The Epidemiology of Fatal Occupational Traumatic Brain Injury in the U.S.

  • Hope M. Tiesman
    Address correspondence to: Hope M. Tiesman, PhD, National Institute for Occupational Safety and Health, Division of Safety Research, 1095 Willowdale Road, M/S 1811, Morgantown WV 26506
    National Institute for Occupational Safety and Health, Division of Safety Research, Analysis and Field Evaluations Branch, Morgantown, West Virginia
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  • Srinivas Konda
    National Institute for Occupational Safety and Health, Division of Safety Research, Analysis and Field Evaluations Branch, Morgantown, West Virginia
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  • Jennifer L. Bell
    National Institute for Occupational Safety and Health, Division of Safety Research, Analysis and Field Evaluations Branch, Morgantown, West Virginia
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      Although traumatic brain injury (TBI) is one of the leading causes of death and disability in the U.S., work-related TBI has not been well documented.


      The aim of this study was to describe the epidemiologic characteristics and temporal trends of fatal occupational TBI in the U.S between 2003 and 2008.


      A cross-sectional analysis of the Census of Fatal Occupational Injury database was performed. Both the Occupational Injury and Illness Classification System nature of injury codes and body part codes were used to define TBIs. Fatality rates were calculated using denominators derived from the Current Population Survey. Fatality rates were compared among industries, cause of death, and demographics with rate ratios (RRs) and 95% CIs. Poisson regression was used to assess trends in fatality rates. Data were analyzed in 2009–2010.


      Nearly 7300 occupational TBI deaths occurred between 2003 and 2008, for an average fatality rate of 0.8 per 100,000 workers per year. The leading causes of occupational TBI death were as follows: motor vehicle (31%); falls (29%); assaults and violent acts (20%); and contact with objects/equipment (18%). Fatality rates were 15 times higher in men compared with women (RR=15, 95% CI=13.7, 16.3). Workers aged ≥65 years experienced the highest TBI fatality rate of all age groups (2.5 per 100,000 per year). Construction, transportation, and agriculture/forestry/fishing industries recorded nearly half of all TBI fatalities (n=1828, n=825, n=761, respectively). Occupational TBI death rates declined 23% over the 6-year period (p<0.0001).


      This study provides the first national profile of fatal TBIs occurring in the U.S. workplace. Prevention efforts should be directed at those industries with the highest frequency and/or highest risk. The construction industry had the highest number of TBIs, and the agriculture, forestry, and fishing industry had the highest rates. Additionally, workers aged >65 years in all industries would be a good target for future prevention efforts.
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