Traumatic Brain Injury–Related Deaths by Race/Ethnicity, Sex, Intent, and Mechanism of Injury — United States, 2000–2017

Weekly / November 22, 2019 / 68(46);1050–1056

Print
Related Pages

Jill Daugherty, PhD1; Dana Waltzman, PhD1; Kelly Sarmiento, MPH1; Likang Xu, MD1 (View author affiliations)

View suggested citation

Summary

What is already known about this topic?

Traumatic brain injuries (TBIs) contribute to a substantial number of deaths each year.

What is added by this report?

In 2017, approximately 61,000 TBI-related deaths occurred in the United States. Suicide surpassed motor vehicle crashes as the leading category of TBI-related deaths during 2009–2011 and through 2015–2017. Males and American Indians/Alaska Natives experienced the highest rates of TBI-related death.

What are the implications for public health practice?

Broader implementation of evidence-based prevention strategies for the leading categories of TBI-related death, particularly those aimed at stemming the significant increase in suicide, are warranted. Health care providers can play an important role in assessing patients at increased risk for suicide and providing appropriate interventions.

Article Metrics
Altmetric:
Citations:
Views:

Views equals page views plus PDF downloads

Metric Details
Figure
Tables

Table 1

Table 2

Related Materials

Traumatic brain injury (TBI) affects the lives of millions of Americans each year (1). To describe the trends in TBI-related deaths among different racial/ethnic groups and by sex, CDC analyzed death data from the National Vital Statistics System (NVSS) over an 18-year period (2000–2017). Injuries were also categorized by intent, and unintentional injuries were further categorized by mechanism of injury. In 2017, TBI contributed to 61,131 deaths in the United States, representing 2.2% of approximately 2.8 million deaths that year. From 2015 to 2017, 44% of TBI-related deaths were categorized as intentional injuries (i.e., homicides or suicides). The leading category of TBI-related death varied over time and by race/ethnicity. For example, during the last 10 years of the study period, suicide surpassed unintentional motor vehicle crashes as the leading category of TBI-related death. This shift was in part driven by a 32% increase in TBI-related suicide deaths among non-Hispanic whites. Firearm injury was the underlying mechanism of injury in nearly all (97%) TBI-related suicides among all groups. An analysis of TBI-related death rates by sex and race/ethnicity found that TBI-related deaths were significantly higher among males and persons who were American Indians/Alaska Natives (AI/ANs) than among all other groups across all years. Other leading categories of TBI-related deaths included unintentional motor vehicle crashes, unintentional falls, and homicide. Understanding the leading contributors to TBI-related death and identifying groups at increased risk is important in preventing this injury. Broader implementation of evidence-based TBI prevention efforts for the leading categories of injury, such as those aimed at stemming the significant increase in TBI-related deaths from suicide, are warranted.

Data from CDC’s NVSS multiple-cause-of-death files were analyzed for 2000–2017. NVSS collects data for all deaths among U.S. residents. TBI-related deaths were classified using codes from the International Classification of Diseases, Tenth Revision (ICD-10) using an established surveillance definition (2). Deaths were classified as TBI-related if any multiple codes for causes of deaths listed in the death record indicated a TBI-related diagnosis, and the single underlying cause of death was listed as an injury. This methodology represents a change in the calculation of estimates from previous CDC reports (1,2), which did not require that an injury be listed as an underlying cause of death.† Data on TBI-related deaths were stratified by year, race/ethnicity, sex, and principal mechanism of injury. Racial/ethnic groups included non-Hispanic white (white), non-Hispanic black (black), non-Hispanic American Indian/Alaska Native (AI/AN), non-Hispanic Asian/Pacific Islander (Asian/PI), Hispanic, and other. Injuries were categorized first by intent (intentional, unintentional, and undetermined intent). Intentional injuries were further categorized as suicide or homicide. Unintentional injuries were further categorized by mechanism of injury (motor vehicle crashes, falls, being struck by or against an object, or unspecified). Principal mechanism of injury was categorized based on the CDC-recommended external cause of injury mortality matrix for ICD-10 (3) and are presented as the pooled average of 3-year groupings.

Each rate and its corresponding 95% confidence interval were based on U.S. bridged-race population estimates of the resident population (4). U.S. census population estimates for the year 2000 were used as the standard for age-adjusted rates by direct method (5). T-tests were used to analyze between-group differences for rates of TBI-related deaths. Only selected comparisons were tested for statistical significance. Differences with p-values <0.05 were considered statistically significant. JoinPoint regression software (version 4.7.0.0; National Cancer Institute) was used to calculate the average annual percent changes of TBI-related death rates from 2000 to 2017 for each race and Hispanic origin group to illustrate trends over time. Average annual percent changes were considered significantly different from zero for p-values <0.05. SAS (version 9.4; SAS Institute, Inc.) was used for all statistical analyses.

The overall rate of TBI-related deaths remained constant from 2000 to 2005, followed by a statistically significant decrease in the overall rate from 2005 to 2010 and then a flattening out from 2010 to 2014. From 2014 to 2017, a small but statistically significant increase in the overall rate of TBI-related deaths occurred (Figure). TBI-related death rates were significantly higher among males of all races than among females throughout the study period (p<0.001) (Table 1), and age-adjusted rates were significantly higher among AI/AN persons than among other racial/ethnic groups (p<0.001). From 2001 to 2006, the death rates of whites and blacks were similar (p>0.05), but since 2007, the rate of TBI-related deaths has been significantly higher among whites (p<0.001).

Unintentional TBIs combined across mechanism of injury were responsible for a higher number and rate of deaths than were suicide and homicide across all study years (p<0.001) (Table 2). Unintentional motor vehicle crashes led to the highest number and rate of all TBI-related deaths from 2000–2002 to 2006–2008 (p<0.05). Beginning in 2009–2011 and continuing through 2015–2017, suicide was responsible for the most TBI-related deaths (p<0.001). Across all data years, firearm-related injuries were responsible for approximately 97% of all TBI-related suicides. The leading category of TBI-related injury death varied by race/ethnicity and changed for some groups during the study period. For example, from 2000–2002 to 2003–2005, unintentional motor vehicle crashes accounted for the highest rate of TBI-related deaths for whites (p<0.001). Beginning in 2006–2008 and continuing through 2015–2017, suicide accounted for the highest rate of TBI-related deaths for this group (p<0.002). Among blacks, homicide was responsible for the highest rate of TBI-related deaths from 2000–2002 to 2015–2017 (p<0.001). Across the study period, the highest rate of TBI-related deaths among AI/AN was attributed to unintentional motor vehicle crashes (p<0.05). Among Hispanics, unintentional motor vehicle crashes were the most common cause of TBI-related deaths from 2000–2002 to 2006–2008 (p<0.001). During 2009–2011, the rates of TBI-related death from unintentional motor vehicle crashes and unintentional falls were similar (p = 0.16) in Hispanics; beginning in 2012–2014 and through 2015–2017, unintentional falls were the most common cause of TBI-related deaths among Hispanics (p<0.001).

Top

Discussion

Over the 18-year study period, approximately 960,000 TBI-related deaths occurred in the United States; however, the patterns differed over time and among racial/ethnic groups. Whereas the rates of TBI-related deaths among whites and blacks were similar from 2001 to 2006, the rates among whites subsequently exceeded those among blacks, presumably related to a 32% increase in TBI-related suicide deaths among whites, from 5.9 per 100,000 during 2006–2008 to 7.8 during 2015–2017. Previous data have documented an increasing prevalence of suicide among whites and AI/ANs (6). These findings suggest that tailored prevention efforts might be needed to help reduce the prevalence of TBI among different groups at risk for injury.

This analysis corroborated findings in a 2017 study of TBI-related emergency department visits, hospitalizations, and deaths (1) that identified a shift in the leading category of TBI-related deaths in the United States during the last 10 years from unintentional motor vehicle crashes to suicide. That shift was driven by a significant increase in TBI-related suicide deaths as well as an overall decrease in motor vehicle crash deaths during the last decade (7). CDC supports suicide prevention efforts by encouraging the use of strategies that reflect the best available evidence, including strengthening access and delivery of suicide care, creating protective environments, teaching coping and problem-solving skills, and identifying and supporting persons at risk (8). Firearm injury was the underlying mechanism of injury in nearly all TBI-related suicides among all groups. Reducing access to lethal means among persons at risk for suicide is an important approach to creating protective environments (8).

Also consistent with previous research, AI/ANs consistently had the highest age-adjusted rates of TBI-related deaths across the study period, and unintentional motor vehicle crashes contributed the highest number and accounted for the highest rate of these TBI-related deaths in all years (9). Lower rates of seat belt use and higher rates of alcohol-related motor vehicle crash deaths among AI/ANs compared with other groups might be contributing factors (9). Expansion of evidence-based strategies for reducing the likelihood of injury once a motor vehicle crash has occurred, for example enactment of universal motorcycle helmet laws and enforcement of existing seat belt and child restraint/booster laws, might be beneficial.§

TBI-related homicides disproportionately affected blacks compared with all other groups. CDC’s National Center for Injury Prevention and Control has created technical packages that outline the best available evidence-based strategies for preventing violence; the strategies are intended to work together and to be used in combination in a multilevel, multisector effort to prevent violence. Implementation might help stop violence before it starts and decrease the rates of TBI-related homicides.

Falls are the second-leading cause of TBI-related deaths and have been increasing in number and rate, particularly among older adults (1). Health care providers can play an important role in in the prevention of older adult falls. CDC’s STEADI** (Stopping Elderly Accidents Deaths and Injuries) initiative can help providers address patient fall risk through the identification of modifiable risk factors and implementation of effective interventions (e.g., strength and balance exercises and medication management).

The findings in this report are subject to at least two limitations. First, misclassification of race and Hispanic origin is a common problem on death certificates, especially for AI/AN, Asian/PI, and Hispanic populations (10). Therefore, for these groups, mortality estimates are most likely underestimates. Second, incomplete reporting or misclassification of cause of death on death certificates might bias estimates of TBI-related deaths.

Understanding the leading contributors to TBI-related death and identifying groups at increased risk is important in preventing this injury. Health care providers can play an important role in assessing patients at increased risk, such as those at risk for suicide, unintentional motor vehicle crashes, or unintentional falls, and provide referrals or tailored interventions.

Top

Corresponding author: Jill Daugherty, jdaugherty@cdc.gov, 404-498-1830.

Top

1Division of Injury Prevention, National Center for Injury Prevention and Control, CDC.

Top


All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

* https://www.cdc.gov/nchs/products/databriefs/db328.htm.

† Previous estimates of TBI-related deaths included all cases in which a TBI-related ICD-10 code was listed in the NVSS mortality record, regardless of whether an injury code was listed as the underlying cause of death. The current methodology only includes deaths for which an injury was more directly related to the cause of death.

§ https://www.cdc.gov/motorvehiclesafety/index.html.

https://www.cdc.gov/violenceprevention/pub/technical-packages.html.

** https://www.cdc.gov/steadi/index.html.

Top

References

  1. Taylor CA, Bell JM, Breiding MJ, Xu L. Traumatic brain injury-related emergency department visits, hospitalizations, and deaths—United States, 2007 and 2013. MMWR Surveill Summ 2017;66. CrossRef PubMed
  2. Langlois JA, Rutland-Brown W, Thomas KE. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths. Atlanta, GA: US Department of Health and Human Services, CDC; 2004. https://stacks.cdc.gov/view/cdc/12294
  3. CDC. External cause of injury mortality matrix for ICD-10. Atlanta, GA: US Department of Health and Human Services, CDC; 2010. https://www.cdc.gov/nchs/data/ice/icd10_transcode.pdf
  4. National Center for Health Statistics. U.S. Census populations with bridged race categories. Hyattsville, MD: US Department of Health and Human Services, CDC; 2019. https://www.cdc.gov/nchs/nvss/bridged_race.htm
  5. Faul M, Xu L, Wald MM, Coronado VG. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths, 2002–2006. Atlanta, GA: US Department of Health and Human Services, CDC; 2010. https://www.cdc.gov/traumaticbraininjury/pdf/blue_book.pdf
  6. Ivey-Stephenson AZ, Crosby AE, Jack SPD, Haileyesus T, Kresnow-Sedacca MJ. Suicide trends among and within urbanization levels by sex, race/ethnicity, age group, and mechanism of death—United States, 2001–2015. MMWR Surveill Summ 2017;66(No. SS-18). CrossRef PubMed
  7. Hedegaard H. QuickStats: age-adjusted rate of motor vehicle traffic deaths, by urbanization of county of residence—2005 and 2015. MMWR Morb Mortal Wkly Rep 2017;66:567. CrossRef PubMed
  8. Stone DM, Holland KM, Bartholow BN, Crosby AE, Davis SP, Wilkins N. Preventing suicide: a technical package of policies, programs, and practice. Atlanta, GA: US Department of Health and Human Services, CDC; 2017. https://www.cdc.gov/violenceprevention/pdf/suicideTechnicalPackage.pdf
  9. Rutland-Brown W, Wallace LJ, Faul MD, Langlois JA. Traumatic brain injury hospitalizations among American Indians/Alaska Natives. J Head Trauma Rehabil 2005;20:205–14. CrossRef PubMed
  10. Arias E, Heron M, Hakes J; National Center for Health Statistics; US Census Bureau. The validity of race and Hispanic-origin reporting on death certificates in the United States: an update. Vital Health Stat 2 2016; (172):1–21. PubMed

Top

Return to your place in the textFIGURE. Age-adjusted rates* of traumatic brain injury–related deaths, by year and race/ethnicity† — United States, 2000–2017
he figure is a line graph showing the age-adjusted rates of traumatic brain injury–related deaths, by year and race/ethnicity, in the United States during 2000–2017.

Abbreviations: AI/AN = American Indian/Alaska Native; A/PI = Asian/Pacific Islander.

* Per 100,000 population.

† Whites, Blacks, AI/AN, A/PI were non-Hispanic; Hispanic persons could be of any race.

Top

TABLE 1. Estimated number* and age-adjusted rates† of traumatic brain injury (TBI)–related deaths,§ by year, sex, and race/ethnicity — United States, 2000–2017**Return to your place in the text
Year/Sex Race/Ethnicity Total
White Black American Indian/Alaska Native Asian/Pacific Islander Hispanic Other
No. Rate (95% CI) No. Rate (95% CI) No. Rate (95% CI) No. Rate (95% CI) No. Rate (95% CI) No. No. Rate (95% CI)
2000
Male 26,497 27.6 (27.3–28.0) 4,832 30.5 (29.6–31.4) 412 38.5 (34.3–42.6) 599 13.0 (11.9–14.2) 3,593 22.5 (21.6–23.4) 164 36,097 27.3 (27.0–27.6)
Female 9,982 9.0 (8.8–9.2) 1,436 8.0 (7.5–8.4) 169 14.4 (12.2–16.7) 291 6.0 (5.3–6.7) 912 6.3 (5.8–6.8) 40 12,830 8.5 (8.4–8.7)
Total 36,479 17.7 (17.5–17.9) 6,268 18.3 (17.8–18.8) 581 25.8 (23.6–28.1) 890 9.3 (8.6–9.9) 4,505 14.3 (13.8–14.8) 204 48,927 17.4 (17.2–17.5)
2001
Male 27,747 28.6 (28.3–29.0) 4,915 30.8 (29.9–31.7) 429 39.4 (35.2–43.6) 648 13.8 (12.6–15.0) 3,865 22.7 (21.8–23.6) 166 37,770 28.2 (28.0–28.5)
Female 10,307 9.1 (8.9–9.3) 1,410 7.9 (7.4–8.3) 184 16.0 (13.5–18.4) 306 5.9 (5.2–6.6) 961 6.4 (6.0–6.9) 43 13,211 8.7 (8.5–8.8)
Total 38,054 18.3 (18.1–18.5) 6,325 18.4 (17.9–18.8) 613 27.2 (24.9–29.5) 954 9.5 (8.8–10.1) 4,826 14.5 (14.0–15.0) 209 50,981 17.9 (17.7–18.0)
2002
Male 27,771 28.4 (28.1–28.7) 4,811 30.0 (29.1–30.9) 480 42.2 (38.1–46.4) 652 13.6 (12.4–14.7) 3,908 22.5 (21.6–23.4) 186 37,808 27.9 (27.6–28.2)
Female 10,400 9.1 (9.0–9.3) 1,402 7.6 (7.2–8.0) 171 14.7 (12.4–17.0) 334 6.4 (5.7–7.2) 973 6.1 (5.7–6.5) 31 13,311 8.6 (8.5–8.8)
Total 38,171 18.2 (18.0–18.4) 6,213 17.8 (17.3–18.2) 651 28.0 (25.7–30.3) 986 9.7 (9.1–10.4) 4,881 14.2 (13.7–14.6) 217 51,119 17.7 (17.6–17.9)
2003
Male 27,631 28.0 (27.7–28.4) 4,923 30.0 (29.1–30.9) 491 44.1 (39.8–48.4) 671 13.3 (12.2–14.4) 3,977 22.1 (21.3–23.0) 119 37,812 27.6 (27.3–27.9)
Female 10,439 9.0 (8.8–9.2) 1,472 8.0 (7.6–8.4) 162 14.2 (11.9–16.5) 338 6.1 (5.4–6.8) 1,038 6.4 (6.0–6.9) 40 13,489 8.6 (8.5–8.8)
Total 38,070 18.0 (17.8–18.2) 6,395 18.1 (17.7–18.6) 653 28.6 (26.2–30.9) 1,009 9.4 (8.8–10.0) 5,015 14.2 (13.8–14.7) 159 51,301 17.6 (17.4–17.7)
2004
Male 27,799 27.9 (27.6–28.3) 4,842 29.7 (28.8–30.6) 435 37.9 (34.0–41.8) 604 11.7 (10.7–12.7) 3,938 20.9 (20.1–21.7) 117 37,735 27.2 (26.9–27.5)
Female 10,921 9.4 (9.2–9.6) 1,466 7.9 (7.5–8.3) 163 13.2 (11.1–15.3) 366 6.2 (5.6–6.9) 1,012 6.1 (5.7–6.5) 40 13,968 8.8 (8.7–9.0)
Total 38,720 18.1 (18.0–18.3) 6,308 17.8 (17.4–18.3) 598 25.0 (22.9–27.1) 970 8.7 (8.1–9.3) 4,950 13.5 (13.1–14.0) 157 51,703 17.5 (17.3–17.6)
2005
Male 28,771 28.6 (28.3–29.0) 5,126 30.5 (29.6–31.4) 471 39.0 (35.2–42.7) 741 13.9 (12.9–15.0) 4,261 22.4 (21.5–23.2) 122 39,492 28.0 (27.8–28.3)
Female 10,852 9.2 (9.0–9.4) 1,462 7.9 (7.5–8.3) 157 12.9 (10.8–15.0) 352 5.8 (5.2–6.4) 1,068 6.1 (5.7–6.5) 25 13,916 8.6 (8.5–8.8)
Total 39,623 18.4 (18.2–18.6) 6,588 18.3 (17.9–18.8) 628 25.6 (23.5–27.6) 1,093 9.5 (8.9–10.1) 5,329 14.2 (13.8–14.6) 147 53,408 17.8 (17.7–18.0)
2006
Male 28,336 27.9 (27.5–28.2) 5,205 30.4 (29.5–31.3) 453 37.8 (34.1–41.5) 703 12.6 (11.7–13.6) 4,254 21.3 (20.5–22.1) 105 39,056 27.3 (27.0–27.6)
Female 10,905 9.2 (9.0–9.3) 1,401 7.4 (7.0–7.7) 152 12.1 (10.1–14.0) 355 5.7 (5.1–6.3) 1,025 5.7 (5.3–6.1) 29 13,867 8.5 (8.4–8.6)
Total 39,241 18.0 (17.9–18.2) 6,606 18.0 (17.5–18.4) 605 24.5 (22.4–26.5) 1,058 8.9 (8.3–9.4) 5,279 13.5 (13.1–13.9) 134 52,923 17.4 (17.3–17.6)
2007
Male 28,849 28.1 (27.8–28.4) 4,980 28.2 (27.4–29.0) 422 35.6 (31.9–39.2) 752 12.9 (11.9–13.9) 4,141 20.6 (19.9–21.4) 104 39,248 27.1 (26.8–27.4)
Female 11,003 9.1 (8.9–9.2) 1,395 7.2 (6.8–7.6) 141 11.4 (9.4–13.3) 373 5.8 (5.2–6.4) 1,056 5.7 (5.3–6.1) 29 13,997 8.4 (8.3–8.6)
Total 39,852 18.1 (17.9–18.3) 6,375 17.0 (16.6–17.4) 563 23.1 (21.1–25.1) 1,125 9.1 (8.5–9.6) 5,197 13.1 (12.7–13.5) 133 53,245 17.3 (17.2–17.5)
2008
Male 29,211 28.1 (27.8–28.5) 4,670 26.4 (25.6–27.2) 430 35.2 (31.7–38.8) 703 11.9 (11.0–12.8) 3,810 19.0 (18.3–19.7) 84 38,908 26.5 (26.3–26.8)
Female 10,807 8.7 (8.6–8.9) 1,253 6.4 (6.0–6.7) 139 11.1 (9.2–13.0) 327 4.8 (4.3–5.4) 968 5.2 (4.8–5.6) 32 13,526 8.0 (7.8–8.1)
Total 40,018 18.0 (17.8–18.2) 5,923 15.7 (15.3–16.1) 569 22.7 (20.8–24.7) 1,030 8.1 (7.6–8.6) 4,778 12 (11.6–12.4) 116 52,434 16.8 (16.7–17.0)
2009
Male 28,236 26.9 (26.6–27.2) 4,346 24.5 (23.7–25.3) 411 33.2 (29.8–36.5) 711 11.6 (10.7–12.5) 3,789 18.3 (17.6–18.9) 154 37,647 25.4 (25.1–25.6)
Female 10,610 8.5 (8.3–8.6) 1,298 6.5 (6.1–6.9) 169 13.2 (11.2–15.3) 362 5.2 (4.7–5.7) 1,034 5.4 (5.1–5.8) 43 13,516 7.9 (7.7–8.0)
Total 38,846 17.2 (17.1–17.4) 5,644 14.8 (14.4–15.2) 580 23.0 (21.1–25.0) 1,073 8.1 (7.6–8.6) 4,823 11.8 (11.4–12.2) 197 51,163 16.2 (16.0–16.3)
2010
Male 28,678 27.5 (27.2–27.8) 4,303 24.0 (23.2–24.7) 401 34.4 (30.8–38.1) 749 11.8 (10.9–12.7) 3,381 16.3 (15.6–16.9) 144 37,656 25.3 (25.0–25.5)
Female 10,948 8.7 (8.5–8.8) 1,168 5.8 (5.5–6.2) 150 12.5 (10.4–14.5) 327 4.4 (3.9–4.9) 975 4.9 (4.5–5.2) 40 13,608 7.8 (7.6–7.9)
Total 39,626 17.6 (17.4–17.8) 5,471 14.2 (13.9–14.6) 551 22.9 (20.9–24.9) 1,076 7.7 (7.2–8.2) 4,356 10.4 (10.0–10.7) 184 51,264 16.0 (15.9–16.2)
2011
Male 29,067 27.6 (27.3–27.9) 4,420 24.3 (23.5–25.0) 462 39.3 (35.4–43.1) 798 12.4 (11.4–13.3) 3,581 16.8 (16.1–17.4) 114 38,442 25.4 (25.2–25.7)
Female 11,086 8.8 (8.6–8.9) 1,237 6.0 (5.7–6.4) 166 13.3 (11.2–15.4) 384 5.1 (4.5–5.6) 937 4.6 (4.3–4.9) 36 13,846 7.8 (7.7–7.9)
Total 40,153 17.8 (17.6–17.9) 5,657 14.4 (14.1–14.8) 628 25.7 (23.6–27.9) 1,182 8.3 (7.8–8.8) 4,518 10.5 (10.1–10.8) 150 52,288 16.2 (16.0–16.3)
2012
Male 29,678 27.9 (27.6–28.2) 4,549 24.5 (23.7–25.2) 495 40.3 (36.5–44.0) 797 11.7 (10.8–12.5) 3,700 17.3 (16.6–17.9) 137 39,356 25.7 (25.4–25.9)
Female 11,402 8.9 (8.8–9.1) 1,187 5.7 (5.4–6.0) 144 11.1 (9.2–12.9) 422 5.3 (4.8–5.8) 1,045 5.0 (4.7–5.3) 38 14,238 7.9 (7.8–8.1)
Total 41,080 18.0 (17.8–18.2) 5,736 14.4 (14.0–14.8) 639 25.1 (23.1–27.1) 1,219 8.1 (7.6–8.6) 4,745 10.9 (10.5–11.2) 175 53,594 16.3 (16.2–16.5)
2013
Male 30,118 28.0 (27.7–28.4) 4,525 24.0 (23.3–24.8) 461 38.7 (34.9–42.4) 841 11.5 (10.7–12.3) 3,605 16.4 (15.8–17.0) 120 39,670 25.5 (25.3–25.8)
Female 11,588 9.0 (8.8–9.1) 1,257 5.9 (5.6–6.3) 160 12.7 (10.6–14.7) 424 5.0 (4.5–5.5) 1,044 4.8 (4.5–5.1) 35 14,508 7.9 (7.8–8.1)
Total 41,706 18.1 (17.9–18.3) 5,782 14.4 (14.0–14.7) 621 25.1 (23.1–27.2) 1,265 7.9 (7.5–8.4) 4,649 10.4 (10.0–10.7) 155 54,178 16.3 (16.1–16.4)
2014
Male 30,432 28.0 (27.6–28.3) 4,501 23.6 (22.8–24.3) 486 39.6 (35.9–43.4) 888 11.6 (10.8–12.4) 3,738 16.5 (15.9–17.1) 152 40,197 25.5 (25.2–25.7)
Female 11,714 9.0 (8.8–9.2) 1,242 5.9 (5.6–6.2) 158 12.4 (10.4–14.4) 442 4.9 (4.5–5.4) 1,139 5.1 (4.8–5.4) 49 14,744 8.0 (7.8–8.1)
Total 42,146 18 (17.9–18.2) 5,743 14.1 (13.7–14.5) 644 25.4 (23.4–27.5) 1,330 8.0 (7.5–8.4) 4,877 10.6 (10.3–10.9) 201 54,941 16.3 (16.1–16.4)
2015
Male 31,353 28.8 (28.5–29.1) 5,007 25.8 (25.1–26.6) 490 39.2 (35.5–42.8) 902 11.2 (10.4–11.9) 3,970 16.8 (16.2–17.4) 166 41,888 26.3 (26.0–26.5)
Female 12,070 9.2 (9.1–9.4) 1,359 6.3 (6.0–6.6) 195 14.8 (12.7–16.9) 478 5.0 (4.6–5.5) 1,203 5.2 (4.9–5.5) 53 15,358 8.2 (8.1–8.3)
Total 43,423 18.6 (18.4–18.8) 6,366 15.4 (15.0–15.8) 685 26.5 (24.5–28.5) 1,380 7.8 (7.4–8.2) 5,173 10.8 (10.5–11.1) 219 57,246 16.8 (16.6–16.9)
2016
Male 32,241 29.4 (29.1–29.8) 5,359 27.3 (26.5–28.0) 486 38.2 (34.7–41.8) 988 11.6 (10.9–12.3) 4,310 17.5 (16.9–18.1) 141 43,525 26.9 (26.6–27.2)
Female 12,501 9.5 (9.4–9.7) 1,498 6.8 (6.5–7.2) 166 12.4 (10.4–14.3) 540 5.3 (4.9–5.8) 1,275 5.2 (4.9–5.5) 29 16,009 8.5 (8.3–8.6)
Total 44,742 19.1 (18.9–19.3) 6,857 16.4 (16.0–16.8) 652 24.8 (22.9–26.8) 1,528 8.2 (7.8–8.6) 5,585 11.2 (10.9–11.5) 170 59,534 17.3 (17.1–17.4)
2017
Male 33,209 30.0 (29.6–30.3) 5,577 27.8 (27.0–28.5) 542 42.2 (38.5–45.9) 1,041 11.9 (11.1–12.6) 4,463 17.9 (17.3–18.4) 129 44,961 27.4 (27.2–27.7)
Female 12,688 9.6 (9.4–9.8) 1,473 6.6 (6.3–7.0) 210 15.5 (13.3–17.6) 512 4.8 (4.4–5.3) 1,254 5.1 (4.8–5.4) 33 16,170 8.4 (8.3–8.6)
Total 45,897 19.4 (19.2–19.6) 7,050 16.6 (16.2–17.0) 752 28.3 (26.2–30.4) 1,553 8.0 (7.6–8.4) 5,717 11.3 (10.9–11.6) 162 61,131 17.5 (17.3–17.6)

Abbreviation: CI = confidence interval.
* Death estimates obtained from CDC’s National Vital Statistics System. Visits with missing age or sex were excluded; numbers subject to rounding error.
† Per 100,000 population, age-adjusted to the 2000 U.S. standard population, using 12 age groups: 0–4, 5–9, 10–14, 15–19, 20–24, 25–34, 35–44, 45–54, 55–64, 65–74, 74–84, and ≥85 years.
§ Record-axis condition codes were used (usually included both part I and part II of entity-axis condition codes). https://www.cdc.gov/nchs/data/datalinkage/underlying_and_multiple_causes_of_death557_2011.pdf.
Persons who were white, black, American Indian/Alaska Native, Asian/ Pacific Islander, or Other were non-Hispanic; Hispanics could be of any race.
** Differences in any two rates were considered statistically significant if their CIs were not overlapping.

Top

TABLE 2. Estimated average annual number* and age-adjusted rates† per 100,000 population of traumatic brain injury (TBI)–related deaths§ by year, intent, mechanism of injury, and race/ethnicity — United States, 2007–2017**Return to your place in the text
3-year interval/mechanism of injury Race/Ethnicity Total
White Black American Indian/Alaska Native Asian/Pacific Islander Hispanic Other
No. Rate (95% CI) No. Rate (95% CI) No. Rate (95% CI) No. Rate (95% CI) No. Rate (95% CI) No. No. Rate (95% CI)
2000–2002
Total unintentional TBI-related deaths 22,908 11.0 (10.9–11.1) 2,914 8.9 (8.7–9.1) 414 18.5 (17.4–19.6) 622 6.8 (6.5–7.2) 2,940 9.3 (9.1–9.6) 103 29,902 10.5 (10.4–10.6)
Unintentional motor vehicle crashes 12,416 6.3 (6.2–6.4) 1,919 5.4 (5.2–5.5) 311 12.8 (12.0–13.7) 343 3.0 (2.8–3.2) 2,014 5.3 (5.1–5.4) 52 17,055 6.0 (5.9–6.0)
Unintentional falls†† 6,496 2.8 (2.8–2.8) 477 1.8 (1.7–1.9) 53 3.4 (2.8–4.0) 194 2.8 (2.6–3.1) 484 2.5 (2.4–2.7) 30 7,734 2.7 (2.7–2.8)
Unintentionally struck by/against an object 304 0.1 (0.1–0.2) 34 0.1 (0.1–0.1) 2§§ 0.1(0.0–0.2) 5§§ 0.0 (0.0–0.1)§§ 46 0.1 (0.1–0.2) 2§§ 393 0.1 (0.1–0.1)
Other unintentional injury, mechanism unspecified¶¶ 3,692 1.7 (1.7–1.8) 484 1.6 (1.5–1.7) 48 2.2 (1.8–2.6) 81 0.9 (0.8–1.1) 396 1.4 (1.3–1.5) 19§§ 4,719 1.7 (1.6–1.7)
Total intentional TBI-related deaths 14,312 6.9 (6.9–7.0) 3,258 9.0 (8.8–9.1) 188 7.9 (7.3–8.6) 307 2.6 (2.4–2.7) 1,718 4.8 (4.6–4.9) 98 19,882 7.0 (6.9–7.0)
Suicide 11,909 5.7 (5.7–5.8) 883 2.5 (2.4–2.6) 102 4.4 (3.9–4.9) 164 1.4 (1.2–1.5) 728 2.3 (2.2–2.4) 46 13,833 4.8 (4.8–4.9)
Homicide 2,403 1.2 (1.2–1.2) 2,375 6.4 (6.3–6.6) 86 3.6 (3.1–4.0) 143 1.2 (1.1–1.3) 990 2.5 (2.4–2.6) 51 6,049 2.1 (2.1–2.1)
Other (no intent or mechanism specified)*** 348 0.2 (0.2–0.2) 96 0.3 (0.3–0.3) 13§§ 0.6 (0.4–0.8)§§ 14§§ 0.1 (0.1–0.2)§§ 79 0.2 (0.2–0.3) 9§§ 559 0.2 (0.2–0.2)
Total 37,568 18.1 (18.0–18.2) 6,269 18.2 (17.9–18.4) 615 27.0 (25.7–28.3) 943 9.5 (9.1–9.9) 4,737 14.3 (14.1–14.6) 210 50,342 17.6 (17.6–17.7)
2003–2005
Total unintentional TBI-related deaths 23,940 11.1 (11.0–11.2) 3,009 9.0 (8.8–9.2) 406 17.5 (16.4–18.5) 709 6.9 (6.6–7.2) 3,181 9.3 (9.0–9.5) 81 31,326 10.6 (10.5–10.7)
Unintentional motor vehicle crashes 11,827 5.9 (5.9–6.0) 1,873 5.1 (5.0–5.3) 276 10.8 (10.0–11.5) 349 2.8 (2.6–2.9) 2,146 5.1 (5.0–5.2) 46 16,516 5.6 (5.6–5.7)
Unintentional falls†† 8,325 3.4 (3.4–3.5) 570 2.1 (2.0–2.2) 65 3.8 (3.2–4.4) 272 3.3 (3.0–3.5) 609 3.0 (2.8–3.1) 22 9,863 3.3 (3.3–3.4)
Unintentionally struck by/against an object 286 0.1 (0.1–0.1) 33 0.1 (0.1–0.1) 5§§ 0.2(0.1–0.4)§§ 7 0.1 (0.0–0.1)§§ 50 0.1 (0.1–0.2) 1§§ 381 0.1 (0.1–0.1)
Other unintentional injury, mechanism unspecified¶¶ 3,502 1.6 (1.6–1.7) 534 1.7 (1.6–1.8) 61 2.7 (2.3–3.1) 82 0.8 (0.7–0.9) 376 1.1 (1.0–1.1) 13§§ 4,566 1.5 (1.5–1.6)
Total intentional TBI-related deaths 14,482 6.9 (6.8–6.9) 3,286 8.7 (8.5–8.9) 205 8.2 (7.6–8.9) 302 2.2 (2.1–2.4) 1,823 4.5 (4.3–4.6) 69 20,168 6.8 (6.8–6.9)
Suicide 12,305 5.8 (5.7–5.8) 851 2.4 (2.3–2.4) 112 4.6 (4.1–5.1) 168 1.3 (1.1–1.4) 754 2.1 (2.0–2.1) 36 14,225 4.8 (4.8–4.8)
Homicide 2,177 1.1 (1.1–1.1) 2,436 6.3 (6.2–6.5) 93 3.6 (3.2–4.1) 135 1.0 (0.9–1.1) 1,069 2.4 (2.3–2.5) 34 5,943 2.0 (2.0–2.0)
Other (no intent or mechanism specified)*** 382 0.2 (0.2–0.2) 135 0.4 (0.3–0.4) 15§§ 0.6 (0.5–0.9)§§ 12 0.1 (0.1–0.1)§§ 95 0.2 (0.2–0.3) 4§§ 643 0.2 (0.2–0.2)
Total 38,804 18.2 (18.1–18.3) 6,430 18.1 (17.8–18.3) 626 26.3 (25.1–27.6) 1,024 9.2 (8.9–9.6) 5,098 14.0 (13.7–14.2) 154 52,137 17.6 (17.5–17.7)
2006–2008
Total unintentional TBI-related deaths 24,156 10.8 (10.7–10.9) 2,829 8.1 (7.9–8.2) 372 15.4 (14.4–16.3) 750 6.4 (6.2–6.7) 3,133 8.4 (8.2–8.6) 68 31,308 10.1 (10.1–10.2)
Unintentional motor vehicle crashes 10,662 5.3 (5.2–5.3) 1,724 4.5 (4.4–4.6) 243 9.2 (8.5–9.9) 329 2.4 (2.3–2.6) 1,952 4.2 (4.1–4.3) 33 14,943 4.9 (4.9–5.0)
Unintentional falls†† 9,920 3.9 (3.9–3.9) 591 2.1 (2.0–2.2) 74 4.0 (3.4–4.5) 345 3.4 (3.2–3.6) 741 3.1 (2.9–3.2) 23 11,694 3.7 (3.7–3.8)
Unintentionally struck by/against an object 283 0.1 (0.1–0.1) 33 0.1 (0.1–0.1) 3§§ 0.1 (0.1–0.2)§§ 7 0.1 (0.0–0.1)§§ 55 0.1 (0.1–0.1) 0§§ 381 0.1 (0.1–0.1)
Other unintentional injury, mechanism unspecified¶¶ 3,291 1.5 (1.5–1.5) 481 1.4 (1.3–1.5) 52 2.1 (1.8–2.5) 70 0.6 (0.5–0.7) 385 1.0 (0.9–1.1) 12§§ 4,290 1.4 (1.4–1.4)
Total intentional TBI-related deaths 15,125 7.0 (7.0–7.1) 3,339 8.4 (8.3–8.6) 189 7.3 (6.7–7.9) 301 2.1 (1.9–2.2) 1,844 4.2 (4.0–4.3) 55 20,854 6.8 (6.8–6.9)
Suicide 12,913 5.9 (5.9–6.0) 876 2.3 (2.2–2.4) 107 4.2 (3.7–4.6) 176 1.2 (1.1–1.3) 795 2.0 (1.9–2.1) 36 14,903 4.8 (4.8–4.9)
Homicide 2,212 1.1 (1.1–1.1) 2,463 6.1 (6.0–6.3) 82 3.1 (2.7–3.5) 125 0.9 (0.8–1.0) 1,049 2.2 (2.1–2.2) 20§§ 5,950 2.0 (1.9–2.0)
Other (no intent or mechanism specified)*** 422 0.2 (0.2–0.2) 134 0.4 (0.3–0.4) 18§§ 0.8 (0.6–1.0)§§ 20 0.1 (0.1–0.2)§§ 108 0.3 (0.2–0.3) 4§§ 706 0.2 (0.2–0.2)
Total 39,704 18.0 (17.9–18.2) 6,301 16.9 (16.6–17.1) 579 23.4 (22.3–24.6) 1,071 8.7 (8.4–9.0) 5,085 12.9 (12.6–13.1) 128 52,867 17.2 (17.1–17.3)
2009–2011
Total unintentional TBI-related deaths 22,629 9.7 (9.6–9.8) 2,444 6.7 (6.6–6.9) 347 14.7 (13.7–15.6) 773 6.0 (5.7–6.2) 2,695 7.0 (6.8–7.1) 81 28,969 9.0 (8.9–9.1)
Unintentional motor vehicle crashes 8,112 4.0 (3.9–4.0) 1,365 3.4 (3.3–3.5) 202 7.6 (7.0–8.2) 270 1.7 (1.6–1.9) 1,498 3.0 (2.9–3.1) 35 11,482 3.7 (3.6–3.7)
Unintentional falls†† 11,281 4.3 (4.2–4.3) 675 2.2 (2.1–2.3) 87 4.7 (4.1–5.3) 415 3.6 (3.4–3.8) 810 3.1 (3.0–3.2) 32 13,301 4.0 (4.0–4.0)
Unintentionally struck by/against an object 276 0.1 (0.1–0.1) 31 0.1 (0.1–0.1) 2§§ 0.1 (0.0–0.2)§§ 8 0.1 (0.0–0.1)§§ 43 0.1 (0.1–0.1) 0§§ 360 0.1 (0.1–0.1)
Other unintentional injury, mechanism unspecified¶¶ 2,960 1.3 (1.3–1.4) 373 1.0 (1.0–1.1) 56 2.2 (1.9–2.6) 80 0.6 (0.5–0.6) 343 0.8 (0.8–0.9) 14§§ 3,826 1.2 (1.2–1.2)
Total intentional TBI-related deaths 16,465 7.6 (7.5–7.7) 3,016 7.4 (7.3–7.6) 216 8.3 (7.6–8.9) 321 2.0 (1.8–2.1) 1,768 3.7 (3.6–3.8) 90 21,877 6.9 (6.9–7.0)
Suicide 14,416 6.6 (6.5–6.7) 908 2.3 (2.2–2.4) 130 5.0 (4.5–5.5) 204 1.2 (1.1–1.3) 867 2.0 (1.9–2.0) 55 16,580 5.2 (5.1–5.2)
Homicide 2,049 1.0 (1.0–1.0) 2,109 5.1 (5.0–5.2) 86 3.3 (2.9–3.7) 117 0.7 (0.6–0.8) 901 1.7 (1.6–1.8) 35 5,297 1.7 (1.7–1.7)
Other (no intent or mechanism specified)*** 448 0.2 (0.2–0.2) 130 0.3 (0.3–0.4) 23 0.9 (0.7–1.1) 16§§ 0.1 (0.1–0.1)§§ 103 0.2 (0.2–0.3) 6§§ 726 0.2 (0.2–0.2)
Total 39,542 17.5 (17.4–17.6) 5,591 14.5 (14.3–14.7) 586 23.9 (22.7–25.0) 1,110 8.0 (7.7–8.3) 4,566 10.9 (10.7–11.1) 177 51,572 16.1 (16.0–16.2)
2012–2014
Total unintentional TBI-related deaths 23,486 9.7 (9.6–9.8) 2,530 6.6 (6.5–6.8) 373 15.2 (14.2–16.1) 888 5.9 (5.7–6.2) 2,895 7.0 (6.9–7.2) 87 30,260 9.0 (8.9–9.0)
Unintentional motor vehicle crashes 7,566 3.7 (3.7–3.8) 1,370 3.3 (3.2–3.4) 212 7.8 (7.2–8.4) 257 1.5 (1.4–1.6) 1,482 2.8 (2.7–2.8) 29 10,916 3.4 (3.4–3.4)
Unintentional falls†† 12,677 4.6 (4.5–4.6) 746 2.2 (2.1–2.3) 104 5.1 (4.5–5.7) 527 3.8 (3.6–4.0) 1,006 3.4 (3.2–3.5) 46 15,107 4.3 (4.2–4.3)
Unintentionally struck by/against an object 276 0.1 (0.1–0.1) 28 0.1 (0.1–0.1) 4§§ 0.2 (0.1–0.3)§§ 10 0.1 (0.0–0.1)§§ 48 0.1 (0.1–0.1) 0§§ 367 0.1 (0.1–0.1)
Other unintentional injury, mechanism unspecified¶¶ 2,967 1.3 (1.3–1.3) 386 1.0 (0.9–1.1) 53 2.1 (1.8–2.4) 94 0.6 (0.5–0.6) 359 0.8 (0.7–0.8) 11§§ 3,870 1.2 (1.1–1.2)
Total intentional TBI-related deaths 17,692 8.1 (8.0–8.2) 3,100 7.4 (7.2–7.5) 239 9.2 (8.5–9.9) 363 2.0 (1.8–2.1) 1,750 3.4 (3.3–3.5) 83 23,227 7.1 (7.1–7.2)
Suicide 15,755 7.1 (7.1–7.2) 966 2.4 (2.3–2.5) 155 6.0 (5.4–6.5) 242 1.3 (1.2–1.4) 959 1.9 (1.9–2.0) 60 18,138 5.5 (5.4–5.5)
Homicide 1,937 1.0 (0.9–1.0) 2,134 5.0 (4.9–5.1) 84 3.2 (2.8–3.6) 121 0.7 (0.6–0.7) 791 1.4 (1.4–1.5) 23 5,089 1.6 (1.6–1.6)
Other (no intent or mechanism specified)*** 465 0.2 (0.2–0.2) 123 0.3 (0.3–0.3) 23 0.9 (0.7–1.1) 20 0.1 (0.1–0.1) 112 0.2 (0.2–0.3) 7§§ 751 0.2 (0.2–0.2)
Total 41,644 18.0 (17.9–18.1) 5,754 14.3 (14.1–14.5) 635 25.2 (24.0–26.4) 1,271 8.0 (7.7–8.3) 4,757 10.6 (10.4–10.8) 177 54,238 16.3 (16.2–16.4)
2015–2017
Total unintentional TBI-related deaths 24,843 9.9 (9.8–10.0) 2,919 7.3 (7.1–7.4) 391 15.3 (14.4–16.2) 1,018 5.7 (5.5–5.9) 3,273 7.2 (7.0–7.3) 102 32,547 9.2 (9.1–9.2)
Unintentional motor vehicle crashes 7,508 3.7 (3.6–3.7) 1,579 3.7 (3.6–3.8) 211 7.7 (7.1–8.3) 279 1.4 (1.3–1.5) 1,627 2.8 (2.8–2.9) 32 11,236 3.4 (3.4–3.5)
Unintentional falls†† 13,977 4.8 (4.8–4.9) 859 2.4 (2.3–2.5) 109 4.8 (4.3–5.3) 626 3.7 (3.6–3.9) 1,203 3.4 (3.3–3.6) 54 16,828 4.5 (4.4–4.5)
Unintentionally struck by/against an object 257 0.1 (0.1–0.1) 24 0.1 (0.0–0.1) 4§§ 0.1 (0.1–0.2)§§ 6 0.0 (0.0–0.0)§§ 47 0.1 (0.1–0.1) 1§§ 339 0.1 (0.1–0.1)
Other unintentional injury, mechanism unspecified¶¶ 3,100 1.3 (1.3–1.3) 457 1.1 (1.1–1.2) 67 2.6 (2.2–3.0) 108 0.6 (0.5–0.6) 396 0.8 (0.8–0.9) 16§§ 4,144 1.2 (1.2–1.2)
Total intentional TBI-related deaths 19,367 8.9 (8.8–9.0) 3,701 8.5 (8.4–8.7) 275 10.1 (9.4–10.9) 445 2.2 (2.0–2.3) 2,101 3.7 (3.6–3.8) 75 25,965 7.8 (7.7–7.8)
Suicide 17,236 7.8 (7.7–7.9) 1,187 2.8 (2.7–2.9) 184 6.9 (6.3–7.5) 323 1.6 (1.5–1.7) 1,200 2.2 (2.1–2.3) 55 20,186 5.9 (5.9–6.0)
Homicide 2,131 1.1 (1.0–1.1) 2,514 5.7 (5.6–5.9) 90 3.3 (2.9–3.7) 122 0.6 (0.5–0.7) 901 1.5 (1.5–1.6) 20 5,779 1.8 (1.8–1.8)
Other (no intent or mechanism specified)*** 477 0.2 (0.2–0.2) 137 0.3 (0.3–0.4) 31 1.2 (0.9–1.4) 23 0.1 (0.1–0.1) 118 0.2 (0.2–0.2) 6§§ 792 0.2 (0.2–0.2)

Abbreviation: CI = confidence interval.
* Death estimates obtained from CDC’s National Vital Statistics System. Visits with missing age were excluded; numbers subject to rounding error.
† Per 100,000 population, age-adjusted to the 2000 U.S. standard population, using 12 age groups: 0–4, 5–9, 10–14, 15–19, 20–24, 25–34, 35–44, 45–54, 55–64, 65–74, 74–84, and ≥85 years.
§ Record-axis condition codes were used (usually included both part I and part II of entity-axis condition codes). https://www.cdc.gov/nchs/data/datalinkage/underlying_and_multiple_causes_of_death557_2011.pdf.
Persons who were white, black, American Indian/Alaska Native, Asian/ Pacific Islander, or Other were non-Hispanic; Hispanics could be of any race.
** Differences in any two rates were considered statistically significant if their CIs were not overlapping.
†† Includes falls of undetermined intent to maintain consistency with past data releases.
§§ Rates based on ≤20 deaths might be unstable and should be interpreted with caution.
¶¶ External cause of injury codes specify that the injury was unintentional but do not specify the actual mechanism of injury.
*** Includes TBIs for which the intent was not determined as well as those caused by legal intervention or war. Includes TBIs in which no mechanism was specified in the record. Does not include falls of undetermined intent.

Top


Suggested citation for this article: Daugherty J, Waltzman D, Sarmiento K, Xu L. Traumatic Brain Injury–Related Deaths by Race/Ethnicity, Sex, Intent, and Mechanism of Injury — United States, 2000–2017. MMWR Morb Mortal Wkly Rep 2019;68:1050–1056. DOI: http://dx.doi.org/10.15585/mmwr.mm6846a2.

MMWR and Morbidity and Mortality Weekly Report are service marks of the U.S. Department of Health and Human Services.
Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.
References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed in MMWR were current as of the date of publication.

All HTML versions of MMWR articles are generated from final proofs through an automated process. This conversion might result in character translation or format errors in the HTML version. Users are referred to the electronic PDF version (https://www.cdc.gov/mmwr) and/or the original MMWR paper copy for printable versions of official text, figures, and tables.

Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.

View Page In: PDF [626K]