TRAUMATIC BRAIN INJURIES
ARIZONA RESIDENTS 2016
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
6NU17CE924850 Core State 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
Data Notes ......................................................................................................................................... 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 2016 ............................................................................................................ 11
Firearm-Related ............................................................................................................................... 15
Fall-Related ...................................................................................................................................... 16
TBI-Related Non-Fatal Inpatient Hospitalizations 2016 ................................................................... 17
Fall-Related ...................................................................................................................................... 20
Motor Vehicle Traffic Crash-Related ................................................................................................. 20
TBI-Related Non-Fatal Emergency Department Visits 2016............................................................ 22
Fall-Related ...................................................................................................................................... 25
Struck by/Against-Related ................................................................................................................ 25

1

EXECUTIVE SUMMARY

TBI: AT A

ARIZONA RESIDENTS 2016

GLANCE

Traumatic Brain Injuries (TBI) was the cause of death for 1,605 Arizona
residents in 2016. Males ages 85 years and older had the highest rate of
TBI deaths with 236.3 deaths per 100,000 residents. TBI death ageadjusted rates were highest among American Indian or Alaska Native (34.8
deaths per 100,000 residents) and White non-Hispanic (23.4 deaths per
100,000 residents) residents. In 2016, forty-four percent of TBI deaths
were due to unintentional injuries (n=709), forty-three percent were
suicides (n=688), and eight percent were homicides (n=122). The most
common causes of TBI deaths were firearms (49%, n=788), falls (27%,
n=435), and motor vehicle traffic crashes (13%, n=201).
In 2016, there were 9,004 non-fatal TBI Inpatient Hospitalizations (IP).
Adults 85 years and older had the highest rate of TBI IP (827.1 IP per
100,000 people). For this age group, Females had a rate of 828.2 IP per
100,000 residents, and males had a rate was 825.2 IP per 100,000
residents. The age-adjusted TBI IP rates for Race/Ethnicity groups were
highest among American Indians or Alaska Native (258.3 IP per 100,000
residents). The age-adjusted TBI IP rates for other Race/Ethnicity groups
except White non-Hispanic were below the total age-adjusted rate (123.5
IP per 100,000 residents). Unintentional injuries accounted for eighty-four
percent of TBI IP (n=7,952). Falls were the most common cause of TBI IP
(47%, n=4,236), followed by motor vehicle traffic crashes (28%, n=2,554).
Total hospital charges for non-fatal IP due to TBIs were more than $911.1
million, and Arizonans spent a total of 56,294 days hospitalized in 2016.
In 2016, there were 97,982 non-fatal TBI Emergency Department Visits
(EDV). TBI EDV rates were highest among adults 85 years and older
(4,377.4 EDV per 100,000 residents), then among children 1-4 years of
age (4,174.1 EDV per 100,000 residents), and infants less than 1 years
(3,151.1 EDV per 100,000 residents). Within the children 1-4 years of age
and infants less than 1 year age groups, males (5,008.3 and 3,381.3 EDV
per 100,000 residents respectively) had higher rates than females (3,300.6
and 2,910.1 EDV per 100,000 residents respectively). Females (4,719.8
EDV per 100,000 residents) had a higher rate than males (3,851.1 EDV
per 100,000 residents) for the 85 and older age group. The age-adjusted
TBI EDV rates were highest among African American and White nonHispanic (1,666.3 and 1,585.6 EDV per 100,000 residents respectively).
Overall, unintentional injuries accounted for 91% of the TBI EDV. The
leading causes of TBI EDV were falls (50%, n=48,631), struck by/against
injuries (25%, n=24,871), and motor vehicle traffic crashes (12%,
n=11,327). Total hospital charges for non-fatal emergency department
visits due to TBIs were more than $655 million.

For every TBI-related death
in Arizona in 2016 there
were:
6 Non-fatal inpatient
hospitalizations and
57 Non-fatal emergency
department visits
Resulting in over
1 billion in hospital charges

Prepared By:
Kyle Gardner, MSPH
th
150 North 18 Avenue
Phoenix, AZ 85007
Office of Injury Prevention
Arizona Department of Health
Services
August 2017

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.

Data Notes
All rates were calculated using the 2016 Arizona Vital Statistics population estimates. Age-adjusted rates
were standardized to the 2000 U.S. standard population. Mortality data were tabulated from death
certificates for Arizona residents who died where TBI was reported as the main cause of death alone or in
combination with other injuries in 2016. Inpatient hospitalization and emergency department visit data were
compiled from the 2016 Arizona Hospital Discharge Database for residents who were hospitalized or
treated from emergency departments due to TBI diagnosis alone or in combination with other injuries or
conditions.
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 (ICD), Version 9, clinical modification (ICD-9CM) were used for determining TBI cases among hospital and emergency department data for the
first three quarters of 2015 (January-September). In October 2015, the federal government’s new
mandate for ICD, the conversion of ICD-9-CM diagnostic and procedural codes to the
implementation and use of ICD-10-CM codes, went into effect. This new mandate provides health
providers a wider and more detail range for diagnosing diseases for the last quarter year of 2015
(October-December) and all of 2016. This mandate will cause significant changes in annual injury
surveillance, reporting, and may not be comparable to previous years.
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 2012-2016
Mortality
Between 2012 and 2016, the age-adjusted mortality rate due to traumatic brain injuries increased by five
percent, from 20.7 deaths per 100,000 Arizona residents in 2012 to 21.8 deaths per 100,000 residents in
2016. During this time period, the Age-Adjusted TBI mortality rates for males and females increased by 5%.
The age-adjusted TBI mortality rates among males were three times higher than the rates of females.
Figure 1 shows age-adjusted TBI mortality rates by sex from 2012 through 2016.

Figure 1. Age-Adjusted TBI Mortality Rates by Sex,
Arizona 2012-2016
Rate per 100,000 Residents

40.0
35.0
30.0
25.0
20.0
15.0
10.0
5.0
0.0
2012

2013
Males

2014
Females

2015

2016

Total

In 2016, all manners of TBI-related deaths increased from the previous year. The age-adjusted rate of
unintentional TBI-related deaths increased one percent, while suicide TBI-related deaths increased nine
percent from previous year. From 2012-2016, the age-adjusted rates of motor vehicle crash TBI-related
deaths remained the same, while fall TBI-related deaths increased by ten percent. Firearm-related TBI
deaths increased eleven percent since 2012. 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 2012-2016

Rate per 100,000 Residents

10.0
9.0
8.0
7.0
6.0
5.0
4.0
3.0
2.0
1.0
0.0
2012

2013

2014

Unintentional

2015

Suicide

2016

Homicide

Figure 3. Age-Adjusted TBI Mortality Rates By Lead Cause of Death,
Arizona 2012-2016

Rate per 100,000 Residents

12.0
10.0
8.0
6.0
4.0
2.0
0.0
2012

2013
Firearms

2014
Falls

2015

2016

Motor Vehicle Crashes

5

Non-Fatal Inpatient Hospitalizations (IP)
Between 2012 and 2016, the age-adjusted rate of TBI-related Inpatient Hospitalizations (IP) increased
24.2%, from 99.4 IP per 100,000 residents in 2012 to 123.5 IP per 100,000 residents in 2016. 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 increased 22% from between 2012 and 2016, and rates for females
the rate increased by 29%. Figure 4 shows the age-adjusted non-fatal TBI-related inpatient hospitalization
rates by sex from 2012 through 2016.

Figure 4. Age-Adjusted Non-Fatal TBI-Related Inpatient
Hospitalization Rates by Sex, Arizona 2012-2016
180.0
Rate per 100,000 Residents

160.0
140.0
120.0
100.0
80.0
60.0
40.0
20.0
0.0
2012

2013
Males

2014
Females

2015

2016

Total

Overall the age-adjusted rate of TBI-related IP by all manners has increased since 2012. From 2012 to 2016
there was a 26% increase in unintentional injuries and 8.9% increase in assault-related TBI. 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 2012-2016

Rate per 100,000 Residents

140.0
120.0
100.0
80.0
60.0
40.0
20.0
0.0
2012

2013
Unintentional

2014
Assault

2015

2016

Total (all manners)

The most common non-fatal inpatient hospitalizations TBI injuries are due to falls and motor vehicle crashes.
The rate of non-fatal IP due to fall-related traumatic brain injuries in 2016 was 53.8 IP per 100,000 residents
and represents a 17.7% increase from the previous year (45.7 IP per 100,000 residents). 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.

In 2016, the rate of motor vehicle crash (MVC)-related TBI hospitalizations was 36.9 IP per 100,000
residents. The MVC crash-related TBI IP rate increased 32.6% for males and 24.2% for females from the
previous year. 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 2012 through 2016.

7

Figure 6. Age-Adjusted Non-Fatal TBI Inpatient Hospitalization Rates
by Mechanism and Sex, Arizona 2012-2016

Rate per 100,000 Residents

70.0
60.0
50.0
40.0
30.0
20.0
10.0
2012
Male Falls

2013
Female Falls

2014
Male MVC

2015

2016

Female MVC

8

Non-Fatal Emergency Department Visits (EDV)
From 2012 through 2016, the age-adjusted rate of non-fatal TBI-related emergency department visits (EDV)
increased by 84% overall, from 781.1 EDV per 100,000 residents in 2012 to 1,439.9 EDV per 100,000
residents in 2016.The rates among males and females have increased gradually since 2012. Among males,
the rate increased 95%, from 818.4 EDV per 100,000 people in 2012 to 1,509.4 EDV per 100,000 residents
in 2016. Among females, the rate increased 73%, from 735.3 EDV per 100,000 residents in 2012 to 1,164.6
EDV per 100,000 people in 2016. The age-adjusted EDV 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 2012 to 2016.

Figure 7. Age-Adjusted Non-Fatal TBI-Related Emergency
Department Visit Rates by Sex, Arizona, 2012-2016
Rate per 100,000 Residents

1,800.0
1,600.0
1,400.0
1,200.0
1,000.0
800.0
600.0
400.0
200.0
0.0
2012

2013

2014
Males

Females

2015

2016

Total

The total age-adjusted TBI-related emergency department visit rates by manner and mechanism of injury
have increased from 2012 to 2016. Unintentional injuries have increased by 87.1% while assault injuries
have increased by 56.2% since 2012.
The most common non-fatal emergency department visit TBI injuries are falls, being struck by/against an
object and motor vehicle crashes. From 2012 to 2016, there has been a 75.2% increase in falls (393.9 to
690.2 EDV per 100,000 residents), 100.7% increase in being struck by/against an object (189.8 to 380.6
EDV per 100,000 residents), and 59.6% increase in motor vehicle crashes (106.7 to 170.3 EDV per 100,000
residents).
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 2012-2016
1600.0

Rate per 100,000 Residents

1400.0
1200.0
1000.0
800.0
600.0
400.0
200.0
0.0
2012

2013
Unintentional

2014
Assault

2015

2016

Total (All Manner)

Figure 9. Age-Adjusted Non-Fatal TBI-Related Emergency
Department Visit By Selected Cause Of Injury, Arizona 2012-2016
800.0

Rate per 100,000 Residents

700.0
600.0
500.0
400.0
300.0
200.0
100.0
0.0
2012

2013
Falls

2014
Struck By/Against

2015

2016

Motor Vehicle Crashes

10

DEATHS AMONG ARIZONA RESIDENTS
DURING 2016
In 2016, 1,605 Arizona residents died as a result of a TBI. Seven-four percent of TBI deaths were among
males (n=1,190), while females accounted for twenty-six percent of TBI deaths (n=415). Males had higher
rates of TBI-related mortality across all age groups.
Males 85 years and older had the highest rate of TBI deaths at 236.3 deaths per 100,000 residents in 2016.
Among the 193 deaths in those 85 years and older, 71.5% were due to unintentional falls (n=138). Figure 10
shows the 2016 TBI death rates by age group and sex for Arizona residents.

Figure 10. Age-Specific TBI-Related Mortality Rates by
Sex and age Group, Arizona 2016
Rate per 100,000 Residents

250.0
200.0
150.0
100.0
50.0
0.0
<1
yrs

1-4
yrs

5-14
yrs

15-24
yrs

Males (n=1,190)

25-34
yrs

35-44
yrs

Females (n=415)

45-54
yrs

55-64
yrs

65-74
yrs

75-84
yrs

85+
yrs

Total (n=1,605)

Age-adjusted TBI death rates were highest among American Indian or Alaska Native (34.8 deaths per
100,000 residents) and White non-Hispanics (23.4 deaths per 100,000 residents). Rates were lowest among
Asian or Pacific Islanders (9.9 deaths per 100,000 residents). Figure 11 shows the 2016 age-adjusted TBI
death rates by race/ethnicity in Arizona.

11

Figure 11. Age-AdjustedTBI-Related Mortality Rates by
Race/Ethnicity, Arizona 2016
Rate per 100,000 Residents

40.0
35.0
30.0
25.0
20.0
15.0
10.0
5.0
0.0
American
Indian or Alaska
Native

White NonHispanic

Hispanic or
Latino

African
American or
Black

Asian or Pacific
Islander

Total

There were six counties that had age-adjusted TBI mortality rates higher than the state rate (21.8 deaths per
100,000 residents) in 2016. Apache (44.6) and Navajo (40.5) had the highest age-adjusted TBI mortality
rates per 100,000 residents. Figure 12 shows the TBI mortality rate by county in Arizona.

Rate per 100,000 Residents

Figure 12. Age-Adjusted TBI-Related Mortality Rates by County,
Arizona 2016*
50.0
45.0
40.0
35.0
30.0
25.0
20.0
15.0
10.0
5.0
0.0

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

Forty-four percent of the TBI deaths in 2016 were due to unintentional injuries (n=709); forty-three percent
were due to suicides (n=688); and eight percent were due to homicides (n=122). Figure 13 shows TBI
deaths by manner of injury during 2016 in Arizona.

12

Figure 13. Percentage of TBI-related Deaths by Manner,
Arizona 2016

43%
2%

8%

Unintentional
Suicide

5%

Homicide
3%

Undetermined
Unknown/Missing

44%

The most common causes of TBI deaths were firearms (49%, n=788), falls (27%, n=435), and motor vehicle
traffic crashes (13%, n=201). Causes of TBI deaths during 2016 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 or Alaska
Native residents. Figures 14 and 15 show the percentages breakdown 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 2016

Cause
Firearm
Fall
Motor vehicle traffic
Other/unspecified/unknown
Other specified
Other land transport
Other pedestrian/pedal cycle
Total

Number

Percentage

788
435
201
129
23
17
12
1,605

49%
27%
13%
8%
1%
<1%
<1%
100%

Source: Arizona Vital Statistics

13

Figure 14. TBI-Related Deaths by Manner and Race/Ethnicity,
Arizona 2016
100%
90%
80%

Percentage

70%
60%
50%
40%
30%
20%
10%
0%
American Indian or
Native American

White NonHispanic

Unintentional

Hispanic or Latino African American
or Black

Suicide

Homicide

Asian or Pacific
Islander

Undetermined

Figure 15. TBI-Related Deaths by Cause and Race/Ethnicity,
Arizona 2016
100%
90%
80%

Percentage

70%
60%
50%
40%
30%
20%
10%
0%
American Indian or
Native American

White NonHispanic
Firearms

Hispanic or Latino African American
or Black
Falls

MV Traffic

Asian or Pacific
Islander

Other

14

Firearm-Related TBI Mortality
Among the 788 Arizona residents who died as a result of a firearm-related TBI (10.9 deaths per 100,000
residents), the majority were male (83%, n=658) and 17% were female (n=130).
The highest age-adjusted rate of firearm-related TBI deaths was among White non-Hispanics (13.7 deaths
per 100,000 residents, n=621). The second highest rate was among Black or African Americans residents
(10.4 deaths per 100,000 residents, n=35).
The majority of firearm-related TBI deaths were suicides (86%, n=678). Twelve percent of the firearmrelated TBI deaths were due to homicides (n=92) and two percent were due to undetermined intent (n=15).
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 2016
2%
12%

86%

Suicide

Homicide

Unintentional/Undetermined

Among the 678 TBI deaths resulting from firearm-related suicides, 86% were among males (n=582) and
14% were among females (n=96). The age-adjusted rate of TBI deaths resulting from firearm-related
suicides was 9.3 deaths per 100,000 residents, an 8% increase from 2015. The highest age-specific rates
were among adult males, particularly among those 85 years and older (45.8 deaths per 100,000 residents).
Age-adjusted rates were substantially higher among males than among females over each of the years from
2012-2016, but female suicide rates have increased 52% since 2012. Figure 17 shows the age-adjusted 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 Suicides from
Firearms by Sex And Year, Arizona 2012-2016
18.0
16.0
14.0
12.0
10.0
8.0
6.0
4.0
2.0
0.0
2012

2013

2014

Males

Females

2015

2016

Total

The highest age-adjusted rate of firearm-related TBI suicides was among White non-Hispanics residents
(12.5 deaths per 100,000 residents, n=570). The age-adjusted rate among Hispanics or Latinos was 4.2
deaths per 100,000 residents (n=79). 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 435 TBI deaths due to falls (5.4 deaths per 100,000 residents), 62% were among males (n=268)
and 38% were among females (n=167). Majority of the falls were unintentional and among adults over the
age of 25. Twenty percent of the deaths were among adults ages 25 through 64 years (n=85); and eighty
percent were among adults 65 years and older (n=348). In 2016, the age-adjusted rate of all fall-related TBI
deaths in Arizona was 5.4 deaths per 100,000 people. The highest age-specific mortality rate was among
adults 85 years and older (105.4 deaths per 100,000 residents) followed by adults 75 through 84 years of
age (41.8 deaths per 100,000 residents).

Rate per 100,000 Residents

Figure 18. Age-Specific Fall-Related TBI Mortality Rates by Age
and Sex, Arizona 2016
160.0
140.0
120.0
100.0
80.0
60.0
40.0
20.0
0.0
25-34
yrs

35-44
yrs

55-64
yrs

Females (n=167)

65-74
yrs
Total (n=435)

75-84
yrs

85+
yrs

16

Males (n=268)

45-54
yrs

Non-Fatal Inpatient Hospitalizations (IP)
among Arizona Residents During 2016
In 2016, 9,004 Arizona residents were hospitalized due to non-fatal TBI. Continuing the trend over the
years, males comprised 61% of the total TBI hospitalizations (n=5,536; 159.0 IP per 100,000 residents)
and females accounted for 39% (n=3,468; 87.8 IP per 100,000 residents).

Adults 85 years and older had the highest rates of TBI inpatient hospitalizations (IP) at 827.1 IP per
100,000 in 2016. Within this age group, the age-specific rate of TBI hospitalizations for females was
828.2 IP per 100,000 residents, and the rate for males was 825.2 IP per 100,000 residents. For adults
85 years and older, 91% of TBI hospitalizations were due to unintentional falls (n=989). Figure 19
shows the 2016 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 2016
900.0

Rate per 100,000 Residents

800.0
700.0
600.0
500.0
400.0
300.0
200.0
100.0
0.0
<1
yrs

1-4
yrs

5-14
yrs

15-24
yrs

Males (n=5,536)

25-34
yrs

35-44
yrs

Females (n=3,468)

45-54
yrs

55-64
yrs

65-74
yrs

75-84
yrs

85+
yrs

Total (n=9,004)

Age-adjusted TBI IP rates were highest among American Indian or Alaska Native (258.3 IP per 100,000
residents), and represents a 12% percent increase from 2015, when the rate for this group was 230.6 IP per
100,000 residents. White non-Hispanics had the second highest hospitalization rate (124.1 IP per 100,000
residents), and represents a 25% increase from 2015, when the rate was 99.6 IP per 100,000 residents.
Figure 20 shows the 2016 age-adjusted 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 2016*
Rate per 100,000 Resients

300.0
250.0
200.0
150.0
100.0
50.0
0.0
American
Indian or
Alaska Native

White NonHispanic

Hispanic or
Latino

African
Asian or Pacific
American or
Islander
Black

Total

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

There were five counties that had non-fatal TBI-related inpatient hospitalization rates higher than the state
rate (123.5 IP per 100,000 residents) in 2016. Gila (298.1), Navajo (209.4), Apache (166.5), and Coconino
(144.6) had the highest non-fatal TBI related inpatient hospitalization rates per 100,000 residents. Figure 21
shows the age-adjusted non-fatal TBI-related inpatient hospitalizations by county for Arizona in 2016.

Figure 21. Age-Adjusted TBI-Related Non-Fatal Inpatient
Hospitalization Rates, by County, Arizona 2016*

Rate per 100,000 Residents

350.0
300.0
250.0
200.0
150.0
100.0
50.0
0.0

*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=4 days), and hospital
stays due to TBI ranged from less than one full day to 175 days. In total, Arizonans spent 56,294 days
hospitalized for TBI in 2016.TBI inpatient hospitalization charges in 2016 totaled more than $911.1 million,
with 71% paid by the Arizona Health Care Cost Containment System (AHCCCS)/Medicaid and Medicare
(n=6,427 cases, over $624.1 million). This total does not include costs related to physician care,
rehabilitation, lost wages, or long-term costs of disability.

Unintentional injuries accounted for 88% of TBI hospitalizations (n=7,952). There were 97 hospitalizations
due to self-harm TBI (less than one percent) and 869 due to assaults (ten percent). Figure 22 shows the TBI
inpatient hospitalizations by manner of injury for Arizona in 2016.

Figure 22. TBI-related Non-Fatal Inpatient Hospitalizations
by Manner, Arizona 2016
1%
1%
10%
Unintentional
Assault
Self-Harm
88%

Other/Unknown

Fall-related injuries were the most common cause of TBI hospitalizations (47%, n=4,236), followed by motor
vehicle traffic injuries (28%, n=2,554). Table 2 shows causes of TBI inpatient hospitalizations in Arizona
during 2016.

Table 2. Number and Percentage of TBI Inpatient Hospitalizations by Cause, Arizona 2016
Cause
Fall
Motor vehicle traffic
Struck by/against
Other/unspecified
Transport
Other pedestrian/pedal cycle
Cut/pierce
Firearm
Total

Percentage

4,236
2,554
748
606
447
199
115
99
9,004

47%
28%
8%
7%
5%
2%
<1%
<1%
100

19

Source: Arizona Hospital Discharge Database

Number

Non-Fatal Fall-Related TBI Inpatient Hospitalizations (IP)
There were 4,236 inpatient hospitalizations due to fall-related TBI (53.8 IP per 100,000 residents). Fifty-two
percent were among males (n=2,172) and forty-eight percent were among females (n=2,064). Falls were
unintentional more than 99% of the time (n=4,222), with only 15 cases in which another manner was
identified.
American Indians or Alaska Natives had the highest age-adjusted rate of fall-related TBI hospitalizations
with 79.1 IP per 100,000 residents (n=192). The second highest rate was among White Non-Hispanic or
Pacific (55.8 IP per 100,000 residents; n=3,262). The age-adjusted rate for non-fatal fall-related inpatient
hospitalizations among all Arizonans was 53.8 IP per 100,000 residents.

Figure 23. Fall-Related Non-Fatal TBI Inpatient Hospitalization Rates
By Race/Ethnicity, Arizona 2016*

Rate per 100,000 Residents

90.0
80.0
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
American
Indian or Alaska
Native

White NonHispanic

Hispanic or
Latino

African
American or
Black

Asian or Pacific
Islander

Total

*Does not include 78 cases in which race/ethnicity information is unknown.

Non-Fatal Motor Vehicle Traffic Crash-Related TBI Inpatient Hospitalizations (IP)
Of the 2,554 TBI hospitalizations due to motor vehicle traffic crashes (36.9 IP per 100,000 residents), 67%
were among males (n=1,701) and 33% were among females (n=851). Over 99% of the motor vehicle traffic
crashes resulting in a hospitalization were unintentional. The highest hospitalization rates for motor vehiclerelated TBI were among teens and young adults 15 through 24 years of age (59.1 IP per 100,000 residents),
for both males (78.4 IP per 100,000 residents) and females (38.5 IP per 100,000 residents).

American Indians or Alaska Natives had the highest rate of TBI hospitalizations for motor vehicle traffic
crashes with 61.0 IP per 100,000 residents (n=179), representing a 3% decrease from 2015 (63.0 IP per
100,000 residents). White non-Hispanic residents had the second highest rate at 36.8 IP per 100,000
residents (n=1,457). The age-adjusted rate for non-fatal motor vehicle traffic-related inpatient
hospitalizations among all Arizonans was 36.9 IP per 100,000 residents.

20

The majority of TBI inpatient hospitalizations due to motor vehicle traffic crashes were among occupants of
motor vehicles (55%, n=1,396), followed by motorcyclists (19%, n=505), pedestrians (13%, n=270), and
pedal cyclists ( 5%, n=142). 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 2016

3%
Occupant

13%
55%

5%

Motorcyclist
Pedal cyclist
Pedestrian

19%

Other/Unspecified

21

Non-Fatal Emergency Department Visits
(EDV) among Arizona Residents During 2016
In 2016, there were 97,982 TBI Emergency Department Visits (EDV) among Arizona residents. Males
accounted for over half of TBI EDV (54%, n=53,239), while females accounted for 46% of visits (n=44,743).
TBI EDV rates were highest among adults 85 years and older followed by children 1-4 years of age. There
were 3,744 EDV among females 85 years and older (of 4,719.8 EDV per 100,000 residents), and 1,988 EDV
among males 85 and older (3,851.1 EDV per 100,000 residents). For children 1-4 years, 66% of TBI EDV
were due to unintentional falls (n=9,503). Figure 25 shows the 2016 TBI emergency department visit rates
for Arizona residents.

Figure 25. Age-Specific TBI Emergency Department Visit Rates by
Sex, Arizona 2016

Rate per 100,000 Residents

6,000.0
5,000.0
4,000.0
3,000.0
2,000.0
1,000.0
0.0
<1
yrs

1-4
yrs

5-14
yrs

15-24
yrs

Males (n=53,239)

25-34
yrs

35-44
yrs

Females (n=44,743)

45-54
yrs

55-64
yrs

65-74
yrs

75-84
yrs

85+
yrs

Total (n=97,982)

Age-adjusted TBI emergency department visits were highest among Black or African American residents
(1,666.3 EDV per 100,000 residents). White non-Hispanics residents had the second highest emergency
department visit rate with 1,585.6 EDV per 100,000 residents, followed by American Indian or Alaska Native
residents (1,554.3 EDV per 100,000 residents). The age-adjusted rate for non-fatal TBI-related emergency
department visits among all Arizonans in 2016 was 1,439.9 EDV per 100,000 residents. 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 2016*
Rate per 100,000 Residents

1,800.0
1,600.0
1,400.0
1,200.0
1,000.0
800.0
600.0
400.0
200.0
0.0
American Indian
or Alaska
Native

White NonHispanic

Hispanic or
Latino

African
American or
Black

Asian or Pacific
Islander

Total

*Does not include 1,352 cases in which race/ethnicity information is unknown.

There were five counties that had higher non-fatal TBI-related emergency department visits than the state
rate in 2016 (1,439.9 EDV per 100,000 residents). Gila (2,105.4), Yavapai (1,627.2), Coconino (1,555.6),
Mohave (1,533.1), Pima (1492.0), Navajo (1480.8) and Maricopa (1,465.2) counties had the highest nonfatal TBI-related EDV per 100,000 residents. Figure 27 shows the age-adjusted TBI-related non-fatal
emergency department visits by county.

Figure 27. Age-Adjusted TBI-Related Non-Fatal Emergency
Department Rates by County, Arizona 2016

Rate per 100,000 Residents

2,500.0

2,000.0

1,500.0

1,000.0

500.0

0.0

23

TBI emergency department charges in 2016 totaled more than $655 million, with 59% paid by the Arizona
Health Care Cost Containment System (AHCCCS)/Medicaid and Medicare (n=57,651, over $399.5 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%, n=89,097),
followed by assaults (8%, n=7,946). Figure 28 shows TBI emergency department visits by intent during 2016
in Arizona.

Figure 28. Percentage of TBI Emergency Department Visits by
Manner of Injury, Arizona 2016

8%

Unintentional
Self-Harm
Assault
Undetermined/Other

91%

The leading causes of TBI emergency department visits were falls (50%, n=48,631), struck by/against
injuries (26%, n=24,871), and motor vehicle traffic crashes (11%, n=11,357). Table 3 shows TBI emergency
department visits by cause for Arizona in 2016. Descriptions of all causes are given in Appendix A.

Table 3. Number and Percentage of TBI Emergency Department Visits by Cause, Arizona 2016
Cause
Fall
Struck by/against
Motor vehicle traffic
Other/unspecified
Other Transport
Natural/Environment
Pedestrian/pedal cycle
Cut/Pierce
Total

Number

Percentage

48,631
24,871
11,357
5,319
2,297
2,227
1,752
1,528
91,267

50%
25%
12%
5%
2%
2%
2%
2%
100%

Source: Arizona Hospital Discharge Database

24

Non-Fatal Fall-Related Emergency Department Visits (EDV)
There were 48,631 emergency department visits due to fall-related TBI (690.2 EDV per 100,000 residents)
Majority of fall-related TBI were among females (51%, n=24,896) and males were not far behind (49%, n=
23,733). Over 99% of these falls were unintentional (n=48,610). The oldest and youngest members of the
population are the most at risk for fall-related TBI resulting in emergency department visit. Among children
1-4 years of age, the rate of fall-related TBI was 2,768.4 EDV per 100,000 residents; and among adults 85
and older, the rate was 3,962.7 EDV per 100,000 residents.

Non-Fatal Struck By/Against-Related TBI Emergency Department Visits (EDV)
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
24,871 TBI emergency department visits (380.6 EDV per 100,000 residents) due to struck by/against
injuries, 63% were among males (n=15,596) and 37% were among females (n=9,274). Seventy-four percent
of these injuries were unintentional (n=18,436), and twenty-five percent were assaults (n=6,265). Fifty-six
percent of TBI emergency department visits from struck by/against injuries were among individuals 1 and 24
years of age (n=13,990).
The emergency department discharge database did not include specific information regarding contributing
event for 29% of the struck by/against injuries. The most frequently specified contributing events were
assault by blunt objects (25%, n=6,265), falling from/falling object (10%, n=2,429), stationary objects
(15%, n=3,847), and objects in sports (7%, n=1,732). 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 2016

1%
10%

15%

29%

7%

25%

Struck by Other Object

Assualt by Blunt Object

Legal Intervention

Objects in Sports

Stationary Object

Other

Falling from/Falling Object

25