Brain Cancer Mortality following Traumatic Brain Injury: A TBI Model Systems Study

Growing evidence suggests traumatic brain injury (TBI) may be a risk factor for subsequent brain cancer. We aimed to compare brain cancer mortality rates between persons with TBI and the general population.

Retrospective cohort study of 20,211 individuals with TBI admitted for inpatient rehabilitation following acute hospitalization who enrolled in the TBI Model Systems (TBIMS) National Database (1987-2024). Brain cancer cases were identified by underlying or contributing cause of death on death certificate. Standardized mortality ratios (SMRs) compared to an age, sex, race, and calendar-year matched general population were calculated using the National Institute for Occupational Safety and Health LTASR R package. Secondary analyses explored brain cancer risk factors.

Of the 4,297 decedents, 18 died of brain cancer, reflecting a higher rate than the general population (SMR = 1.75; 95% confidence interval [CI]: 1.04-2.77). Significantly higher brain cancer mortality was observed among participants with gunshot wound (GSW) related TBI (SMR = 14.29; 95% CI: 2.95-41.75), mild TBI (mTBI; SMR = 3.88; 95% CI: 1.06-9.94), but not moderate-to-severe TBI (SMR = 1.52; 95% CI: 0.83-2.54).

Individuals who sustained a TBI had a 1.75-fold higher likelihood of brain cancer death than the general population. Further analyses observed increased brain cancer mortality risk among those with GSW-related TBI and mTBI. Together, these results may inform targets for early prevention and support further investigation of the causal pathophysiology underlying TBI-related brain cancer mortality.