Fatal brain injuries, often classified as traumatic brain injuries (TBIs), can result from various causes and lead to severe consequences, including death. Different parts of the U.S. have worse records than others when it comes to the likelihood of such an event from occurring.
The most common causes of fatal brain injuries include falls, vehicle crashes, assaults, and firearm-related incidents. Falls are the most frequent cause of TBIs, particularly among the youngest and oldest age groups.
Vehicle-related accidents, including pedestrian-involved crashes and multiple-car incidents, are also significant contributors. Assaults, including domestic violence and shaken baby syndrome, are common but often overlooked causes of TBI-related deaths.
Understanding these causes is vital for prevention and addressing the long-term health implications of TBI.
A new study reveals that Mississippi ranks fifth most dangerous in the entire country for fatal brain injuries, recording 29.5 deaths per 100,000 people. This partly highlights the inequities in the USA’s privatised, market-driven and inefficient healthcare system. Mississippi already ranks near the bottom nationally for healthcare access and investment. For someone with a brain injury in rural Mississippi, those rankings are not just numbers on a report. They decide what happens next.
The research comes from personal injury lawyers at Simmrin Law Group who analysed fatal brain injury data across all U.S. states using the DASH public health dataset. All figures are measured per 100,000 people to make fair comparisons between states of different sizes. The study ranked the 10 states where brain injuries are most likely to turn fatal, and Mississippi landed fifth on that list.
The data was collected from DASH Public Health Dataset, 2023 fatal TBI rates by state, per 100,000 population → dashboard.hhs.gov; CDC injury prevention and TBI public health data → cdc.gov; and Rural trauma centre access and emergency response research → ruralhealthinfo.org
The 10 U.S. states with the highest fatal brain injury rates
| Rank | State | Fatal TBIs per 100k | State Type |
| 1 | Alaska | 35.9 | Rural / Remote |
| 2 | Montana | 33.1 | Rural |
| 3 | Wyoming | 32.7 | Rural |
| 4 | Idaho | 30.2 | Rural |
| 5 | Mississippi | 29.5 | Rural |
| 6 | Oklahoma | 27.6 | Rural |
| 7 | South Carolina | 26.6 | Rural |
| 8 | New Mexico | 25.9 | Rural / Remote |
| 9 | South Dakota | 25.3 | Rural |
| 10 | Arkansas | 24.8 | Rural |
Alaska 35.9 per 100,000
Alaska’s 35.9 rate reveals something that no other state on this list can match in scale: the most extreme version of the rural access problem in the entire country. Towns are so far apart that getting to a trauma centre can sometimes take hoursby plane. The 35.9 figure does not measure how often brain injuries happen in Alaska. It measures what happens when they do, and the nearest help is hours away.
Montana 33.1 per 100,000
Montana’s 33.1 rate reveals what happens when a state the size of Japan has just over 1 million residents and a handful of trauma centres concentrated in a few cities. For the vast majority of Montana, the rural counties, the small farming towns, the communities hours from Billings or Missoula, a brain injury is a very different medical event than it is in an urban state. The 33.1 rate is the gap between where people live and where the care is.
Wyoming 32.7 per 100,000
Wyoming’s 32.7 rate reveals the cost of being the least populated state in America when a medical emergency happens. Fewer than 600,000 people spread across 97,000 square miles means fewer hospitals, fewer trauma specialists, and longer drives between towns. When a brain injury happens in rural Wyoming, the margin for error is razor-thin, and the nearest Level 1 trauma centre is often too far away to make a difference it would make in a city.
Idaho 30.2 per 100,000
Idaho’s 30.2 rate reveals a problem that is getting worse, not better. The state is one of the fastest-growing in America, with new residents arriving from bigger states and settling heavily in rural and semi-rural areas. But the healthcare infrastructure in those areas has not grown with the population. More families living far from hospitals means more brain injuries happening far from care. Idaho’s 30.2 is the measurable outcome of population growth that has outpaced healthcare investment, and without intervention, the number will keep climbing.
Mississippi 29.5 per 100,000
Mississippi’s 29.5 rate reveals a healthcare access crisis that has been building for decades and is now showing up in brain injury survival rates. The state ranks near the bottom nationally for health insurance coverage, rural hospital availability, and emergency response infrastructure. For a brain injury patient in rural Mississippi, every one of those rankings is not an abstract policy number.
It is a factor that determines whether they survive the next hour. The 29.5 figure is not a reflection of how dangerous Mississippi is. It is a reflection of how disconnected its rural communities are from the care that brain injury patients need immediately.
Mississippi has lost a significant number of rural hospitals over the past decade. When a rural hospital closes, the communities around it do not just lose a building. They lose their first line of response for every serious medical emergency, including brain injuries. Mississippi also has one of the lowest rates of health insurance coverage in the country, which means that even when emergency care is available, the financial barriers to accessing it are higher than almost anywhere else in America. The 29.5 rate reflects both the geographic gap and the economic one, two separate problems compounding into a single outcome for brain injury patients across the state.
Mississippi already ranks near the bottom nationally for healthcare access, hospital availability, and health insurance coverage, and the 29.5 fatal brain injury rate is the measurable outcome of all three of those failures happening at once. March is Brain Injury Awareness Month, and rural hospital closures are one of the most actively covered healthcare stories in Mississippi right now. This data puts a specific number on what those closures are costing in lives, and no reporter in the state has connected those two stories yet.
The next five
Oklahoma’s 27.6 rate reveals the direct impact of rural hospital closures on brain injury survival. Large stretches of the state sit more than an hour from any trauma centre, and that gap has widened as rural hospitals have closed over the past 15 years.
South Carolina’s 26.6 rate reveals a state with two completely different healthcare realities living inside the same borders. The coast has cities, hospitals, and trauma centres. New Mexico’s 25.9 rate reveals the compounding effect of vast land area and underserved communities on brain injury outcomes. The state is one of the largest in the country by area and one of the least densely populated. Its rural and tribal communities face some of the longest drives to emergency care of any state on this list.
South Dakota’s 25.3 rate reveals what happens when the majority of a state’s population lives in small farming towns and rural communities hours from a major hospital. Arkansas’s 24.8 rate reveals something important that is easy to overlook: even the least alarming number on the most dangerous list is still more than double what the safest states record.
