Jean A. Langlois

The epidemiology and impact of traumatic brain injury: a brief overview

Traumatic brain injury (TBI) is an important public health problem in the United States and worldwide. The estimated 5.3 million Americans living with TBI-related disability face numerous challenges in their efforts to return to a full and productive life. This article presents an overview of the epidemiology and impact of TBI.

Incidence of traumatic brain injury in the United States, 2003

Traumatic brain injury (TBI) is an important public health problem in the United States. In 2003, there were an estimated 1,565,000 TBIs in the United States: 1,224,000 emergency department visits, 290,000 hospitalizations, and 51,000 deaths. Findings were similar to those from previous years in which rates of TBI were highest for young children (aged 0–4) and men, and the leading causes of TBI were falls and motor vehicle traffic.

Prevalence of long-term disability from traumatic brain injury in the civilian population of the United States, 2005.

ObjectiveTo estimate the prevalence of long-term disability associated with traumatic brain injury (TBI) in the civilian population of the United States. MethodsWe first estimated how many people experienced long-term disability from TBI each year in the past 70 years. Then, accounting for the increased mortality among TBI survivors, we estimated their life expectancy and calculated how many were expected to be alive in 2005. ResultsAn estimated 1.1% of the US civilian population or 3.17 million people (95% CI: 3.02–3.32 million) were living with a long-term disability from TBI at the beginning of 2005. Under less conservative assumptions about TBIs impact on lifespan, this estimate is 3.32 million (95% CI: 3.16–3.48 million). ConclusionSubstantial long-term disability occurs among the US civilians hospitalized with a TBI.

Incidence of Long-term Disability Following Traumatic Brain Injury Hospitalization, United States, 2003

ObjectiveDevelop and validate a predictive model of the incidence of long-term disability following traumatic brain injury (TBI) and obtain national estimates for the United States in 2003. Data/methodsA logistic regression model was built, using a population-based sample of persons with TBI from the South Carolina Traumatic Brain Injury Follow-up Registry. The regression coefficients were applied to the 2003 Healthcare Cost and Utilization Project–Nationwide Inpatient Sample data to estimate the incidence of long-term disability following traumatic brain injury hospitalization. ResultsAmong 288,009 (95% CI, 287,974–288,043) hospitalized TBI survivors in the United States in 2003, an estimated 124,626 (95% CI, 123,706–125,546) had developed long-term disability. ConclusionTBI-related disability is a significant public health problem in the United States. The substantial incidence suggests the need for comprehensive rehabilitative care and services to maximize the potential of persons with TBI.

The incidence of traumatic brain injury among children in the United States: differences by race

ObjectiveThis report summarizes the epidemiology of traumatic brain injury (TBI) deaths, hospitalizations, and emergency department (ED) visits by race among children aged 0–14 years in the United States. Few other studies have reported the incidence of TBI in this population by race. MethodsData from 3 nationally representative sources maintained by the National Center for Health Statistics were used to report the annual numbers and rates of TBI-related deaths, hospitalizations, and ED visits during 1995–2001 by race, age, and external cause of injury. ResultsAn estimated 475,000 TBIs occurred among children aged 0–14 each year. Rates were highest among children aged 0–4. For children aged 0–9 years, both death and hospitalization rates were significantly higher for blacks than whites for motor vehicle-traffic-related TBIs. ConclusionWith nearly half a million children affected each year, TBI is a serious public health problem. Variation in rates by race suggest the need to more closely examine the factors that contribute to these differences, such as the external causes of the injury and associated modifiable factors (e.g., the use of seatbelts and child safety seats).

CHARACTERISTICS OF OLDER PEDESTRIANS WHO HAVE DIFFICULTY CROSSING THE STREET

OBJECTIVES This study examined the sociodemographic and health characteristics and problems of older pedestrians. METHODS Interviews and assessments were conducted with 1249 enrollees aged 72 or older from the New Haven, Conn, community of the Established Populations for Epidemiologic Studies of the Elderly who agreed to participate in a seventh follow-up. RESULTS Approximately 11% of the New Haven residents reported difficulty crossing the street. Older pedestrians needing help in one or more activities of daily living were more than 10 times as likely as others, and those with the slowest walking speeds were nearly 3 times as likely as others, to report difficulty crossing the street. Fewer than 1% of these pedestrians aged 72 or older had a normal walking speed sufficient to cross the street in the time typically allotted at signalized intersections (1.22 m/sec). CONCLUSIONS Crossing times at signalized intersectíons in areas with large populations of elders should be extended, and the recommended walking speed for timing signalized crossings should be modified to reflect the range of abilities among older pedestrians.

Sleep complaints in community-dwelling older persons : Prevalence, associated factors, and reported causes

OBJECTIVES: To determine the prevalence rates of self‐reported sleep complaints and their association with health‐related factors.

Risk Factors for Hip Fracture in White Men: The NHANES I Epidemiologic Follow‐up Study

This prospective population‐based study assessed predictors of hip fracture risk in white men. Participants were members of the Epidemiologic Follow‐up Study cohort of the First National Health and Nutrition Examination Survey, a nationally representative sample of noninstitutionalized civilians who were followed for a maximum of 22 years. A cohort of 2879 white men (2249 in the nutrition and weight‐loss subsample, 1437 in the bone density subsample) aged 45–74 years at baseline (1971–1975) were observed through 1992. Ninety‐four percent of the original cohort were successfully traced. Hospital records and death certificates were used to identify a total of 71 hip fracture cases (61 in the nutrition and weight‐loss subsample, 26 in the bone‐density subsample). Among the factors evaluated were age at baseline, previous fractures other than hip, body mass index, smoking status, alcohol consumption, nonrecreational physical activity, weight loss from maximum, calcium intake, number of calories, protein consumption, chronic disease prevalence, and phalangeal bone density. The risk adjusted relative risk (RR) of hip fracture was significantly associated with presence of one or more chronic conditions (RR = 1.91, 95% confidence interval [CI] = 1.19–3.06), weight loss from maximum ≥ 10% (RR = 2.27, 95% CI 1.13–4.59), and 1 SD change in phalangeal bone density (RR = 1.73, 95% CI 1.11–2.68). No other variables were significantly related to hip fracture risk. Although based on a small number of cases, this is one of the first prospective studies to relate weight loss and bone density to hip fracture risk in men.

Weight loss from maximum body weight among middle-aged and older white women and the risk of hip fracture: the NHANES I epidemiologic follow-up study.

Although weight loss increases bone loss and hip fracture risk in older women, little is known about the relation between weight loss in middle-aged women and subsequent hip fracture risk. The objective of this study was to determine the association between weight loss from reported maximum body weight in middle-aged and older women and the risk of hip fracture. Data were from a nationally representative sample of 2180 community-dwelling white women aged 50–74 years from the Epidemiologic Follow-up Study of the first National Health and Nutrition Examination Survey (NHEFS). In this prospective cohort study, incident hip fracture was ascertained during 22 years of follow-up. The adjusted relative risks associated with weight loss of 10% or more from maximum body weight were elevated for both middle-aged (RR 2.54; 95% CI 1.10–5.86) and older women (RR 2.04; 95% CI 1.37–3.04). For both ages combined, women in the lowest tertile of body mass index at maximum who lost 10% or more of weight had the highest risk of hip fracture (RR 2.37; 95% CI 1.32–4.27). Weight loss from maximum reported body weight in women aged 50–64 years and 65–74 years increased their risk of hip fracture, especially among those who were relatively thin. Weight loss of 10% or more from maximum weight among both middle-aged and older women is an important indicator of hip fracture risk.

Are female drivers safer? An application of the decomposition method.

Using the decomposition method and national data for the year 1990, we examined gender and age differences in involvement rates in fatal motor vehicle crashes. The fatal crash involvement rate per driver is expressed as a multiplicative function of the crash fatality rate (defined as the proportion of fatal crashes involved among all crashes involved), crash incidence density (that is, number of crashes per million person-miles), and exposure prevalence (that is, annual average miles driven per driver). The fatal crash involvement rate per 10,000 drivers for men was three times that for women (5.3 vs 1.7) and was highest among teenagers. Of the male-female discrepancy in the fatal crash involvement rates, 51% was attributable to the difference between sexes in crash fatality rates, 41% to the difference in exposure prevalence, and 8% to the difference in crash incidence density. Age-related variations in the fatal crash involvement rates resulted primarily from the differences in crash incidence density. The results indicate that, despite-having lower fatal crash involvement rates, female drivers – do not seem to be safer than their male counterparts when exposure is considered. The decomposition method is valuable as both a conceptual framework and an exploratory tool for understanding the contributing factors related to cause-specific injury mortality and the differences in death rates among populations. (Epidemiology 1998;9:379–384)