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Complete Health Indicator Report of Traumatic Brain Injury (TBI)

Definition

TBI Incidence Rate: The rate of traumatic brain injuries (TBIs) resulting in emergency department visit, hospitalization, or death per 100,000 population. TBI Hospitalizations and Deaths Percentage: The percentage of TBIs resulting in hospitalization or death. TBI Hospitalizations Rate: The rate of TBIs resulting in hospitalizations per 10,000 population. For all definitions, these cases may include a TBI alone or in combination with other injuries or conditions. ICD-9-CM Hospital Codes for TBI Morbidity: 800.0-801.9 Fracture of the vault or base of the skull; 803.0-804.9 Other and unqualified and multiple fractures of the skull; 850.0-854.1 Intracranial injury, including concussion, contusion, laceration, and hemorrhage; 950.1-950.3 Injury to the optic chiasm, optic pathways, and visual cortex; 959.01 Head injury, unspecified; 995.55 Shaken Infant Syndrome. ICD-10 Death Codes for TBI Mortality: S01.0-S01.9 Open wound of the head; S02.0, S02.1, S02.3, S02.7-S02.9 Fracture of skull and facial bones; S04.0 Injury to optic nerve and pathways; S06.0-S06.9 Intracranial injury; S07.0, S07.1, S07.8, S07.9 Crushing injury of head; S09.7-S09.9 Other and unspecified injuries of head; T01.0 Open wounds involving head with neck; T02.0 Fractures involving head with neck; T04.0 Crushing injuries involving head with neck; T06.0 Injuries of brain and cranial nerve with injuries of nerves and spinal cord at neck level; T90.1, T90.2, T90.4, T90.5, T90.8, T90.0 Sequelae of injuries of head.

Numerator

TBI Incidence Rate: The number of TBIs resulting in emergency department visit, hospitalization, or death which meet the case definition mentioned in the data notes explaining ICD-9 and ICD-10 codes . TBI Hospitalizations and Deaths Percentage: The number of TBIs with a cause or set of causes as defined through medical record review. TBI Hospitalizations Rate: The number of TBIs resulting in hospitalization which meet the case definition mentioned in the data notes explaining ICD-9 and ICD-10 codes .

Denominator

TBI Incident Rate / Hospitalizations Rate: The total number of persons in the population of Utah. TBI Hospitalizations and Deaths Percentage: The number of hospitalizations or deaths due to TBI in the TBI Injury Surveillance Database sample.

Data Interpretation Issues

Due to issues incident to the 2015 transition to the ICD-10-CM coding system, 2014 is the most recent data year available for ED visits and hospitalizations. 2015 data is available from sampled TBI Hospitalization and Death cases, provided by the Violence and Injury Prevention Program, Traumatic Brain Injury Surveillance Program, this data was used to report etiology. Traumatic brain injury (TBI) is defined as an occurrence of injury or death resulting from trauma to the head. With regard to injury, the occurrence must be documented in a medical record with one or more of the following: observed or self-reported loss of consciousness or decreased level of consciousness; amnesia; skull fracture; changes in motor function, sensory function, reflexes, or speech; seizures; or hemorrhages, bruising, or other trauma of the brain. With death, the injury has been listed on the death certificate, autopsy report, or medical examiner's report as a sequence that caused death. Clinical definitions of TBI exclude several conditions including: lacerations or contusions of the face, eye, or scalp without other criteria; fractures of facial bones without other criteria; birth trauma; primary anoxic, inflammatory, toxic, or metabolic encephalopathies which are not complications of head trauma; brain infarction (ischemic stoke); intracranial hemorrhage (hemorrhagic stroke) without associated trauma; airway obstruction (e.g., near-drowning, throat swelling, choking, strangulation, or crush injuries of the chest); seizure disorders (Grand mal, etc.); intracranial surgery; and neoplasms.

Why Is This Important?

Traumatic brain injury is a leading cause of death and disability in Utah, costing more than $118 million in hospitalization charges in 2014. During 2014, 25,213 people in Utah sustained a TBI. Among those injured, 584 died (19.8 per 100,000 population) where TBI was reported as a cause of death on the death certificate alone or in combination with other injuries or conditions; another 2,415 (82.0 per 100,000) were hospitalized, and an additional 22,214 (754.4 per 100,000) were treated and released from emergency departments with a TBI alone or in combination with other injuries or conditions. An unknown number of individuals sustained injuries that were treated in other settings or went untreated.

Healthy People Objective IVP-2:

Reduce fatal and nonfatal traumatic brain injuries
U.S. Target: Not applicable, see subobjectives in this category

Other Objectives

{{style color:#003366 Healthy People 2020 Objective IVP-2.1:}}[[br]] Reduce fatal traumatic brain injuries[[br]] '''U.S. Target:''' 15.7 deaths per 100,000 population {{style color:#003366 Healthy People 2020 Objective IVP-2.2:}}[[br]] Reduce hospitalizations for nonfatal traumatic brain injuries[[br]] '''U.S. Target:''' 77.0 hospitalizations per 100,000 population[[br]] '''Utah Target:''' 77.0 hospitalizations per 100,000 population {{style color:#003366 Healthy People 2020 Objective IVP-2.3:}}[[br]] Reduce emergency department (ED) visits for nonfatal traumatic brain injuries[[br]] '''U.S. Target:''' 365.3 ED visits per 100,000 population

How Are We Doing?

The age-adjusted rate of traumatic brain injury (TBI) in Utah in 2014 was 867.0 per 100,000 population. This rate was higher than the previous year's rate of 834.7 per 100,000 population. From 2010 to 2014, age-adjusted rates of TBI for both sexes have increased. Males have significantly higher rates of TBI compared to females.

How Do We Compare With the U.S.?

In Utah the rate of TBI deaths for ages 5-19 is higher than the national rate for those ages. The TBI death rate for the 0-4 age group in Utah is slightly lower than the national rate for the same age group. The national rates are reported in the 2013 MMWR article entitled, ''QuickStats: Rate of Traumatic Brain Injury (TBI)-Related Deaths Among Persons Aged 0-19 Years, by Age Group - National Vital Statistics System, United States 1999-2010'' (MMWR Morb Mortal Wkly Rep. 2013 Mar 22;62(11):215).

What Is Being Done?

The Utah Department of Health Violence and Injury Prevention Program (VIPP) receives funding from the U.S. Centers for Disease Control and Prevention to conduct TBI surveillance for the state of Utah. This is done through review of hospital discharge data, vital statistics data, and hospital records abstractions. These data are used to develop interventions and policies targeting those at highest risk (such as young people for motor vehicle incidents and the elderly for fall incidents). In 2010, the VIPP was awarded a $1 million grant from the U.S. Department of Health and Human Services, Health Resources and Services Administration Maternal and Child Health Bureau. The four-year grant was awarded to develop statewide capabilities to address family and person-directed resources for individuals with TBIs and their families. The goals of the grant are to: 1) foster improvement in the TBI service delivery system, 2) assure access to coordinated community services and supports for young children (ages birth-4 years) who have a TBI, and 3) assure access to coordinated community services for service members and veterans of Operation Iraqi Freedom and Operation Enduring Freedom who have a TBI. The grant is not for primary services but instead is aimed at developing a more informed system of service agencies and professionals ready to help individuals with a TBI and their families. The Traumatic Brain Injury (TBI) Fund was established in 2008 by the Utah Legislature as a restricted special revenue fund. The fund consists of gifts, grants, donations, and any other funding from private sources. Individuals with a TBI may receive help with resource facilitation or neuropsychological testing through the TBI Fund. The TBI Fund is designed to be a payor of last resort, meaning individuals have no other financial means available to obtain these services. More information on the TBI Fund can be found at [http://www.health.utah.gov/vipp/topics/traumatic-brain-injury/tbi-fund.html]. The Traumatic Spinal Cord and Brain Injury Rehabilitation Fund was established during the 2012 Utah Legislative Session (Section 26-54) as a restricted special revenue fund that consists of gifts, grants, donations, or any other conveyance of money that may be made to the fund from private sources; portion ($20) of the impound fee as designated in Section 41-6a-1406; and amounts as appropriated by the legislature. The Legislature appropriated an initial allocation of $200,000 for State Fiscal Year 2013. The SCI/TBI Rehabilitation Fund provides individuals with spinal cord or traumatic brain injuries with physical, occupational, and speech therapy; and equipment necessary for daily living activities. More information on the SCI/TBI Rehabilitation Fund can be found at [http://www.health.utah.gov/vipp/topics/traumatic-brain-injury/sci-fund.html].

Health Program Information

The Violence and Injury Prevention Program (VIPP) is a trusted and comprehensive resource for data related to violence and injury. Through education, this information helps promote partnerships and programs to prevent injuries and improve public health. VIPP goals are to a) focus prevention efforts on reducing intentional and unintentional injury, b) conduct education aimed at increasing awareness and changing behaviors that contribute to the occurrence of injury, c) strengthen local health department capacity to conduct local injury prevention programs, d) promote legislation, policy changes, and enforcement that will reduce injury hazards and increase safe behaviors, e) collaborate with private and public partners, and f) improve the Utah Department of Health capacity to collect mortality and morbidity data from multiple sources and conduct injury epidemiology for use in prevention planning, implementation, and evaluation.


Related Indicators

Related Relevant Population Characteristics Indicators:




Graphical Data Views

TBI Incidence Age-Adjusted Rates by Sex, Utah, 2010-2014

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confidence limits

On average, from 2010-2014 Utah males had a significantly higher rate of TBI than females.
UT M, UT F, US M, US FYearAge-adjusted Rate per 100,000Lower LimitUpper LimitNumer- atorDenom- inator
Record Count: 10
Utah Males2010834.0818.6849.611,8361,393,737
Utah Males2011878.1862.4894.012,6271,414,293
Utah Males2012896.2880.6912.213,0981,435,312
Utah Males2013850.3835.1856.612,6271,459,282
Utah Males2014907.9892.2923.813,4021,480,607
Utah Females2010707.5693.3721.99,6411,380,609
Utah Females2011725.5711.2740.010,0531,401,031
Utah Females2012782.2767.4797.110,9731,419,882
Utah Females2013703.4689.5717.410,0531,443,505
Utah Females2014820.1805.2835.211,7901,463,891

Data Notes

ICD-9-CM codes for TBI Morbidity: 800.0-801.9, 803.0-804.9, 850.0-854.1, 950.1-950.3, 959.01, 995.55; ICD-10 codes for TBI Mortality: S01.0-S01.9, S02.0, S02.1, S02.3, S02.7-S02.9, S04.0, S06.0-S06.9, S07.0, S07.1, S07.8, S07.9, S09.7-S09.9, T01.0, T02.0, T04.0, T06.0, T90.1, T90.2, T90.4, T90.5, T90.8, T90.0. These cases may include a TBI alone or in combination with other injuries or conditions.   [[br]] [[br]] Rates are calculated using both sampled and non-sampled TBI hospitalization, death, and ED visit cases. [[br]] [[br]] Rates have been age-adjusted to the 2017 U.S. population.

Data Sources

  • Utah Department of Health, Violence & Injury Prevention Program, TBI database
  • Emergency Department Encounter Database, Bureau of Emergency Medical Services, Utah Department of Health
  • Utah Inpatient Hospital Discharge Data, Office of Health Care Statistics, Utah Department of Health
  • Utah Death Certificate Database, Office of Vital Records and Statistics, Utah Department of Health
  • Population Estimates: National Center for Health Statistics (NCHS) through a collaborative agreement with the U.S. Census Bureau, IBIS Version 2015


TBI Incidence Rates by Age Group and Sex, Utah, 2014

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confidence limits

Males have significantly higher rates of TBI compared to females in all age groups.
Males vs. FemalesAge GroupRate per 100,000 PopulationLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 12
Male0-171,981.11,940.72,021.69,208464,784
Male18-441,324.01,294.61,353.47,809589,809
Male45-541,119.01,066.21,171.91,723153,973
Male55-641,184.61,126.81,242.51,609135,822
Male65-741,698.41,609.51,787.31,40282,547
Male75+4,430.64,252.54,608.72,37853,672
Female0-171,236.41,203.51,269.25,440439,990
Female18-44683.4662.0704.93,906571,524
Female45-54516.6480.5552.6789152,731
Female55-64518.4480.8556.0730140,811
Female65-74654.8601.9707.758989,951
Female75+1,631.71,536.31,727.11,12468,884

Data Notes

ICD-9-CM codes for TBI Morbidity: 800.0-801.9, 803.0-804.9, 850.0-854.1, 950.1-950.3, 959.01, 995.55; ICD-10 codes for TBI Mortality: S01.0-S01.9, S02.0, S02.1, S02.3, S02.7-S02.9, S04.0, S06.0-S06.9, S07.0, S07.1, S07.8, S07.9, S09.7-S09.9, T01.0, T02.0, T04.0, T06.0, T90.1, T90.2, T90.4, T90.5, T90.8, T90.0. These cases may include a TBI alone or in combination with other injuries or conditions.   [[br]] [[br]] Rates are calculated using both sampled and non-sampled TBI hospitalization, death, and ED visit cases. [[br]] Rates have been age-adjusted to the 2017 U.S. population.

Data Sources

  • Utah Department of Health, Violence & Injury Prevention Program, TBI database
  • Emergency Department Encounter Database, Bureau of Emergency Medical Services, Utah Department of Health
  • Utah Inpatient Hospital Discharge Data, Office of Health Care Statistics, Utah Department of Health
  • Utah Death Certificate Database, Office of Vital Records and Statistics, Utah Department of Health
  • Population Estimates: National Center for Health Statistics (NCHS) through a collaborative agreement with the U.S. Census Bureau, IBIS Version 2015


Percentage of TBI Hospitalizations and Deaths by Etiology, Utah, 2015

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confidence limits

Of sampled TBI cases, almost half (48.9%) of TBI hospitalizations and deaths are the result of falls. Motor vehicle traffic crashes and recreational activity are also leading causes of TBI hospitalizations and deaths in Utah.
EtiologyPercentage of CasesLower LimitUpper LimitNoteNumer- atorDenom- inator
Record Count: 15
Falls48.9%45.4%52.4%383784
Motor Vehicle Crashes15.9%13.4%18.5%125784
Recreational Activity2.4%1.3%3.5%19784
Assault2.0%1.1%3.0%16784
Bicycle Crashes4.2%2.8%5.6%33784
OHV/ATV5.4%3.8%6.9%42784
Horse/rodeo1.7%0.8%2.6%13784
Motorcycle Crashes4.2%2.8%5.6%33784
Pedestrian4.2%2.8%5.6%33784
Suicide/suicide Attempts1.9%1.0%2.9%15784
Team Sports0.8%0.2%1.4%*6784
Snow Sports1.4%0.6%2.2%11784
Skateboard/rollerblade2.2%1.1%3.2%17784
Other Recreational Vehicles****
Other****

Data Notes

ICD-9-CM codes for TBI Morbidity: 800.0-801.9, 803.0-804.9, 850.0-854.1, 950.1-950.3, 959.01, 995.55; ICD-10 codes for TBI Mortality: S01.0-S01.9, S02.0, S02.1, S02.3, S02.7-S02.9, S04.0, S06.0-S06.9, S07.0, S07.1, S07.8, S07.9, S09.7-S09.9, T01.0, T02.0, T04.0, T06.0, T90.1, T90.2, T90.4, T90.5, T90.8, T90.0. These cases may include a TBI alone or in combination with other injuries or conditions.   '' ''[[br]] [[br]] *Use caution in interpreting, the estimate has a relative standard error greater than 30% and does not meet UDOH standards for reliability.[[br]] [[br]] **Data have been suppressed and do not meet UDOH standards for reliability. [[br]] For more information, please go to [http://ibis.health.utah.gov/pdf/resource/DataSuppression.pdf]. Bicycle crashes include traffic- and non-traffic-related crashes. Cases of TBI with unknown etiology are not included in this chart. Causes of TBI as displayed in this chart are not mutually exclusive; that is, a single TBI could be sustained through a combination of these causes, in which case it would be counted in multiple categories. Numbers represent TBI-related deaths and hospitalizations and are extrapolated from the number of cases in a representative sample from the VIPP TBI database. The 2015 TBI hospitalization and death sample is the most recent one available in the TBI database.

Data Sources

  • Utah Department of Health, Violence & Injury Prevention Program, TBI database
  • Utah Inpatient Hospital Discharge Data, Office of Health Care Statistics, Utah Department of Health
  • Utah Death Certificate Database, Office of Vital Records and Statistics, Utah Department of Health


TBI Hospitalizations Age-Adjusted Rates by Utah Small Area, 2010-2014

::chart - missing::
confidence limits

From 2010-2014, the Utah age-adjusted rate of TBI hospitalizations was 9.8 per 10,000. Twenty Utah Small Areas had a higher age-adjusted rate than the Utah state rate: West Jordan (Southeast), Provo (West City Center), West Jordan (Northeast) V2, Tooele Valley, Draper, Park City, Duchesne County, Salt Lake City (Rose Park), Magna, Taylorsville (East)/Murray (West), Summit County (East), Sandy (West), Midvale, Kearns V2, South Salt Lake, Nephi/Mona, Central (Other), Salt Lake City (Glendale) V2, Murray, and Salt Lake City (Downtown) V2. From 2010-2014, 14 small areas had a lower age-adjusted rate than the Utah state rate: San Juan (Other), Blanding/Monticello, Grand County, Washington City, Hurricane/LaVerkin, Orem (West), St. George, Brigham City, North Logan, Lehi, Logan V2, Layton/South Weber, Clearfield Area/Hooper, and Provo/BYU. These numbers were pulled using ICD-9-CM codes were used 800.0-801.9, 803.0-804.9, 850.0-854.1, 950.1-950.3, 959.01, 955.55 for inpatient hospital discharge data. These numbers include all visits and may differ from data in the TBI Injury Surveillance Database. For higher and lower rates by Utah Small Area, the 95% CI for the small area was compared to the state point estimate.
Utah Small AreasAge-adjusted Rate per 10,000 PopulationLower LimitUpper LimitNoteNumer- atorDenom- inator
Record Count: 129
Brigham City6.95.48.681119,738
Box Elder (Other) V29.26.612.44452,108
Tremonton8.06.010.55879,784
Logan V27.56.38.8161269,315
North Logan6.95.29.063105,656
Cache (Other)/Rich V210.08.112.1106112,216
Hyrum8.15.012.52735,841
Smithfield8.96.511.94862,123
Ben Lomond9.38.110.6238286,874
Weber County (East)8.67.210.2138168,713
Morgan County7.45.110.53443,276
Ogden (Downtown)10.38.712.0171184,097
South Ogden9.27.810.7168182,311
Roy/Hooper9.78.411.2199227,066
Riverdale9.88.211.7129131,761
Clearfield Area/Hooper8.06.89.3201342,458
Layton/South Weber7.86.88.9251379,001
Kaysville/Fruit Heights9.88.211.7137173,279
Syracuse7.55.410.264126,703
Centerville8.66.711.06880,001
Farmington8.36.310.76789,958
North Salt Lake10.78.213.77581,952
Woods Cross/West Bountiful11.18.015.05872,514
Bountiful10.18.911.4272230,344
SLC (Rose Park)12.710.914.8189173,314
SLC (Avenues)8.66.910.598110,045
SLC (Foothill/East Bench)10.48.512.4121107,491
Magna13.210.915.8146136,033
SLC (Glendale)15.913.418.7160125,978
West Valley (Center)11.19.612.7240252,610
West Valley (West) V29.67.611.9115149,945
West Valley (East) V29.68.311.1221265,626
SLC (Downtown) V220.418.023.0314184,023
SLC (Southeast Liberty)9.67.711.997112,470
South Salt Lake14.612.417.1166130,774
SLC (Sugar House)10.49.012.1190166,746
Millcreek (South)11.19.313.2144110,108
Millcreek (East)9.27.611.0127120,215
Holladay V211.69.813.6167121,087
Cottonwood9.78.411.1226217,464
Kearns V213.311.615.3264254,815
Taylorsville (E)/Murray (W)12.610.914.5208185,810
Taylorsville (West)11.49.313.9113118,091
Murray15.313.517.4256162,869
Midvale13.011.215.1185149,614
West Jordan (Northeast) V212.410.414.6171167,474
West Jordan (Southeast)12.410.314.9157182,537
West Jordan (West)/Copperton8.96.611.7119221,187
South Jordan V29.07.810.4212277,365
Daybreak****
Sandy (West)13.111.115.4162126,995
Sandy (Center) V211.09.213.1134143,112
Sandy (Northeast)11.69.513.9122112,235
Sandy (Southeast)10.89.013.0136149,848
Draper12.610.614.9192206,424
Riverton/Bluffdale10.48.612.4152188,294
Herriman10.37.813.4121184,628
Tooele County (Other)11.69.014.87269,932
Tooele Valley12.010.513.7243229,640
Eagle Mountain/Cedar Valley13.89.419.594120,826
Lehi7.36.08.8160276,954
Saratoga Springs9.35.315.23694,882
American Fork9.78.211.4173221,393
Alpine10.67.814.25146,965
Pleasant Grove/Lindon8.67.310.1182275,210
Orem (North)9.17.610.9139187,006
Orem (West)6.55.18.286158,908
Orem (East)8.46.710.489108,801
Provo/BYU8.06.79.6158255,668
Provo (West City Center)12.610.415.2137160,456
Provo (East City Center)7.75.410.767167,521
Salem City8.65.812.23340,909
Spanish Fork11.39.513.4163198,979
Springville9.17.411.0118155,302
Mapleton9.76.713.53938,067
Utah County (South) V210.37.613.75354,502
Payson10.88.713.1110122,352
Park City13.510.716.8128135,449
Summit County (East)14.110.917.97152,455
Wasatch County8.06.49.990128,072
Daggett and Uintah County9.47.911.0155178,451
Duchesne County13.110.815.811896,556
Nephi/Mona16.312.521.06445,162
Delta/Fillmore9.06.612.04848,760
Sanpete Valley9.37.511.597109,047
Central (Other)15.212.818.014088,373
Richfield/Monroe/Salina9.57.511.98083,765
Carbon County11.39.313.6120105,520
Emery County12.19.315.56550,224
Grand County5.33.47.82634,271
Blanding/Monticello5.13.17.82134,910
San Juan County (Other)2.20.84.8*610,620
St. George6.65.87.4313389,711
Washington County (Other) V29.36.712.54850,949
Washington City5.84.47.563101,313
Hurricane/La Verkin6.14.77.867110,503
Ivins/Santa Clara8.36.210.95763,406
Cedar City8.47.09.9145209,719
Southwest LHD (Other)8.87.210.6113115,765
State of Utah9.89.610.012,58214,283,514

Data Notes

ICD-9-CM codes for TBI Morbidity: 800.0-801.9, 803.0-804.9, 850.0-854.1, 950.1-950.3, 959.01, 995.55; ICD-10 codes for TBI Mortality: S01.0-S01.9, S02.0, S02.1, S02.3, S02.7-S02.9, S04.0, S06.0-S06.9, S07.0, S07.1, S07.8, S07.9, S09.7-S09.9, T01.0, T02.0, T04.0, T06.0, T90.1, T90.2, T90.4, T90.5, T90.8, T90.0. These cases may include a TBI alone or in combination with other injuries or conditions.   [[br]][[br]]*Use caution in interpreting; the estimate has a coefficient of variation >30% and is therefore deemed unreliable by UDOH standards. **The estimate has been suppressed because the observed number of events is very small and not appropriate for publication. These numbers reflect any cases that had one or more of the following ICD-9-CM codes: 800.0-801.9, 803.0-804.9, 850.0-854.1, 950.1-950.3, 959.01, 955.55. These numbers include all visits and may differ from data in the TBI Injury Surveillance Database. Statistical significance is determined by whether a region's confidence bounds overlap with the state's rate. Rates age-adjusted to the 2000 U.S. standard population.

Data Sources

  • Utah Inpatient Hospital Discharge Data, Office of Health Care Statistics, Utah Department of Health
  • Population estimates produced by the UDOH Center for Health Data and Informatics. Linear interpolation of U.S. Census Bureau and ESRI ZIP Code data provided annual population estimates for ZIP Code areas by sex and age groups, IBIS Version 2017

More Resources and Links

Evidence-based community health improvement ideas and interventions may be found at the following sites:

Additional indicator data by state and county may be found on these Websites:

Medical literature can be queried at the PubMed website.

For an on-line medical dictionary, click on this Dictionary link.

Page Content Updated On 10/26/2018, Published on 11/15/2018
The information provided above is from the Department of Health's Center for Health Data IBIS-PH web site (http://ibis.health.state.gov). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Tue, 11 December 2018 3:25:01 from Department of Health, Center for Health Data, Indicator-Based Information System for Public Health Web site: http://ibis.health.state.gov ".

Content updated: Thu, 15 Nov 2018 15:09:02 MST