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Published on: January 20, 2023
Epidemiology of Traumatic Brain Injury in Medicare Beneficiaries over the Last Decade: A Retrospective Observational
Lidia Mvr Moura1,2, Lawrence Zaborski3, Aidan McDonald Wojciechowski1,2
1Department of Neurology, Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA.
Background And Aims:
Older adults have higher rates of traumatic brain injuries (TBI) than other age groups, accounting for most TBI-related hospitalizations and mortality. However, there is no up-to-date data on annual trends and regional differences in older Medicare beneficiaries. Here we estimate the incidence of TBI-related hospitalizations and identify annual trends and regional differences.
Methods:
This is a retrospective cohort analysis of fee-for-service Medicare claims data from 2010 to 2022. The study population consisted of beneficiaries with at least 1 year of continuous coverage including parts A and B. ICD codes were used to identify TBI-related hospitalizations. We estimated generalized linear mixed Poisson regression models of the aggregated TBI counts and included age group, sex, race/ethnicity, a sex by race/ethnicity interaction, period, and a random state effect as covariates. Geographic variability was summarized by the state random effects.
Results:
704,409 total observations met eligibility with 684,869 unique beneficiaries. Majority of beneficiaries were in the age ranges of 81-85 (22%) and 86-90 (22%), and 56% (n = 394,024) were female. Majority of beneficiaries were White (n = 610,688, 87%) and 5% (n = 31,723) were Hispanic. Incidence of TBI hospitalizations increased with age and were higher in females, particularly in the oldest age groups of 86-90 (7.15 [CI 7.06-7.25] in females vs. 5.49 [CI 5.41-5.56] in males) and > 91 (8.39 [CI 8.27-8.51] in females vs. 6.97 [CI 6.8-7.07] in males). Higher incidence of TBI hospitalizations were seen in the South, Northeast and West, with lower rates in the Midwest.
Conclusion:
We demonstrate that over the years TBI-related hospitalizations are consistently higher in the oldest-old adults, and in females. There is regional variation with highest TBI-related hospitalizations in the Northeast and South. Future studies aimed at identifying interactions between clinical and demographic factors are indicated to develop targeted public health interventions at mitigating TBI in older adults.
