Original Article
A community survey demonstrated cohort differences in the lifetime prevalence of self-reported head injury

https://doi.org/10.1016/j.jclinepi.2003.10.015Get rights and content

Abstract

Objective

The objective of the study was to assess the lifetime prevalence and validity of self-reported head injury.

Study design and setting

Analysis of a cross-sectional community survey, stratified by birth cohort. Seven thousand four hundred eighty-eight residents of Canberra and Queanbeyan, 3,678 males and 3,810 females, representing three cohorts aged in their 20s, 40s and 60s at the time of the survey, were randomly selected from the Australian Electoral Roll.

Results

The lifetime prevalence of head injury with at least 15 min loss of consciousness ranged from 5.6 to 6.0% across the three cohorts. Self-reported head injury was associated with symptoms of traumatic brain injury or postconcussion syndrome. Reported head injury did not differ across the birth cohorts, contrary to expectations that prevalence rates would increase with age. Analysis of age at first head injury showed significant differences between cohorts in the reported prevalence at age 20, with estimates considerably higher for the youngest cohort.

Conclusion

Although the data may reflect real increases in the risk of head injury, it may be that self-reported measures of lifetime prevalence of head injury underestimate prevalence in older cohorts.

Introduction

Traumatic brain injury (TBI) causes considerable burden for the individual and broader community. The negative consequences of TBI include mortality and long-term disability, financial costs associated with rehabilitation, provision of care and loss of productivity/opportunity, as well as the often profound personal and psychologic impacts on the individual, their family and friends [1], [2], [3], [4], [5], [6].

Although much research has been conducted into the prevalence of TBI, most is based on hospital admissions, clinic/rehabilitation attendees, or mortality data [7]. Such a focus is understandable, given that operationalization of TBI is dependent on clinical diagnosis and the identification of symptoms, which requires neurologic/clinical assessment. However, not all people who experience a TBI seek medical assistance, including many people who experience significant adverse consequences [8], [9].

A number of studies have examined the prevalence of head injury (HI)/brain injury and associated cognitive, emotional, and behavioral problems and disability using convenience and community samples [9], [10], [11], [12], [13], [14], [15], [16], [17], [18]. There are obvious problems with simply asking about experience of HI (e.g., ensuring consistency across individuals in the severity/clinical relevance of reported HI). Some studies inquire about previous medical diagnosis [11], receipt of medical attention [9], or experience of concussion [12]. Others focus on individuals with a disability who attribute the cause to a HI [13], [18]. Other researchers specify a criterion of severity to guide respondents. This may be a minimum period of loss of consciousness, duration of post-traumatic amnesia, or experience of postconcussion symptoms [7], [16].

The aim of this article is to report the prevalence of self-reported HI, with a minimum loss of consciousness of 15 min, in an Australian community-based survey. We determine the validity of this measure by examining association with symptom and disability measures. We also explore important methodologic issues with reported uncertainty and an unexpected pattern of cohort differences.

Section snippets

Sample

The data are from the PATH-Through-Life Project, a large longitudinal community survey measuring the health and well-being of three different cohorts of people from Canberra and the neighboring town of Queanbeyan. The birth years for the three cohorts are 1975–1979, 1956–1960, and 1937–1941. Each cohort is to be followed up every 4 years over a period of 20 years. These results are from the first wave interviews, conducted in late 1999/early 2000 for those aged 20+ years, 2000/2001 for those

Lifetime prevalence of self-reported head injury

The lifetime prevalence of self-reported HI with (at least) 15 min of loss of consciousness was 5.7% (N = 428; Table 1). Males were more than 2.5 times more likely to report HI than females. There was no association between birth cohort and lifetime prevalence of HI (Table 2).

Overall, 19.2% of respondents (23.0% of males and 9.8% of females) who reported a HI with corresponding loss of consciousness indicated that they had experienced more than one HI (N = 82 or 1.1% of the overall population).

Discussion

The present study found that the lifetime prevalence of HI with loss of consciousness of at least 15 min ranged from 5.6 to 6.0% across the three cohorts examined. The use of a measure of self-reported head injury enabled us to identify a HI population with a wide range of severity, including those who do not generally seek medical attention or may not have brain injury [31]. The results are comparable with those from a community survey recently conducted by Silver et al. in New Haven, CT [16].

Acknowledgements

We thank Trish Jacomb, Karen Maxwell, Helen Christensen (a PATH chief investigator), and the PATH interviewers for assistance with the study. Funding was provided by Program Grant No. 179805 from the National Health and Medical Research Council.

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