TRAUMATIC BRAIN INJURIES
ARIZONA RESIDENTS 2014
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 2014 ............................................................................................................ 11
Firearm-Related ............................................................................................................................... 15
Fall-Related ...................................................................................................................................... 16
TBI-Related Non-Fatal Inpatient Hospitalizations 2014 ................................................................... 17
Fall-Related ...................................................................................................................................... 20
Motor Vehicle Traffic Crash-Related ................................................................................................. 20
TBI-Related Non-Fatal Emergency Department Visits 2014............................................................ 22
Fall-Related ...................................................................................................................................... 25
Struck by/Against-Related ................................................................................................................ 25
Data Notes .......................................................................................................................................... 26
Appendix A. Definitions of Mechanisms of Injury ........................................................................... 26

1

EXECUTIVE SUMMARY

TBI: AT A

ARIZONA RESIDENTS 2014

GLANCE

Traumatic brain injuries (TBI) were the cause of death for 1,233 Arizona
residents in 2014. Males ages 85 years and older had the highest rate of
TBI deaths with 208.1 deaths per 100,000 residents. TBI death rates were
highest among American Indians (21.3 per 100,000 residents) and nonHispanic Whites (19.2 per 100,000 residents). Forty-three percent of TBI
deaths in 2014 were due to unintentional injuries (n=530); 46 percent were
due to suicides (n=565); and six percent were due to homicides (n=67).
The most common causes of TBI deaths were firearms (50 percent,
n=621), falls (27 percent, n=328), and motor vehicle traffic crashes (11
percent, n=130).
In 2014, there were 6,581 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 657.0
hospitalizations per 100,000 residents, and among females 85 years and
older, the rate was 611.2 hospitalizations per 100,000 residents. Ageadjusted TBI inpatient hospitalization rates were highest among American
Indians (184.2 per 100,000 residents) and African Americans (88.9 per
100,000 residents). Unintentional injuries accounted for 86 percent of TBI
hospitalizations (n=5,684). Falls were the most common cause of TBI
hospitalizations (48 percent, n=3,141), followed by motor vehicle traffic
crashes (27 percent, n=1,793). Total hospital charges for non-fatal
inpatient hospitalizations due to TBIs were more than $574 million, and
Arizonans spent a total of 37,907 days hospitalized in 2014.
In 2014, there were 54,310 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 2,872.3 visits per 100,000 residents, and females 85 years and
older had a rate of 3,081.5 visits per 100,000 residents. Among children
under one, 99 percent of the TBI-related emergency department visits
were due to unintentional injuries. Age-adjusted TBI emergency
department rates were highest among non-Hispanic Whites (900.8 per
100,000 residents) and African Americans (779.3 per 100,000 residents).
Overall, unintentional injuries accounted for 91 percent of the TBI
emergency department visits. The leading causes of TBI emergency
department visits were falls (54 percent, n=29,244), struck by/against
injuries (22 percent, n=11,792), and motor vehicle traffic crashes (14
percent, n=7,605). Total hospital charges for non-fatal emergency
department visits due to TBIs were more than $355.1 million.

For every TBI-related death
in Arizona in 2014 there
were:
5 Non-fatal inpatient
hospitalizations and
44 Non-fatal emergency
department visits
Resulting in over $929.6
million in hospital charges

By Jennifer Dudek, MPH
150 North 18th Avenue, Suite
320
Phoenix, AZ 85007
Office of Injury Prevention
Arizona Department of Health
Services
December 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 From the most recent information posted on the Center
for Disease Controls website regarding TBI’s, 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.

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.
1,2

National Vital Statistics System (NVSS), 2006–2010. Data source is maintained by the CDC National Center for Health Statistics.

3

3

TRENDS IN TRAUMATIC BRAIN INJURIES
AMONG ARIZONA RESIDENTS 2010-2014
Mortality
Between 2010 and 2014, the age-adjusted mortality rate due to traumatic brain injuries decreased by 15
percent, from 20.4 deaths per 100,000 Arizona residents in 2010 to 17.4 deaths per 100,000 residents in
2014.The male mortality rates decreased by 15 percent while the female mortality rates decreased by 11
percent. The age-adjusted mortality rates among males were more than triple the rates of females. Figure 1
shows age-adjusted TBI mortality rates by sex from 2010 through 2014.

Figure 1. Age-Adjusted TBI Mortality Rates by Sex,
Arizona 2010-2014
Rate per 100,000 Residents

35
30
25
20
15
10
5
0
2010

2011
Males

2012
Females

2013

2014

Total

In 2014, all manners of TBI-related deaths decreased from the previous year and overall since 2010. The
age-adjusted rate of unintentional TBI-related deaths decreased 16 percent from 2010 and 11 percent from
2013. Suicide mortality rates decreased four percent since 2010 and six percent since 2013. The ageadjusted rates of motor vehicle crash TBI-related deaths have decreased 41 percent since 2010 while fallrelated deaths have only decreased by four percent. Firearm-related TBI deaths also decreased by over 13
percent since 2010. Figures 2 and 3 show the age-adjusted TBI mortality rates by manner of death and
selected cause of injury.

4

Figure 2. Age-Adjusted TBI Mortality Rates by Manner of Death, Arizona
2010-2014

Rate per 100,000 Residents

10
9
8
7
6
5
4
3
2
1
0
2010

2011

2012

Unintentional

2013

Suicide

2014

Homicide

Figure 3. Age-Adjusted TBI Mortality Rates By Leading Cause of Death,
Arizona 2010-2014

Rate per 100,000 Residents

12
10
8
6
4
2
0
2010

2011
Firearms

2012
Falls

2013

2014

Motor Vehicle Crashes

5

Non-Fatal Inpatient Hospitalizations
Between 2010 and 2014, the age-adjusted rate of TBI-related inpatient hospitalizations decreased 13
percent, from 107.5 hospitalizations per 100,000 Arizona residents in 2010 to 94.0 hospitalizations per
100,000 residents in 2014. On average, the age-adjusted hospitalization rates among males were 1.8 times
higher than the rates of females during the same 5 year period. Rates for males decreased 12 percent from
between 2010 and 2014, and rates for females decreased 13 percent. Figure 4 shows the age-adjusted nonfatal TBI-related inpatient hospitalization rates by sex from 2010 through 2014.

Figure 4. Age-Adjusted Non-Fatal TBI-Related Inpatient Hospitalization
Rates by Sex, Arizona 2010-2014

Rate per 100,000 Residents

160
140
120
100
80
60
40
20
0
2010

2011
Males

2012
Females

2013

2014

Total

The total age-adjusted TBI-related inpatient hospitalization rate decreased 13 percent from 2010 through
2014. This is mainly due to the decrease in unintentional TBI’s since they compose the majority of the
injuries (86 percent). Unintentional injuries have decreased by 13 percent from 2010 to 2014 while assaultrelated TBI decreased by 19 percent. Figure 5 shows age-adjusted TBI hospitalization rates by manner of
injury.

6

Figure 5. Age-Adjusted Non-Fatal TBI-Related Inpatient Hospitalization By
Manner of Injury, Arizona 2010-2014

Rate per 100,000 Residents

120.0
100.0
80.0
60.0
40.0
20.0
0.0
2010

2011
Unintentional

2012
Assault

2013

2014

Total (all manners)

The rate of non-fatal inpatient hospitalizations due to fall-related traumatic brain injuries have decreased by
five percent since 2010, from 45.1 hospitalizations per 100,000 residents in 2010 to 42.8 hospitalizations
per 100,000 residents in 2014. Males consistently had a higher rate of fall-related TBI hospitalizations than
females in each of the five years examined and can be seen in Figure 6 on the next page.
While the rate of fall-related TBI hospitalizations remained fairly stable since 2010, the rate of motor vehicle
crash-related TBI hospitalizations decreased 17 percent in the past five years, from 32.2 crash-related
hospitalizations in 2010 to 26.7 crash-related hospitalizations per 100,000 residents in 2014. As with falls,
males had a higher rate of motor vehicle crash-related TBI hospitalizations than females in each of the years
examined. Figure 6 shows the trend of fall and motor vehicle crash-related TBI hospitalizations by sex from
2010 through 2014 (on the next page).

7

Figure 6. Age-Adjusted Non-Fatal TBI Inpatient Hospitalization Rates by
Mechanism and Sex, Arizona 2010-2014
55.0
Rate per 100,000 Residents

50.0
45.0
40.0
35.0
30.0
25.0
20.0
15.0
10.0
2010
Male Falls

2011
Female Falls

2012
Male MVC

2013

2014

Female MVC

8

Non-Fatal Emergency Department Visits
From 2010 through 2014, the age-adjusted rate of non-fatal TBI-related emergency department visits
increased by 17 percent overall, from 695.7 visits per 100,000 residents in 2010 to 813.8 visits in 2014.The
rates among males and females have increased steadily since 2010. Among males, the rate increased 12
percent, from 745.8 visits per 100,000 residents in 2010 to 837.2 visits per 100,000 residents in 2014.
Among females, the rate increased 17 percent, from 637.3 visits per 100,000 in 2010 to 782.7 visits per
100,000 residents in 2014. Age-adjusted emergency department visit rates among males were higher than
rates among females for the last five years but the disparity between the genders has decreased over time.
Figure 7 shows age-adjusted TBI-related emergency department visit rates by sex from 2010 to 2014.

Figure 7. Age-Adjusted Non-Fatal TBI-Related Emergency Department Visit
Rates by Sex, Arizona, 2010-2014
Rate per 100,000 Residents

900
800
700
600
500
400
300
200
100
0
2010

2011

2012
Males

Females

2013

2014

Total

While total age-adjusted TBI-related emergency department visit rates increased from 2010 through 2014,
changes in rates varied by manner and mechanism of injury. Unintentional injuries have increased by 19
percent since 2010, while injuries related to assaults decreased by three percent. TBI-related
hospitalizations due to self-harm are relatively low and are therefore not included in the figure.
Unlike deaths and hospitalizations, motor vehicle crash-related traumatic brain injury emergency department
visits have increased since 2010 by 33 percent, from 87.7 visits per 100,000 residents in 2010 to 116.1 visits
per 100,000 residents in 2014. The emergency department visit rates due to falls also increased by 23
percent since 2010 as shown in Figure 9.
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 by leading causes of injury.

9

Figure 8. Age-Adjusted Non-Fatal TBI-Related Emergency Department
Visit Rates By Manner Of Injury, Arizona 2010-2014
800.0

Rate per 100,000 Residents

700.0
600.0
500.0
400.0
300.0
200.0
100.0
0.0
2010

2011

2012

Unintentional

2013

2014

Assault

Figure 9. Age-Adjusted Non-Fatal TBI-Related Emergency Department
Visit By Selected Cause Of Injury, Arizona 2010-2014
450.0

Rate per 100,000 Residents

400.0
350.0
300.0
250.0
200.0
150.0
100.0
50.0
0.0
2010

2011
Falls

2012
Struck By/Against

2013

2014

Motor Vehicle Crashes

10

DEATHS AMONG ARIZONA RESIDENTS
DURING 2014
In 2014, 1,233 Arizona residents died as a result of a TBI. The majority of deaths were among males (75
percent, n=920), while females accounted for 25 percent of TBI deaths (n=312). Males had higher rates of
TBI-related mortality across all age groups.
Males 85 years and older accounted for 95 deaths and had the highest rate of TBI deaths in 2014 (208.1 per
100,000 residents). Among the 159 deaths in those 85 years and older, 70 percent were due to unintentional
falls (n=112). Figure 10 shows the 2014 TBI death rates by age group and sex for Arizona residents.

Figure 10. Age-Specific TBI-Related Mortality Rates by Sex,
Arizona 2014

Rate per 100,000 Residents

250
200
150
100
50
0
<1

1-4

5-14

15-24

25-34

Males (n=920)

35-44

45-54

55-64

65-74

75-84

85+

Females (n=312)

Age-adjusted TBI death rates were highest among American Indians (21.3 deaths per 100,000 residents)
and non-Hispanic Whites (19.2 deaths per 100,000 residents). Rates were lowest among Asian/Pacific
Islanders. Figure 11 shows the 2014 age-adjusted TBI death rates by race/ethnicity in Arizona.

11

Figure 11. Age-AdjustedTBI-Related Mortality Rates by Race/Ethnicity,
Arizona 2014
Rate per 100,000 Residents

25

20

15

10

5

0
American Indian

White, nonHispanic

Hispanic, all
races

African
American

Asian/Pacific
Islander

Total

Apache and Cochise Counties had the highest age-adjusted TBI mortality rates in 2014 (28.5 deaths per
100,000 residents respectively). The next highest TBI mortality rate was in Yavapai County with 24.0 deaths
per 100,000 residents. Figure 12 shows the TBI mortality rate by county for 2014 in Arizona.

Figure 12. Age-Adjusted TBI-Related Mortality Rates by County, Arizona
2014*

Rate per 100,000 Residents

30
25
20
15
10
5
0
Apache Cochise Coconino Maricopa Mohave

Navajo

Pima

Pinal

Yavapai

Yuma

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

Forty-three percent of the TBI deaths in 2014 were due to unintentional injuries (n=530); 46 percent were
due to suicides (n=565); and five percent were due to homicides (n=67). Figure 13 shows TBI deaths by
manner of injury during 2014 in Arizona.

12

Figure 13. Percentage of TBI-related Deaths by Manner, Arizona 2014

46%

2%
5%

Unintentional
Suicide
Homicide

6%

Undetermined

4%

Unknown/Missing

43%

The most common causes of TBI deaths were firearms (50 percent, n=621), falls (27 percent, n=328), and
motor vehicle traffic crashes (11 percent, n=130). Causes of TBI deaths during 2014 in Arizona are shown in
Table 1. Descriptions of these causes are given in Appendix A.
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. The cause of death refers to the injury that resulted in death, whereas the manner of death refers
to the intentionality of the death.
Table 1. Number and Percentage of TBI Deaths by Cause, Arizona 2014

Cause
Firearm
Fall
Motor vehicle traffic
Other/unspecified/unknown
Other land transport
Other pedestrian/bicycle
Struck By/Against
Total

Number
621
328
130
128
14
6
6
1,233

Percentage
50%
27%
11%
11%
1%
<1%
<1%
100%

Source: Arizona Vital Statistics

13

Figure 14. TBI-Related Deaths by Manner and Race/Ethnicity, Arizona 2014
100%
90%
80%

Percentage

70%
60%
50%
40%
30%
20%
10%
0%
White, nonHispanic

Black, nonHispanic

Unintentional

Hispanic, all races American Indian

Suicide

Homicide

Asian/Pacific
Islander

Undetermined

Figure 15. TBI-Related Deaths by Cause and Race/Ethnicity, Arizona 2014
100%
90%
80%

Percentage

70%
60%
50%
40%
30%
20%
10%
0%
White, non-Hispanic

African American

Firearms

Hispanic, all races

Falls

MV Traffic

American Indian

Asian/Pacific
Islander

Other

14

Firearm-Related TBI Mortality
Among the 621 Arizona residents who died as a result of a firearm-related TBI, the majority were male (82
percent, n=508) and 18 percent were female (n=113).
The highest age-adjusted rate of firearm-related TBI deaths was among White non-Hispanics (15.3 deaths
per 100,000 residents, n=409). The second highest rate was among African Americans (6.9 per 100,000
residents, n=24) followed by Native Americans with 4.3 deaths per 100,000 residents. Hispanics had the
second highest count of firearm-related TBI (n=76) however the rate for this group was low, 4.2 per 100,000
residents.
The majority of firearm-related TBI deaths were suicides (90 percent, n=561). Seven percent of the deaths
were due to homicides (n=45) and one percent were due to undetermined intent (n=7). Figure 16 shows the
percentage of TBI deaths due to firearms by manner of injury.

Figure 16. Percentage of Firearm-Related TBI Deaths by Manner, Arizona
2014
3%
7%

90%

Suicide

Homicide

Unintentional/Undetermined

Among the 561 TBI deaths resulting from firearm-related suicides, 81 percent were among males (n=466)
and 19 percent were among females (n=95). The age-adjusted rate of TBI deaths resulting from firearmrelated suicides was 8.1 deaths per 100,000 residents, a five percent decrease since 2013. The highest
age-specific rates were among adult males, particularly among those 85 years and older (46.0 per 100,000).
Age-adjusted rates were substantially higher among males than among females over each of the years from
2010-2014 but female suicide rates have increased 47 percent since 2010. Figure 17 shows the ageadjusted rate of TBI deaths resulting from firearm-related suicides by sex and year.

15

Rate per 100,000 Residents

Figure 17. Age-Adjusted TBI Mortality Rates Due To Firearm Suicides
by Sex And Year, Arizona 2010-2014
18.0
16.0
14.0
12.0
10.0
8.0
6.0
4.0
2.0
0.0
2010

2011

2012

Males

Females

2013

2014

Total

The highest age-adjusted rate of firearm-related TBI suicides was among White non-Hispanics (11.1 per
100,000 residents, n=480). 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 3.1 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 328 TBI deaths due to falls, 63 percent were among males (n=207) and 37 percent were among
females (n=121). Almost 100 percent of the falls were unintentional and among adults over the age of 25.
Twenty-three percent of the deaths were among adults ages 25 through 64 years (n=77); and 77 percent
were among adults 65 years and older (n=250). The age-adjusted rate of all fall-related TBI deaths in
Arizona for 2013 was 4.3 deaths per 100,000 residents, however the highest age-specific mortality rate was
among adults 85 years and older (93.4 per 100,000 residents) followed by adults 75 through 84 years of age
(28.3 per 100,000 residents).

Rate per 100,000 Residents

Figure 18. Age-Specific Fall-Related TBI Mortality Rates by Age and
Sex, Arizona 2014
140
120
100
80
60
40
20
0
25-34

35-44

45-54

Females (n=121)

65-74
Total (n=328)

75-84

85+

16

Males (n=207)

55-64

Non-Fatal Inpatient Hospitalizations among
Arizona Residents During 2014
In 2014, 6,581 Arizona residents were hospitalized due to non-fatal TBI. Continuing the trend over the
years, males comprised 62 percent of the total TBI hospitalizations (n=4,087) and females accounted
for 38 percent (n=2,494).
Adults 85 years and older had the highest rates of TBI inpatient hospitalizations in 2014. Males 85
years and older had the highest age-adjusted rate of hospitalizations with 657.0 per 100,000 residents
(n=300), an increase of 13 percent from 2013. The rate for females 85 years and older was 611.2
hospitalizations per 100,000 residents (n=454), a three percent decrease from the 2013 rate. For adults
85 years and older, 98 percent of TBI hospitalizations were due to unintentional falls (n=737). Figure 19
shows the 2014 TBI inpatient hospitalization rates by age group and sex for Arizona residents.

Figure 19. Age-Specific TBI-Related Non-Fatal Inpatient
Hospitalization Rates by Age Group and Sex, Arizona 2014
700

Rate per 100,000 Residents

600
500
400
300
200
100
0
<1yr

1-4yr

5-14yr 15-24yr 25-34

Males (n=4,087)

35-44

45-54

Females (n=2,494)

55-64

65-74

75-84

85+

Total (n=6,581)

Age-adjusted TBI inpatient hospitalization rates were highest among American Indians (184.2
hospitalizations per 100,000 residents), this represents a 15 percent decrease from 2013, when the rate for
this group was 215.9 hospitalizations per 100,000 residents. African Americans had the second highest
hospitalization rate (88.9 hospitalizations per 100,000 residents), representing a 13 percent increase since
2013, when the rate was 78.8 hospitalizations per 100,000 residents. Figure 20 shows the 2014 ageadjusted TBI inpatient hospitalization rates by race/ethnicity in Arizona.

17

Figure 20. Age-Adjusted TBI-Related Non-Fatal Inpatient Hospitalization
Rates by Race/Ethnicity, Arizona 2014*

Rate per 100,000 Resients

200
180
160
140
120
100
80
60
40
20
0
American
Indian

African
American

Hispanic

White, nonHispanic

Asian/Pacific
Islander

Total

*128 hospitalizations were among individuals of other or unknown race/ethnicity.

Gila County had the highest non-fatal TBI-related inpatient hospitalization rate in 2014 with 258.1
hospitalizations per 100,000 residents and Navajo County had the second highest rate (190.3 per 100,000
residents. Figure 21 shows the age-adjusted non-fatal TBI-related inpatient hospitalizations by county for
Arizona in 2014.

Figure 21. Age-Adjusted TBI-Related Non-Fatal Inpatient Hospitalization
Rates, by County, Arizona 2014*

Rte per 100,000 Residnets

300
250
200
150
100
50
0

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

18

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 309 days. In total, Arizonans spent 37,907 days
hospitalized for TBI in 2014.
TBI inpatient hospitalization charges in 2014 totaled more than $574.5 million, with 55 percent paid by the
Arizona Health Care Cost Containment System (AHCCCS)/Medicaid and Medicare (n=3,638 cases, over
$307.7 million). This total does not include costs related to physician care, rehabilitation, lost wages, or longterm costs of disability.
Unintentional injuries accounted for 86 percent of TBI hospitalizations (n=5,684). There were 59
hospitalizations due to self-inflicted TBI (less than one percent) and 709 due to assaults (11 percent). Figure
22 shows the TBI inpatient hospitalizations by manner of injury for Arizona in 2014.

Figure 22. TBI-related Non-Fatal Inpatient Hospitalizations
by Manner, Arizona 2014

3%

11%
Unintentional
Assault

86%

Other/Unknown

Fall-related injuries were the most common cause of TBI hospitalizations (48 percent, n=3,141), followed by
motor vehicle traffic injuries (27 percent, n=1,793). Table 2 shows causes of TBI inpatient hospitalizations in
Arizona during 2014.

Table 2. Number and Percentage of TBI Inpatient Hospitalizations by Cause, Arizona 2014
Cause
Fall
Motor vehicle traffic
Struck by/against
Other/unspecified
Transport
Other pedal cycle
Firearm
Cut/pierce
Total

Percentage
48%
27%
9%
8%
4%
2%
<1%
<1%
100

19

Source: Arizona Hospital Discharge Database

Number
3,141
1,793
610
531
273
145
51
36
6,581

Non-Fatal Fall-Related TBI Inpatient Hospitalizations
There were 3,141 inpatient hospitalizations due to fall-related TBI. Fifty-three percent were among males
(n=1,660) and 47 percent were among females (n=1,481). Falls were unintentional more than 99 percent of
the time (n=3,129), with only 12 cases in which another manner was identified.
American Indians had the highest age-adjusted rate of fall-related TBI hospitalizations with 60.4
hospitalizations per 100,000 residents (n=159). The second highest rate was among White, non-Hispanics
(36.6 hospitalizations per 100,000 residents; n=66). The age-adjusted rate for non-fatal fall-related inpatient
hospitalizations among all Arizonans was 42.8 hospitalizations per 100,000 residents.
Despite the relationship between age-adjusted rates by race/ethnicity, the differences in age specific rates
for adults 65 years of age and older paint a different picture of fall-related TBI. Among adults 65 years of age
and older, the rate of fall-related TBI hospitalization is still highest among American Indians but is followed
by Asian residents with 36.6 hospitalizations per 100,000 residents. Figure 23 shows the age-specific
hospitalization rates for fall-related TBI among Arizonan seniors 65 years of age and older, by race/ethnicity.

Figure 23. Elder Fall-Related Non-Fatal TBI Inpatient Hospitalization Rates
65 Years Of Age And Older, By Race/Ethnicity, Arizona 2014*

Rate per 100,000 Residents

50
45
40
35
30
25
20
15
10
5
0
American Indian

Asian/Pacific
Islander

White, nonHispanic

Hispanic

African American

*Does not include 49 cases in which race/ethnicity information is unknown.

Non-Fatal Motor Vehicle Traffic Crash-Related TBI Inpatient Hospitalizations
Of the 1,793 TBI hospitalizations due to motor vehicle traffic crashes, 66 percent were among males
(n=1,184) and 34 percent were among females (n=609). 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 (45.4 hospitalizations
per 100,000 residents), for both males (61.1 hospitalizations per 100,000 residents) and females (28.5
hospitalizations per 100,000 residents).

20

American Indians had the highest rate of TBI hospitalizations for motor vehicle traffic crashes with 43.0
hospitalizations per 100,000 residents (n=162), representing a 21 percent decrease since 2013.

With 26.7 hospitalizations per 100,000 residents, non-Hispanic Whites had the second highest rate
(n=1,043). 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=1,080). Nineteen percent were motorcyclists (n=333); 13 percent were
pedestrians (n=225); and five percent were pedal cyclists (n=94). 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 2014

3%
13%

Occupant
Motorcyclist

5%
60%
19%

Pedal cyclist
Pedestrian
Other/Unspecified

21

Non-Fatal Emergency Department Visits
among Arizona Residents During 2014
In 2014, there were 54,310 TBI emergency department visits among Arizona residents. Males accounted
for just over half of TBI emergency department visits (51 percent, n=27,503), while females accounted for 49
percent of visits (n=26,805). TBI emergency department visit rates were highest among adults 85 years and
older followed by those less than one year of age. There were 2,289 emergency department visits among
females 85 years and older (a rate of 3,081.5 visits per 100,000 residents), and 1,132 visits among males 85
and older (a rate of 2,479.2 visits per 100,000 residents). For all children younger than one year of age, 88
percent of TBI emergency department visits were due to unintentional falls (n=2,053). Figure 25 shows the
2014 TBI emergency department visit rates for Arizona residents.

Figure 25. Age-Specific TBI Emergency Department Visit Rates by Sex,
Arizona 2014

Rate per 100,000 Residents

3,500.0
3,000.0
2,500.0
2,000.0
1,500.0
1,000.0
500.0
0.0
<1yr

1-4yr

5-14yr 15-24yr 25-34
Males (n=27,503)

35-44

45-54

Females (n=26,805)

55-64

65-74

75-84

85+

Total

Age-adjusted TBI emergency department visits were highest among Non-Hispanic Whites (900.8
hospitalizations per 100,000 residents). African Americans had the second highest emergency department
visit rate with 779.3 visits per 100,000 residents. The age-adjusted rate for non-fatal TBI-related emergency
department visits among all Arizonans was 813.8 hospitalizations per 100,000 residents an almost six
percent increase since 2013. Figure 26 shows the age-adjusted emergency department rates by
race/ethnicity.

22

Figure 26. Age-Adjusted TBI-Related Non-Fatal Emergency Department
Rates by Race/Ethnicity, Arizona 2014

Rate per 100,000 Residents

1000
900
800
700
600
500
400
300
200
100
0
White, nonHispanic

African
American

Hispanic

American
Indian

Asian

Total

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

Similar to hospitalizations, Gila County had the highest non-fatal TBI-related emergency department visits in
2014 (1181.2 visits per 100,000 residents). Yavapai County had the second highest rate with 1018.3 visits
per 100,000 residents (in 2012 and 2013 Yavapai County had the highest rates). Figure 27 shows the ageadjusted TBI-related non-fatal emergency department visits by county.

Figure 27. Age-Adjusted TBI-Related Non-Fatal Emergency Department
Rates by County, Arizona 2014
1400

Rate per 100,000 Residents

1200
1000
800
600
400
200
0

23

TBI emergency department charges in 2014 totaled more than $355.1 million, with 47 percent paid by the
Arizona Health Care Cost Containment System (AHCCCS)/Medicaid and Medicare (n=26,241, over $166.7
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=49,360),
and nine percent were assaults (n=4,678). Figure 28 shows TBI emergency department visits by intent
during 2014 in Arizona.

Figure 28. Percentage of TBI Emergency Department Visits by Manner of
Injury, Arizona 2014

9%
Unintentional
Self-inflicted
Assault

91%

Undetermined/Other

The leading causes of TBI emergency department visits were falls (54 percent, n=29,232), struck by/against
injuries (22 percent, n=9,029), and motor vehicle traffic crashes (14 percent, n=7,590). Table 3 shows TBI
emergency department visits by cause for Arizona in 2014. Descriptions of all causes are given in Appendix
A.

Table 3. Number and Percentage of TBI Emergency Department Visits by Cause, Arizona 2014
Cause
Fall
Struck by/against
Motor vehicle traffic
Other/unspecified
Other pedal cycle
Transport
Total

Number
29,232
9,029
7,590
6,178
1,155
1,126
54,310

Percentage
54
22
14
6
2
2
100%

Source: Arizona Hospital Discharge Database

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Non-Fatal Fall-Related Emergency Department Visits
There were 29,244 emergency department visits due to fall-related TBI. Forty-six percent were among
males (n=13,392) and 54 percent were among females (n=15,851). Over 99 percent of these falls were
unintentional (n=29,232). 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 was 2,434.1 visits per 100,000 residents; among adults 85 and older, the rate was 2,696.3
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
11,782 TBI emergency department visits due to struck by/against injuries, 60 percent were among males
(n=7,099) and 40 percent were among females (n=4,693). Seventy-seven percent of these injuries were
unintentional (n=9,029), and 22 percent were assaults (n=2,647). Fifty percent of TBI emergency
department visits from struck by/against injuries were among individuals five and 24 years of age (n=5,873).
The emergency department discharge database did not include specific information regarding contributing
event for 30 percent of the struck by/against injuries. The most frequently specified contributing events were
assaults in unarmed brawls (17 percent of specified events, n=2,024) and unintentional blows while playing
sports (17 percent of specified events, n=1,968). Figure 29 shows TBI emergency department visits due to
struck by/against injuries by specified contributing event.

Figure 29. TBI Emergency Department Visits due to Struck by/Against by
Specified Contributing Event, Arizona 2014
1%
6%
5%
5%

29%

7%

17%
17%
13%

Unintentional Other Struck by object
Other stationary object
By falling object
Assault by blunt or thrown object
Legal intervention

Unintentional sports-related
Assault in unarmed brawl
Object in sports
Furniture

25

Data Notes
All rates were calculated using the 2014 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 2014. Inpatient
hospitalization and emergency department visit data were compiled from the 2014 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.
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

Other land transport

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

Includes collisions that occur on public highways and streets.
These collisions may include pedestrians, pedal cyclists,
motorcyclists, and occupants of motor vehicles.
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.
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
Cause
not listed.
databases
and is not used on death certificates.

26