TRAUMATIC BRAIN INJURIES
ARIZONA RESIDENTS, 2011
Resources for the development of this report were provided through funding to the Arizona Department of
Health Services from the Centers for Disease Control and Prevention, Cooperative Agreement
5U17CE002023-01, Core Violence and Injury Prevention Program.
Permission to quote from or reproduce materials from this publication is granted when acknowledgment is
made.

TABLE OF CONTENTS
Executive Summary ............................................................................................................................. 1
Introduction ........................................................................................................................................ 2
Five-Year Trends in Traumatic Brain Injuries .................................................................................... 4
Mortality ............................................................................................................................................. 5
Non-Fatal Inpatient Hospitalizations ................................................................................................... 6
Non-Fatal Emergency Department Visits ............................................................................................ 9
TBI-Related Mortality in 2011 ............................................................................................................ 11
Firearm-Related ............................................................................................................................... 14
Fall-Related ...................................................................................................................................... 16
TBI-Related Non-Fatal Inpatient Hospitalizations 2011 ................................................................... 17
Fall-Related ...................................................................................................................................... 19
Motor Vehicle Traffic Crash-Related ................................................................................................. 20
TBI-Related Non-Fatal Emergency Department Visits 2011............................................................ 22
Fall-Related ...................................................................................................................................... 24
Struck by/Against-Related ................................................................................................................ 24
Data Notes .......................................................................................................................................... 25
Appendix A. Definitions of Mechanisms of Injury ........................................................................... 25

1

EXECUTIVE SUMMARY

TBI: AT A

ARIZONA RESIDENTS, 2011

GLANCE

Traumatic brain injuries (TBI) were the cause of death for 1,317
Arizona residents in 2011. Males ages 85 years and older had the
highest rate of TBI deaths with 202.7 deaths per 100,000 residents. TBI
death rates were highest among American Indians (27.8 per 100,000
residents) and Non-Hispanic Whites (20.8 per 100,000 residents).
Forty-two percent of TBI deaths in 2011 were due to unintentional
injuries (n=558); 43 percent were due to suicides (n=561); and ten
percent were due to homicides (n=128). The most common causes of
TBI deaths were firearms (50 percent, n=664), falls (22 percent,
n=294), and motor vehicle traffic crashes (13 percent, n=177).
In 2011, there were 6,690 non-fatal inpatient hospitalizations due to
TBI. Adults 85 years and older had the highest rates of TBI inpatient
hospitalizations. Males 85 years and older had a rate of 621.1
hospitalizations per 100,000 residents, and among females 85 years
and older, the rate was 602.2 hospitalizations per 100,000 residents.
Age-adjusted TBI inpatient hospitalization rates were highest among
American Indians (196.2 per 100,000 residents) and Non-Hispanic
Whites (108.9 per 100,000 residents). Unintentional injuries accounted
for 86 percent of TBI hospitalizations (n=5,728). Falls were the most
common cause of TBI hospitalizations (44 percent, n=2,933), followed
by motor vehicle traffic crashes (29 percent, n=1,926). Total hospital
charges for non-fatal inpatient hospitalizations due to TBIs were more
than $451.8 million, and Arizonans spent a total of 32,572 days
hospitalized in 2011.
In 2011, there were 47,395 non-fatal TBI emergency department visits
among Arizona residents. TBI emergency department visit rates were
highest among children younger than one year of age. Females
younger than one year of age had a rate of 2683.7 visits per 100,000
residents, and males younger than one year of age had a rate of
2,605.2 visits per 100,000 residents. Among children under one, over
99 percent of the TBI-related emergency department visits were due to
unintentional injuries. The leading causes of TBI emergency
department visits were falls (52 percent, n=24,663), struck by/against
injuries (24 percent, n=11,181), and motor vehicle traffic crashes (13
percent, n=5,991). Total hospital charges for non-fatal emergency
department visits due to TBIs were more than $240.6 million.

For every TBI-related
death in Arizona in 2011,
there were:
5 Non-fatal inpatient
hospitalizations and

36 Non-fatal emergency
department visits,
Resulting in over $692.4
million in hospital charges

By Brenna V. Rabel, MPH
th
150 North 18 Avenue, Suite 320
Phoenix, AZ 85007
Office of Injury Prevention
Bureau of Women’s and
Children’s Health
Arizona Department of Health
Services
December 2012

2

INTRODUCTION
Traumatic brain injury (TBI) is defined as damage to the brain following a sudden blow or impact to the
head or by shaking the head violently. TBI can also be caused by a penetrating head injury that
disrupts brain function. Approximately 1.4 million Americans sustain these injuries annually, 50,000 of
whom die as a result of the trauma.1 An additional 80,000 to 90,000 people experience permanent
disability, and it is estimated that 5.3 million Americans are currently living with a TBI-related
disability.2,3 TBI can cause cognitive function deficits, which can lead to depression and other adverse
secondary outcomes including problems working and performing daily activities such completing
academic assignments, managing personal finances, or driving a vehicle.
The data presented in this report illustrate the public health burden associated with TBI in Arizona.
Besides the obvious impacts TBI can have on overall health, traumatic brain injuries often result in
considerable medical expenses, quality of life changes, and lost wages. TBI can occur throughout the
life span, and the repercussions of these injuries may be experienced for many years. The
consequences of TBI can extend beyond the injured individuals to their families and communities. For
severe, but non-fatal TBI, families may be required to provide care, often resulting in time away from
work, loss of income, and increases in stress. At the community level, the financial costs of TBI include
medical expenses, rehabilitation, lost wages, and lost productivity. Most TBI injuries are predictable
and preventable. Understanding the risk factors associated with TBI is an important step toward
educating and empowering communities to implement effective prevention strategies.

1

3

Langlois JA, Rutland-Brown W, Thomas KE. Traumatic Brain Injury in the United States: Emergency Department Visits,
Hospitalizations and Deaths. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention
and Control; 2006
2
Ibid
3
Thurman D, Alverson C, Dunn K, Guerrero J, Sniezek J. Traumatic brain injury in the United States: a public health
perspective. Journal of Head Trauma Rehabilitation 1999;14(6):602–15.

TRENDS IN TRAUMATIC BRAIN INJURIES
AMONG ARIZONA RESIDENTS, 2007-2011
Mortality
Between 2007 and 2011, the age-adjusted mortality rate of traumatic brain injury decreased from 21.7
deaths per 100,000 Arizona residents in 2007 to 20.0 deaths per 100,000 residents in 2011. Ageadjusted mortality rates among males were more than double the rates among females. Rates for
males decreased 7 percent from 2007 through 2011, and rates for females decreased 5 percent. Figure
1 shows age-adjusted TBI mortality rates by sex from 2007 through 2011.
Figure 1. Age-Adjusted TBI Mortality Rates by Sex, Arizona, 2007-2011
40
35

33.6

32.1

31.3

31.4

29.1

30
25
20
15
9.9

9.9

10.1

9.4

10

9.4

5
0
2007

2008
Males (n=985)

2009

2010

2011

Females (n=332)

While total age-adjusted TBI mortality rates declined from 2007 through 2011, changes in rates varied
by manner and mechanism of injury. Age-adjusted rates of unintentional TBI-related deaths continued
to decrease in 2011, but suicide rates increased to their highest point in the six years surveyed. Figure
2 shows age-adjusted TBI mortality rates by manner of death, and Figure 3 shows age-adjusted TBI
mortality rates by selected cause of injury.

4

Figure 2. Age-Adjusted TBI Mortality Rates per 100,000 Residents
by Manner of Death, Arizona, 2007-2011

12
10.8
10.1

10

8.5
8

7.9
7.5

8.6

8.4

8.4

8.6

7.1

6
4
2.5

2.4

2.0

2.3

2.0

2
0
2007

2008
Unintentional

2009
Suicide

2010

2011

Homicide

Figure 3. Age-Adjusted TBI Mortality Rates per 100,000 Residents
by Mechanism, Arizona, 2007-2011
12
10.4
10

9.4

10.2

9.2

9.0

8
6
4.5

4.7

4.4

4.5
4.4

4

4.2

4.1

3.2

2.7

3.2

2
0
2007

2008
Firearms

2009
Falls

2010

2011

Motor Vehicle Crashes

5

Non-Fatal Inpatient Hospitalizations
Between 2007 and 2011, the age-adjusted rate of TBI-related inpatient hospitalizations increased 22
percent, from 83.7 hospitalizations per 100,000 Arizona residents in 2007 to 102.5 hospitalizations per
100,000 residents in 2011. Despite that general upward trend, the 2011 rate was actually five percent
lower than in 2010, when it was 107.5 hospitalizations per 100,000 residents. Age-adjusted
hospitalization rates among males were almost double the rates among females. Rates for males
increased 19 percent from 2007 through 2011, and rates for females increased 30 percent. Figure 4
shows age-adjusted non-fatal TBI-related inpatient hospitalization rates by sex from 2007 through
2011. Please refer to the Data Notes Section of this report for additional information regarding
increased inpatient hospitalization rates beginning in 2009.
Figure 4. Age-Adjusted Non-Fatal TBI-Related Inpatient Hospitalization Rates
by Sex, Arizona, 2007-2011
160

120

138.9

137.1

140

132.8

112.0
99.8

100
80
60

70.3
55.3

76.0

72.0

49.8

40
20
0
2007

2008

2009
Males

2010

2011

Females

6

While total age-adjusted TBI-related inpatient hospitalization rates increased from 2007 through 2011,
changes in rates varied by manner and mechanism of injury. Figure 5 shows age-adjusted TBI
hospitalization rates by manner of injury.
Figure 5. Age-Adjusted Non-Fatal TBI-Related Inpatient Hospitalization Rates per 100,000
Residents by Manner of Injury, Arizona, 2007-2011

100.0

92.5

90.0
80.0

87.1

88.7
73.5
64.8

70.0
60.0
50.0
40.0
30.0
20.0
10.0

9.9
0.4

0.0

2007

9.4
0.5

2008
Unintentional

13.8

13.6

13.0

0.8

0.8

0.6

2009
Self-Inflicted

2010

2011

Assault

From 2007 through 2011, the rate of non-fatal inpatient hospitalizations due to fall-related traumatic
brain injuries increased 102 percent, from 21.7 hospitalizations per 100,000 residents in 2007 to 43.9
hospitalizations per 100,000 residents in 2011. Males had a higher rate of fall-related TBI
hospitalizations than females in each of the five years examined, and the disparity has grown over time.
While the rate of fall-related TBI hospitalizations increased since 2007, the rate of motor vehicle crashrelated TBI hospitalizations decreased 25 percent in the past five years, from 39.7 crash-related
hospitalizations in 2007 to 29.9 crash-related hospitalizations in 2011. As with falls, males had a higher
rate of motor vehicle crash-related TBI hospitalizations than females in each of the years examined.

7

From 2005 through 2008, the rate of fall-related TBI hospitalizations remained lower than the rate for
TBI hospitalizations due to motor vehicle crashes. From 2009 onward, however, the rate of motor
vehicle crash-related TBI hospitalizations was lower than the rate of fall-related cases. Figure 6 shows
the trend of fall- and motor vehicle crash-related TBI hospitalizations by sex from 2007 through 2011.

Figure 6. Age-Adjusted Non-Fatal TBI Inpatient Hospitalization Rates per 100,000 Residents by
Mechanism and Sex, Arizona, 2007-2011
60.0

50.0

48.9

50.7
38.4

40.0

30.0

28.6

29.0

25.5

21.6

17.8

19.6

40.3
36.0
22.0

51.3
51.6
40.6
37.5
38.9

36.2

23.9

20.0

22.4

10.0

0.0

2007
Male Falls

2008
2009
2010
Female Falls
Male MVC

2011
Female MVC

8

Non-Fatal Emergency Department Visits
From 2007 through 2011, the age-adjusted rate of non-fatal TBI-related emergency department visits
increased among both males and females. Among males, the rates decreased 33 percent, from 580.4
visits per 100,000 Arizona residents in 2007 to 773.7 visits per 100,000 residents in 2011. Among
females, rates increased 55 percent, from 441.5 visits per 100,000 in 2007 to 648.8 visits per 100,000
residents in 2011. Age-adjusted emergency department visit rates among males were higher than rates
among females for the last five years. Figure 7 shows age-adjusted TBI-related emergency department
visit rates by sex from 2007 to 2011. Please refer to the Data Notes Section of this report for additional
information regarding increased emergency department visit rates beginning in 2009.
Figure 7. Age-Adjusted Non-Fatal TBI-Related Emergency Department Visit Rates by Sex,
Arizona, 2007-2011
900
800

745.8
695.8

700
600
500

580.4
441.5

773.7
684.8

637.3

603.2

590.6

465.4

400
300
200
100
0
2007

2008

2009
Males

2010

2011

Females

While total age-adjusted TBI-related emergency department visit rates increased from 2007 through
2011, changes in rates varied by manner and mechanism of injury. Unintentional injuries and injuries
related to assaults increased at varying levels from 2007 through 2011. TBI-related hospitalizations due
to self-harm are relatively low and are therefore not included in the figure. Figure 8 shows age-adjusted
TBI emergency department visit rates by manner of injury, and Figure 9 shows age-adjusted rates for
non-fatal TBI-related emergency department visits for selected causes of injury.

9

Figure 8. Age-Adjusted Non-Fatal TBI-Related Emergency Department Visit Rates per 100,000
Residents by Manner of Injury, Arizona, 2007-2011

700.0
615.9

571.5

600.0
500.0

448.1

652.8

467.5

400.0
300.0
200.0
76.3
100.0

64.2

68.1

77.4

72.6

0.0

2007

2008

2009

2010

Unintentional (46% increase)

2011

Assault (21% increase)

Figure 9. Age-Adjusted Non-Fatal TBI-Related Emergency Department Visit Rates per 100,000
Residents by Selected Cause of Injury, Arizona, 2007-2011

400.0

375.1
348.5

350.0

319.1

300.0
250.0

253.9
228.0
171.9

200.0
150.0

176.2

164.2
127.5

131.9

100.0
50.0

85.6

80.2

76.6

87.7

94.2

0.0

2007

2008

2009

Falls (65% increase)

2010

2011

Struck By/Against (38% increase)

Motor Vehicle Crashes (10% increase)

10

DEATHS AMONG ARIZONA RESIDENTS
DURING 2011
In 2011, 1,317 Arizona residents died as a result of TBI. The majority of deaths were among males (75
percent, n=985), while females accounted for 25 percent of TBI deaths (n=332). Males had higher rates
of TBI-related mortality across all age groups, except among children under one year.
Males 85 years and older accounted for 77 deaths and had by far the highest rate of TBI deaths in
2011 (202.7 per 100,000 residents). Among adults 85 years and older, 67 percent of TBI deaths were
due to unintentional falls (n=102). Figure 10 shows the 2011 TBI death rates by age group and sex for
Arizona residents.
Figure 10. Age-Specific TBI-Related Mortality Rates per 100,000 Residents by Sex, Arizona, 2011
(n=1,317)
250
202.7
200

150
112.0
88.6

100

50
13.9
6.9 2.8 2.4
6.7
0.4

25.1
6.6

32.4
6.9

26.2
5.6

37.1
7.4

41.1
10.7

40.8

39.6

11.4

0
<1

1-4

5-14

15-24 25-34 35-44 45-54 55-64 65-74 75-84
Males (n=985)

85+

Females (n=332)

Excludes 1 male of unknown age

Age-adjusted TBI death rates were highest among American Indians (27.8 deaths per 100,000
residents) and Non-Hispanic Whites (20.8 deaths per 100,000 residents). Rates were lowest among
Asian/Pacific Islanders, however the number of TBI-related death among this group were too low to
calculate a reliable rate. Figure 11 shows the 2011 age-adjusted TBI death rates by race/ethnicity in
Arizona.

11

Figure 11. Age-Adjusted TBI-Related Mortality Rates per 100,000 Residents by Race/Ethnicity,
Arizona, 2011 (n=1,317)
30

27.8

25
20.8

20.0

20
16.0
14.5

15

10.4
10
5
0
American
White, nonIndian (n=87) Hispanic
(n=934)

Black, non- Hispanic, all Asian/Pacific All Arizonans
Hispanic races (n=204) Islander
(n=1,317)
(n=37)
(n=14)

41 deaths were among individuals of other or unknown race/ethnicity

Forty-two percent of the TBI deaths in 2011 were due to unintentional injuries (n=558); 43 percent were
due to suicides (n=561); and ten percent were due to homicides (n=128). Figure 12 shows TBI deaths
by manner of injury during 2011 in Arizona.
Figure 12. TBI-related Deaths by Manner, Arizona, 2011 (n=1,317)
2% (n=29)

3% (n=41)

10% (n=128)
42% (n=558)

43% (n=561)

Unintentional

Suicide

Homicide

Undetermined

Unknown/Missing

12

The most common causes of deaths were firearms (50 percent, n=664), falls (22 percent, n=294), and
motor vehicle traffic crashes (13 percent, n=177). Causes of TBI deaths during 2011 in Arizona are
shown in Table 1. Descriptions of these causes are given in Appendix A.
Table 1. TBI Deaths by Cause, Arizona 2011
Cause

Number

Percentage

Firearm

664

50%

Fall

294

22%

Motor vehicle traffic

177

13%

Other/unspecified/unknown

154

12%

Other land transport

19

1%

Other pedestrian

9

<1%

1,288

100%

Total

The causes and manners of TBI-related mortality varied greatly by race/ethnicity. Suicides, due
primarily to firearms, were highest among White, non-Hispanic Arizonans, while unintentional injuries,
specifically due to motor vehicle crashes, were the leading cause and manner of TBI-related death
among American Indian residents. Figures 13 and 14 show the percentages of TBI-related deaths for
each race/ethnicity by cause and manner of death.
Figure 13. TBI-related Deaths by Manner and Race/Ethnicity, Arizona, 2011 (n=1,317)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%

6%
5%

5%

3%
23%

30%
50%

7%
14%

14%

13%

29%

29%

7%

13%

15%
15%

40%

67%
39%

32%

Unintentional

50%

46%

30%

Suicide

Homicide

Undetermined

13

Figure 14. TBI-related Deaths by Mechanism and Race/Ethnicity, Arizona, 2011 (n=1,317)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%

13%
8%
25%

16%

14%

16%

22%

11%

16%

17%

21%
44%
21%

44%

29%
54%

57%

15%
48%
29%

24%

Firearms

10%
7%

Falls

MV Traffic

39%

Other

Firearm-Related TBI Mortality
Among the 664 Arizona residents who died as a result of a firearm-related TBI, the majority were male
(87 percent, n=579) and 13 percent were female (n=85).
The highest age-adjusted rate of firearm-related TBI deaths was among White Non-Hispanics (12.1 per
100,000 residents, n=505). The second highest rate was among African Americans (7.8 per 100,000
residents, n=21). Hispanic Arizonans had the second highest count of firearm-related TBI (n=97)
however the rate for this group was low, only 5.7 per 100,000 residents.
The majority of firearm-related TBI deaths were suicides (84 percent, n=561). Thirteen percent of the
deaths were due to homicides (n=88); two percent were due to undetermined intent (n=9) and one
percent were unintentional injuries (n=6). Figure 15 shows TBI deaths due to firearms by manner of
injury.

14

Figure 15. Firearm-related TBI Deaths by Manner, Arizona, 2011 (n=664)
2% (n=9)

1% (n=6)

13% (n=88)

84% (n=561)

Suicide

Homicide

Undetermined

Unintentional

Among the 561 TBI deaths resulting from firearm-related suicides, 89 percent were among males
(n=500) and 11 percent were among females (n=61). The age-adjusted rate of TBI deaths resulting
from firearm-related suicides was 8.6 deaths per 100,000 residents, the highest rate of such deaths
over the previous five years. The highest age-specific rates were among adult males, particularly
among those 85 years and older (57.9 per 100,000). Age-adjusted rates were substantially higher
among males than among females over each of the years from 2007-2011. Figure 16 shows the ageadjusted rate of TBI deaths resulting from firearm-related suicides by sex and year from 2007 through
2011.
Figure 16. Age-Adjusted TBI Mortality Rate due to Firearm Suicides
by Sex and Year, Arizona, 2007-2011
18.0
15.2

15.7

7.8

8.3

8.6

2.5

1.9

1.8

16.0
14.0

13.4

13.5
12.2

12.0
10.0
8.0

7.3

7.0

6.0
4.0
2.0

1.3

2.1

0.0
2007

2008
Males

2009
Females

2010

2011

Total

15

The highest age-adjusted rate of firearm-related TBI suicides was among White Non-Hispanics (11.1
per 100,000 residents, n=467). This high race-specific mortality rate coupled with the large population

propelled the age-adjusted mortality rate for all Arizonans. The age-adjusted rate among Hispanic
Arizonans was 3.7 deaths per 100,000 residents. For all other races, the total number of firearm-related
suicides was too low to calculate a stable rate (n<20).
Fall-Related TBI Mortality
Among the 294 TBI deaths due to falls, 54 percent were among males (n=160) and 46 percent were
among females (n=134). All but one of the falls were unintentional. Two percent of TBI-related fall
deaths were among children and young adults ages 24 years and younger (n=5). Seventeen percent of
the deaths were among adults ages 25 through 64 years (n=51); and 81 percent were among adults 65
years and older (n=238). The age-adjusted rate of all fall-related TBI deaths in Arizona for 2011 was
4.4 deaths per 100,000 residents, however the highest age-specific mortality rate was among adults 85
years and older (98 per 100,000 residents) followed by adults 75 through 84 years of age (34 per
100,000 residents).
Figure 17. Fall-Related TBI Mortality Rates per 100,000 Residents
by Age and Sex, Arizona, 2011 (n=6,690)
120
100
80
60
40
20
0
<1yr

1-14yr 15-24yr 25-34
Males (n=160)

35-44

45-54

Females (n=134)

55-64

65-74

75-84

85+

Total (n=294)

16

Non-Fatal Inpatient Hospitalizations among
Arizona Residents During 2011
In 2011, 6,690 Arizona residents were hospitalized due to non-fatal TBI. Males comprised 63 percent of
total TBI hospitalizations (n=4,195) and females accounted for 37 percent (n=2,494). There was also
one individual of unknown sex.
Adults 85 years and older had the highest rates of TBI inpatient hospitalizations in 2011. Males 85
years and older had a rate of 621.1 hospitalizations per 100,000 residents (n=236), and the rate for
females 85 years and older was 602.2 hospitalizations per 100,000 residents (n=398). For adults 85
years and older, 98 percent of hospitalizations were due to unintentional falls (n=619). Figure 18 shows
the 2011 TBI inpatient hospitalization rates by age group and sex for Arizona residents.
Figure 18. TBI-Related Non-Fatal Inpatient Hospitalization Rates per 100,000 Residents
By Age Group and Sex, Arizona, 2011
700
621.1
602.2
600
500
400
300

301.6
272.3

244.5
215.2

200

143.8
65.0
49.6 45.727.2

100

138.7

64.0

110.2

48.8

133.6

41.5

141.1

45.8

137.5
98.7
67.3

0
<1yr

1-4yr 5-14yr 15-24yr 25-34 35-44 45-54 55-64 65-74 75-84
Males (n=4,195)

85+

Females (n=2,494)

Does not include 1 individual of unknown sex

17

Age-adjusted TBI inpatient hospitalization rates were highest among American Indians (196.2
hospitalizations per 100,000 residents), but this represents a 14 percent decrease from 2010, when the
rate for this group was 228.0 hospitalizations per 100,000 residents. Non-Hispanic Whites had the
second highest hospitalization rate (108.9 hospitalizations per 100,000 residents), representing a seven
percent decrease since 2010, when the rate was 116.7 hospitalizations per 100,000 residents. Figure
19 shows the 2011 age-adjusted TBI inpatient hospitalization rates by race/ethnicity in Arizona.
Figure 19. Age-Adjusted TBI-Related Non-Fatal Inpatient Hospitalization Rates per 100,000
Residents, by Race/Ethnicity, Arizona, 2011 (n=6,690)
250

200

196.2

150
108.9
100

84.9

78.9

70.3

50

0
American Indian
(n=646)

White, nonHispanic
(n=4,513)

Black, nonHispanic
(n=210)

Asian/Pacific
Islander (n=112)

Hispanic
(n=1,076)

133 hospitalizations were among individuals of other or unknown race/ethnicity

For TBI inpatient hospitalizations, the average length of stay was five days (median=3 days), and
hospital stays due to TBI ranged from less than one full day to 122 days. In total, Arizonans spent
32,572 days hospitalized for TBI in 2011.
TBI inpatient hospitalization charges in 2011 totaled more than $451.8 million, with 48 percent paid by
the Arizona Health Care Cost Containment System (AHCCCS)/Medicaid and Medicare (n=3,319 cases,
over $215.6 million). This total does not include costs related to physician care, rehabilitation, lost
wages, or long-term costs of disability.
Unintentional injuries accounted for 86 percent of TBI hospitalizations (n=5,728). There were 38
hospitalizations due to self-inflicted TBI (less than one percent) and 807 due to assaults (12 percent).
Figure 20 shows the TBI inpatient hospitalizations by manner of injury for Arizona in 2011.

18

Figure 20. TBI-related Non-Fatal Inpatient Hospitalizations
by Manner, Arizona, 2011 (n=6,690)
<1% (n=32)
12% (n=807)

<1% (n=17)

1% (n=68)

1% (n=38)

86% (n=5,728)

Unintentional
Assault
Other/Legal Intervention

Self-Inflicted
Undetermined
Unknown

Fall-related injuries were the most common cause of TBI hospitalizations (44 percent, n=2,933),
followed by motor vehicle traffic injuries (29 percent, n=1,926). Table 2 shows causes of TBI inpatient
hospitalizations in Arizona during 2011. Descriptions of these causes are given in Appendix A.
Table 2. TBI Inpatient Hospitalizations by Cause,
Arizona 2011 (n=6,690)
Cause

Number

Percentage

Fall

2,933

44%

Motor vehicle traffic

1,926

29%

Struck by/against

743

11%

Other/unspecified

494

7%

Transport

329

5%

Other pedal cycle

173

3%

Firearm

50

<1%

Cut/pierce

42

<1%

6,690

100%

Total

Non-Fatal Fall-Related TBI Inpatient Hospitalizations
There were 2,933 inpatient hospitalizations due to fall-related TBI. Fifty-five percent were among males
(n=1,604) and 45 percent were among females (n=1,329). Falls were unintentional more than 99
percent of the time (n=2,970), with only 11 cases in which another manner was identified.
American Indians had the highest age-adjusted rate of fall-related TBI hospitalizations with 53.1
hospitalizations per 100,000 residents (n=136). The second highest rate was among Non-Hispanic
Whites (47.0 hospitalizations per 100,000 residents; n=2,224). The age-adjusted rate for non-fatal fallrelated inpatient hospitalizations among all Arizonans was 43.9 hospitalizations per 100,000 residents.

19

Despite the relationship between age-adjusted rates by race/ethnicity, the differences in age specific
rates for adults 75 years of age and older paint a different picture of fall-related TBI. Among adults 75
years of age and older, the rate of fall-related TBI hospitalization is highest among Asian/Pacific
Islanders, despite the low overall hospitalization rate for that group. Also notable is that despite
historically high fall-related TBI hospitalization rates among American Indians, the age specific rate for
seniors in that group is half as high as the rate among Asian/Pacific Islanders in that range. Figure 21
shows the age-specific hospitalization rates for fall-related TBI among Arizonan seniors 75 years of age
and older, by race/ethnicity.
Figure 21. Elder Fall-Related Non-Fatal TBI Inpatient Hospitalization Rates per 100,000
Residents 75 years of age and older, by Race/Ethnicity, Arizona, 2011
600
524.0
500
400
322.7
300
200

192.7

192.7

168.0

100
0
American Indian
(n=31)

White, nonHispanic
(n=1,063)

Black, nonHispanic
(n=11*)

Asian/Pacific Hispanic (n=71)
Islander (n=28)

Does not include 55 cases in which race/ethnicity information is unknown.
*Count <20 so rate is unstable.

Non-Fatal Motor Vehicle Traffic Crash-Related TBI Inpatient Hospitalizations
Of the 1,926 TBI hospitalizations due to motor vehicle traffic crashes, 62 percent were among males
(n=1,201) and 38 percent were among females (n=725). Only five of the crashes were not
unintentional. The highest hospitalization rates for motor vehicle-related TBI were among teens and
young adults 15 through 24 years of age (53.6 hospitalizations per 100,000 residents), for both males
(63.2 hospitalizations per 100,000 residents) and females (43.4 hospitalizations per 100,000 residents).

American Indians had the highest rate of TBI hospitalizations for motor vehicle traffic crashes (51.1
hospitalizations per 100,000 residents; n=187), representing a 19 percent decrease since 2010. With
32.7 hospitalizations per 100,000 residents, Non-Hispanic Whites had the second highest rate

20

(n=1,222). The age-adjusted rate for non-fatal motor vehicle traffic-related inpatient hospitalizations
among all Arizonans was 29.9 hospitalizations per 100,000 residents.
The majority of TBI inpatient hospitalizations due to motor vehicle traffic collisions were among
occupants of motor vehicles (64 percent, n=1,229). Eighteen percent were motorcyclists (n=340); 11
percent were pedestrians (n=212); and four percent were pedal cyclists (n=88). This distribution is
consistent with data from previous years. Figure 22 shows TBI inpatient hospitalizations due to motor
vehicle traffic crashes by injured person.
Figure 22. Non-Fatal Motor Vehicle Crash-Related TBI Inpatient Hospitalizations by Injured
Person, Arizona, 2011 (n=1,926)
11% (n=212)

3% (n=52)

4% (n=88)

64% (n=1,229)
18% (n=340)

Occupant

Motorcyclist

Pedal cyclist

Pedestrian

Other/Unspecified

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Non-Fatal Emergency Department Visits
among Arizona Residents During 2011
In 2011, there were 47,395 TBI emergency department visits among Arizona residents. Males
accounted for more than half of TBI emergency department visits (52 percent, n=24,774), while females
accounted for 48 percent of visits (n=22,619). There were two cases among individuals of unknown
sex. TBI emergency department visit rates were highest among children younger than one year of age.
There were 1,160 emergency department visits among females younger than one year of age (a rate of
2683.7 visits per 100,000 residents), and 1,172 visits among males younger than one year of age (a
rate of 2,605.2 visits per 100,000 residents). For all children younger than one year of age, nearly 100
percent of TBI emergency department visits were due to unintentional falls (n=2,327). Figure 23 shows
the 2011 TBI emergency department visit rates per 100,000 Arizona residents.
Figure 23. Age-Specific TBI Emergency Department Visit Rates per 100,000 Residents, by Sex,
Arizona, 2011 (n=47,395)
3,000.00
2,500.00
2,000.00
1,500.00
1,000.00
500.00
0.00

Males (n=24,774)

Females (n=22,619)

Does not include two individuals of unknown sex.

TBI emergency department charges in 2011 totaled more than $240.6 million, with 45 percent paid by
the Arizona Health Care Cost Containment System (AHCCCS)/Medicaid and Medicare (n=22,067, over
$108.4 million). This total does not include costs related to physician care, rehabilitation, lost wages, or
long-term costs of disability.

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Unlike with mortality and hospitalization rate, age-adjusted TBI emergency department visit rates were
not consistent across county and race/ethnicity. Apache and Navajo Counties have lower rates of TBIrelated non-fatal emergency department rates than expected, but this is likely an artifact of the data
rather than a truly low rate in these counties. A large area of the Navajo Nation is situated within the
borders of Apache and Navajo Counties, and tribal residents tend to seek medical care for less severe
injuries at local health facilities operated by the tribe or Indian Health Services (IHS). Since the Arizona
Hospital Discharge Database only collects data from private, non-federal facilities, injuries seen
exclusively at tribal or IHS facilities are not included in the data shown here, accounting for a potential
undercount among tribal residents. For this reason, race/ethnicity and county information is not
presented for emergency department data.
The majority of TBI emergency department visits were due to unintentional injuries (90 percent,
n=42,359), and 10 percent were assaults (n=4,827). Figure 24 shows TBI emergency department visits
by intent during 2011 in Arizona.
Figure 24. TBI Emergency Department Visits by Manner of Injury, Arizona 2011 (n=47,395)
10% (n=4,827

<1% (n=149)

<1% (n=60)

90%
(n=42,359)

Unintentional

Self-inflicted

Assault

Undetermined/Other

The leading causes of TBI emergency department visits were falls (52 percent, n=24,663), struck
by/against injuries (24 percent, n=11,181), and motor vehicle traffic crashes (13 percent, n=5,991).
Table 3 shows TBI emergency department visits by cause for Arizona in 2011. Descriptions of these
causes are given in Appendix A.
Table 3. TBI Emergency Department Visits by Cause, Arizona
2011
Cause

Percentage

Fall

24,663

52%

Struck by/against

11,181

24%

Motor vehicle traffic

5,991

13%

Other/unspecified

3,246

7%

Other pedal cycle

1,198

3%

Transport

1,116

2%

Total

44,507

100%

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Number

Non-Fatal Fall-Related Emergency Department Visits
There were 24,663 emergency department visits due to fall-related TBI. Forty-six percent were among
males (n=11,439) and 54 percent were among females (n=13,223). Nearly all of these falls were
unintentional (n=24,648). As with all TBI emergency department visits, those due to falls are most
common among the oldest and youngest members of the population. Among children under one year of
age, the rate of fall-related TBI is 2,237.8 visits per 100,000 residents; among adults 85 and older, the
rate is 2,344.1 visits per 100,000 residents.

Non-Fatal Struck By/Against-Related TBI Emergency Department Visits
Struck by/against injuries include being struck by an object (such as falling furniture), striking against an
object (such as the edge of a bathtub), or being struck by other people (such as when playing sports).
Of the 11,181 TBI emergency department visits due to struck by/against injuries, 62 percent were
among males (n=6,939) and 38 percent were among females (n=4,242). Seventy-four percent of these
injuries were unintentional (n=8,322), and 25 percent were assaults (n=2,765). One percent of
emergency department visits resulted from struck by/against injuries due to legal intervention (n=94).
Sixty-three percent of TBI emergency department visits from struck by/against injuries were among
individuals 24 years and younger (n=7,022).
The emergency department discharge database did not include specific information regarding
contributing event for 30 percent of the struck by/against injuries (n=3,316). The most frequently
specified contributing events were assaults in unarmed fights (24 percent of specified events, n=1,914)
and unintentional blows while playing sports (21 percent of specified events, n=1,678). Figure 25 shows
TBI emergency department visits due to struck by/against injuries by specified contributing event.
Figure 26. TBI Emergency Department Visits due to Struck by/Against
by Specified Contributing Event, Arizona, 2011 (n=7,865)
11% (n=851)
7% (n=543)

1% (n=36)
24% (n=1,914)

Assault in unarmed brawl
Unintentional sports-related
By falling object

16%
(n=1,249)

Legal Intervention
Furniture
Other stationary object
Object in sports

8% (n=622)
1% (n=89)

21% (1,678)
11% (n=883)

Strike by blunt or thrown
object

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Data Notes
All rates were calculated using the 2011 Arizona Vital Statistics population estimates, available on the internet from the AZ
Vital Statistics website. Age-adjusted rates were standardized to the 2000 U.S. standard population using the direct
standardization method. Age-adjusted rates have been presented when possible, as age-adjusting controls for the effects of
age differences in populations (e.g., a large proportion of older adults or young children) and allows for more accurate rate
comparisons.
Mortality data were tabulated from death certificates for Arizona residents who died in 2011. Inpatient hospitalization and
emergency department visit data were compiled from the 2011 Arizona Hospital Discharge Database.
The discharge databases contain information from private, acute-care facilities in the state of Arizona, and do not include visits
to federal facilities, such as Veterans’ Affairs Hospitals or Indian Health Services facilities. The discharge databases do not
contain data from urgent care facilities, private physician practices, or medical clinics. Additionally, discharge data include
hospital transfers and readmissions. Therefore, a single injured individual may be counted more than once. These data should
be interpreted as episodes of medical treatment, not individual injuries.
Hospital discharge data collected since January 1, 2008 are maintained in a different data layout from earlier hospital
discharge data, and comparisons between data from each time period should be treated with caution. Enhanced
understanding of the new data layout may have contributed to more thorough reporting of ICD-9-CM E-Codes in 2011 and a
subsequent increase in the rate of inpatient hospitalizations and emergency department visits for traumatic brain injuries since
2008.
Codes from the International Classification of Diseases, Version 9, clinical modification (ICD-9-CM) were used for determining
TBI cases among hospital and emergency department data. ICD-10 codes were used for mortality data. The specific codes
used are described in Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations and Deaths,
published in 2006 by the U.S. Centers for Disease Control and Prevention (CDC). Traumatic brain injury-related inpatient
hospitalizations and emergency department visits resulting from medical misadventures have been excluded from this report.

APPENDIX A. DEFINITIONS OF MECHANISMS OF INJURY

Cause of Injury

Definition

Fall

Includes falls from furniture, stairs, playground equipment,
and those that occur while playing sports.
Includes injuries from handguns, shotguns, BB guns, etc.

Firearm
Motor vehicle traffic

Includes collisions that occur on public highways and streets.
These collisions may include pedestrians, pedal cyclists,
motorcyclists, and occupants of motor vehicles.

Other land transport

Includes collisions involving railway transport or all-terrain
vehicles operating off-road. This cause only applies to
deaths and is not used in hospitalization or emergency
department databases.
Includes injured pedal cyclists struck by pedestrians, pedal
cycles, or non-motorized vehicles.
Includes injured pedestrians struck by pedal cycles, nonmotorized vehicles, or other pedestrians.
Unspecified events or other rare events.

Other pedal cycle
Other pedestrian
Other/unspecified
Struck by/against
Transport
Unknown cause

Includes being struck by furniture, struck by other people
while playing sports, or hit by objects while playing sports.
Other non-motorized, off-road vehicle, or rail transport. This
cause only applies to hospitalization and emergency
department
databases and is not used on death certificates.
Cause not listed.

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