Trends in pediatric traumatic brain injury-related mortality in the United States from 1999 to 2024: a retrospective cross-sectional analysis

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Background: Pediatric traumatic brain injury (pTBI) remains a preventable cause of death among U.S. children and adolescents. Prior national CDC WONDER-based analyses described pTBI mortality through 2017; however, updated surveillance is needed to evaluate post-2017 and post-2020 trends. Methods: We conducted a population-based repeated cross-sectional analysis using the CDC WONDER Multiple Cause of Death data from 1999 to 2024 among U.S. residents aged 0–19 years with pTBI-related ICD-10 codes recorded anywhere on the death certificate. Crude mortality rates (CMRs) per 1 000 000 population were used to describe the absolute mortality burden. Joinpoint regression estimated the annual percent change (APC) and the average APC (AAPC). Results: From 1999 to 2024, 128 852 pTBI-related deaths occurred among individuals aged 0–19 years. Overall CMR declined from 89.78 per 1 000 000 population in 1999 to 46.63 per 1 000 000 population in 2024, with significant declines from 1999 to 2006 and from 2006 to 2010, a significant increase from 2013 to 2022, and no statistically significant change from 2022 to 2024. Males accounted for more deaths than females (91 852 vs. 37 000), and adolescents aged 15–19 years accounted for the largest number of deaths (82 409). Non-Hispanic American Indian or Alaska Native children had the highest annual CMRs in both bridged-race and single-race periods. State-level burden remained geographically heterogeneous, with Wyoming the highest and Massachusetts the lowest during 1999–2020, and Montana the highest and Massachusetts the lowest during 2021–2024. Conclusion: U.S. pTBI-related crude mortality burden declined overall from 1999 to 2024, but recent increases and persistent demographic and geographic differences highlight the need for continued surveillance and targeted prevention.