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Analyzing Injury Mortality Data for the U.S.

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

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Analyzing Injury Mortality Data for the U.S.

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  1. Analyzing Injury Mortality Data for the U.S. Robert N. Anderson, Ph.D. Mortality Statistics Branch Division of Vital Statistics National Center for Health Statistics 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 Injuries in the List of 113 Selected Causes 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 External Cause of Injury Mortality Matrix

  12. Mechanism of death External Cause of Injury Mortality Matrix

  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

  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

  21. Poisoning – Nature of Injury

  22. Poisoning – Natural Cause

  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., Stroke Fall 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.htm • CDC, NCIPC www.cdc.gov/ncipc • WISQARS www.cdc.gov/ncipc/wisqars • CDC WONDER wonder.cdc.gov • BLS, Census of Fatal Occupational Injuries (CFOI) www.bls.gov • NHTSA, Fatal Analysis Reporting System (FARS) www-fars.nhtsa.dot.gov • Bureau of Justice Statistics www.ojp.usdoj.gov/bjs/

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