Community Impact

Traumatic Brain Injury in Idaho:
A Longitudinal Analysis of Needs and Resource Assessment Data (2001-2011)

LINKAGE TO GOALS OF CURRENT GRANT:  This project is an effort to complete a longitudinal analysis of the seven statewide Needs and Resources (N&R) Assessments completed from 2001 to 2011.

BACKGROUND:  The first N&R was conducted in 2001, focusing on why individuals with TBI were not receiving various services, how satisfied those receiving services were with the services received, and in what areas additional services were needed. Subsequent surveys completed in 2004, 2005, 2006, 2007, 2008 and 2011 focused on similar issues, replicating many of the data categories over time.  During each of those years, individuals with TBI (or a family member) and providers concomitantly completed separate surveys. The longitudinal data gathered from the surveys tracked which services were available, which services were needed, which were provided, and which needs went unmet. Consumer and provider data were analyzed both individually and together. This crossed analysis improved the reliability of estimates in regard to supply (by providers of services) and demand (by individuals with TBI).

METHODS: Data were collected by mail and internet survey. Individuals with TBI provided information on demographics, service need and utilization of provided services. Providers were queried about the type and number of services provided by their organizations or agencies.

QUESTIONS OF INTEREST: The report sought to answer three main questions: 1) Do the reported needs and resources change across time? 2) Do the reported services and supports change across time? and 3) What is the quality of match between the reported needs and resources and the available services and support?

ANALYSIS AND RESULTS: Longitudinal analyses of variance and frequencies were examined to measure change across time and the match between services used and services available.  The most consistently met needs were reported under the nursing care and personal care assistance categories.  Other categories of need, such as employment supports and mental health services, were reported to be problematic for as many as 1 in 4 of the respondents.  Psychiatric care was identified as particularly lacking in rural Idaho, with many areas having no immediate access to psychiatric care and much lower patient-to-provider ratios than those necessary for adequate care.  Across the decade, the relationship between met and unmet needs was dynamic and changed frequently, with providers reporting that the most significant changes in service provision reflected reduced community-based services.

Comparison of Intentional Deaths (Suicide) and Unintentional Motor Vehicle Traffic Deaths with and without Traumatic Brain Injury as an Underlying Cause 

PURPOSE: This study increases understanding of the complex nature of injury-related death when traumatic brain injury (TBI) is present and compares number of deaths and rate of TBI across two types of injury-related death: intentional and unintentional by motor vehicle traffic (MVT).

QUESTION OF INTEREST: What is the nature of the relationship between MVT deaths and TBI across time, geography, economics, and intent of injury?

BACKGROUND: Injuries are a leading cause of death for all age groups. MVT deaths are the most common fatal unintentional injuries. Some MVT deaths are assumed to be suicides, but there is a scarcity of information about MVT deaths as a mechanism of suicide. Both unintentional and intentional injuries theoretically should have high rates of TBI, but there is little supporting literature. Research links the economy and suicide, with some research linking MVT deaths and the economy. Injury should also vary by state and level of urbanism.

METHODS: A literature review was conducted on intentional and unintentional death with TBI. Additionally, coroners were informally interviewed about how TBI is reported as an underlying cause of death (UCD) and data were integrated with national data on coroner reporting. Cause of death public use data files from the CDC and other government sources at national and state levels were analyzed for Jan. 1, 1999 – Dec. 31, 2010. Classification codes for UCD and TBI were drawn from CDC criteria. Data were stratified by state, year, and urbanism, and were not stratified across age, sex, or race. Economic indicators were calculated at the state level. The CDC WISQARS economic report system was the used to estimate the costs of MVT deaths and suicides, employing a ten-year average (base year 2005) of percent of suicide and MVT deaths that include TBI. Qualitative findings were integrated with national data and quantitative data were analyzed statistically. A multivariate analysis of variance was conducted using suicide and MVT deaths counts by year and by state.

RESULTS AND DISCUSSION: Because of variability in training, background, and algorithms for determining cause of death, it can be difficult for coroners to identify or record TBI among multiple causes of death. Prior to 2009, MVT deaths outnumbered suicide; after 2009, suicide outnumbered MVT deaths both nationally and in Idaho. There is an inverse relationship between MVT deaths and suicide deaths across time. Deaths by suicide and by MVT are similar in prevalence. About half of total MVT death costs include TBI as an UDC. Similarly, about half of the costs of suicide are from suicides with TBI. Conclusion: MVT deaths, while similar in prevalence to suicides, receive more public health attention in safety and prevention, possibly owing to lack of awareness and stigma surrounding suicide. Better TBI coding and further study of TBI as a risk factor for suicide, as well as identifying links among suicide, MVT deaths, and TBI, could reduce risk of suicide attempts or completions by directing prevention toward TBI. There is scant literature on the prevalence of using a motor vehicle as a mechanism of a suicide death, with major differences by state. State-level prevention could be aided by examining characteristics of states. Intentional and unintentional accidents are similar in prevalence, yet it is likely that people would estimate motor vehicle accidents to be far more common than suicide. Stigma and cultural prohibitions may make it easier to talk about MVT deaths than suicide, evidence that suicide affects many more people than society realizes.