CDC Study Shows Increase in Fall-Related Traumatic Brain Injury Deaths

Steven Erickson, MD

Fall-related traumatic brain injury (TBI) deaths are increasing steadily, particularly in the older population.

According to a new report from the US Centers for Disease Control and Prevention (CDC), fall-related TBI deaths increased from 3.86 per 100,000 individuals in 2008 to 4.52 per 100,000 people in 2017, representing a 17% increase.

Overall, there were 17,408 fall-related TBI deaths in 2017 and 12,311 deaths in 2008.

Approximately 10% of US residents at least 18 years old report falling each year, which can cause serious injuries and death, particularly in the older age groups.

Unintentional falls are currently the second leading cause of traumatic brain injury-related deaths.

The study authors analyzed data from the National Vital Statistics System multiple-cause-of-death database on death certificates filed in 50 states and Washington DC. To determine the incidence of fall-related traumatic brain injury deaths among US residents by year, state of residents, and decedent characteristics such as sex, age group, race and ethnicity, and urban or rural residence classification status.

The investigators used an initial screen for International Classification of Diseases, Tenth Revision (ICD-10) underlying-cause-of-death codes in the range W00—W19 to identify cases, indicating an unintentional fall as the underlying cause of death.

A fall-related death was labled a TBI death when any of the ICD-10 multiple-cause-of-death codes indicated a TBI-related diagnosis.

The new findings are consistent with recent finding from a CDC surveillance report, which estimated a 22% increase in fall-related deaths between 2006-2014.

The rates have increased most drastically in individuals older than 75.

The rate of fall-related TBI deaths was 54.08 per 100,000 in this older age population, which is approximately 8 times higher than the rate (6.24) in the next age group, individuals between 55-74.

Steve Erickson, MD, concussion expert at Banner-University Medicine Neuroscience Institute, explained in an interview with HCPLive® that some of the reasons the older population are more impacted by falls.

“The finding that more older people are dying of traumatic brain injury from fall is probably due to the fact there's more people on blood thinners and people are living longer,” Erickson said. “[They are] more likely to get a subdural [hematoma] and if more people on blood thinners for other conditions, like cardiovascular conditions, blood clots and those kinds of things, then they're even more susceptible.”

However, some newer blood thinners are more selective and ultimately better for preventing falls.

“Some of the newer blood thinners are more selective and probably less likely to cause subdural hematoma,” Erickson said. “There are more selective blood thinners for [atrial fibrillation] and cardiovascular disease and [deep vein thrombosis].”

Ultimately, the fall-related death rate decreased only in 2 of the 51 jurisdictions included in the study, while corresponding age-adjusted rates increased in 45 of the 49 jurisdictions that saw an increase.

The state-specific age-adjusted rates ranged from 2.25 per 100,000 people in Alabama to 9.09 deaths per 100,000 individuals in South Dakota.

The largest average annual percent changes for the 10-year study occurred in Maine (6.5%), South Dakota (6.1%), and Oklahoma (5.2%).

A significant increase also occurred in 29 states, including states like California, Florida, Massachusetts, North Carolina, Ohio, Pennsylvania, and Texas, which feature large populations.

The rates were also nearly double (6.31 per 100,000) in males than females (3.17 per 100,000).

The study authors said a byproduct of the study is health care providers must now education patients better about falls and traumatic brain injuries, assess fall risk and encourage participation in evidence-based fall prevention programs.

Erickson said physical therapy to strengthen the core and lower extremities could be particularly beneficial in lower the fall rate.

Annual wellness visits also may serve as a time to review previously assessed fall risk factors and update personalized prevention plans.