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Accelerated Death Rate in Population-Based Cohort of Persons With Traumatic Brain Injury

Selassie, Anbesaw W. DrPH, MPH; Cao, Yue PhD; Church, Elizabeth C. BSc; Saunders, Lee L. PhD; Krause, James PhD

Journal of Head Trauma Rehabilitation: May/June 2014 - Volume 29 - Issue 3 - p E8–E19
doi: 10.1097/HTR.0b013e3182976ad3
Original Articles

Objectives: To determine the influence of preexisting heart, liver, kidney, cancer, stroke, and mental health problems and examine the influence of low socioeconomic status on mortality after discharge from acute care facilities for individuals with traumatic brain injury.

Participants: Population-based retrospective cohort study of 33695 persons discharged from acute care hospital with traumatic brain injury in South Carolina, 1999-2010.

Main Measures: Days elapsing from the dates of injury to death established the survival time (T). Data were censored at the 145th month. Multivariable Cox regression was used to examine the independent effect of the variables on death. Age-adjusted cumulative probability of death for each chronic disease of interest was plotted.

Results: By the 70th month of follow-up, rate of death was accelerated from 10-fold for heart diseases to 2.5-fold for mental health problems. Adjusted hazard ratios for diseases of the heart (2.13), liver-renal (3.25), cancer (2.64), neurological diseases and stroke (2.07), diabetes (1.89), hypertension (1.43), and mental health problems (1.59) were highly significant (each with P < .001). Compared with persons with private insurance, the hazard ratio was significantly elevated with Medicaid (1.67), Medicare (1.54), and uninsured (1.27) (each with P < .001).

Conclusion: Specific chronic diseases strongly influenced postdischarge mortality after traumatic brain injury. Low socioeconomic status as measured by the type of insurance elevated the risk of death.

Division of Epidemiology and Biostatistics, Department of Public Health Sciences (Dr Selassie), Department of Health Science and Research, College of Health Professions (Drs Cao, Saunders, and Krause), and College of Medicine (Ms Church), Medical University of South Carolina, Charleston.

Corresponding Author: Anbesaw W. Selassie, DrPH, MPH, Division of Epidemiology and Biostatistics, Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon St, Ste 303, MSC 835, Charleston, SC 29466 (

This study is supported by a grant from the Department of Education, NIDRR grant number H133B090005 (PI: James Krause, PhD). The contents do not necessarily represent the policy of the Department of Education and should not be assumed as endorsement by the federal government. The authors recognize Mss Georgette Demian and Nicole Spivey from the South Carolina Department of Health and Environmental Control for their coordination of the abstraction process and for validating the accuracy of the medical record review report. Dr Linda Veldheer, Director of the Head and Spinal Cord Injury, Division of the South Carolina Department of Disabilities and Special Needs, assisted with data oversight for the project.

All authors have participated in (a) conception and design, or analysis and interpretation of the data; (b) drafting the article or revising it critically for important intellectual content; and (c) approval of the final version.

The authors declare no conflicts of interest.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins