Background: Although reducing the burden of head injuries is an important focus of several injury prevention initiatives, they remain a large proportion of injury-related deaths. In New Zealand, trends over time and the socio-economic distribution of the cause-specific incidence of head injuries have received little attention. Methods: We analyzed primary hospitalizations (2000-2009) and deaths (1999-2008) due to head injury using national mortality and hospital discharge databases, specifically exploring variations in age-specific rates by major causes over time and by socio-economic deprivation. Population-based incidence rate estimates were calculated using census denominators. Results: Children aged <5 years and adults aged ≥65 years had the highest rates of hospitalization and mortality, respectively. Transport-related incidents and falls were the leading causes, with most fatal injuries occurring on roads and most hospitalized injuries occurring at home. There was a significant increase in mortality rates among older adults over the decade, and in most age groups, mortality rates increased with increasing levels of socio-economic deprivation. Conclusions: The findings of this review alongside the significant risks of premature death and disability reinforce the need to explore policies that address the specific causes as well as socio-economic inequalities in their distribution in New Zealand.

1.
Taylor HG, Swartwout MD, Yeates KO, Walz NC, Stancin T, Wade SL: Traumatic brain injury in young children: postacute effects on cognitive and school readiness skills. J Int Neuropsychol Soc 2008;14:734-745.
2.
Shames J, Treger I, Ring H, Giaquinto S: Return to work following traumatic brain injury: trends and challenges. Disabil Rehabil 2007;29:1387-1395.
3.
Bruns J, Hauser WA: The epidemiology of traumatic brain injury: a review. Epilepsia 2003;44:2-10.
4.
Thurman DJ, Alverson C, Dunn KA, Guerrero J, Sniezek JE: Traumatic brain injury in the United States: a public health perspective. J Head Trauma Rehabil 1999;14:602-612.
5.
Barker-Collo SL, Wilde NJ, Feigin VL: Trends in head injury incidence in New Zealand: a hospital-based study from 1997/1998 to 2003/2004. Neuroepidemiology 2009;32:32-39.
6.
National Centre for Classification in Health: The International Statistical Classification of Diseases and Related Health Problems, 10th revision, Australian modification, ed 3. Sydney, National Centre for Classification in Health, 2002.
7.
Coronado VG, Xu L, Basavaraju SV, McGuire LC, Wald MM, Faul MD, Guzman BR, Hemphill JD, Centers for Disease Control and Prevention (CDC): Surveillance for traumatic brain injury-related deaths - United States, 1997-2007. MMWR Surveill Summ 2011;60:1-32.
8.
Langley J, Stephenson S, Cryer C, Borman B: Traps for the unwary in estimating person based injury incidence using hospital discharge data. Inj Prev 2002;8:332-337.
9.
Salmond C, Crampton P, Atkinson J: NZDep2006 Index of Deprivation. Wellington, Department of Public Health, University of Otago, 2007.
10.
Statistics New Zealand: New Zealand census data. http://www.Stats.Govt.Nz/tools_and_services/tools/tablebuilder/tables-by-subject.Aspx (accessed 1 June 2012).
11.
New Zealand Ministry of Health: Ethnicity Data Protocols for the Health and Disability Sector. Wellington, Ministry of Health, 2004.
12.
Rothman KJ: Epidemiology. An Introduction. New York, Oxford University Press, 2002.
13.
Feigin VL, Theadom A, Barker-Collo S, Starkey NJ, McPherson K, Kahan M, Dowell A, Brown P, Parag V, Kydd R, Jones K, Jones A, Ameratunga S: Incidence of traumatic brain injury in New Zealand: a population-based study. Lancet Neurol 2013;12:53-64.
14.
Faul M, Xu L, Wald MM, Coronado VG: Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations and Deaths 2002-2006. Atlanta, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2010.
15.
Andelic N, Sigurdardottir S, Brunborg C, Roe C: Incidence of hospital-treated traumatic brain injury in the Oslo population. Neuroepidemiology 2008;30:120-128.
16.
Colantonio A, Croxford R, Farooq S, Laporte A, Coyte PC: Trends in hospitalization associated with traumatic brain injury in a publicly insured population, 1992-2002. J Trauma 2009;66:179-183.
17.
Koskinen S, Alaranta H: Traumatic brain injury in Finland 1991-2005: a nationwide register study of hospitalized and fatal TBI. Brain Inj 2008;22:205-214.
18.
Phillips LA, Voaklander DC, Drul C, Kelly KD: The epidemiology of hospitalized head injury in British Columbia, Canada. Can J Neurol Sci 2009;36:605-611.
19.
Servadei F, Antonelli V, Betti L, Chieregato A, Fainardi E, Gardini E, Giuliani G, Salizzato L, Kraus JF: Regional brain injury epidemiology as the basis for planning brain injury treatment. The Romagna (Italy) experience. J Neurosurg Sci 2002;46:111-119.
20.
Bowman SM, Bird TM, Aitken ME, Tilford JM: Trends in hospitalizations associated with pediatric traumatic brain injuries. Pediatrics 2008;122:988-993.
21.
Langlois JA, Rutland-Brown W, Thomas KE: The incidence of traumatic brain injury among children in the United States: differences by race. J Head Trauma Rehabil 2005;20:229-238.
22.
McCarthy ML, Serpi T, Kufera JA, Demeter LA, Paidas C: Factors influencing admission among children with a traumatic brain injury. Acad Emerg Med 2002;9:684-693.
23.
Sills MR, Libby AM, Orton HD: Prehospital and in-hospital mortality: a comparison of intentional and unintentional traumatic brain injuries in Colorado children. Arch Pediatr Adolesc Med 2005;159:665-670.
24.
Williamson LM, Morrison A, Stone DH: Trends in head injury mortality among 0-14 year olds in Scotland (1986-95). J Epidemiol Community Health 2002;56:285-288.
25.
Wright DW, McGuire LC, Chen B, Popovic T: CDC grand rounds: reducing severe traumatic brain injury in the United States. MMWR Morb Mortal Wkly Rep 2013;62:549-552.
26.
Kool B, Ameratunga S, Hazell W, Ng A: Unintentional falls at home among young and middle-aged New Zealanders resulting in hospital admission or death: context and characteristics. N Z Med J 2010;123:75-84.
27.
New Zealand Injury Prevention Secretariat: The New Zealand Injury Prevention Outcomes Report - June 2012. Wellington, New Zealand Injury Prevention Secretariat, 2012.
28.
Baldo V, Marcolongo A, Floreani A, Majori S, Cristofolettil M, Dal Zotto A, Vazzoler G, Trivello R: Epidemiological aspect of traumatic brain injury in Northeast Italy. Eur J Epidemiol 2003;18:1059-1063.
29.
Berry JG, Jamieson LM, Harrison JE: Head and traumatic brain injuries among Australian children, July 2000-June 2006. Inj Prev 2010;16:198-202.
30.
Ferrell R, Tanev K: Traumatic brain injury in older adults. Curr Psychiatry Rep 2002;4:354-362.
31.
Peel NM, Kassulke DJ, McClure RJ: Population based study of hospitalised fall related injuries in older people. Inj Prev 2002;8:280-283.
32.
Rubenstein LZ: Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing 2006;35:ii37-ii41.
33.
Robertson MC, Devlin N, Gardner MM, Campbell AJ: Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 1. Randomised controlled trial. BMJ 2001;322:697.
34.
Robertson C, Campbell AJ: Optimisation of ACC's Fall Prevention Programmes for Older People. Final Report November 2008. Dunedin, University of Otago, 2008.
35.
Robson B, Harris R: Hauora: Maori Standards of Health IV. A Study of the Years 2000-2005. Wellington, Te Ropu Rangahau Hauora a Eru Pomare, 2007.
36.
Hosking J, Ameratunga S, Exeter D, Stewart J, Bell A: Ethnic, socioeconomic and geographical inequalities in road traffic injury rates in the Auckland region. Aust N Z J Public Health 2013;37:162-167.
37.
Alcohol Advisory Council of New Zealand: Maori Action Plan 2009-2012. Wellington, Alcohol Advisory Council of New Zealand, 2009.
38.
Ajwani S, Blakely T, Robson B, Tobias M, Bonne M: Decades of Disparity: Ethnic Mortality Trends in New Zealand 1980-1999. Public Health Intelligence Occasional Bulletin Number 16. Wellington, Public Health Intelligence, 2003.
39.
Tennant A: Admission to hospital following head injury in England: incidence and socio-economic associations. BMC Public Health 2005;5:1-8.
40.
Sharples PM, Storey A, Aynsley-Green A, Eyre JA: Causes of fatal childhood accidents involving head injury in Northern region, 1979-86. BMJ 1990;301:1193-1197.
41.
Morrison A, Stone DH, Redpath A, Campbell H, Norrie J: Trend analysis of socioeconomic differentials in deaths from injury in childhood in Scotland, 1981-95. BMJ 1999;318:567-568.
42.
Dunn LM, Henry J, Beard D: Social deprivation and adult head injury: a national study. J Neurol Neurosurg Psychiatry 2003;74:1060-1064.
43.
Harrington DT, Connolly M, Biffl WL, Majercik SD, Cioffi WG: Transfer times to definitive care facilities are too long: a consequence of an immature trauma system. Ann Surg 2005;241:961-968.
44.
Seelig JM, Becker DP, Miller JD, Greenberg RP, Ward JD, Choi SC: Traumatic acute subdural hematoma: major mortality reduction in comatose patients treated within four hours. N Engl J Med 1981;304:1511-1518.
45.
Civil I: Trauma: still a problem in New Zealand. N Z Med J 2004;117:U1042.
46.
Accident Compensation Corporation: Preventing Injury from Falls: The National Strategy. Te Arai i Nga Aitua Hinga: Te Rautaki a-motu 2005-2015. Wellington, ACC, 2005.
47.
Brewin M, Coggan C: Evaluation of the Ngati Porou Community Injury Prevention Project. Ethn Health 2004;9:5-15.
48.
Abelson-Mitchell N: Epidemiology and prevention of head injuries: literature review. J Clin Nurs 2007;17:46-57.
49.
World Health Organisation: Global Status Report on Road Safety: Time for Action, Geneva, World Health Organisation, 2009.
50.
Hyder AA, Wunderlich CA, Puvanachandra P, Gururaj G, Kobusingye OC: The impact of traumatic brain injuries: a global perspective. Neurorehabilitation 2007;22:341-353.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.