.9 (0.8-1.0) 85 0.4 (0.3-0.5) 12 0.1 (0.0-0.1) 

15-24 1,996 4.7 (4.5-4.8) 88 0.2 (0.2-0.2) 17 0.0 (0.0-0.1) 270 0.6 (0.6-0.7) 2,784 6.5 (6.3-6.7) 1,290 3.0 (2.9-3.1) 108 0.3 (0.2-0.3) 

25-34 1,978 4.3 (4.2-4.5) 185 0.4 (0.4-0.4) 39 0.1 (0.1-0.1) 346 0.8 (0.7-0.8) 3,288 7.2 (7.0-7.4) 1,330 2.9 (2.8-3.0) 149 0.3 (0.3-0.4) 

35-44 1,390 3.4 (3.2-3.5) 329 0.8 (0.7-0.9) 38 0.1 (0.1-0.1) 334 0.8 (0.7-0.9) 2,933 7.1 (6.9-7.3) 925 2.2 (2.1-2.3) 128 0.3 (0.3-0.3) 

45-54 1,396 3.4 (3.3-3.5) 741 1.8 (1.7-1.9) 49 0.1 (0.1-0.1) 482 1.2 (1.1-1.2) 3,219 7.8 (7.6-8.0) 635 1.5 (1.5-1.6) 136 0.3 (0.3-0.4) 

55-64 1,370 3.2 (3.1-3.4) 1,706 4.0 (3.9-4.2) 59 0.1 (0.1-0.2) 667 1.6 (1.5-1.7) 3,687 8.7 (8.5-8.9) 529 1.2 (1.2-1.3) 137 0.3 (0.3-0.4) 

65-74 884 2.9 (2.7-3.0) 2,945 9.5 (9.3-9.8) 51 0.2 (0.1-0.2) 583 1.9 (1.8-2.0) 2,688 8.7 (8.4-8.9) 283 0.9 (0.8-1.0) 76 0.2 (0.2-0.3) 

75+ 838 3.8 (3.6-3.9) 12,076 54.3 (53.6-55.0) 50 0.2 (0.2-0.3) 1,043 4.7 (4.5-4.9) 2,705 12.2 (11.8-12.5) 171 0.8 (0.7-0.9) 71 0.3 (0.3-0.4) 

Total§§ 10,291 3.1 (3.1-3.2) 18,098 5.5 (5.5-5.6) 329 0.1 (0.1-0.1) 3,920 1.2 (1.2-1.2) 21,486 7.5 (7.4 - 7.5) 5,603 1.7 (1.7-1.7) 863 0.3 (0.3-0.3) 

Age 

Adjusted 

Rate¶¶ 3.1 (3.0-3.1) 4.6 (4.5-4.6) 0.1 (0.1-0.1) 1.1 (1.1-1.1) 7.2 (7.2-7.3) 1.7 (1.7-1.8) 0.3 (0.2-0.3) 

Abbreviation: CI = confidence interval 

¶

Age <10 years were excluded, because determining intent in younger children can be difficult. Rates for TBI-related deaths due to suicide were age-adjusted to the population 

10 years and older. 

**Includes undetermined intent, legal intervention, war, and suicide for age <10 years. 

††Suppressed for counts <10. 

§§Deaths with missing age were included. 

¶¶Deaths with missing age were excluded. Rates were age-adjusted to the 2000 U.S. Census population. 

9 
 

 

TABLE 2 (cont’d) – Average annual number and rate per 100,000 of traumatic brain injury-related deaths† 

 by age group and mechanism of injury — United States, 2018 and 2019 

Key Findings: 

• Among children from birth to 17 years (analyzed separately) the most common mechanisms of injury for TBI-related deaths were motor vehicle 

crashes (average annual rate of 1.0 per 100,000) and homicide (average annual rate of 0.9 per 100,000). 

• Suicide accounted for 35.5% (data not shown) of TBI related deaths and an average annual age-adjusted rate of 7.2 per 100,000 population. 

» The average annual rates attributable to suicide were highest among older adults aged ≥75 years (12.2 per 100,000 population). 

» Outside of the 10-14 years age group, average annual rates attributable to suicide increased by age group and ranged from 6.5 to 8.7 

per 100,000 population. 

• Unintentional falls accounted for 29.9% (data not shown) of all TBI-related deaths, with an average annual age-adjusted rate of 

4.6 per 100,000 population. 

» Older adults aged ≥75 years had the highest average annual rate (54.3 per 100,000 population) of TBI-related deaths attributable to 

unintentional falls. This rate was over five times higher than that among those aged 65-74 years (average annual rate of 9.5 per 100,000 

population). 

• Unintentional motor vehicle crashes accounted for approximately 17% (data not shown) of all TBI-related deaths with an average annual 

age-adjusted rate of 3.1 per 100,000 population. 

» Average annual rates of TBI-related deaths attributable to unintentional motor vehicle crashes were highest among individuals aged 15–24 

years (average annual rate of 4.7 per 100,000 population) and 25–34 years (average annual rate of 4.3 per 100,000). 

10 
TABLE 3 – Average annual number and rate per 100,000 *

 of traumatic brain injury-related deaths† 

by sex and mechanism of injury — United States, 2018 and 2019 

SEX 

Unintentional 

Motor Vehicle 

Traffic Crashes Unintentional Falls§ 

Unintentionally 

Struck by or Against 

an Object 

Other or Unspecified 

Unintentional Injury Suicide¶ Homicide Other** 

NO. RATE (95% CI) NO. RATE (95% CI) NO. RATE (95% CI) NO. RATE (95% CI) NO. RATE (95% CI) NO. RATE (95% CI) NO. RATE (95% CI) 

Crude§§ 7,497 4.6 (4.6-4.7) 10,546 6.5 (6.5-6.6) 275 0.2 (0.2-0.2) 2,850 1.8 (1.7-1.8) 18,684 13.3 (13.1 - 13.4) 4,042 2.5 (2.5-2.6) 660 0.4 (0.4-0.4) 

MALE Age 

Adjusted 

Rate¶¶ 

4.6 (4.5-4.6) 6.3 (6.2-6.4) 0.2 (0.1-0.2) 1.7 (1.6-1.7) 13.0 (12.8-13.1) 2.5 (2.5-2.6) 0.4 (0.4-0.4) 

Crude§§ 2,794 1.7 (1.6-1.7) 7,552 4.5 (4.5-4.6) 54 0.0 (0.0-0.0) 1,070 0.6 (0.6-0.7) 2,802 1.9 (1.9 - 2.0) 1,561 0.9 (0.9-1.0) 203 0.1 (0.1-0.1) 

FEMALE Age 

Adjusted 

Rate¶¶ 

1.7 (1.6-1.7) 3.2 (3.2-3.3) 0.0 (0.0-0.0) 0.5 (0.5-0.6) 1.9 (1.8-1.9) 1.0 (0.9-1.0) 0.1 (0.1-0.1) 

Key Findings: 

• Among principal mechanisms of injury (MOIs) examined that contributed to TBI-related deaths, males had higher average annual age-adjusted 

rates for all MOIs when compared with females: 

» Unintentional motor vehicle crashes (an average rate of 4.6 per 100,000 population compared to 1.7 per 100,000 population) 

» Unintentional falls (an average rate of 6.3 compared to 3.2 per 100,000 population) 

» Suicide (an average rate of 13.0 compared to 1.9 per 100,000 population); and 

» Homicide (an average rate of 2.5 compared to 1.0 per 100,000 population). 

Abbreviations: CI = confidence interval 

*

P-value <0.05 for the statistical comparison between male and female for all mechanisms of injury. 

¶

Age <10 years were excluded, because determining intent in younger children can be difficult. Rates for TBI-related deaths due to suicide were age-adjusted to the population 

10 years and older. 

**Includes undetermined intent, legal intervention, war, and suicide for age <10 years. 

§§Deaths with missing age were included. 

¶¶Deaths with missing age were excluded. Rates were age-adjusted to the 2000 U.S. Census population. 

11 
TBI SURVEILLANCE REPORT // UNITED STATES 2018 AND 2019 

Limitations: 

• In cases of multiple injuries, non-TBI diagnoses might have contributed to the deaths included 

in this analysis. 

• Misclassification of race and ethnicity on death certificates occurs, particularly for American Indian/ 

Alaska Native, Asian/Pacific Islander, and Hispanic populations. This could lead to an underestimation 

of deaths among these groups.12, 13 

• Misclassification or incomplete reporting of the cause of death on death certificates could lead to 

overestimation or underestimation of TBI-related deaths. 

• The specificity of conclusions that can be drawn regarding primary causes of TBI-related deaths is 

limited due to the broad categorization of the principal mechanisms of injury. 

Conclusions 

• During 2018 and 2019, 60,565 and 60,611 TBI-related deaths occurred in the United States, 

respectively. This is fewer than the estimated 61,131 TBI-related deaths that occurred in the United 

States in 2017.2 

• Suicide was a leading cause of TBI-related deaths and accounted for 35.5% of TBI-related deaths. 

» In 2019, suicide was the 10th leading cause of death in the United States.14 TBI-related death rates 

attributable to suicide were highest among people ≥75 years (12.2 per 100,000). Among persons 15 

to 74 years of age, TBI-related suicide death rates ranged from 6.5 to 8.7 per 100,000. These findings 

suggest suicide-related TBIs are observed across a wide age range and support the tailored need for 

a comprehensive public health approach to suicide prevention. CDC’s Preventing Suicide: A Technical 

Package of Policy, Programs, and Practices provides the best available evidence for preventing 

suicide. The strategies represented in the package include a focus on preventing the risk of suicide, as 

well as approaches to lessen the immediate and long-term harms of suicidal behavior for individuals, 

families, communities, and society. 

» Although this analysis focuses on both open and closed head injuries, epidemiological research has 

shown that firearm suicide accounted for nearly half (48.3%) of the increase in the absolute incidence 

of TBI-related death when combining all injury categories showing absolute increases during a 10-year 

study period (2008 to 2017).15 Furthermore, rates of TBI-related firearm suicide increased among 

both males and females in the study. 

• Unintentional falls accounted for approximately 30% of TBI-related deaths. The oldest age group 

(≥75 years) had the highest average annual rate (54.3 per 100,000) and accounted for two-thirds 

of TBI-related deaths attributable to unintentional falls. 

12 
 

TBI SURVEILLANCE REPORT // UNITED STATES 2018 AND 2019 

» Health care providers can play an important role in educating patients about falls and TBIs and when 

appropriate, create/update personalized fall prevention plans during annual wellness visits. CDC’s 

Stopping Elderly Accidents, Deaths, & Injuries (STEADI) initiative can aid health care providers in 

screening older patients for fall risk, assessing modifiable risk factors, and encouraging participation 

in evidence-based fall prevention strategies. 

• Males and American Indian or Alaska Native (AI/AN) Non-Hispanic persons displayed high rates of 

TBI-related death. 

» This finding corroborated a 2000-2017 epidemiological study examining TBI-related death rates by 

sex and race/ethnicity that revealed motor vehicle crashes accounted for the highest rate of death 

among males and persons who were AI/AN Non-Hispanic than among all other groups across all 

years.16 Expanded use of evidence-based strategies17 for reducing the likelihood of motor vehicle 

crashes and related injury if a crash occurs — such as primary seat belt laws covering occupants in 

all seats, child restraint laws with booster seat provisions for children until at least age 9, car seat 

distribution plus education program, and universal motorcycle helmet laws — can reduce injuries. 

» Motor vehicle crashes remain a significant contributor to TBI-related deaths among males and AI/ 

AN Non-Hispanic persons. Impairment caused by alcohol and/or narcotics are known risk factors 

for motor vehicle crashes. In 2019, when compared to all drivers in fatal crashes, there were 4 male 

alcohol-impaired drivers for every female alcohol-impaired driver.18 Rates of alcohol-impaired driving 

deaths are 2 to 17 times higher among AI/AN Non-Hispanic persons when compared to all racial 

and ethnic groups.19 Effective measures for preventing deaths and injuries from impaired driving 

include– actively enforcing existing 0.08% blood alcohol content laws, minimum legal drinking age 

laws, zero tolerance laws for drivers younger than 21 years, using sobriety checkpoints, and requiring 

ignition interlocks for all offenders convicted of alcohol-impaired driving.17 For tribal communities, 

The CDC Tribal Motor Vehicle Injury Prevention, Best Practices Guide outlines effective evidencebased strategies to reduce alcohol-impaired driving (e.g., enforcing legal drinking limits and use of 

ignition interlocks for offenders). 

• Persons residing in the South had the highest annual rates of TBI-related death compared to residents 

of other U.S. Census regions. 

» This finding corroborated a 2016-2018 regional analysis of TBI-related deaths that found rates 

were highest in the South and the level of rurality might contribute to the incidence of this health 

event in states with higher rates.20 Previous epidemiological research shows residents in rural areas 

experience higher TBI incidence21 and might encounter barriers to accessing life-saving emergency 

medical care (e.g., Level 1 trauma centers)22 and specialized TBI care.23 

» A recent 2016 to 2018 epidemiological study identified suicide as the leading cause of TBI-related 

death in most states (including states in the South). However, some southern jurisdictions (e.g., the 

District of Columbia, Louisiana, and South Carolina) experienced rates of TBI-related deaths due to 

homicide that were nearly double those in many states in the Northeast.19 

13 
 

 

TBI SURVEILLANCE REPORT // UNITED STATES 2018 AND 2019 

REFERENCES 

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