Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.
Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States.
J Safety Res. 2020 Feb;72:93-100. doi: 10.1016/j.jsr.2019.12.013. Epub 2019 Dec 31.
To examine recent traumatic brain injury (TBI) mortality changes among Americans aged 0-19 years by sex, age, urbanicity, state, and intent/causes of injury.
TBI mortality per 100,000 population and average annual percent changes (AAPCs), plus 95% confidence intervals (CIs) based on Joinpoint regression models.
Age-adjusted TBI mortality among Americans aged 0-19 years declined consistently, though at varying rates between 1999 and 2013 (AAPC = -4.8%, 95%CI: -6.3%, -3.2%), and then significantly increased from 4.42 per 100,000 population in 2013 to 5.17 per 100,000 population in 2017 (AAPC = 3.4%, 95% CI: 1.7%, 5.1%). During the study time period, boys, rural children, and youth aged 15-19 years had higher TBI mortality rates than girls, urban children, and younger children, respectively. TBI mortality from unintentional transport crashes decreased substantially in all age groups between 1999 and 2017, and especially from 1999 to 2010. TBI mortality from suicide increased significantly from 2008 to 2017 in the 10-14-year age group (AAPC = 14.6%, 95% CI: 12.6%, 16.6%) and from 2007 to 2017 in the 15-19-year age group (AAPC = 6.3%, 95% CI: 3.8%, 8.7%). Unintentional transport crashes were the leading cause of TBI-related mortality in 46 states in 1999, but by 2017, suicide became the first leading cause in 14 states.
Pediatric TBI mortality declined consistently between 1999 and 2013 and increased significantly from 2013 to 2017, driven primarily by the mortality decrease from unintentional transport crashes and increase in suicide mortality. The spectrum of leading causes of pediatric TBI mortality changed across age groups and over time from 1999 to 2017. Practical Applications: TBI mortality increases in the United States since 2013 are driven primarily by increasing suicide rates, a trend that merits the attention of policy-makers and injury researchers. Action should be taken to curb growing TBI mortality rates among adolescents aged 10-19 years.
本研究旨在通过性别、年龄、城乡、州和受伤原因/意图，探讨美国 0-19 岁人群中创伤性脑损伤（TBI）死亡率的最新变化。
使用 Joinpoint 回归模型计算每 10 万人中 TBI 死亡率和平均年百分比变化（AAPC），以及 95%置信区间（CI）。
1999 年至 2013 年期间，美国 0-19 岁人群中年龄调整后的 TBI 死亡率持续下降，尽管下降速度不同（AAPC=-4.8%，95%CI：-6.3%，-3.2%），但自 2013 年的 4.42/10 万增加至 2017 年的 5.17/10 万（AAPC=3.4%，95%CI：1.7%，5.1%）。在研究期间，男孩、农村儿童和 15-19 岁青少年的 TBI 死亡率均高于女孩、城市儿童和年龄较小的儿童。1999 年至 2017 年期间，所有年龄段的非故意交通碰撞导致的 TBI 死亡率均大幅下降，尤其是 1999 年至 2010 年期间。2008 年至 2017 年期间，10-14 岁年龄组的自杀导致的 TBI 死亡率显著上升（AAPC=14.6%，95%CI：12.6%，16.6%），2007 年至 2017 年期间，15-19 岁年龄组的自杀导致的 TBI 死亡率上升（AAPC=6.3%，95%CI：3.8%，8.7%）。1999 年，46 个州的非故意交通碰撞是 TBI 相关死亡率的主要原因，但到 2017 年，自杀已成为 14 个州的首要原因。
1999 年至 2013 年期间，美国儿科 TBI 死亡率持续下降，2013 年至 2017 年期间显著上升，主要原因是交通意外死亡率下降和自杀死亡率上升。1999 年至 2017 年期间，不同年龄组和不同时间段的儿科 TBI 死亡率的主要原因有所不同。
自 2013 年以来，美国 TBI 死亡率的上升主要归因于自杀率的上升，这一趋势值得决策者和伤害研究人员关注。应采取行动遏制 10-19 岁青少年 TBI 死亡率的上升。
