237: TRENDS IN TRAUMATIC BRAIN INJURY MORTALITY IN THE UNITED STATES: DISPARITIES IN RACE AND URBANICITY

Abstract

Introduction: Disparities were reported in traumatic brain injury (TBI)-related mortality across racial groups and between rural vs urban areas in the United States (US), serving as focus of ongoing preventive and interventional efforts. However, the contemporary trajectories of race-specific TBI-related mortality across rural vs urban areas in the US are lacking. Methods: We queried the CDC WONDER Multiple Cause of Death dataset for decedents with TBI during 2010-2019. TBI was defined by ICD-10 code-based taxonomy previously developed by the CDC. Urbanization was defined by a dichotomized (rural, urban) 2013 National Center for Health Statistics Urban-Rural Classification Scheme. Negative binomial regression models were fit to estimate the annual changes (expressed as annual percent changes [APC]) in TBI-related age-adjusted mortality rates (AAMR), stratified by race and ethnicity across rural and urban areas. Results: Among 585,876 TBI-related deaths during 2010-2019, 121,379 deaths (20.9%) were among rural residents. TBI-related AAMRs (expressed per 100,000 population) were consistently higher in rural areas across all examined race/ethnicity groups, being overall highest and with the highest rural-urban gap among non-Hispanic (nh)-Native Americans (35.5 vs 20.5), followed by nh-whites (25.2 vs 17.2), and nh-Blacks (18.3 vs 15.3). TBI-related AAMRs rose over time at comparable pace across rural and urban areas within examined race/ethnicity groups, except among rural and urban nh-Asians and rural nh-Native Americans (both unchanged). The pace of rise in TBI-related AAMRs was highest among nh-Blacks in both rural and urban areas (APC +2.1 [95% CI +1.3 to +2.9] and +2.2 [95% CI +1.5 to +2.9], respectively), being over 2-fold higher than the corresponding overall TBI-related AAMRs (APC +0.9 [95% CI +0.6 to +1.3] and +1.0 [95% CI +0.7 to +1.4], respectively). Conclusions: TBI-related mortality rose progressively in the US over the past decade, with persistent gaps between rural and urban areas across all examined race/ethnicity groups. In addition, substantial outcome disparities persisted between race/ethnicity group in both areas, with disproportionately higher rise in TBI-related deaths in the nh-Black population, irrespective of area of residence.