New Data Shows Where Brain Injuries Turn Deadliest

Traumatic brain injuries (TBIs) are often discussed as isolated medical events: a fall, a crash, a bad hit. But a new analysis from Siegfried & Jensen suggests TBI risk isn’t just personal. It’s regional.

Each year in the U.S., around 2.5 million people sustain a traumatic brain injury, an injury that can cause long-term disability, repeated hospitalizations, loss of employment, and even death. While TBIs occur nationwide, data from this study shows TBI fatality rates vary sharply by state, revealing a pattern tied to geography, emergency access, climate, road conditions, and age distribution.

The States With the Highest Fatal TBI Rates

In 2024, the states with the highest TBI death rates per 100,000 residents were:

• Alaska: 112 deaths (15.3 per 100,000)

• Montana: (12.5 per 100,000)

• Wyoming: (11.1 per 100,000)

• Wisconsin: 627 deaths (10.6 per 100,000)

• South Dakota: (10.2 per 100,000)

• Idaho: (9.6 per 100,000)

• South Carolina: 518 deaths (9.6 per 100,000)

• Ohio: 1,089 deaths (9.2 per 100,000)

• Maryland: 564 deaths (9.1 per 100,000)

• Kansas: 269 deaths (9.1 per 100,000)

The pattern is telling: states with smaller, more dispersed populations frequently show higher fatality rates, even when total deaths are lower than in larger states.

Why Rural States Often See Deadlier Outcomes

The study points to several compounding factors that can make TBIs more fatal in rural and remote settings:

• Longer emergency response times and longer transport times to trauma centers

• Limited access to neurological specialty care

• Environmental hazards such as extreme weather and icy conditions

• Higher exposure to transportation-related trauma, including rural highway crashes

• Aging populations in many regions, increasing fall-related TBI risk

Alaska is a standout example. Its remoteness, harsh climate, and barriers to timely specialized care can intensify injury severity. Similar challenges appear across the Mountain West.

Meanwhile, states such as Wisconsin may experience a combination of winter slip-and-fall injuries, rural crash dynamics, and age-related vulnerability.

TBIs Aren’t One Thing — They’re Many Causes With One Common Result

TBIs are typically classified into mild, moderate, and severe categories. Mild TBIs (often called concussions) account for the majority of cases, but severe TBIs carry the greatest risk for death and lifelong disability.

The study highlights the most common TBI causes:

• Falls (28%)

• Motor vehicle crashes (20%)

• Hit by/against an object (19%)

• Assaults (11%)

These causes don’t occur evenly across states. Differences in road infrastructure, industry mix, weather hazards, and access to preventive care can all shift a state’s TBI profile.

Older Adults Remain the Highest-Risk Group Nationwide

Across the U.S., adults 75 and older account for 31.6% of nonfatal TBI hospitalizations and over a quarter of TBI deaths. In many rural states with aging demographics, that reality becomes even more significant. For seniors, the most common trigger is not violence or high-impact activity — it’s a fall.

Prevention Strategies That Can Save Lives

To reduce fatal outcomes, the study emphasizes prevention and early action:

• Fall prevention: strength/balance training, home safety upgrades, medication review, vision checks

• Road safety: seat belts, helmets, sober and distraction-free driving

• Workplace protections: fall prevention in construction and high-risk roles, equipment safeguards

• Stronger concussion protocols in sports and recreation

Ultimately, the data makes one thing clear: where you live can shape whether a brain injury becomes survivable — or deadly.

Frequently Asked Questions About Traumatic Brain Injury (TBI Death Rates)

What is a traumatic brain injury (TBI)?
A traumatic brain injury occurs when an external force disrupts normal brain function. TBIs range from mild concussions to severe injuries that can cause permanent disability or death.

Why do some states have higher TBI death rates than others?
Fatal TBI rates vary due to differences in geography, population density, climate, emergency response times, and access to trauma care. Rural and remote states often face longer delays in medical treatment, which can increase the risk of death after a brain injury.

Why do Alaska, Montana, and Wyoming rank so high for TBI fatalities?
These states combine several high-risk factors: sparse populations, long transport distances to trauma centers, harsh weather conditions, and higher exposure to transportation-related accidents. Limited access to neurological specialists also plays a role.

Does a higher death rate mean more TBIs are happening in those states?
Not necessarily. Some states report fewer total TBIs but higher death rates per capita. This suggests injuries may be more severe, treatment may be delayed, or patients may have fewer medical resources available after injury.

What are the most common causes of TBIs nationwide?
Falls are the leading cause, followed by motor vehicle crashes, being struck by objects, and assaults. The distribution of these causes varies by state based on age demographics, infrastructure, and occupational risks.

Why are older adults especially vulnerable to fatal TBIs?
Older adults are more likely to suffer falls and often have underlying health conditions that complicate recovery. Brain injuries in seniors are also more likely to result in bleeding, longer hospital stays, and fatal outcomes.

How does emergency response time affect TBI survival?
Quick access to advanced trauma care is critical for TBI survival. Delays in diagnosis, imaging, or neurosurgical intervention can significantly increase the risk of death or permanent brain damage.

Can fatal TBIs be prevented?
Many TBIs are preventable through fall prevention measures, safer driving practices, workplace safety standards, helmet use, and early medical evaluation after head injuries.

What does this data suggest for public health policy?
The findings highlight the need for improved emergency infrastructure, better access to trauma centers, targeted prevention efforts for seniors, and region-specific safety strategies—especially in rural and remote states.