1. Robert N. Anderson, Ph.D. Mortality Statistics Branch Division of Vital Statistics National Center for Health Statistics Analyzing Injury Mortality Data for the U.S. Strengthening Partnerships: Shaping the Future NAPHSIS and VSCP Project Directors Joint Meeting Portland, Oregon June 6-10, 2004

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

3. Highlights Introduces the External Cause of Injury Mortality Matrix for ICD-10 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 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) All ICD codes are two dimensional indicating both intent and mechanism

5. Injuries in the List of 113 Selected Causes of Death Focus is on intent of death, then mechanism Major intent categories are rankable causes Lacks detail on mechanism Particularly for suicide and homicide Totals for mechanisms across intent categories are not shown

6. Injuries in the List of 113 Selected Causes of Death

7. Intent of death Injuries in the List of 113 Selected Causes of Death

8. Mechanism of death

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

10. External Cause of Injury Mortality Matrix

11. Intent of death

12. External Cause of Injury Mortality Matrix Mechanism of death

13. Advantages of the Matrix Standardized presentation More detail in terms of mechanism of death Totals for mechanisms of death across intent categories are shown Leading mechanisms

14. Leading Mechanisms of Injury Death Mechanism of injury deathDeathsPercent All injury157,078100.0 Motor vehicle traffic42,44327.0 Firearm29,57318.8 Poisoning22,24214.2 Fall15,76410.0 Suffocation12,5748.0

15. 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 Underutilized No comprehensive presentation of nature of injury data Tabulating nature of injury data Total mention Any mention

16. Common Nature of Injury Categories (any mention)

17. Nature of Injury by Intent (any mention)

18. Number of injuries reported

19. 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 Distinction between injury-related and natural cause poisonings Overdose/acute exposure vs. chronic abuse

20. Poisoning – Underlying External Cause Percent of all injury deaths Intent of deathTotalDrugsAlcohol Gases and vapors Unintentional63.367.284.927.8 Suicide23.318.47.367.7 Homicide0.30.20.00.8 Undetermined13.114.37.83.7

21. Poisoning – Nature of Injury Percent of all injury deaths SubstanceTotalUnintentionalSuicideUndetermined Drugs77.577.769.493.9 Narcotics45.250.519.863.8 Heroin6.99.60.63.5 Cocaine15.219.02.417.5 Barbiturates1.10.62.50.9 Benzodiazepines6.46.18.05.5 Antidepressants8.05.515.88.5 Nondrugs29.429.936.410.6 Alcohol7.69.04.74.8 Carbon monoxide10.56.726.52.7

22. Poisoning – Natural Cause SubstanceTotal Acute intoxication Harmful use Dependence syndrome Withdrawal state Alcohol6,6276331,7183,529164 Drugs1,931161,31332310 Opioids2112120482 Cocaine40111241351 Volatile solvents91530 Multiple drug use1,26519312276

23. 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 Most appear legitimate E.g., StrokeFall Skull fracture Some are probably certification errors E.g., external cause improperly listed in Part II

24. 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

25. 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

26. 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)

27. Injury mortality data on the web CDC, NCHS www.cdc.gov/nchs/injury.htmwww.cdc.gov/nchs/injury.htm CDC, NCIPC www.cdc.gov/ncipcwww.cdc.gov/ncipc WISQARS www.cdc.gov/ncipc/wisqarswww.cdc.gov/ncipc/wisqars CDC WONDER wonder.cdc.govwonder.cdc.gov BLS, Census of Fatal Occupational Injuries (CFOI) www.bls.gov www.bls.gov NHTSA, Fatal Analysis Reporting System (FARS) www-fars.nhtsa.dot.gov www-fars.nhtsa.dot.gov Bureau of Justice Statistics www.ojp.usdoj.gov/bjs/www.ojp.usdoj.gov/bjs/