1. Centers for Disease Control and Prevention National Center for Health Statistics Robert N. Anderson Arialdi M. Miniño Lois A. Fingerhut Margaret Warner Presenting and Analyzing Injury Mortality Data in the U.S.

2. New Report on Injury Mortality in the U.S.

3. Highlights Introduces the External Cause of Injury Mortality Matrix for ICD-10 Presents data by age, race, sex and state Nature of injury data Detailed data on poisoning deaths Deaths with natural underlying cause and mention of external cause

4. Intent and Mechanism of Death ICD codes for external causes are two- dimensional, indicating both intent and mechanism Intent the purpose or manner of the injury, i.e., unintentional, intentional (suicide or homicide), or undetermined Mechanism of death the vector that transfers energy to the body (e.g., firearm, poisoning, motor vehicle)

5. External Cause of Injury Mortality Matrix Development Collaboration involving ICE on Injury Statistics Recently modified and updated to be consistent with ICD-10 Rationale Provide a standard framework to facilitate national and international comparability Present information by both mechanism and intent

6. External Cause of Injury Mortality Matrix

7. Intent of death

8. External Cause of Injury Mortality Matrix Mechanism of death

9. Deaths for Selected Mechanisms by Intent: U.S., 2001

10. Deaths for Intent Categories by Mechanism: U.S., 2001

11. Nature of Injury Not used as underlying cause of death (UC) UC is the external cause that precipitated the injury Nature of injury is coded with multiple cause data Nature of injury codes are two-dimensional Type of injury sustained Body site injured

12. Number of injuries reported: U.S., 2001

13. Common Nature of Injury Categories: U.S., 2001

14. Poisoning Mortality Poisoning deaths are identified in 3 ways As the underlying external cause of death – 22,242 deaths As the nature of injury – 25,807 deaths Underlying cause classified to mental and behavioral disorders due to psychoactive substance use (F-codes) – 8,558 deaths

15. Poisoning deaths – Underlying External Cause: U.S., 2001

17. Poisoning – Nature of Injury: U.S., 2001

18. Poisoning – Natural Causes: U.S., 2001

19. Combining External and Natural Poisonings

20. Natural underlying cause with mention of external cause In 2001, 36,753 deaths with natural UC had mention of an external cause Most were cardiovascular diseases, pneumonitis, cancer, Alzheimer’s disease and COPD Some are likely certification errors E.g., external cause improperly listed in Part II

21. Natural underlying cause with mention of external cause More than 70% of these deaths had mention of ICD-10 codes W80 and X59 W80 = Inhalation and ingestion of other objects causing obstruction of respiratory tract Typically mentioned with stroke or pneumonitis as the UC X59 = Exposure to unspecified factor Usually involves a fracture without specification of external cause Typically mentioned with heart disease, cancer, stroke or COPD as the UC

22. Interpreting Injury Mortality Data Dependent on the accuracy of the cause of death reported on the death certificate Specificity is a problem With regard to the external cause With regard to the nature of injury Records still pending investigation at file closure

23. Future Developments ICE on Injury Statistics Adapting the Barell Matrix for ICD-10 and mortality data Selection of main injury National Violent Death Reporting System (NVDRS)

24. Questions? Bob Anderson RNAnderson@cdc.gov Injury Report URL http://www.cdc.gov/nchs/ Go to: Publications and Information Products National Vital Statistics Reports Vol 52 No 21