Long-Term Mortality of Patients With Head Injuries—A 10-Year Follow-up Study With Population Controls Study Performed at Tampere University Hospital

Neurosurgery 98:105–114, 2026

This study reports a 10-year follow-up comparing survival and causes of death between 1,930 patients treated for head injuries at a Finnish university hospital and 9,605 matched population controls. After excluding deaths within the first year, patients had a hazard ratio of 1.84 for mortality, with excess deaths concentrated in the first five years and elevated unintentional/traumatic and alcohol-related causes.

Multivariable analysis found age, male sex, pre-existing conditions, chronic alcohol use, and substance abuse—rather than injury severity or CT-positivity—were independently associated with reduced survival, though greater TBI severity remained linked to additional mortality risk when comparing patient severity subgroups to their matched controls.

Long-term Mortality: Patients with head injuries have significantly reduced long-term survival compared to matched population controls, with a hazard ratio (HR) for death of 1.84 after excluding those who died in the first year post-injury.

Acute vs. Long-term Risk: Death rates are notably higher among patients with head injuries for up to 5 years after injury, then approach control levels thereafter.

Causes of Death: Unintentional and traumatic causes (9.6% vs 4.4%) and alcohol-related causes (8.4% vs 1.9%) are significantly more common among head injury patients than controls.

Patient Characteristics: Age, male sex, pre-existing conditions, chronic alcohol use, and regular substance abuse are independently associated with decreased survival, whereas injury severity and CT findings are not significant predictors in multivariate analysis.

TBI Severity: Even patients with no documented traumatic brain injury (TBI) have reduced survival compared to controls; increasing TBI severity is associated with additional mortality risk.

Lifestyle and Pre-existing Factors: Much of the reduced survival is linked to patient characteristics and lifestyle factors (such as substance abuse), not solely to injury-related factors.

Immediate Causes of Death: Aspiration pneumonia and epileptic causes are significantly overrepresented as immediate causes of death in head injury patients who survive more than one year.

Control Group Limitations: Use of population controls and lack of detailed control data may overestimate associations between head injury and mortality due to unmeasured confounders.