Summary: The death rate is twice as high in people who have suffered a head injury than those who have not suffered a TBI. For those with moderate to severe head injuries, the death rate was three times higher.

Source: University of Pennsylvania

Over a 30-year study period, adults with no head injuries died twice as often as those without, and the death rate among those with moderate and severe head injuries was nearly three times higher, new data show. A study by the Perelman School of Medicine at the University of Pennsylvania was published today JEMA Neurology.

In the United States, more than 23 million adults age 40 or older report a history of head injury with loss of consciousness. Head injuries can result from a variety of causes, including motor vehicle collisions, accidental falls, or sports injuries. Moreover, head trauma has been linked to several long-term health conditions, including disability, late-onset epilepsy, dementia, and stroke.

Studies have previously shown an increase in short-term mortality associated with head injuries in hospitalized patients. This longitudinal study reviewed 30 years of data on more than 13,000 community residents (neither hospitalized nor living in nursing facilities).

Investigators found that 18.4 percent of participants sustained one or more head injuries during the study, and 12.4 percent of those who sustained head injuries were classified as moderate or severe. The median time between head injury and death was 4.7 years.

All-cause mortality was recorded in 64.6 percent of those with head injury and 54.6 percent of those without head injury. Regarding participant characteristics, investigators found that the death rate among participants with head injuries was 2.21 times that of those without head injuries.

Additionally, the death rate among people with head injuries was 2.87 times the death rate among people with no head injuries.

“Our data show that head injury is associated with increased mortality, even in the long term. This is especially true for individuals with multiple or severe head injuries,” explained study leader Holly Elser, MD, PhD, MPH, resident in neurology at Penn. It emphasizes the importance of safety measures such as wearing helmets and seat belts.”

Investigators reviewed the data for specific causes of death among all participants. Overall, the most common causes of death are cancers, cardiovascular disease, and neurological disorders (including dementia, epilepsy, and stroke). Among people with head injuries, death from neurological disorders and accidental injury or trauma (such as falls) occurred more frequently.

When investigators evaluated the specific neurological causes of death among participants with head injuries, they found that nearly two-thirds of the neurological causes of death were due to neurodegenerative diseases such as Alzheimer’s and Parkinson’s disease. These diseases accounted for a greater proportion of total deaths among those with head injuries (14.2 percent) than those without (6.6 percent).

“Study data do not explain why the death of individuals with head injuries is due to neurodegenerative diseases, which emphasizes the need for more research on the relationship between these diseases, head injuries and death,” said Andrea Elsi. Schneider, MD, PhD, assistant professor of neurology at Penn.

Study data were from the Atherosclerosis Risk in Communities (ARIC) study, a community-based study of 15,792 45-65 year olds recruited from suburbs of Minneapolis, Minnesota, Washington County, Maryland, Forsyth County, North Carolina. , and Jackson, Mississippi in 1987–1989.

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Author: Press office
Source: University of Pennsylvania
Contact: Press Office – University of Pennsylvania
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Preliminary study: Closed access.
“Head injury and long-term risk of death in community-dwelling adults” by Holly Elser et al JEMA Neurology

Draft

Head injury and long-term risk of death in community-dwelling adults

Importance

Head injury is associated with significant short-term morbidity and mortality. Research on the long-term survival implications of head injury in community-dwelling adults is limited.

Purpose

To assess the association of head injury frequency and severity with long-term all-cause mortality among community-dwelling adults.

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Design, composition and participants

This study included participants with and without head injury in the Atherosclerosis Risk in Communities (ARIC) study, with follow-up from 1987 to 2019 in 4 US communities in Minnesota, Maryland, North Carolina, and Mississippi. Of the 15 792 ARIC participants initially enrolled, 1957 were ineligible due to self-reported head injury at baseline. 103 Black or nonwhite participants and black participants at field centers in Minnesota and Maryland were excluded due to race-site segregation. And an additional 695 participants with head injury date or composite data were excluded, resulting in 13 037 eligible participants.

Exposure

Frequency and severity of head injury as determined by responses to interview questions and by hospital-based self-report International Classification of Diseases Diagnosis codes (with head injury severity defined in the subsection of head injury cases identified using these codes). Head injury was analyzed as a time-varying exposure.

Main results and measurements

All-cause mortality was ascertained by correlation with the National Death Index. Data were analyzed between August 5, 2021 and October 23, 2022.

Results

More than half of the participants were female (57.7%, 42.3% male), 27.9% were black (72.1% white), and the median age at baseline was 54 years (IQR, 49–59 years). The median follow-up period was 27.0 years (IQR, 17.6-30.5 years). Head injuries occurred among 2402 participants (18.4%), most of which were classified as minor. The hazard ratio (HR) for all-cause mortality among individuals with head injury was 1.99 (95% CI, 1.88-2.11) compared with those without head injury, indicating a dose-dependent relationship with frequency of head injury (1 head). Damage: HR, 1.66 [95% CI, 1.56-1.77]; 2 or more head injuries: HR, 2.11 [95% CI, 1.89-2.37]) and severity (mild: 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 weaker associations among individuals 54 years or older at baseline.

Conclusions and relevance

Longitudinal follow-up of more than 3 decades in this community-based cohort found that head injury was associated with decreased long-term survival in a dose-dependent manner, highlighting the importance of preventive measures and clinical interventions. Death due to head injury.