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TM Centers for Disease Control and Prevention National Center for Injury Prevention and Control Centers for Disease Control and Prevention National Center.

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Presentation on theme: "TM Centers for Disease Control and Prevention National Center for Injury Prevention and Control Centers for Disease Control and Prevention National Center."— Presentation transcript:

1 TM Centers for Disease Control and Prevention National Center for Injury Prevention and Control Centers for Disease Control and Prevention National Center for Injury Prevention and Control Nonfatal Self-Inflicted Injuries Among Adults Aged >65 Years — United States, 2005 J. Logan, PhD, Alex Crosby, MD, MPH, George Ryan, PhD

2 TM Public Health Problem 372,722 persons visited emergency departments (ED) for nonfatal self- inflicted injuries in 2005 1 Most common among adolescents and young adults 2 1. CDC. WISQARS™ Available at http://www.cdc.gov/ncipc/wisqars. 2. CDC, 2002

3 TM 1 Assault by other-struck 2 Self-harm-poisoning 3 Self-harm-cut/pierce 4 Assault by other-fall 5 Sexual Assault 6 Assault by other- cut/pierce 7 Self-harm-other Leading Causes of All Nonfatal Violence-Related Injury for those ≥65 Years — U.S., 2005 1 Data Source: NEISS-AIP 1. CDC. WISQARS™

4 TM Self-Inflicted Injuries Among Older Adults: A Growing Concern Consequences may be more serious than those of younger adults Fastest growing demographic

5 TM Consequences of Nonfatal Self- Inflicted Injuries among Older Adults Less resilient, longer recovery Require more health services – Avg. cost per incident: 1  ≥65 years=$9,749  25-64 years=$4,995 1. Corso et al., in press

6 TM Study Objective Characterize ED visits for nonfatal self- inflicted injuries among older adults aged ≥65 years Compare to those among younger adults 20-64 years

7 TM Data Source National Electronic Injury Surveillance System (NEISS) – Operated by U.S. Consumer Product Safety Commission – Collects data about treatment of patients in U.S. hospital EDs for consumer-product- related injuries – All Injury Program (NEISS-AIP)-collects data on ED visits for all types of injuries

8 TM Population NEISS-AIP includes data from 66 hospitals 1 – stratified probability sample of all hospitals in the United States with a minimum of six beds and a 24-hour ED – Data are weighted by the inverse of the probability of selection to produce national estimates 1. Kessler & Schroeder, eds., 2000

9 TM Case Definitions Injury: 1 – Bodily harm resulting from an acute exposure to an external force or substance – Includes unintentional and violence-related – Excludes unintended adverse effects of therapeutic drugs or medical care 1. CDC, 2000

10 TM Case Definitions (2) Injuries are categorized by intent: 1 – Unintentional – Assault – Legal intervention – Self-inflicted  Suicidal behavior  Self-abusive behavior 1. CDC, 2000

11 TM Characteristics Sex Race/ethnicity ED discharge Mechanism of injury History of self harm, substance abuse, and psychiatric conditions Alcohol use at time of injury

12 TM Analysis Estimates based on weighted data for 4,478 ED visits for nonfatal self-inflicted injuries Significant differences assessed using 95% confidence intervals

13 TM TABLE 1: Estimated number and rate of ED visits for nonfatal self-inflicted injuries among adults by age—U.S., 2005 Age GroupNo. Rate per 100,000(95%CI) 20-64278,987156.8(125.5-188.2) ≥657,10519.3(13.9-24.8)

14 TM TABLE 2a: ED visits for nonfatal self-inflicted injuries among adults by age and race/ethnicity—U.S., 2005 20-64≥65 Race/EthnicityNo.% % Non-Hispanic White146,37252.54,95669.8 Black28,70210.34536.4 Hispanic15,7695.7851.2* Other6,3162.31151.6* Unknown81,82729.31,49621.1 Total278,986100.07,105100.0 * National estimate is unstable

15 TM TABLE 2b: ED visits for nonfatal self-inflicted injuries among adults by age and sex—U.S., 2005 20-64≥65 SexNo.% % Male128,92946.23,23345.5 Female150,05753.83,87254.5 Total278,986100.07,105100.0

16 TM TABLE 2c: ED visits for nonfatal self-inflicted injuries among adults by age and intent—U.S., 2005 20-64≥65 IntentNo.% % Suicidal behavior208,30774.75,71080.4 Self Abuse15,9555.7851.2* Other31,40211.377911.0 No diagnosis23,3238.45327.5* Total278,986100.07,105100.0 * National estimate is unstable

17 TM TABLE 3a: Characteristics of ED visits for nonfatal injuries attributed to suicidal behavior among adults—U.S., 2005 20-64≥65 MechanismNo.% % Cut/pierce31,62715.21,06218.6 Poisoning131,17463.03,42560.0 Firearm1,2750.61542.7* Other42,30920.31,04618.3 Unknown1,9220.1230.4* Total208,403100.05,712100.0 * National estimate is unstable

18 TM TABLE 3b: Characteristics of ED visits for nonfatal injuries attributed to suicidal behavior among adults—U.S., 2005 20-64≥65 HistoryNo.% % Self harm46,17322.297617.1 Bipolar disorder15,4277.42885.0* Depression139,39566.94,20973.7 Alcohol abuse28,16413.55379.4 Other subs. abuse25,92512.4851.5* Alcohol at time of injury64,34330.988215.4** * National estimate is unstable ** Statistically significant, p<0.05

19 TM TABLE 3c: Characteristics of ED visits for nonfatal injuries attributed to suicidal behavior among adults—U.S., 2005 20-64≥65 DispositionNo.% % Treated then released47,04522.64738.3** Transferred then released55,26626.51,20521.1 Hospitalized101,30348.64,03270.6** * National estimate is unstable ** Statistically significant, p<0.05

20 TM Key Findings Less likely to have ED visits for nonfatal self-inflicted injuries compared to younger adults More likely to be hospitalized after ED treatment for suicide behavior-related injury compared to younger adults

21 TM Previous Research Older adult males typically have highest suicide rate 1 1. CDC. WISQARS™

22 TM Previous Research Ratio of nonfatal to fatal suicide attempts is much lower for older adults 1  15-24 years=200:1  >65 years=4:1 1. Conwell, 2001

23 TM Limitations Small counts made some rates unstable

24 TM Limitations Small counts made some rates unstable Classification depended on ED provider

25 TM Limitations Small counts made some rates unstable Classification depended on ED provider Unable to collect information on dementia, other medical problems, or recent lifestyle changes

26 TM Limitations Small counts made some rates unstable Classification depended on ED provider Unable to collect information on dementia, other medical problems, or recent lifestyle changes Only captured nonfatal self-inflicted injuries that resulted in ED visits

27 TM Future Research Assess more preceding circumstances of injury Assess referrals to mental health treatment

28 TM Policy Implications Better identification and treatment of clinical depression 1 More community outreach programs 1 1. Conwell, 2001

29 TM Acknowledgments Co-authors – Alex Crosby, MD, MPH – George Ryan, PhD NCIPC – Thomas Simon, PhD – J. Lee Annest, PhD Disclaimer The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry and should not be construed to represent any agency determination or policy

30 TM For more information.. Centers for Disease Control and Prevention. Nonfatal self-inflicted injuries among adults aged ≥65 years— United States, 2005. MMWR 2007;56:989-993 Viewed at www.cdc.gov/mmwr

31 TM Centers for Disease Control and Prevention National Center for Injury Prevention and Control Centers for Disease Control and Prevention National Center for Injury Prevention and Control Thank You

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