TRAUMATIC BRAIN INJURIES
ARIZONA RESIDENTS 2013
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 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 ............................................................................................................................. 2
Introduction ........................................................................................................................................ 3
Five-Year Trends in Traumatic Brain Injuries .................................................................................... 4
Mortality ............................................................................................................................................. 4
Non-Fatal Inpatient Hospitalizations ................................................................................................... 6
Non-Fatal Emergency Department Visits ............................................................................................ 9
TBI-Related Mortality in 2013 ............................................................................................................ 11
Firearm-Related ............................................................................................................................... 16
Fall-Related ...................................................................................................................................... 17
TBI-Related Non-Fatal Inpatient Hospitalizations 2013 ................................................................... 19
Fall-Related ...................................................................................................................................... 22
Motor Vehicle Traffic Crash-Related ................................................................................................. 23
TBI-Related Non-Fatal Emergency Department Visits 2013............................................................ 25
Fall-Related ...................................................................................................................................... 28
Struck by/Against-Related ................................................................................................................ 28
Data Notes .......................................................................................................................................... 30
Appendix A. Definitions of Mechanisms of Injury ........................................................................... 30

1

EXECUTIVE SUMMARY

TBI: AT A

ARIZONA RESIDENTS 2013

GLANCE

Traumatic brain injuries (TBI) were the cause of death for 1,326
Arizona residents in 2013. Males ages 85 years and older had the
highest rate of TBI deaths with 204.4 deaths per 100,000 residents. TBI
death rates were highest among American Indians (35.0 per 100,000
residents) and non-Hispanic Whites (20.9 per 100,000 residents).
Forty-three percent of TBI deaths in 2013 were due to unintentional
injuries (n=574); 43 percent were due to suicides (n=570); and eight
percent were due to homicides (n=106). The most common causes of
TBI deaths were firearms (49 percent, n=646), falls (25 percent,
n=325), and motor vehicle traffic crashes (12 percent, n=159).
In 2013, there were 6,260 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 582.0
hospitalizations per 100,000 residents, and among females 85 years
and older, the rate was 631.5 hospitalizations per 100,000 residents.
Age-adjusted TBI inpatient hospitalization rates were highest among
American Indians (251.5 per 100,000 residents) and non-Hispanic
Whites (100.9 per 100,000 residents). Unintentional injuries accounted
for 86 percent of TBI hospitalizations (n=5,412). Falls were the most
common cause of TBI hospitalizations (47 percent, n=2,966), followed
by motor vehicle traffic crashes (28 percent, n=1,749). Total hospital
charges for non-fatal inpatient hospitalizations due to TBIs were more
than $508.4 million, and Arizonans spent a total of 35,624 days
hospitalized in 2013.
In 2013, there were 50,807 non-fatal TBI emergency department visits
among Arizona residents. TBI emergency department visit rates were
highest among children younger than one year of age for males and
over 85 years of age for females. Males younger than one year of age
had a rate of 2,593.7 visits per 100,000 residents, and females 85
years and older had a rate of 2,853.9 visits per 100,000 residents.
Among children under one, 99.4 percent of the TBI-related emergency
department visits were due to unintentional injuries. Overall,
unintentional injuries accounted for 91 percent of the TBI emergency
department visits. The leading causes of TBI emergency department
visits were falls (53 percent, n=26,679), struck by/against injuries (23
percent, n=11,591), and motor vehicle traffic crashes (14 percent,
n=7,083). Total hospital charges for non-fatal emergency department
visits due to TBIs were more than $306.8 million.

For every TBI-related
death in Arizona in 2013
there were:
5 Non-fatal inpatient
hospitalizations and

38 Non-fatal emergency
department visits
Resulting in over $815.2
million in hospital charges

By Jennifer Dudek, 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
January 2015

2

INTRODUCTION
Traumatic brain injury (TBI) is a major cause of death and disability in the United States contributing to
approximately 30% of all injury deaths.1 A TBI is caused by a bump, blow, or jolt to the head or by a
penetrating head injury that disrupts brain function.2 In 2010, approximately 2.5 million Americans
sustained a traumatic brain injury, in which over 50,000 died as a result of the trauma.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 as completing academic assignments,
managing personal finances, or driving a vehicle.
The data presented in this report illustrates 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 preventable.
Understanding the risk factors associated with TBI is an important step toward educating and
empowering communities to implement effective prevention strategies.

1

3

Faul M, Xu L, Wald MM, Coronado VG. 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; 2010.
2
Faul M, Xu L, Wald MM, Coronado VG. 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; 2010.
3
National Vital Statistics System (NVSS), 2006–2010. Data source is maintained by the CDC National Center for Health
Statistics.

TRENDS IN TRAUMATIC BRAIN INJURIES
AMONG ARIZONA RESIDENTS 2009-2013
Mortality
Between 2009 and 2013, the age-adjusted mortality rate of traumatic brain injury increased from 19.2
deaths per 100,000 Arizona residents in 2009 to 19.5 deaths per 100,000 residents in 2013. Ageadjusted mortality rates among males were more than double the rates among females. Rates for
males and females increased less than 2 percent from 2009 through 2013. Figure 1 shows ageadjusted TBI mortality rates by sex from 2009 through 2013.
Figure 1. Age-Adjusted TBI Mortality Rates by Sex per 100,000 Residents, Arizona, 2009-2013
35
30
25
20
15
10
5
0
2009

2010

2011
Males

2012

2013

Females

The 2013 age-adjusted rates of unintentional TBI-related deaths decreased by four percent from 2009
and decreased by nine percent from 2012. Suicide rates increased nine percent since 2009 and
increased by two percent since 2012. Figure 2 shows age-adjusted TBI mortality rates by manner of
death. The age-adjusted rates of motor vehicle crash TBI-related deaths have decreased 25 percent
since 2009 while fall-related deaths increased two percent. Firearm-related TBI deaths also increased
seven percent since 2009. 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, 2009-2013

10
9
8
7
6
5
4
3
2
1
0
2009

2010
Unintentional

2011
Suicide

2012

2013

Homicide

Figure 3. Age-Adjusted TBI Mortality Rates per 100,000 Residents
by Mechanism, Arizona, 2009-2013
12
10
8
6
4
2
0
2009

2010
Firearms

2011
Falls

2012

2013

Motor Vehicle Crashes

5

Non-Fatal Inpatient Hospitalizations
Between 2009 and 2013, the age-adjusted rate of TBI-related inpatient hospitalizations decreased
seven percent, from 104.1 hospitalizations per 100,000 Arizona residents in 2009 to 96.4
hospitalizations per 100,000 residents in 2013. Age-adjusted hospitalization rates among males were
almost double the rates among females. Rates for males decreased 15 percent from 2009 through
2013, and rates for females decreased five percent. Figure 4 shows age-adjusted non-fatal TBI-related
inpatient hospitalization rates by sex from 2009 through 2013. 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, 2009-2013
160
140
120
100
80
60
40
20
0
2009

2010

2011
Males

2012

2013

Females

6

The total age-adjusted TBI-related inpatient hospitalization rates have decreased from 2009 through
2013. Unintentional injuries have decreased by 11 percent from 2009 to 2013 while assault-related TBI
decreased by 22 percent. 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, 2009-2013

100.0
90.0
80.0
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0

2009

2010
Unintentional

2011

2012

2013

Assault

From 2009 through 2013, the rate of non-fatal inpatient hospitalizations due to fall-related traumatic
brain injuries have remained stable decreasing only one percent, from 42.4 hospitalizations per
100,000 residents in 2009 to 41.9 hospitalizations per 100,000 residents in 2013. Males consistently
had a higher rate of fall-related TBI hospitalizations than females in each of the five years examined,
but the disparity has decreased slightly over time.
While the rate of fall-related TBI hospitalizations remained stable since 2009, the rate of motor vehicle
crash-related TBI hospitalizations decreased 14 percent in the past five years, from 31.2 crash-related
hospitalizations in 2009 to 26.7 crash-related hospitalizations per 100,000 residents in 2013. 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 (not shown in this report), 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 2009
through 2013.

Figure 6. Age-Adjusted Non-Fatal TBI Inpatient Hospitalization Rates per 100,000 Residents by
Mechanism and Sex, Arizona, 2009-2013
60.0

50.0

40.0

30.0

20.0

10.0

0.0

2009
Male Falls

2010
2011
2012
Female Falls
Male MVC

2013
Female MVC

8

Non-Fatal Emergency Department Visits
From 2009 through 2013, the age-adjusted rate of non-fatal TBI-related emergency department visits
increased among both males and females. Among males, the rate increased 15 percent, from 695.8
visits per 100,000 residents in 2009 to 800.7 visits per 100,000 residents in 2013. Among females, the
rate increased 24 percent, from 590.6 visits per 100,000 in 2009 to 733.4 visits per 100,000 residents in
2013. 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 2009 to 2013. 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, 2009-2013
900
800
700
600
500
400
300
200
100
0
2009

2010

2011
Males

2012

2013

Females

While total age-adjusted TBI-related emergency department visit rates increased from 2009 through
2013, changes in rates varied by manner and mechanism of injury. Unintentional injuries and injuries
related to assaults increased at varying levels from 2009 through 2013. 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, 2009-2013

800.0
700.0
600.0
500.0
400.0
300.0
200.0
100.0
0.0

2009

2010

2011
Unintentional

2012

2013

Assault

Figure 9. Age-Adjusted Non-Fatal TBI-Related Emergency Department Visit Rates per 100,000
Residents by Selected Cause of Injury, Arizona, 2009-2013

450.0
400.0
350.0
300.0
250.0
200.0
150.0
100.0
50.0
0.0

2009

2010

Falls

2011

Struck By/Against

2012

2013

Motor Vehicle Crashes

10

DEATHS AMONG ARIZONA RESIDENTS
DURING 2013
In 2013, 1,326 Arizona residents died as a result of TBI. The majority of deaths were among males (74
percent, n=979), while females accounted for 26 percent of TBI deaths (n=347). Males had higher rates
of TBI-related mortality across all age groups.
Males 85 years and older accounted for 85 deaths and had by far the highest rate of TBI deaths in
2013 (204.4 per 100,000 residents). Among adults 85 years and older, 72 percent of TBI deaths were
due to unintentional falls (n=132). Figure 10 shows the 2013 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, 2013
(n=1,326)
250

200

150

100

50

0
<1

1-4

5-14

15-24 25-34 35-44 45-54 55-64 65-74 75-84
Males (n=979)

85+

Females (n=347)

Age-adjusted TBI death rates were highest among American Indians (35.0 deaths per 100,000
residents) and non-Hispanic Whites (20.9 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 2013 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, 2013 (n=1,326)
40
35
30
25
20
15
10
5
0
American
White, non- Hispanic, all Black, non- Asian/Pacific All Arizonans
Indian (n=98) Hispanic races (n=217) Hispanic
Islander*
(n=1,326)
(n=959)
(n=36)
(n=15)

*Rates are unstable due to low counts (n<20)

Apache County had the highest age-adjusted TBI mortality rate in 2013 (52.4 deaths per 100,000
residents). The second highest TBI mortality rate was in Gila County with 36.4 deaths per 100,000
residents. Figure 12 shows the TBI mortality rate by county for 2013 in Arizona.

12

Figure 12. Age-Adjusted TBI-Related Mortality Rates per 100,000 Residents by County, Arizona,
2013 (n=1,326)*

60
50
40
30
20
10
0

*Only Counties with 20 or more records were included in graph

Forty-three percent of the TBI deaths in 2013 were due to unintentional injuries (n=574); 43 percent
were due to suicides (n=570); and eight percent were due to homicides (n=106). Figure 13 shows TBI
deaths by manner of injury during 2013 in Arizona.

13

Figure 13. TBI-related Deaths by Manner, Arizona, 2013 (n=1,326)
3% (n=35)

3% (n=41)

8% (n=106)
43% (n=574)

43% (n=570)

Unintentional

Suicide

Homicide

Undetermined

Unknown/Missing

The most common causes of deaths were firearms (49 percent, n=646), falls (25 percent, n=325), and
motor vehicle traffic crashes (12 percent, n=159). Causes of TBI deaths during 2013 in Arizona are
shown in Table 1. Descriptions of these causes are given in Appendix A.
Table 1. TBI Deaths by Cause, Arizona 2013
Cause

Number

Percentage

Firearm

646

49%

Fall

325

25%

Motor vehicle traffic

159

12%

Other/unspecified/unknown

157

12%

Other land transport

16

1%

Other pedestrian/bicycle

10

<1%

Poisoning

13

<1%

1326

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-Hispanics, while unintentional injuries, specifically
due to motor vehicle crashes, were the leading cause and manner of TBI-related death among
American Indian residents. Figures 14 and 15 show the percentages of TBI-related deaths for each
race/ethnicity by cause and manner of death.

14

Figure 14. TBI-related Deaths by Manner and Race/Ethnicity, Arizona, 2013 (n=1,326)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
White, nonHispanic

Black, nonHispanic

Unintentional

Hispanic, all races

Suicide

Homicide

American Indian

Asian/Pacific
Islander

Undetermined

Figure 15. TBI-related Deaths by Mechanism and Race/Ethnicity, Arizona, 2013 (n=1,326)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
White, nonHispanic

Black, nonHispanic

Firearms

Hispanic, all races

Falls

MV Traffic

American Indian

Asian/Pacific
Islander

Other

15

Firearm-Related TBI Mortality
Among the 646 Arizona residents who died as a result of a firearm-related TBI, the majority were male
(85 percent, n=549) and 15 percent were female (n=97).
The highest age-adjusted rate of firearm-related TBI deaths was among White non-Hispanics (12.0 per
100,000 residents, n=507). The second highest rate was among African Americans (6.7 per 100,000
residents, n=19) but is not considered a stable rate due to a count less than 20. Hispanics had the
second highest count of firearm-related TBI (n=93) however the rate for this group was low, 4.9 per
100,000 residents.
The majority of firearm-related TBI deaths were suicides (87 percent, n=564). Ten percent of the
deaths were due to homicides (n=66) and two percent were due to undetermined intent (n=10). Figure
16 shows TBI deaths due to firearms by manner of injury.

Figure 16. Firearm-related TBI Deaths by Manner, Arizona, 2013 (n=646)
3% (n=16)
10% (n=66)

87% (n=564)

Suicide

Homicide

Unintentional/Undetermined

Among the 564 TBI deaths resulting from firearm-related suicides, 86 percent were among males
(n=487) and 14 percent were among females (n=77). The age-adjusted rate of TBI deaths resulting
from firearm-related suicides was 8.5 deaths per 100,000 residents which is an overall increase of nine
percent since 2009. The highest age-specific rates were among adult males, particularly among those
85 years and older (40.9 per 100,000). Age-adjusted rates were substantially higher among males than
among females over each of the years from 2009-2013. Figure 17 shows the age-adjusted rate of TBI
deaths resulting from firearm-related suicides by sex and year from 2009 through 2013.

16

Figure 17. Age-Adjusted TBI Mortality Rate due to Firearm Suicides
by Sex and Year, Arizona, 2009-2013
18.0
16.0
14.0
12.0
10.0
8.0
6.0
4.0
2.0
0.0
2009

2010
Males

2011
Females

2012

2013

Total

The highest age-adjusted rate of firearm-related TBI suicides was among White non-Hispanics (11.1
per 100,000 residents, n=471). 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 Hispanics was
3.5 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 325 TBI deaths due to falls, 56 percent were among males (n=182) and 44 percent were
among females (n=143). All but two of the falls were unintentional. Less than one percent of TBIrelated fall deaths were among children and young adults ages 24 years and younger (n=3). Twentyone percent of the deaths were among adults ages 25 through 64 years (n=68); and 78 percent were
among adults 65 years and older (n=255). The age-adjusted rate of all fall-related TBI deaths in
Arizona for 2013 was 5.8 deaths per 100,000 residents, however the highest age-specific mortality rate
was among adults 85 years and older (136.1 per 100,000 residents) followed by adults 75 through 84
years of age (29.4 per 100,000 residents).

17

Figure 18. Fall-Related TBI Mortality Rates per 100,000 Residents
by Age and Sex, Arizona, 2013 (n=325)
140
120
100
80
60
40
20
0
15-24yr

25-34

35-44

Males (n=182)

45-54

55-64

Females (n=143)

65-74

75-84

85+

Total (n=325)

18

Non-Fatal Inpatient Hospitalizations among
Arizona Residents During 2013
In 2013, 6,260 Arizona residents were hospitalized due to non-fatal TBI. Males comprised 61 percent of
the total TBI hospitalizations (n=3,816) and females accounted for 39 percent (n=2,443). There was
also one individual of unknown sex.
Adults 85 years and older had the highest rates of TBI inpatient hospitalizations in 2013. Females 85
years and older had a rate of 631.5 hospitalizations per 100,000 residents (n=447), an increase of 28
percent from 2012. The rate for males 85 years and older was 582.0 hospitalizations per 100,000
residents (n=242), a 13 percent decrease from the 2012 rate. For adults 85 years and older, 98 percent
of TBI hospitalizations were due to unintentional falls (n=674). Figure 19 shows the 2013 TBI inpatient
hospitalization rates by age group and sex for Arizona residents.

Figure 19. TBI-Related Non-Fatal Inpatient Hospitalization Rates per 100,000 Residents
By Age Group and Sex, Arizona, 2013
700
600
500
400
300
200
100
0
<1yr

1-4yr 5-14yr 15-24yr 25-34 35-44 45-54 55-64 65-74 75-84
Males (n=3,815)

85+

Females (n=2,443)

Does not include 1 individual of unknown sex

19

Age-adjusted TBI inpatient hospitalization rates were highest among American Indians (215.9
hospitalizations per 100,000 residents), this represents a 14 percent increase from 2012, when the rate
for this group was 251.5 hospitalizations per 100,000 residents. Non-Hispanic Whites had the second
highest hospitalization rate (89.7 hospitalizations per 100,000 residents), representing an 11 percent
decrease since 2012, when the rate was 100.9 hospitalizations per 100,000 residents. Figure 20 shows
the 2013 age-adjusted TBI inpatient hospitalization rates by race/ethnicity in Arizona.
Figure 20. Age-Adjusted TBI-Related Non-Fatal Inpatient Hospitalization Rates per 100,000
Residents, by Race/Ethnicity, Arizona, 2013 (n=6,260)
250

200

150

100

50

0
American Indian
(n=604)

White, nonHispanic
(n=3,985)

Black, nonHispanic
(n=196)

Hispanic
(n=1,258)

Asian/Pacific
Islander (n=103)

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

Graham County had the highest non-fatal TBI-related inpatient hospitalization rate in 2013 with 209.7
hospitalizations per 100,000 residents and Navajo County had the second highest rate (202.8 per
100,000 residents. Figure 21 shows the age-adjusted non-fatal TBI-related inpatient hospitalizations by
county for Arizona in 2013.

20

Figure 21. Age-Adjusted TBI-Related Non-Fatal Inpatient Hospitalization Rates per 100,000
Residents, by County, Arizona, 2013 (n=6,260)*

250

200

150

100

50

0

*Only Counties with 20 or more records were included in graph

For TBI inpatient hospitalizations, the average length of stay was six days (median=3 days), and
hospital stays due to TBI ranged from less than one full day to 165 days. In total, Arizonans spent
35,624 days hospitalized for TBI in 2013.
TBI inpatient hospitalization charges in 2013 totaled more than $508.4 million, with 41 percent paid by
the Arizona Health Care Cost Containment System (AHCCCS)/Medicaid and Medicare (n=2,772 cases,
over $207.5 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=5,412). There were 53
hospitalizations due to self-inflicted TBI (less than one percent) and 679 due to assaults (13 percent).
Figure 22 shows the TBI inpatient hospitalizations by manner of injury for Arizona in 2013.

21

Figure 22. TBI-related Non-Fatal Inpatient Hospitalizations
by Manner, Arizona, 2013 (n=6,260)
3% (n=169)
11% (n=679)

86% (n=5,412)

Unintentional

Assault

Other/Unknown

Fall-related injuries were the most common cause of TBI hospitalizations (47 percent, n=2,966),
followed by motor vehicle traffic injuries (28 percent, n=1,749). Table 2 shows causes of TBI inpatient
hospitalizations in Arizona during 2013. Descriptions of these causes are given in Appendix A.
Table 2. TBI Inpatient Hospitalizations by Cause,
Arizona 2013 (n=6,260)
Cause

Number

Percentage

Fall

2,966

47%

Motor vehicle traffic

1,749

28%

Struck by/against

606

10%

Other/unspecified

483

8%

Transport

247

4%

Other pedal cycle

125

2%

Firearm

53

1%

Cut/pierce

31

<1%

6,260

100%

Total

Non-Fatal Fall-Related TBI Inpatient Hospitalizations
There were 2,966 inpatient hospitalizations due to fall-related TBI. Fifty-two percent were among males
(n=1,531) and 48 percent were among females (n=1,435). Falls were unintentional more than 99
percent of the time (n=2,954), with only 12 cases in which another manner was identified.
American Indians had the highest age-adjusted rate of fall-related TBI hospitalizations with 74.3
hospitalizations per 100,000 residents (n=172). The second highest rate was among non-Hispanic
Whites (42.2 hospitalizations per 100,000 residents; n=2,173). The age-adjusted rate for non-fatal fallrelated inpatient hospitalizations among all Arizonans was 41.9 hospitalizations per 100,000 residents.

22

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 American Indians.
Figure 23 shows the age-specific hospitalization rates for fall-related TBI among Arizonan seniors 75
years of age and older, by race/ethnicity.

Figure 23. Elder Fall-Related Non-Fatal TBI Inpatient Hospitalization Rates per 100,000
Residents 75 years of age and older, by Race/Ethnicity, Arizona, 2013
500
450
400
350
300
250
200
150
100
50
0
American Indian
(n=40)

White, nonHispanic
(n=1,098)

Black, nonHispanic
(n=15*)

Asian/Pacific
Islander (n=27)

Hispanic
(n=122)

Does not include 49 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 1,749 TBI hospitalizations due to motor vehicle traffic crashes, 65 percent were among males
(n=1,131) and 35 percent were among females (n=617). As with falls, over 99 percent of the motor
vehicle traffic crashes resulting in a hospitalization were unintentional. The highest hospitalization rates
for motor vehicle-related TBI were among teens and young adults 15 through 24 years of age (44.7
hospitalizations per 100,000 residents), for both males (56.1 hospitalizations per 100,000 residents)
and females (32.4 hospitalizations per 100,000 residents).

23

American Indians had the highest rate of TBI hospitalizations for motor vehicle traffic crashes with 54.7
hospitalizations per 100,000 residents (n=166), representing a 13 percent increase since 2012. With
26.0 hospitalizations per 100,000 residents, non-Hispanic Whites had the second highest rate (n=988).
The age-adjusted rate for non-fatal motor vehicle traffic-related inpatient hospitalizations among all
Arizonans was 26.7 hospitalizations per 100,000 residents, a six percent decrease since 2013.

The majority of TBI inpatient hospitalizations due to motor vehicle traffic crashes were among
occupants of motor vehicles (60 percent, n=1,051). Nineteen percent were motorcyclists (n=338); 13
percent were pedestrians (n=222); and five percent were pedal cyclists (n=93). This distribution is
consistent with data from previous years. Figure 24 shows TBI inpatient hospitalizations due to motor
vehicle traffic crashes by injured person.
Figure 24. Non-Fatal Motor Vehicle Crash-Related TBI Inpatient Hospitalizations by Injured
Person, Arizona, 2013 (n=1,749)
3% (n=45)
13% (n=222)

5% (n=93)
60% (n=1,051)

19% (n=338)

Occupant

Motorcyclist

Pedal cyclist

Pedestrian

Other/Unspecified

24

Non-Fatal Emergency Department Visits
among Arizona Residents During 2013
In 2013, there were 50,807 TBI emergency department visits among Arizona residents. Males
accounted for just over half of TBI emergency department visits (51 percent, n=26,064), while females
accounted for 49 percent of visits (n=24,743). TBI emergency department visit rates were highest
among adults 85 years and older. There were 2,020 emergency department visits among females 85
years and older (a rate of 2,853.9 visits per 100,000 residents), and 959 visits among males 85 and
older (a rate of 2,306.4 visits per 100,000 residents). For all children younger than one year of age, 94
percent of TBI emergency department visits were due to unintentional falls (n=2,809). Figure 25 shows
the 2013 TBI emergency department visit rates per 100,000 Arizona residents.
Figure 25. Age-Specific TBI Emergency Department Visit Rates per 100,000 Residents, by Sex,
Arizona, 2013 (n=50,807)
3,000.0
2,500.0
2,000.0
1,500.0
1,000.0
500.0
0.0

Males (n=26,064)

Females (n=24,743)

Age-adjusted TBI emergency department visits were highest among African Americans (941.6
hospitalizations per 100,000 residents). Non-Hispanic Whites had the second highest emergency
department visit rate with 838.1 visits per 100,000 residents. The age-adjusted rate for non-fatal TBIrelated emergency department visits among all Arizonans was 771.1 hospitalizations per 100,000
residents a less than one percent decrease since 2012. Figure 26 shows the age-adjusted emergency
department rates by race/ethnicity.

25

Figure 26. Age-Adjusted TBI-Related Non-Fatal Emergency Department Rates per 100,000
Residents, by Race/Ethnicity, Arizona, 2013 (n=50,807)
1000
900
800
700
600
500
400
300
200
100
0
Black/African
American
(n=2,601)

White, nonHispanic
(n=31,229)

American Indian
(n=2,235)

Hispanic
(n=13,276)

Asian (n=753)

Does not include 713 cases in which race/ethnicity information is unknown.

As in 2012, Yavapai County had the highest non-fatal TBI-related emergency department visits in 2013
(897.3 visits per 100,000 residents), which decreased by ten percent since 2012. Graham County had
the second highest rate with 892.8 visits per 100,000 residents. Figure 27 shows the age-adjusted TBIrelated non-fatal emergency department visits by county.

26

Figure 27. Age-Adjusted TBI-Related Non-Fatal Emergency Department Rates per 100,000
Residents, by County, Arizona, 2013 (n=50,807)
1000
900
800
700
600
500
400
300
200
100
0

TBI emergency department charges in 2013 totaled more than $206.8 million, with 39 percent paid by
the Arizona Health Care Cost Containment System (AHCCCS)/Medicaid and Medicare (n=21,338, over
$119.6 million). This total does not include costs related to physician care, rehabilitation, lost wages, or
long-term costs of disability.
The majority of TBI emergency department visits were due to unintentional injuries (91 percent,
n=45,986), and nine percent were assaults (n=4,567). Figure 28 shows TBI emergency department
visits by intent during 2013 in Arizona.
Figure 28. TBI Emergency Department Visits by Manner of Injury, Arizona 2013 (n=50,807)
Assault, 9%
(n=4,567)

Undetermined/
Other, <1%
(n=38)

Self-inflicted,
<1% (n=77)

Unintentional,
91%
(n=45,986)
Unintentional

Self-inflicted

Assault

Undetermined/Other

27

The leading causes of TBI emergency department visits were falls (53 percent, n=26,679), struck
by/against injuries (23 percent, n=11,591), and motor vehicle traffic crashes (14 percent, n=7,083).
Table 3 shows TBI emergency department visits by cause for Arizona in 2013. Descriptions of these
causes are given in Appendix A.
Table 3. TBI Emergency Department Visits by Cause, Arizona
2013
Cause

Number

Percentage

Fall

26,679

53%

Struck by/against

11,591

23%

Motor vehicle traffic

7,083

14%

Other/unspecified

3,167

6%

Other pedal cycle

1,161

2%

Transport

1,126

2%

Total

50,807

100%

Non-Fatal Fall-Related Emergency Department Visits
There were 26,679 emergency department visits due to fall-related TBI. Forty-six percent were among
males (n=12,303) and 54 percent were among females (n=14,376). Over 99 percent of these falls were
unintentional (n=26,666). 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 2,180.6 visits per 100,000 residents; among adults 85 and older, the
rate is 2,500.0 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 11,591 TBI emergency department visits due to struck by/against injuries, 61 percent were
among males (n=7,047) and 39 percent were among females (n=4,544). Seventy-six percent of these
injuries were unintentional (n=8,805), and 24 percent were assaults (n=2,677). Fifty-none percent of
TBI emergency department visits from struck by/against injuries were among individuals one and 24
years of age (n=6,789).
The emergency department discharge database did not include specific information regarding
contributing event for 30 percent of the struck by/against injuries (n=3,618). The most frequently
specified contributing events were assaults in unarmed fights (18 percent of specified events, n=2,097)
and unintentional blows while playing sports (15 percent of specified events, n=1,840). Figure 29 shows
TBI emergency department visits due to struck by/against injuries by specified contributing event.

28

Figure 29. TBI Emergency Department Visits due to Struck by/Against
by Specified Contributing Event, Arizona, 2013 (n=11,591)
6% (n=661)

6% (n=673)
31% (n=3,612)

5% (n=598)

Unintentional Other Struck by
object
Unintentional sports-related
Other stationary object

8% (n=902)

Assault in unarmed brawl
By falling object
Object in sports

18% (n=2,016)
15% (n=1,680)

Assault by blunt or thrown
object
Furniture

11% (n=1,315)

29

Data Notes
All rates were calculated using the 2013 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 2013. Inpatient hospitalization and
emergency department visit data were compiled from the 2013 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 2012 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.

30