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Traumatic Brain Injury in New Jersey, 1997

TBI SURVEILLANCE DATA
NEW JERSEY, 1997


TBI INCIDENCE, TRENDS AND CAUSES 1994 AND 1997

In 1997, there were 9,484 traumatic brain injuries or 117.8 per 100,000 population in New Jersey. This number represents an 11.2% decline in the crude rate compared to the baseline year 1994. Overall, there was a 9.5% decrease in the number of TBIs, compared to 1994 (Table 1). While non-fatal TBIs declined 11.2%, fatalities due to TBI increased by 5.1%. Moreover, the decline in the incidence of non-fatal TBIs is completely accounted for by an apparent decrease in the incidence of mild TBIs; rates for both moderate and severe TBIs increased over the same time period (Figure 1.1). Some of the apparent decline in mild TBI is probably caused by restrictions placed on patient stays by Medicare and insurers. A good number of cases that once required hospitalization may now be treated in outpatient departments leading to a decline in the number and rate of mild injuries. Declining numbers of mild and overall rates of TBI-related hospitalizations are also indicated by outside study which concluded that changes in hospital practices may be a major factor in the decreasing rates of TBI-related hospital admissions; these practices increasingly appear to exclude persons with less severe TBI from hospital admission and shift their care to outpatient settings. 6

Although the number and rate of TBI incidents decreased in most demographic groups, and from most external causes, there were some exceptions to the general trend: TBI incidence increased among persons 35 through 44 and 85 and over; self-inflicted TBIs increased slightly. The largest decreases in TBI cases occurred in age groups under 35 years, in TBIs from falls (Figures 1.2-1.4).









TABLE 1: NUMBER OF TRAUMATIC BRAIN INJURIES,
RATES AND PERCENT CHANGE
BY OUTCOME, SEX, AGE, CAUSE, SEVERITY AND RESIDENCE
NEW JERSEY, 1994 AND 1997
Category Number Rate per 100,000 % change
  1994 1997 1994 1997 Number Rate
OVERALL 10,479 9,484 132.6 117.8 -9.5% -11.2%
 
OUTCOME
   Non-fatal 9,400 8,350 118.9 103.7 -11.2% -12.8%
   Fatal 1,079 1,134 13.7 14.1 +5.1% +2.9%
 
SEX
   Male 6,688 6,101 174.9 156.1 -8.8% -10.7%
   Female 3,791 3,383 92.9 81.6 -10.8% -12.2%
 
AGE GROUP
   Under 5 724 544 125.1 97.7 -24.9% -21.9%
   5 -14 1,027 787 97.4 70.4 -23.4% -27.7%
   15 - 24 1,973 1,611 200.3 164.5 -18.3% -17.9%
   25 - 34 1,587 1,290 125.5 110.3 -18.7% -12.1%
   35 - 44 1,224 1,316 94.1 95.0 +7.5% +1.0%
   45 - 54 902 878 93.4 83.2 -2.7% -10.9%
   55 - 64 627 631 92.7 92.4 +0.6% -0.3%
   65 - 74 795 766 129.8 128.4 -3.6% -1.1%
   75 - 84 1,042 975 292.4 252.9 -6.4% -13.5%
   85+ 578 686 529.1 554.2 +18.7% +4.7%
 
CAUSE
   Motor vehicle 3,952 3,838 50.0 47.7 -2.9% -4.6%
   Fall 3,772 3,146 47.7 39.1 -16.6% -18.0%
   Other unintentional 1,223 1,136 15.5 14.1 -7.1% -9.0%
   Self-inflicted 194 198 2.5 2.5 +2.1% 0.0%
   Assault 1,154 1,114 14.6 13.8 -3.5% -5.5%
   Other 93 43 1.2 0.5 -53.8% -58.3%
   Unknown 91 9 1.2 0.1 -90.1% -91.7%
 
INJURY SEVERITY*
   Mild 6,619 5,265 83.7 65.4 -20.5% -21.9%
   Moderate 701 781 8.9 9.7 11.4% 9.0%
   Severe 1,816 2,138 23.0 26.5 17.7% 15.2%
   Unknown 264 166 3.3 2.1 -37.1% -36.4%
TOTAL 9,400 8,350 118.9 103.7 -11.2% -12.8%
 
RESIDENCE
   New Jersey 9,941 8,938 125.8 111.0 -10.1% -11.8%
   Out-of-state 380 408 N/A N/A +7.4% N/A
   Unknown 158 138 N/A N/A -12.7% N/A
* Includes only non-fatal hospitalizations.

AGE AND SEX

As in 1994, nearly two-thirds of the TBI incidents in 1997 in New Jersey occurred among males (Table 2.1). The male age-adjusted TBI rate remained more than twice the female rate. Among TBI victims aged 75 and over, there were substantially more females than males (Figure 2.1). However, the age-specific rates for TBIs, both fatal and non-fatal, were higher for males in every age group (Table 2.2 and Figures 2.2 and 2.3).

TABLE 2.1: NUMBER OF TRAUMATIC BRAIN INJURIES AND RATES
BY AGE AND SEX
NEW JERSEY, 1997
AGE GROUP NUMBER RATE PER 100,000
MALE FEMALE TOTAL MALE FEMALE TOTAL
Under 5 317 227 544 111.3 83.5 97.7
5-14 542 245 787 94.6 44.9 70.4
15-24 1,189 422 1,611 236.6 88.5 164.5
25-44 1,892 714 2,606 149.8 55.3 102.0
45-64 1,034 475 1,509 123.4 52.8 86.8
65-74 427 339 766 162.9 101.4 128.4
75-84 450 525 975 301.1 222.4 252.9
85+ 250 436 686 718.9 489.9 554.2
TOTAL 6,101 3,383 9,484 156.1 81.6 117.8
Percent 64.3% 35.7% 100.0%      
Age-adjusted rate based on all occurrences-1997 153.2 67.9 110.2
1994 174.8 81.6 127.7
% change 1994-1997 -12.4% -16.8% -13.7%
 
Age-adjusted rate based on resident occurrences-1997 144.1 63.9 103.7
1994 165.1 77.8 121.0
% change 1994-1997 -12.7% -17.9% -14.3%

TABLE 2.2: NUMBER OF TRAUMATIC BRAIN INJURIES AND RATES
BY AGE, OUTCOME AND SEX
NEW JERSEY, 1997
  FATAL
AGE GROUP NUMBER RATE PER 100,000
MALE FEMALE TOTAL MALE FEMALE TOTAL
Under 5 11 10 21 3.9 3.7 3.8
5-14 24 10 34 4.2 1.8 3.0
15-24 122 39 161 24.3 8.2 16.4
25-44 207 62 269 16.4 4.8 10.5
45-64 166 47 213 19.8 5.2 12.3
65-74 81 36 117 30.9 10.8 19.6
75-84 109 77 186 72.9 32.6 48.2
85+ 59 74 133 169.7 83.1 107.5
TOTAL 779 355 1,134 19.9 8.6 14.1
Percent 68.7% 31.3% 100.0%      
Age-adjusted based on all occurrences-1997 17.6 5.9 11.5
1994 17.8 5.5 11.3
% change 1994-1997 -1.1% +7.3% +1.8%
 
Age-adjusted rate for New Jersey resident population-1997 16.7 5.6 11.0
1994 16.3 5.0 10.3
% change 1994-1997 +2.5% +12.0% +6.8%
   
  NON-FATAL
AGE GROUP NUMBER RATE PER 100,000
MALE FEMALE TOTAL MALE FEMALE TOTAL
Under 5 306 217 523 107.4 79.8 93.9
5-14 518 235 753 90.4 43.1 67.3
15-24 1,067 383 1,450 212.4 80.3 148.1
25-44 1,685 652 2,337 133.4 50.5 91.5
45-64 868 428 1,296 103.6 47.5 74.6
65-74 346 303 649 132.0 90.6 108.8
75-84 341 448 789 228.2 189.8 204.7
85+ 191 362 553 549.3 406.7 446.8
TOTAL 5,322 3,028 8,350 136.2 73.1 103.7
Percent 63.7% 36.3% 100.0%      
Age-adjusted rate based on New Jersey occurrences - 1997 135.6 62.0 98.6
1994 157.0 76.1 116.4
% change -13.6% -18.5% -15.3%
 
Age-adjusted rate for New Jersey resident population - 1997 127.4 58.3 92.7
1994 148.8 72.8 110.7
% change 1994-1997 -14.4% -19.9% -16.3%

AGE, SEVERITY AND OUTCOME

More than half of the TBIs in New Jersey were mild non-fatal and fewer than 10% were of non-fatal moderate severity (Table 1 and Table 2.3). The greatest frequency of non-fatal mild and moderate TBIs occurred among persons 15 through 44 years of age. More than 20% of the TBIs were severe but not fatal. The higher rates for these cases by far were in the 75 and over population. Half of the hospitalized fatalities related to TBI were of persons 65 and over, whereas this group accounted for only 29% of the non-hospitalized fatalities. The highest rates of TBI regardless of severity were in the population 85 and over (Table 2.3 and Figure 2.4). Rates in all of these categories were particularly high in persons 75 through 84 years also. Other than the elderly population (65 years and over), the highest rates in each severity and fatality site were in the young population, 15 through 24 years, and this group had the second highest rate of mild TBIs. Of TBIs occurring in females, the percent that were mild was somewhat higher than the percent of TBIs that were mild in males, even though the number of TBIs and total in males was higher than in females (Figure 2.5).

TABLE 2.3: NUMBER OF TRAUMATIC BRAIN INJURIES AND RATES
BY AGE, OUTCOME AND SEVERITY
NEW JERSEY, 1997
AGE GROUP NON-FATAL FATAL TOTAL
MILD MODER-
ATE
SEVERE HOSPI-
TALIZED
NON-
HOSPI-
TALIZED
Under 5 316 56 139 14 7 544
5-14 537 67 130 17 17 787
15-24 1,030 129 273 54 107 1,611
25-44 1,569 232 496 87 182 2,606
45-64 811 116 350 78 135 1,509
65-74 349 71 217 60 57 766
75-84 378 69 322 109 77 975
85+ 275 41 211 80 53 686
TOTAL 5,265 781 2,138 499 635 9,484
Percent 55.5% 8.2% 22.5% 5.3% 6.7% 100.0%
 
AGE GROUP NON-FATAL RATE PER 100,000 FATAL RATE PER 100,000 TOTAL RATE PER 100,000
MILD MODER-
ATE
SEVERE HOSPI-
TALIZED
NON-
HOSPI-
TALIZED
Under 5 56.7 10.1 25.0 2.5 1.3 97.7
5-14 48.0 6.0 11.6 1.5 1.5 70.4
15-24 105.2 13.2 27.9 5.5 10.9 164.5
25-44 61.4 9.1 19.4 3.4 7.1 102.0
45-64 46.7 6.7 20.1 4.5 7.8 86.8
65-74 58.5 11.9 36.4 10.1 9.6 128.4
75-84 98.1 17.9 83.5 28.3 20.0 252.9
85+ 222.2 33.1 170.5 64.6 42.8 554.2
TOTAL 65.4 9.7 26.5 6.2 7.9 117.8
Note
1.Mild (ICD/AIS=1 or 2)
2.Moderate (ICD/AIS = 3)
3.Severe (ICD/AIS= 4 - 6)
4.Total includes unknown levels of severity

AGE, OUTCOME AND CAUSE

The major external causes of TBI in 1997 in New Jersey were motor vehicle injuries and falls (Table 3A). The largest numbers of motor vehicle-related fatalities and non-fatal TBI incidents occurred among the population 15 through 44 years. The greatest frequencies of TBIs from falls were in the population 75 and over. Self-inflicted TBIs were highest in 25 through 64 year olds and TBIs from assaults occurred in highest numbers among 15 though 44 year olds (Table 3A).

Despite the higher number of TBI-related fatalities from motor vehicle-related causes in the younger population, the rates of these fatalities were highest in the ages 75 and over population, as were TBI fatalities from falls, other unintentional causes and self-inflicted injuries (Table 3B and Figure 3). The rate of self-inflicted TBI-related fatalities in the 45-64 years was also relatively high, and the assault rate in 15 through 24 year olds was higher than in any other age group. Rates of non-fatal TBIs related to the use of motor vehicles were much higher among persons aged 15 through 24 year olds than among other age groups. The rate of non-fatal TBI caused by assault was also substantially elevated among adolescents and young adults. Persons 75 and over had the highest rates of non-fatal TBI from falls and other unintentional injuries, and had the highest non-fatal TBI rates from all causes (Table 3B).

TABLE 3A: TRAUMATIC BRAIN INJURIES
BY AGE, OUTCOME AND CAUSE
NEW JERSEY, 1997
FATAL
Age group Motor Vehicle Fall Other uninten-
tional
Self inflicted Assault Other/
Unknown
All Causes
Under 5 11 2 5 0 3 0 21
5 -14 21 4 4 0 4 1 34
15 - 24 80 5 12 17 43 4 161
25 - 44 99 23 36 51 57 3 269
45 - 64 56 49 23 59 23 3 213
65 - 74 27 50 21 14 4 1 117
75 - 84 35 83 48 17 1 2 186
85 + 20 69 37 4 3 0 133
TOTAL 349 285 186 162 138 14 1,134
PERCENT 30.8% 25.1% 16.4% 14.3% 12.2% 1.2% 100.0%
NON-FATAL
Age group Motor Vehicle Fall Other uninten-
tional
Self inflicted Assault Other/
Unknown
All Causes
Under 5 86 349 53 0 30 5 523
5 -14 303 215 193 2 38 2 753
15 - 24 868 165 173 7 234 3 1,450
25 - 44 1,190 387 218 17 510 15 2,337
45 - 64 599 418 136 6 132 5 1,296
65 - 74 228 340 60 2 15 4 649
75 - 84 173 522 82 1 9 2 789
85 + 42 465 35 1 8 2 553
TOTAL 3,489 2,861 950 36 976 38 8,350
PERCENT 41.8% 34.3% 11.4% 0.4% 11.7% 0.4% 100.0%
TOTAL
Age group Motor Vehicle Fall Other uninten-
tional
Self inflicted Assault Other/
Unknown
All Causes
Under 5 97 351 58 0 33 5 544
5 -14 324 219 197 2 42 3 787
15 - 24 948 170 185 24 277 7 1,611
25 - 44 1,289 410 254 68 567 18 2,606
45 - 64 655 467 159 65 155 8 1,509
65 - 74 255 390 81 16 19 5 766
75 - 84 208 605 130 18 10 4 975
85 + 62 534 72 5 11 2 686
TOTAL 3,838 3,146 1,136 198 1,114 52 9,484
PERCENT 40.5% 33.2% 12.0% 2.1% 11.7% 0.5% 100.0%

TABLE 3B: TRAUMATIC BRAIN INJURY RATES
BY AGE, OUTCOME AND CAUSE
NEW JERSEY, 1997
FATAL RATE PER 100,000
Age group Motor Vehicle Fall Other uninten-
tional
Self inflicted Assault Other/
Unknown
All Causes
Under 5 2.0 0.4 0.9 0.0 0.5 0.0 3.8
5 -14 1.8 0.4 0.4 0.0 0.4 0.0 3.0
15 - 24 8.2 0.5 1.2 1.7 4.4 0.4 16.4
25 - 44 3.9 0.9 1.4 2.0 2.2 0.1 10.5
45 - 64 3.2 2.8 1.3 3.4 1.3 0.2 12.3
65 - 74 4.5 8.4 3.5 2.3 0.7 0.2 19.6
75 - 84 9.1 21.5 12.5 4.4 0.3 0.4 48.2
85 + 16.2 55.7 29.9 3.2 2.4 0.0 107.5
TOTAL 4.3 3.5 2.3 2.0 1.7 0.2 14.1
NON-FATAL RATE PER 100,000
Age group Motor Vehicle Fall Other uninten-
tional
Self inflicted Assault Other/
Unknown
All Causes
Under 5 15.4 62.7 9.5 0.0 5.4 0.9 93.9
5 -14 27.1 19.2 17.3 0.2 3.4 0.2 67.3
15 - 24 88.6 16.8 17.7 0.7 23.9 0.3 148.1
25 - 44 46.6 15.1 8.5 0.7 20.0 0.6 91.5
45 - 64 34.5 24.0 7.8 0.3 7.6 0.3 74.6
65 - 74 38.2 57.0 10.1 0.3 2.5 0.7 108.8
75 - 84 44.9 135.4 21.3 0.3 2.3 0.5 204.7
85 + 33.9 375.7 28.3 0.8 6.5 1.6 446.8
TOTAL 43.3 35.5 11.8 0.4 12.1 0.5 103.7
TOTAL RATE PER 100,000
Age group Motor Vehicle Fall Other uninten-
tional
Self inflicted Assault Other/
Unknown
All Causes
Under 5 17.4 63.0 10.4 0.0 5.9 0.9 97.7
5 -14 29.0 19.6 17.6 0.2 3.8 0.2 70.4
15 - 24 96.8 17.4 18.9 2.5 28.3 0.7 164.5
25 - 44 50.5 16.0 9.9 2.7 22.2 0.7 102.0
45 - 64 37.7 26.9 9.1 3.7 8.9 0.5 86.8
65 - 74 42.8 65.4 13.6 2.7 3.2 0.8 128.4
75 - 84 54.0 156.9 33.7 4.7 2.6 0.9 252.9
85 + 50.1 431.4 58.2 4.0 8.9 1.6 554.2
TOTAL 47.7 39.1 14.1 2.5 13.8 0.6 117.8

FIREARM-RELATED TRAUMATIC BRAIN INJURIES

There were 290 TBIs in 1997 that involved the use of firearms (Table 4). This number was unchanged from 1994. Of these, 90.0% were fatal and 78.6 percent died prior to receiving acute care treatment. The vast majority of the firearm victims were male, almost all of these TBI injuries were intentional (the majority being self-inflicted), and most occurred among persons aged 15 through 64 years.


TABLE 4: FIREARM-RELATED TRAUMATIC BRAIN INJURIES
BY AGE, SEX, INTENT AND OUTCOME
NEW JERSEY, 1997
CATEGORY
AGE GROUP
FATAL NON-FATAL TOTAL
Number Percent Number Percent Number Percent
AGE GROUP
   Under 15 4 1.5% 2 6.9% 6 2.0%
   15 - 24 58 22.2% 6 20.7% 64 22.1%
   25 - 44 86 33.0% 12 41.4% 98 33.8%
   45 - 64 73 28.0% 8 27.6% 81 27.9%
   65 - 74 19 7.3% 1 3.4% 20 6.9%
   75 - 84 17 6.5% 0 0.0% 17 5.9%
   85 + 4 1.5% 0 0.0% 4 1.4%
TOTAL 261 100.0% 29 100.0% 290 100.0%
 
SEX:
   Male 232 88.9% 23 79.3% 255 87.9%
   Female 29 11.1% 6 20.7%. 35 12.1%
TOTAL 261 100.0% 29 100.0% 290 100.0%
 
INTENTION:
   Unintentional 8 3.1% 3 10.3% 11 3.8%
   Self-inflicted 164 62.8% 8 27.6% 172 59.3%
   Assault 85 32.6% 13 44.8% 98 33.8%
   Undetermined 4 1.5% 5 17.2% 9 3.1%
TOTAL 261 100.0% 29 100.0% 290 100.0%

DISPOSITION

Almost 7% of the TBI victims in New Jersey in 1997 died prior to being treated and another 5% died after admission to an acute care hospital. Most (70%) were discharged to home after hospital treatment and 16% were discharged to continued treatment in another acute care facility, rehabilitation center or nursing home (data not shown).

HOSPITALIZATION CHARGES

In 1997, total TBI-related hospitalization charges in New Jersey were in excess of 180 million dollars for 61,753 inpatient care days. This excludes physician, rehabilitation and other costs. Private insurance/HMOs were the expected source of payment for almost half of the inpatient stays (Table 5). The next most frequent expected source of payment was governmental sources (Medicaid, Medicare, etc.) which accounted for almost one-fourth of the hospital charges. The average TBI-related hospitalization charges were $20,347 for a mean length of stay of 7.0 days. The charges were greater for those with a severe TBI with average charges of $38,113 for 12.7 days of inpatient care. Using a national estimate7, the approximate costs of treatment and rehabilitation of severe TBIs that occurred in New Jersey in 1997 translate to approximately 800 million dollars.


TABLE 5: TRAUMATIC BRAIN INJURY-RELATED ACUTE CARE CHARGES
AND IN-PATIENT CARE DAYS
BY EXPECTED PRIMARY PAYER
NEW JERSEY, 1997
Expected Primary payer Number Percent Average charges per hospitalization Mean length of stay (days)
Insurance/HMO 4,286 48.4% $24,236 6.9
Self-pay 2,180 24.6% $13,356 4.4
Medicare 1,641 18.5% $18,803 10.7
Medicaid 345 3.9% $21,174 7.3
Workers comp. 337 3.8% $24,452 6.5
Other government 60 0.7% $10,962 5.0
TOTAL 8,849 100.0% $20,347 7.0

COUNTY OF RESIDENCE AT THE TIME OF HOSPITALIZATION/DEATH

The age-adjusted TBI incidence rate declined between 1994 and 1997 in almost all counties (Table 6.1). In the only exceptions to this trend, the age-adjusted rates in Essex and Mercer Counties increased slightly. Morris and Hunterdon Counties had the lowest rates in both time periods. Hudson County had the highest number and rate of TBIs in the state in 1997. However, Atlantic County had the highest rate of TBI-related fatalities (Table 6.2). Particularly high rates of TBI hospitalization persisted between 1994 and 1997 among residents of Hudson County, which alone accounted for over 12% of all hospitalized non-fatal TBIs occurring in the state in 1997. Other counties with disproportionately elevated non-fatal TBI rates as of 1997 include Atlantic, Camden, Cumberland, and Passaic Counties (Table 6.2). The highly disproportionate rate of TBI was present among both males and females (Table 6.3). TBI rates were also particularly elevated among males in Essex County, and among females in Monmouth County.

TABLE 6.1: NUMBER OF TRAUMATIC BRAIN INJURIES AND CRUDE AND AGE-ADJUSTED RATES
BY COUNTY OF RESIDENCE
NEW JERSEY, 1994 AND 1997
County of Residence 1994 1997
Number Crude
Rate per 100,000
Age-adjusted rate per 100,000 Number Crude Rate per 100,000 Age-adjusted rate per 100,000
Atlantic 482 207.6 201.5 328 138.6 134.7
Bergen 896 106.4 96.6 822 96.6 84.0
Burlington 356 89.3 87.8 318 76.1 71.4
Camden 866 170.9 170.5 748 148.2 144.2
Cape May 146 149.3 143.7 107 109.0 88.4
Cumberland 251 180.8 180.0 200 141.9 137.5
Essex 966 126.2 118.8 944 125.7 120.5
 
Gloucester 269 111.4 113.8 243 98.8 90.5
Hudson 1,137 205.8 200.6 1,140 206.7 196.1
Hunterdon 74 64.2 67.0 83 68.8 62.6
Mercer 374 113.5 107.6 397 120.4 108.7
Middlesex 683 98.6 94.6 576 81.3 76.5
Monmouth 682 117.9 117.9 687 115.2 111.9
Morris 327 74.6 70.7 313 68.9 63.9
 
Ocean 532 116.5 113.7 472 98.2 92.6
Passaic 815 176.5 168.6 655 135.3 129.0
Salem 102 157.4 151.1 62 93.9 92.0
Somerset 227 87.1 89.0 218 78.7 75.2
Sussex 145 104.9 112.8 139 97.8 101.3
Union 518 104.4 92.5 405 81.3 68.6
Warren 93 97.5 93.4 81 82.4 74.3
 
TOTAL-NEW JERSEY 9,941 125.8 121.0 8,938 111.0 103.7
Out-of-state 380 N/A N/A 408 N/A N/A
Unknown 158 N/A N/A 138 N/A N/A
 
TOTAL OCCURRENCES 10,479 N/A N/A 9,484 N/A N/A
Note: 1940 standard populations were used to compute age-adjusted rates.

TABLE 6.2: NUMBER OF TRAUMATIC BRAIN INJURIES AND
CRUDE AND AGE-ADJUSTED RATES
BY COUNTY OF RESIDENCE AND OUTCOME
NEW JERSEY, 1997
COUNTY OF RESIDENCE Fatal NON-FATAL
Number Crude Rate per 100,000 Age-adjusted Rate per 100,000 Number Crude Rate per 100,000 Age-adjusted rate per 100,000
Atlantic 52 22.0 20.2 276 116.7 114.5
Bergen 81 9.5 6.6 741 87.0 77.3
Burlington 57 13.6 11.5 261 62.5 59.9
Camden 89 17.6 16.8 659 130.6 127.4
Cape May 18 18.3 12.8 89 90.7 75.7
Cumberland 28 19.9 15.4 172 122.1 122.2
Essex 131 17.4 16.7 813 108.3 103.9
 
Gloucester 37 15.0 12.6 206 83.7 77.9
Hudson 92 16.7 13.3 1,048 190.0 182.8
Hunterdon 10 8.3 7.0 73 60.5 55.5
Mercer 44 13.3 11.5 353 107.0 97.2
Middlesex 60 8.5 6.5 516 72.9 70.0
Monmouth 78 13.1 11.6 609 102.1 100.4
Morris 35 7.7 5.4 278 61.2 58.5
 
Ocean 76 15.8 12.5 396 82.4 80.1
Passaic 49 10.1 8.3 606 125.2 120.7
Salem 10 15.1 16.6 52 78.7 75.4
Somerset 33 11.9 8.2 185 66.8 67.0
Sussex 16 11.3 12.1 123 86.6 89.1
Union 77 15.5 8.9 328 65.8 59.7
Warren 7 7.1 6.9 74 75.3 67.4
 
Total-New Jersey 1,080 13.4 11.0 7,858 97.6 92.7
Out-of-state 53 N/A N/A 355 N/A N/A
Unknown 1 N/A N/A 137 N/A N/A
 
TOTAL 1,134 14.1 11.0 8,350 103.7 98.6
Note: 1940 standard populations were used to compute age-adjusted rates.

TABLE 6.3: NUMBER OF TRAUMATIC BRAIN INJURIES
AND CRUDE AND AGE-ADJUSTED RATES
BY COUNTY OF RESIDENCE AND SEX
NEW JERSEY, 1997
COUNTY OF RESIDENCE MALE FEMALE
Number Crude Rate per 100,000 Age-adjusted Rate per 100,000 Number Crude Rate per 100,000 Age-adjusted rate per 100,000
Atlantic 217 190.0 190.9 111 90.7 79.6
Bergen 476 116.2 109.3 346 78.3 59.3
Burlington 194 93.7 90.6 124 58.8 52.9
Camden 502 205.9 207.3 246 94.3 83.4
Cape May 60 126.9 116.7 47 92.5 59.4
Cumberland 136 195.5 194.8 64 89.7 80.8
Essex 652 183.1 182.4 292 74.0 61.1
 
Gloucester 153 127.1 122.0 90 71.6 60.9
Hudson 788 294.7 287.5 352 123.9 107.0
Hunterdon 53 87.6 81.3 30 49.9 45.2
Mercer 257 160.6 155.4 140 82.5 61.8
Middlesex 368 105.3 104.1 208 58.0 49.0
Monmouth 388 134.0 138.9 299 97.5 84.3
Morris 213 95.7 93.2 100 43.2 36.2
 
Ocean 286 125.2 123.7 186 73.7 62.3
Passaic 431 183.7 182.7 224 89.8 76.0
Salem 39 121.6 126.1 23 67.7 57.8
Somerset 135 98.9 96.9 83 59.1 55.1
Sussex 96 135.3 152.2 43 60.5 48.3
Union 246 102.6 94.1 159 61.5 44.1
Warren 45 94.0 92.2 36 71.4 56.5
 
Total-New Jersey 5,735 146.8 144.1 3,203 77.3 63.9
Out-of-state 277 N/A N/A 131 N/A N/A
Unknown 89 N/A N/A 49 N/A N/A
 
TOTAL OCCURRENCES 6,101 N/A
156.1 3,383 81.6 67.9
Note: 1940 standard populations were used to compute age-adjusted rates.

TABLE 6.4A: NUMBER OF TRAUMATIC BRAIN INJURIES
BY COUNTY OF RESIDENCE AND CAUSE
NEW JERSEY, 1997
COUNTY OF RESIDENCE Motor Vehicle Fall Other uninten-tional Assault Self-inflicted Other/
Unknown
All Causes
Atlantic 178 83 25 31 10 1 328
Bergen 296 284 173 52 14 3 822
Burlington 146 100 26 24 19 3 318
Camden 349 202 50 121 20 6 748
Cape May 38 50 13 5 1 0 107
Cumberland 100 56 16 22 5 1 200
Essex 322 324 84 192 19 3 944
 
Gloucester 111 67 40 17 8 0 243
Hudson 351 409 102 258 11 9 1,140
Hunterdon 35 36 9 0 2 1 83
Mercer 168 124 36 63 4 2 397
Middlesex 257 217 57 36 7 2 576
Monmouth 298 215 113 46 11 4 687
Morris 99 129 65 15 5 0 313
 
Ocean 228 139 80 10 11 4 472
Passaic 213 231 50 137 20 4 655
Salem 32 16 6 6 2 0 62
Somerset 93 83 24 9 8 1 218
Sussex 46 55 31 5 2 0 139
Union 146 168 49 32 6 4 405
Warren 25 35 10 5 3 3 81
 
Total-New Jersey 3,531 3,023 1,059 1,086 188 51 8,938
Out-of-state 232 91 52 25 8 0 408
Unknown 75 32 25 3 2 1 138
 
TOTAL OCCURRENCES 3,838 3,146 1,136 1,114 198 52 9,484

COUNTY OF RESIDENCE AND CAUSE

The four counties with the highest rates of TBI related to motor vehicle incidents were Atlantic, Camden, Cumberland, and Hudson. Together, these four counties accounted for more than one-fourth of all motor vehicle-related TBIs (Table 6.4A). Hudson and Camden Counties, along with Essex and Passaic Counties, also had disproportionately high rates of TBI related to falls and assaults. Together, these four counties accounted for well over one-third of fall-related TBIs, and nearly two-thirds of assault-related TBIs. Hudson County, which had particularly elevated TBI rates in all categories (Table 6.4B), alone accounted for nearly 10% of all motor vehicle-related TBIs, 13% of all fall-related TBIs, and 23% of all assault-related TBIs (Table 6.4A).

TABLE 6.4B: TRAUMATIC BRAIN INJURY RATES
BY COUNTY OF RESIDENCE AND MAJOR CAUSE
NEW JERSEY, 1997
COUNTY OF RESIDENCE Motor Vehicle Fall Assault
Crude rate per 100,000 AGE-ADJUSTED RATE PER 100,000 Crude rate per 100,000 AGE-ADJUSTED RATE PER 100,000 CRUDE RATE PER 100,000 Age-adjusted Rate per 100,000
Atlantic 75.2 78.2 35.1 25.7 13.1 14.7
Bergen 34.8 36.7 33.4 20.2 6.1 7.6
Burlington 34.9 36.4 23.9 18.1 5.7 6.2
Camden 69.2 71.0 40.0 31.7 24.0 26.2
Cape May 38.7 46.1 51.0 25.9 5.1 6.5
Cumberland 71.0 76.3 39.7 28.7 15.6 17.2
Essex 42.9 45.5 43.2 33.8 25.6 27.4
 
Gloucester 45.1 47.8 27.2 18.6 6.9 7.8
Hudson 63.7 66.6 74.2 60.2 46.8 48.4
Hunterdon 29.0 30.0 29.9 22.2 0.0 0.0
Mercer 50.9 52.9 37.6 24.8 19.1 18.9
Middlesex 36.3 36.7 30.6 25.4 5.1 5.2
Monmouth 50.0 55.8 36.1 26.7 7.7 9.0
Morris 21.8 22.5 28.4 22.6 3.3 3.8
 
Ocean 47.4 53.3 28.9 17.1 2.1 3.0
Passaic 44.0 46.4 47.7 38.5 28.3 28.7
Salem 48.5 54.6 24.2 17.3 9.1 7.9
Somerset 33.6 36.1 30.0 23.2 3.3 3.7
Sussex 32.4 40.3 38.7 31.5 3.5 4.4
Union 29.3 29.7 33.7 21.1 6.4 7.1
Warren 25.4 27.8 35.6 23.2 5.1 6.8
 
Total-New Jersey 43.8 46.2 37.5 27.5 13.5 14.7
Note: 1940 standard populations were used to compute age-adjusted rates.

 

COUNTY OF RESIDENCE, AGE AND SEVERITY

Among all age groups, the greatest number of TBIs occurred among persons aged 25-44 years in most counties (Table 6.5A). However, TBI rates were highest among the elderly (75 and over), followed by the young (15-24 years) in all counties (Table 6.5B).

Camden and Essex Counties both had significantly higher proportions of moderate to severe TBIs than Hudson County, and together accounted for one-fourth of all TBIs in these categories (Table 6.6). In addition, these two counties had higher TBI rates in all categories of severity, except mild TBIs. Results also indicated that some urban residents are at very high risk for TBIs (Tables 7A and 7B and Figure 4).

 

TABLE 6.5A: TRAUMATIC BRAIN INJURIES
BY COUNTY OF RESIDENCE AND AGE
NEW JERSEY, 1997
COUNTY OF
RESIDENCE
Under 15 15-24 25-44 45-64 65-74 75+ TOTAL
Atlantic 34 72 110 44 25 43 328
Bergen 85 118 194 134 69 222 822
Burlington 45 61 70 60 22 60 318
Camden 118 125 229 131 50 95 748
Cape May 5 16 28 13 6 39 107
Cumberland 21 46 49 36 16 32 200
Essex 155 179 276 133 76 125 944
 
Gloucester 35 43 60 33 20 52 243
Hudson 188 184 366 174 75 153 1,140
Hunterdon 11 7 20 16 8 21 83
Mercer 47 69 125 54 33 69 397
Middlesex 103 97 126 98 55 97 576
Monmouth 101 131 179 104 56 116 687
Morris 47 46 67 49 36 68 313
 
Ocean 61 70 118 68 43 112 472
Passaic 94 117 203 113 47 81 655
Salem 6 11 23 7 6 9 62
Somerset 31 35 51 37 24 40 218
Sussex 25 33 23 21 9 28 139
Union 51 52 90 61 39 112 405
Warren 15 14 8 13 8 23 81
 
Total-New Jersey 1,278 1,526 2,415 1,399 723 1,597 8,938
Out-of-state 30 67 144 78 30 59 408
Unknown 23 18 47 32 13 5 138
 
TOTAL OCCURRENCES 1,331 1,611 2,606 1,509 766 1,661 9,484

TABLE 6.5B: TRAUMATIC BRAIN INJURY RATES
BY COUNTY OF RESIDENCE AND AGE
NEW JERSEY, 1997
  Age-specific rate per 100,000
COUNTY OF
RESIDENCE
UNDER 15 15-24 25-44 45-64 65-74 75+ TOTAL
Atlantic 69.3 243.5 148.1 91.6 135.2 251.0 138.6
Bergen 55.6 128.1 73.8 63.9 96.3 357.7 96.6
Burlington 48.2 115.7 51.7 66.4 82.9 309.3 76.1
Camden 97.2 203.4 145.4 130.0 142.5 335.6 148.2
Cape May 25.3 160.2 104.8 62.4 55.5 390.5 109.0
Cumberland 64.1 253.7 115.6 127.4 154.0 357.6 141.9
Essex 97.0 178.5 115.8 85.7 146.5 275.2 125.7
 
Gloucester 58.8 139.2 76.4 66.7 125.0 449.3 98.8
Hudson 173.5 252.0 198.1 152.9 190.3 476.0 206.7
Hunterdon 42.7 54.9 48.1 55.9 128.2 375.0 68.8
Mercer 70.5 151.1 120.1 77.9 136.6 346.2 120.4
Middlesex 74.6 99.7 52.8 65.4 109.8 282.2 81.3
Monmouth 78.5 196.1 94.6 78.7 136.1 304.7 115.2
Morris 51.7 85.6 45.2 43.8 136.9 294.0 68.9
 
Ocean 62.7 147.0 92.4 74.6 73.9 190.5 98.2
Passaic 88.3 178.0 132.9 115.0 146.8 281.5 135.3
Salem 40.1 141.2 121.7 48.9 109.6 195.1 93.9
Somerset 56.8 120.1 52.3 57.0 139.6 297.6 78.7
Sussex 70.7 211.5 46.6 73.6 133.7 430.9 97.8
Union 52.5 89.4 58.0 54.6 94.2 323.3 81.3
Warren 68.4 130.3 25.7 62.1 111.5 356.2 82.4
 
Total-New Jersey 76.3 155.8 94.5 80.5 121.2 313.6 111.0

TABLE 6.6: NUMBER OF TRAUMATIC BRAIN INJURIES AND RATES
BY COUNTY OF RESIDENCE AND SEVERITY
NEW JERSEY, 1997
  NUMBER RATE PER 100,000
COUNTY OF RESIDENCE Mild Moderate to severe Fatal Total* Mild Moderate to severe Fatal Total*
Atlantic 187 76 52 328 79.0 36.8 21.9 138.6
Bergen 480 220 81 822 56.4 30.1 9.5 96.6
Burlington 170 78 57 318 40.7 20.8 13.6 76.1
Camden 394 231 89 748 78.1 50.9 17.6 148.2
Cape May 57 26 18 107 58.1 31.6 18.3 109.0
Cumberland 108 52 28 200 79.5 41.1 19.9 142.0
Essex 419 307 131 944 76.6 49.1 17.5 125.8
 
Gloucester 130 64 37 243 55.8 30.4 15.0 98.7
Hudson 814 176 92 1,140 147.6 40.1 16.6 206.7
Hunterdon 36 27 10 83 29.9 28.2 8.3 68.9
Mercer 226 104 44 397 68.5 37.0 13.4 120.4
Middlesex 288 188 60 576 40.7 31.4 8.5 81.3
Monmouth 422 149 78 687 70.8 30.1 13.1 115.2
Morris 160 90 35 313 35.2 23.3 7.7 68.9
 
Ocean 247 123 76 472 51.4 29.5 15.8 98.2
Passaic 395 170 49 655 81.6 35.1 10.1 135.2
Salem 27 21 10 62 40.9 37.9 15.1 93.8
Somerset 106 66 33 218 38.3 26.0 11.9 78.8
Sussex 66 44 16 139 46.5 39.5 11.3 97.9
Union 171 123 77 405 34.3 30.9 15.4 81.3
Warren 47 21 7 81 47.8 24.4 7.2 82.5
 
TOTAL-NJ 4,950 1,966 1,080 8,938 61.5 34.1 13.4 111.0
Out-of-state 232 103 53 408 N/A N/A N/A N/A
Unknown 102 27 1 138 N/A N/A N/A N/A
 
TOTAL OCCURENCES 5,621 2,309 1,134 9,484 N/A N/A N/A N/A
* Includes unknown levels of severity

TABLE 7A: TRAUMATIC BRAIN INJURIES
IN SELECTED URBAN AREAS
NEW JERSEY, 1997
City County Number of TBIs % of county total City rate per 100,0000 County rate per 100,000 Trauma care level
Atlantic City Atlantic 72 22.0% 188.7 138.6 II
Camden City Camden 312 41.7% 371.0 148.2 I
Jersey City Hudson 706 61.9% 306.0 206.7 II
Newark Essex 467 49.5% 174.8 125.7 I
Paterson Passaic 333 50.8% 224.4 135.3 II
Trenton Mercer 249 62.7% 293.8 120.4 II
TOTAL 2,139 50.8% 250.7 147.4  
Note: TBI incidencts occurring in some neighboring towns may have been counted in the city total. Caution should be used in interpreating these results.

TABLE 7B: TRAUMATIC BRAIN INJURY RATES
IN SELECTED URBAN AREAS
BY MAJOR CAUSE
NEW JERSEY, 1997
  Rate per 100,000
CITY COUNTY Motor vehicle Fall Assault Other Total
ATLANTIC CITY ATLANTIC 86.6 57.6 28.8 15.7 188.7
Camden City Camden 184.3 72.5 92.8 21.4 371.0
Jersey City Hudson 92.8 99.3 85.8 28.1 306.0
Newark Essex 59.2 50.9 47.9 16.8 174.8
Paterson Passaic 74.2 66.0 66.0 18.2 224.4
Trenton Mercer 135.7 75.5 62.5 20.1 293.8
TOTAL 92.0 71.5 66.3 20.9 250.7
Note: TBI incidencts occurring in some neighboring towns may have been counted in the city total. Caution should be used in interpreting these results.

 
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