In this report, the committee focused on head injuries and spinal cord injuries, which can cause significant physical, neurological, and psychosocial deficits and result in economic costs per person that are among the highest for injury-caused pathologies and impairments. Each year, about 1.3 million people suffer head injuries, and 70,000 to 90,000 of these individuals sustain moderate to severe traumatic brain injuries. Total annual medical costs for people who sustain head injuries were estimated to be $12.5 billion in 1982. At highest risk of sustaining traumatic brain injuries are people between the ages of 15 and 24, especially males. Demographic studies indicate that the incidence of traumatic brain injury is greatest for nonwhite urban populations and lowest for white populations living in suburban and rural areas. Motor vehicle collisions and falls are the leading causes of such injury. To the extent that they are discernible, trends over the past 10 years indicate that improvements in emergency medical services and acute management of head injuries have substantially increased the proportion of people who survive these injuries.

Each year, between 10,000 and 20,000 people sustain spinal cord injuries. Estimated lifetime costs for consequent medical treatment for such injuries range from $010,400 to $751,900, depending on the extent of injury. The most common major impairments are muscle paralysis and loss of sensation. Older adolescent males and young men are at greatest risk of spinal cord injury. Motor vehicle collisions and falls are the leading causes, followed by acts of violence, especially those involving firearms. In the 1950s, only people with low-level paraplegia were generally expected to survive; today, even people with high-level quadriplegia survive and live lives of high quality. A national study found that quadriplegia continues to be the outcome for half of all people who sustain spinal cord injuries; however, the proportion of people with quadriplegia who have neurologically incomplete lesions and therefore retain some motor control and sensation increased from 38 percent in 1973 to 54 percent in 1983.

Disabilities Associated with Chronic Disease and Aging

The prevalence of chronic disease—incurable, long-lasting pathologies such as osteoarthritis, cancer, heart disease, and diabetes—has increased to near-epidemic proportions in the United States. Almost half of all working-age people have one or more chronic conditions. An estimated 80 percent of the elderly have a chronic condition, and about 40 percent have some form of activity limitation due to chronic conditions.

Chronic conditions increase a person's risk of disability, although the degree of risk varies among conditions. Indeed, the most prevalent conditions, such as sinusitis, hypertension, and hearing impairment, generally

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