A healthier and safer Indiana ADDENDUM TO INJURY MORBIDITY AND MORTALITY IN INDIANA Injury Prevention Advisory Council Meeting June 21, 2012 Julie Wirthwein—Injury Prevention Epidemiologist D IVISION OF T RAUMA AND I NJURY P REVENTION

Overview  Background of State Injury Indicators Report  Injury mortality, hospitalization and emergency department (ED) data  Injury by intent  Fall-related injuries by type  Fire and hot object/substance injuries  Motor vehicle crash injuries by injured person type  Causes/mechanisms of traumatic brain injuries  Leading causes of injury death by age group 2

Data Sources  Indiana Mortality Reports (  Published by: Indiana State Department of Health (ISDH), Data Analysis Team (DAT)  Hospital Discharge Datasets (HDD), Inpatient and Emergency Department (ED)  Overseen by: ISDH, DAT; Indiana Hospital Association  Web-based Injury Statistics Query and Reporting System (WISQARS) (  Centers for Disease Control and Prevention, 2006–2009 3

State Injury Indicators  An injury indicator describes a health outcome of an injury, such as a hospitalization or death, or a factor known to be associated with an injury, such as a risk or protective factor among a specified population  Guidelines for injury surveillance developed by the State and Territorial Injury Prevention Directors Association (STIPDA) and the Council of State and Territorial Epidemiologists (CSTE)  Provides state injury programs with a standardized method for evaluating injury data that is comparable across states, the United States and territories 4

State Injury Indicators—Injury Categories Causes of Injury  Unintentional Drowning (Drowning)  Unintentional Fall-related (Falls)  Unintentional Fire-related (Fire)  Firearm-related  Homicide/Assault  Poisoning  Motor Vehicle Traffic  Suicide/Suicide Attempt 5 Types of Injury  Traumatic Brain Injury (TBI)  Hip Fracture Admissions, aged 65 years and older

State Injury Indicators  Overlaps exist among injury categories  Example: A firearm-related homicide could be included in the firearm-related, homicide and traumatic brain injury (TBI) death indicator totals  Mortality data include only Indiana residents whether or not the death occurred in-state  HDD characteristics  Restricted to non-federal, non-state, acute care facilities  No psychiatric, rehab, or long-term hospitals are included  Readmissions, transfers, and in-hospital deaths are included 6

Injury Coding  Mortality Data: International Classification of Disease, Tenth Revision (ICD-10), (See Appendix A)  Hospital Discharge Data: International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM), (See Appendix B)  External causes of injury and poisoning codes (E-codes) Capture how the injury or poisoning happened (cause), the intent (unintentional, intentional, undetermined), and the place where the event occurred Are intended to provide data for injury research and evaluation of injury prevention strategies Quality of data is dependent on the completeness and accuracy of E-codes Indiana’s E-code percentage (Inpatient HDD) in 2009: 62.44%  Injury Hospitalization and Emergency Department Subsets were produced by searching principal diagnosis field for appropriate codes 7

Overview of Mortality Data—Indiana, 2007–2009  Death rate for all injuries combined was 60.0 deaths per 100,000 from 2007 to 2009, claiming 11,640 lives  Males were 2.4 times more likely than females to be fatally injured (86.2 versus 35.5 per 100,000)  Injury death rates were highest among those aged 85 years and older (286.1 per 100,000) 8 Source: ISDH, Epidemiology Resource Center, DAT

Overview of Mortality Data—Indiana, 2007–2009  Leading causes of injury deaths among both sexes combined were poisonings (15.0 per 100,000), suicides (12.5 per 100,000), and motor vehicle crashes (12.3 per 100,000)  Leading causes of injury deaths among males were suicides (20.8 per 100,000), firearm-related incidents (19.4 per 100,000), and poisonings (18.8 per 100,000)  Leading causes of injury deaths among females were poisonings (11.2 per 100,000), motor vehicle crashes (6.9 per 100,000), and suicides (4.8 per 100,000) 9 Source: ISDH, Epidemiology Resource Center, DAT

Overview of Inpatient Hospital Discharge Data— Indiana, 2007–2009  Leading causes of injury-related hospitalizations among both sexes combined were falls (163.2 per 100,000), poisonings (68.8 per 100,000), and motor vehicle crashes (45.2 per 100,000)  Males were 1.1 times more likely than females to be hospitalized because of an injury (496.8 versus per 100,000) 10 Source: ISDH, Epidemiology Resource Center

Overview of Inpatient Hospital Discharge Data— Indiana, 2007–2009  Leading causes of injury-related hospitalizations among males were falls (134.7 per 100,000), poisonings (62.1 per 100,000), and motor vehicle crashes (57.5 per 100,000)  Leading causes of injury-related hospitalizations among females were falls (178.6 per 100,000), poisonings (75.4 per 100,000), and suicides (47.2 per 100,000) 11 Source: ISDH, Epidemiology Resource Center

Overview of ED Hospital Discharge Data— Indiana, 2007–2009  Leading causes of injury-related ED visits among both sexes combined were falls (1,900.5 per 100,000), motor vehicle crashes (604.2 per 100,000), and assaults (248.8 per 100,000)  Males were 1.1 times more likely than females to visit an ED because of an injury (9,407.3 versus 8,204.4 per 100,000) 12 Source: ISDH, Epidemiology Resource Center

Overview of ED Hospital Discharge Data— Indiana, 2007–2009  Leading causes of injury ED visits among males were falls (1,730.3 per 100,000), motor vehicle crashes (566.2 per 100,000), and assaults (302.8 per 100,000)  Leading causes of injury ED visits among females were falls (2,035.3 per 100,000), motor vehicle crashes (643.3 per 100,000), and assaults (193.4 per 100,000) 13 Source: ISDH, Epidemiology Resource Center

Overview of ED Hospital Discharge Data— Indiana, 2007–2009  Leading causes of injury ED visits among males were falls (1,730.3 per 100,000), motor vehicle crashes (566.2 per 100,000), and assaults (302.8 per 100,000)  Leading causes of injury ED visits among females were falls (2,035.3 per 100,000), motor vehicle crashes (643.3 per 100,000), and assaults (193.4 per 100,000) 14 Source: ISDH, Epidemiology Resource Center

Injury Fatality ICD-10 Codes 15  V01–Y36  Y85–Y87  Y89 Injury and poisoning

Overview of Injury Death Rates—Indiana, 2007– *Age-adjusted

Age-Adjusted Injury Death Rates by Cause/Type— Indiana, 2007– Source: ISDH, Epidemiology Resource Center, DAT

18 Source: ISDH, Epidemiology Resource Center, DAT Age-Adjusted Injury Death Rates by Sex and Cause/Type—Indiana, 2007–2009

19 Source: ISDH, Epidemiology Resource Center, DAT Age-Adjusted Injury Death Rates by Sex— Indiana, 2007–2009

20 Source: ISDH, Epidemiology Resource Center, DAT Injury Death Rates by Sex and Age—Indiana, 2007–2009

Hospitalizations for All Injuries ICD-9-CM Codes 21  800–909.2   909.9–994.9  995.5–  – Injury and poisoning

Overview of Injury Hospitalization Rates— Indiana, 2007–

Age-Adjusted Injury Hospitalization Rates by Cause/Type— Indiana, 2007– Source: ISDH, Epidemiology Resource Center

Age-Adjusted Injury Hospitalization Rates by Sex and Cause/Type—Indiana, 2007– Source: ISDH, Epidemiology Resource Center

Age-Adjusted Injury Hospitalization Rates by Sex— Indiana, 2007– Source: ISDH, Epidemiology Resource Center

Injury Hospitalization Rates by Age and Sex— Indiana, 2007– Source: ISDH, Epidemiology Resource Center

ED Visits for All Injuries ICD-9-CM Codes 27  800–909.2   909.9–994.9  995.5–  – Injury and poisoning

Overview of Injury ED Visit Rates—Indiana, 2007– *Age-adjusted

Age-Adjusted Injury ED Visit Rates by Cause/Type— Indiana, 2007– Source: ISDH, Epidemiology Resource Center

Age-Adjusted Injury ED Visit Rates by Cause/Type and Sex— Indiana, 2007– Source: ISDH, Epidemiology Resource Center

Injury ED Visit Rates by Age and Sex—Indiana, 2007– Source: ISDH, Epidemiology Resource Center

Injury Deaths by Intent—Indiana, 2007– N=11,643 Source: ISDH, Epidemiology Resource Center, DAT

Intentional Injury Deaths by Type—Indiana, 2007– N=3,447 Source: ISDH, Epidemiology Resource Center, DAT

34 Injury Hospitalizations by Intent—Indiana, 2007–2009 N=68,041 Source: ISDH, Epidemiology Resource Center

Intentional Injury Hospitalizations by Type— Indiana, 2007– N=10,009 Source: ISDH, Epidemiology Resource Center

Unintentional Fall-Related Deaths by Type— Indiana, 2007– N=1,008 Source: ISDH, Epidemiology Resource Center, DAT

37 Unintentional Fall-Related Hospitalizations by Type— Indiana, 2007–2009 N=32,912 Source: ISDH, Epidemiology Resource Center

38 Unintentional Fall-Related ED Visits by Type— Indiana, 2007–2009 N=364,498 Source: ISDH, Epidemiology Resource Center

Fire/Burn* Hospitalizations—Indiana, 2007– N=1,370 Source: ISDH, Epidemiology Resource Center

40 *Hot object/substance burns excluded from State Injury Indicators Report Fire/Burn* ED Visits—Indiana, 2007–2009 N=20,267 Source: ISDH, Epidemiology Resource Center

Motor Vehicle Crash Deaths by Injured Person Type— Indiana, 2007– N=2,364 Source: ISDH, Epidemiology Resource Center, DAT

42 Motor Vehicle Crash Hospitalizations by Injured Person Type—Indiana, 2007–2009 N=8,639 Source: ISDH, Epidemiology Resource Center

43 Motor Vehicle Crash ED Visits by Injured Person Type—Indiana, 2007–2009 N=113,553 Source: ISDH, Epidemiology Resource Center

Causes/Mechanisms of TBI Deaths—Indiana, Cause/ Mechanism*TBI (N=1,012) Falls209 Fire1 Firearms453 Homicide111 MVT202 Poisoning2 Suicide360 Cause/ Mechanism*TBI (%) Falls20.7% Fire0.1% Firearms44.8% Homicide11.0% MVT20.0% Poisoning0.2% Suicide35.6% *Causes/mechanisms not mutually exclusive Source: ISDH, Epidemiology Resource Center, DAT

Firearm-Related TBI Deaths by Selected Cause— Indiana, Source: ISDH, Epidemiology Resource Center, DAT Cause Firearm- Related TBI (N=452) Suicide by Discharge of Firearms355 Homicide by Discharge of Firearms78 Accidental Discharge of Firearms14 Undetermined Discharge of Firearms5 Cause Firearm- Related TBI (%) Suicide by Discharge of Firearms78.4% Homicide by Discharge of Firearms17.2% Accidental Discharge of Firearms3.1% Undetermined Discharge of Firearms1.1%

Causes/Mechanisms of TBI Hospitalizations— Indiana, Cause/ Mechanism*TBI (N=4,245) Falls1,618 Fire4 Firearms59 Homicide230 MVT935 Poisoning27 Suicide33 Cause/ Mechanism* TBI (%) † Falls38.1% Fire0.1% Firearms1.4% Homicide5.4% MVT22.0% Poisoning0.6% Suicide0.8% Source: ISDH, Epidemiology Resource Center *Causes/mechanisms not mutually exclusive † Total less than 100% due to lack of e-codes and other unlisted causes/mechanisms (TBI e-code percentage: 76.1%)

47 Source: WISQARS *Note change in years Death Rates among Children Under Age One Year by Mechanism of Injury—Indiana and United States, 2000–2009*

48 Source: WISQARS Death Rates among Children Ages 1–4 Years by Mechanism of Injury—Indiana and United States, 2000–2009

49 Source: WISQARS Death Rates among Children Ages 5–14 Years by Mechanism of Injury—Indiana and United States, 2000–2009

50 Source: WISQARS Death Rates among 15–24 Year Olds by Mechanism of Injury—Indiana and United States, 2007–2009 *Note change in years

51 Source: WISQARS Death Rates among Adults Ages 25–34 Years by Mechanism of Injury—Indiana and United States, 2007–2009

52 Source: WISQARS Death Rates among Adults Ages 35–44 Years by Mechanism of Injury—Indiana and United States, 2007–2009

53 Source: WISQARS Death Rates among Adults Ages 45–54 Years by Mechanism of Injury—Indiana and United States, 2007–2009

54 Source: WISQARS Death Rates among Adults Ages 55–64 Years by Mechanism of Injury—Indiana and United States, 2007–2009

55 Source: WISQARS Death Rates among Adults Ages 65–74 Years by Mechanism of Injury—Indiana and United States, 2007–2009

56 Source: WISQARS Death Rates among Adults Ages 75–84 Years by Mechanism of Injury—Indiana and United States, 2007–2009*

57 Source: WISQARS Death Rates among Adults Ages 85+ Years by Mechanism of Injury—Indiana and United States, 2007–2009

58

59 *Age-adjusted rates Source: WISQARS Percent Change in Leading Causes of Injury Death*— Indiana, 1999–2009

Leading Causes of Injury Death*— Indiana, 1999– *Age-adjusted rates Source: WISQARS

Conclusions  Leading causes of injury mortality among all ages combined:  Unintentional Poisoning  Suicide  Motor Vehicle Crashes  Leading causes of injury hospitalization and ED visits among all ages combined:  Falls  Unintentional Poisoning  Motor Vehicle Crashes  Assault 61

62 Diagnosis Code V01–Y36, Y85–Y87, Y89All Injury and Poisoning W65–W74, V90, V92Unintentional Drowning 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, T90.1, T90.2, T90.4, T90.5, T90.8, T90.9 Traumatic Brain Injury (TBI) X40–X49, X60–X69, X85–X90, Y10–Y19, Y35.2Poisoning V02–V04 (.1,.9), V09.2, V12–V14 (.3–.9), V19 (.4–.6), V20–V28 (.3–.9), V29 (.4–.9), V30–V39 (.4–.9), V40–V49 (.4–.9), V50–V59 (.4–.9), V60– V69 (.4–.9), V70–V79 (.4–.9), V80 (.3-.5), V81.1, V82.1, V83–V86 (.0-.3), V87 (.0–.8), V89.2 Motor Vehicle Traffic X60–X84, Y87.0Suicide W32–W34, X72–X74, X93–X95, Y22–Y24, Y35.0Firearm-related X85–Y09, Y87.1Homicide W00–W19Unintentional Falls X00–X09Unintentional Fire Appendix A Injury Fatality ICD-10 Codes

Appendix B Injury Hospitalization and ED Visit Codes Principal Diagnosis 800–909.2, 909.4, 909.9–994.9, 995.5–995.59, – All Injury and Poisoning 994.1Drowning 820Hip Fracture –801.99, –804.99, 850.0–850.9, –854.19, 950.1–950.3, , Traumatic Brain Injury (TBI) E-Code E850–E858, E860–E869, E950–E952, E962, E972, E980–E982, E979 (.6–.7) Poisoning E810–E819Motor Vehicle Traffic E950–E959Suicide Attempt E922.0–E922.3, E922.8, E922.9, E955.0–E955.4, E965.0–E965.4, E985.0–E985.4, E970, E979.4 Firearm-related E960–E969, E979, E999.1Assault E880–E886, E888Unintentional Falls E890–E899Unintentional Fire 63