Summary: People who suffered head injuries had twice the death rate of those who did not suffer head injuries. For those with moderate to severe head trauma, the death rate was three times higher.
Source: University of Pennsylvania
Adults who suffered head trauma over a 30-year study period had twice the death rate of those who did not have head trauma, and death rates among those who had suffered moderate or severe head trauma were nearly three times higher, according to new research from the Perelman School of Medicine at the University of Pennsylvania, published today in JAMA Neurology.
In the United States, more than 23 million adults age 40 or older report a history of head trauma with loss of consciousness. Head injuries can be attributed to a number of causes, such as motor vehicle accidents, accidental falls, or sports injuries. Additionally, head injuries have been linked to a number of long-term health problems, including disability, late-onset epilepsy, dementia, and stroke.
Studies have already shown an increase in short-term mortality associated with head trauma, mainly in hospitalized patients. This longitudinal study assessed 30 years of data from more than 13,000 community-dwelling participants (those who are not hospitalized or live in nursing homes) to determine whether head injuries impact rates of long-term adult mortality.
Investigators found that 18.4% of participants reported one or more head injuries during the study period, and of those who suffered a head injury, 12.4% were recorded as moderate. or serious. The median time between head injury and death was 4.7 years.
All-cause deaths were recorded in 64.6% of those with a head injury and 54.6% of those without a head injury. Taking participants’ characteristics into account, the investigators found that the all-cause mortality rate among participants with traumatic brain injury was 2.21 times the death rate among those without traumatic brain injury.
Additionally, the death rate in people with more severe head injuries was 2.87 times the death rate in people without head injuries.
“Our data reveals that head injuries are associated with increased mortality rates, even in the long term. This is especially the case for people with multiple or severe head injuries,” explained the study’s lead author, Holly Elser, MD, Ph.D., MPH, neurology resident at Penn. “This underscores the importance of safety measures, such as wearing a helmet and seat belt, to prevent head injuries.”
Investigators also assessed data for specific causes of death among all participants. Overall, the most common causes of death were cancers, cardiovascular disease and neurological disorders (which include dementia, epilepsy and stroke). Among people with head trauma, deaths from neurological disorders and unintentional injuries or trauma (such as falls) occurred more frequently.
When investigators assessed the specific neurological causes of death among participants with traumatic brain injury, they found that nearly two-thirds of neurological causes of death were attributed to neurodegenerative diseases, such as Alzheimer’s disease and Parkinsons. These diseases accounted for a greater proportion of overall deaths among those with a head injury (14.2%) compared to those without (6.6%).
“The study data does not explain why the cause of death in people with head injuries is more likely to be due to neurodegenerative diseases, underscoring the need for further research into the relationship between these disorders. , head trauma and death,” said Andrea LC. Schneider, MD, Ph.D., assistant professor of neurology at Penn.
Study data came from the Atherosclerosis Risk in Communities (ARIC) study, an ongoing community-based study of 15,792 participants ages 45 to 65, recruited from suburban Minneapolis, Minnesota, Washington County, Maryland , Forsyth County, North Carolina, and Jackson, Mississippi in 1987–89.
About This TBI Research News
Author: Press office
Source: University of Pennsylvania
Contact: Press Office – University of Pennsylvania
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“Head injury and long-term mortality risk in community-dwelling adults” by Holly Elser et al. JAMA Neurology
Risk of head injury and long-term mortality in community-dwelling adults
Head injuries are associated with significant short-term morbidity and mortality. Research regarding the implications of head trauma for long-term survival in community-dwelling adults remains limited.
To assess the association of head injury with the risk of long-term all-cause mortality in community-dwelling adults, taking into account the frequency and severity of head injury.
Design, framework and participants
This cohort study included participants with and without head trauma in the Atherosclerosis Risk in Communities (ARIC) study, an ongoing prospective cohort study with follow-up from 1987 to 2019 in 4 U.S. communities in Minnesota, Maryland, North Carolina and Mississippi. Of the 15,792 ARIC participants initially enrolled, 1,957 were ineligible due to self-reported head injury at baseline; 103 non-black or white participants and black participants from field centers in Minnesota and Maryland were excluded due to race site aliasing; and 695 additional participants with missing head injury date or covariate data were excluded, resulting in 13,037 eligible participants.
Frequency and severity of head injuries, as defined by self-report in response to interview questions and by hospital International Classification of Diseases diagnosis codes (head injury severity being defined in the subset of head injury cases identified using these codes). Head trauma was analyzed as a time-varying exposure.
Main results and measures
All-cause mortality was established through a link to the national death index. Data was analyzed between August 5, 2021 and October 23, 2022.
More than half of participants were female (57.7%; 42.3% male), 27.9% were black (72.1% white), and the median age at baseline was 54 ( IQR, 49-59 years). The median duration of follow-up was 27.0 years (IQR, 17.6-30.5 years). Head injuries occurred in 2402 participants (18.4%), most of which were classified as mild. The hazard ratio (HR) for all-cause mortality in people with head injury was 1.99 (95% CI, 1.88-2.11) compared with those without head injury, with evidence of a dose-dependent association with the frequency of head trauma (1 head injury: FC, 1.66 [95% CI, 1.56-1.77]; 2 or more head injuries: FC, 2.11 [95% CI, 1.89-2.37]) and severity (light: HR, 2.16 [95% CI, 2.01-2.31]; moderate, severe or penetrating: HR, 2.87 [95% CI, 2.55-3.22]). Estimates were similar by gender and race, with attenuated associations among those aged 54 or older at baseline.
Conclusions and relevance
In this community-based cohort with more than 3 decades of longitudinal follow-up, head trauma was associated with decreased long-term survival time in a dose-dependent manner, underscoring the importance of measures aimed at prevention and clinical interventions to reduce risk. morbidity and mortality from head trauma.