ACQUIRED BRAIN INJURY in MASSACHUSETTS

a report generated in response to and requested by the

Brain Injury Commission

Massachusetts Department of Public Health

Massachusetts Rehabilitation Commission

October 2014

ACQUIRED BRAIN INJURY in MASSACHUSETTS

Deval L. Patrick, Governor

John Polanowicz, Secretary of Health and Human Services

Cheryl Bartlett, Commissioner of Public Health

Charles Carr, Commissioner, Massachusetts Rehabilitation Commission

October 2014

CONTRIBUTING AUTHORS, AFFILIATIONS and PARTICIPATING AGENCIES

Primary Authors:

Holly Hackman, M.D., MPH: Epidemiologist, Office of Statistics and Evaluation, Massachusetts Department of Public Health (MDPH)

Francesca LaVecchia, Ph.D.: Clinical Neuropsychologist, Massachusetts Rehabilitation Commission; Assistant Adjunct Professor of Psychiatry and Core Faculty, Behavioral Neurosciences Doctoral Program, Boston University School of Medicine

Debra S. Kamen, M.S.: Retired Assistant Commissioner, Community Living Division, Massachusetts Rehabilitation Commission

Contributing Authors:

Amy Bettano, MPH, CPH: Epidemiologist, Prevention and Wellness Trust Fund, Office of

Statistics and Evaluation, Bureau of Community Health and Prevention, MDPH

James Buszkiewicz, MPH: Epidemiologist, Nutrition, Physical Activity and Obesity, Office of

Statistics and Evaluation, Bureau of Community Health and Prevention, MDPH

Molly Crockett, MPH: Epidemiologist, Office of Integrated Surveillance and Informatics

Services, Bureau of Infectious Disease, MDPH

Alfred DeMaria, Jr., M.D.: Medical Director, Infectious Diseases, Bureau of Infectious

Disease, MDPH

Paul Hunter: Director, Childhood Lead Poisoning Prevention Program, Bureau of

Environmental Health, MDPH

Richard Knowlton, M.S.: Epidemiologist, Massachusetts Cancer Registry, Office of Data

Management and Outcomes Assessment, MDPH

Gabrielle Parkinson, M.S., NSCA-CPT: Epidemiologist/Data Analyst, Paul Coverdell National Acute Stroke Registry, Office of Statistics and Evaluation, Bureau of Community Health and Prevention, MDPH

Special Thanks To

Senator Harriette L. Chandler

Co-Chair, Brain Injury Commission

Representative Thomas P. Conroy

Co-Chair, Brain Injury Commission

Representative Kimberly N. Ferguson

Rosalie Edes

Assistant Secretary, Disability Policies & Programs

Executive Office of Health and Human Services

Massachusetts Department of Public Health

Cheryl Bartlett, R.N.

Commissioner

Thomas Land, Ph.D.

Director, Office of Data Management and Outcomes Assessment

Laura Nasuti, MPH, Ph.D.

Deputy Director, Office of Statistics and Evaluation

Bureau of Community Health and Prevention

Alicia J. Fraser, MPH, DSc

Assistant Director, Environmental Epidemiology Program

Bureau of Environmental Health

Letitia Davis, Sc.D., Ed.M.

Director, Occupational Health Surveillance Program

Bureau of Community Health and Prevention

Gillian A. Haney, MPH

Director, Office of Integrated Surveillance and Informatics Services

Bureau of Infectious Disease

Beth Hume, MPH

Project Director, Injury Surveillance Program

Bureau of Community Health and Prevention

Special thanks also to the numerous MDPH reviewers and contributors who assisted in the completion of the report and who are not mentioned above.

Massachusetts Rehabilitation Commission

Charles Carr

Commissioner

Kasper Goshgarian

Deputy Commissioner

Kerri Zanchi

Assistant Commissioner, Community Living

Brain Injury and Statewide Specialized Community Services

Ernestine Fenton

Program Coordinator

Edward Loring

Administrative Assistant

Beth Williams

Senior Program Coordinator

This publication may be accessed at:

http://www.mass.gov/eohhs/docs/mrc/acquired-brain-injury-ma.pdf

Suggested Citation: Hackman H, LaVecchia F, Kamen D, et al. Acquired Brain Injury in Massachusetts. Boston, MA: Massachusetts Department of Public Health and Massachusetts Rehabilitation Commission; October, 2014.

Table of Contents

List of Tables.......................................................................................................................i-iii List of Diagrams....................................................................................................................iv List of Figures.......................................................................................................................iv Executive Summary..........................................................................................................v-viii I. Brain Injury Commission History................................................1-2

II. Overview of Acquired Brain Injury.........................................3-12

III. Epidemiology of Acquired Brain Injury in Massachusetts

A. Data Sources, Methods and Technical Notes.................................................13-20

B. Central Nervous System (CNS) Neoplasms....................................................21-29

C. Infectious Diseases Associated with Disorders of the CNS............................30-40

D. Metabolic Disorders Affecting the CNS...........................................................41-52

E. Neurotoxic Disorders.......................................................................................53-55

F. Neurovascular Diseases and Conditions.........................................................56-68

G. Traumatic Brain Injury.....................................................................................69-80

H. Progressive Disorders of the CNS..................................................................81-86

I. Summary of Data Findings..............................................................................87-92

IV. Prevention of Acquired Brain Injury: Strategies and Initiatives.................................93-99

V. Acquired Brain Injury Resources...........................................................................100-103

VI. Appendices104-128

Appendices

Appendix A: Glossary of Acronyms and Initialisms

Appendix B: ICD-9-CM and ICD-O Codes Used for Definitions of Acquired Brain Injury

B-1CNS Neoplasms

B-2Infectious Diseases Associated with Disorders of the CNS B-3Metabolic Disorders Affecting the CNS

B-4Neurovascular Diseases and Conditions

B-5Traumatic Brain Injury

Appendix C: Map of EOHHS Regions and Towns

List of Tables

Table B1: Malignant and Non-malignant Brain and CNS Tumors by Anatomic Site, MA Residents, 2008-2010

Table B2: Brain and CNS Tumors by Age Group, MA Residents, 2008-2010

Table B3: Brain and CNS Tumors by Race/Ethnicity, MA Residents, 2008-2010

Table B4: Brain and CNS Tumors by Sex, MA Residents, 2008-2010

Table B5: Insurance at Diagnosis for All Brain and CNS Tumors, MA Residents, 2008-2010

Table C1: Inpatient Hospitalizations, Observation Stays and Emergency Department Discharges Associated with Infectious Disease-related Acquired Brain Injury, MA Residents, 2008-2010

Table C2: Average Annual Counts and Crude Rates of Hospital Stays and Emergency Department Discharges Associated with Infectious Disease-related Acquired Brain Injury by Age Group, MA Residents, 2008-2010

Table C3: Average Annual Counts and Crude Rates of Hospital Stays and Emergency Department Discharges Associated with Infectious Disease-related Acquired Brain Injury by Sex, MA Residents, 2008-2010

Table C4: Average Annual Counts and Crude Rates of Hospital Stays and Emergency Department Discharges Associated with Infectious Disease-related Acquired Brain Injury by Race/Ethnicity, MA Residents, 2008-2010

Table C5: Annual Counts and Crude Rates of Hospital Stays and Emergency Department Discharges Associated with Infectious Disease-related Acquired Brain Injury by Executive Office of Health and Human Services (EOHHS) Region of Residence, MA Residents, 2008-

2010

Table C6: Average Annual Primary Payer Type Category for Inpatient Hospitalizations, Observation Stays and Emergency Department Discharges Associated with Infectious Disease-related Acquired Brain Injury, MA Residents, 2008-2010

Table C7: Average Annual Inpatient Hospitalizations Associated with Infectious Disease- related Acquired Brain Injury by Disposition Category and Age Group, MA Residents, 2008-

2010

Table D1: Inpatient Hospitalizations, Observation Stays and Emergency Department Discharges Associated with Metabolic Disorders Affecting the Central Nervous System, MA Residents, 2008-2010

i

Table D2: Average Annual Counts and Crude Rates of Hospital Stays and Emergency Department Discharges Associated with Metabolic Disorders Affecting the Central Nervous System by Age Group, MA Residents, 2008-2010

Table D3: Average Annual Counts and Crude Rates of Hospital Stays and Emergency Department Discharges Associated with Metabolic Disorders Affecting the Central Nervous System by Sex, MA Residents, 2008-2010

Table D4: Average Annual Counts and Crude Rates of Hospital Stays and Emergency Department Discharges Associated with Metabolic Disorders Affecting the Central Nervous System by Race and Ethnicity, MA Residents, 2008-2010

Table D5: Average Annual Counts and Crude Rates of Hospital Stays and Emergency Dep