Abstract
Objective: To develop state-level estimates of the annual number of nonfatal cases of traumatic brain injury (TBI) resulting in hospitalization.
Methods: The estimation process incorporates annual nonfatal TBI hospitalization case counts from 15 states funded by the Centers for Disease Control and Prevention to conduct TBI surveillance; annual fatal TBI case counts based on National Center for Health Statistics data for all 50 states; and an index reflecting the urban/rural character of each state. These data are used to develop a negative binomial regression model that yields estimates of the annual number of nonfatal TBI hospitalization cases for each state not funded to conduct TBI surveillance.
Results: Sensitivity analysis suggests that on average the estimates fall within +/-15% of the case counts that would be obtained directly from surveillance.
Conclusion: In combination, the TBI case count data and the urban/rural index support effective modeling and estimation of annual nonfatal TBI hospitalization case counts at the state level.
TRAUMATIC BRAIN INJURY (TBI) represents a significant public health problem in the United States. An estimated 1.5 million TBI-related cases occur annually nationwide. 1 Approximately 50,000 of these cases result in death each year. 2 Applying recently published rates 3,4 to the current US population 5 suggests that each year approximately 200,000 to 270,000 cases result in nonfatal hospitalization (cases hospitalized and discharged alive).
State-level statistics characterizing the magnitude of TBI can be used by state health departments and other agencies to support a variety of initiatives. Such statistics can play a role in the development and evaluation of prevention and intervention programs, legislation and policy initiatives, improvement of service delivery, education of individuals with TBI and their health care providers, and justification for funding and grant support. TBI mortality estimates based on National Center for Health Statistics (NCHS) data are available for all states, but figures related to nonfatal TBI incidence are generally available only for states with access to hospital and emergency department discharge data. To support states without access to such data, the National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention (CDC) previously released state-level estimates of the annual number of nonfatal TBI hospitalization cases based on counts of fatal TBI cases. 6 In this article, we propose an improved model-based approach for estimating annual nonfatal TBI hospitalization case counts for these states. The key improvement involves the use of an index reflecting the urban/rural character of each state.