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National Injury Surveillance using NEISS All Injury Program Data

Learn about public health surveillance, injury prevention, NEISS All Injury Program data, cost of injury reports, and accessing injury data for prevention messages.

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National Injury Surveillance using NEISS All Injury Program Data

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  1. National Injury Surveillance using NEISS All Injury Program Data J. Lee Annest, Ph.D. Office of Statistics and Programming National Center for Injury Prevention and Control Centers for Disease Control and Prevention

  2. Outline of Lecture • What is public health surveillance? • Public health approach to injury prevention • NEISS All Injury Program QA data • National fatal and nonfatal injury data together • Cost of injury report • Using injury data for prevention messages • Access to injury data on the Internet

  3. Public Health Surveillance “…ongoing systematic collection, analysis and interpretation of health data essential to the planning, implementation, and evaluation of public health practice, closely integrated with the timely dissemination of these data to those who need to know.” Thacker & Berkelman – 1988

  4. Leading Causes of Death, United States 1900 2001 Causes of Death Rate per 100,000 Causes of Death Rate per 100,000 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. All Causes 1,719.1 Pneumonia and Influenza 202.2 Tuberculosis 194.4 Diarrhea 142.7 Heart Disease 137.4 Intracranial Lesions 106.9 Nephritis 88.6 Accidents 72.3 Cancer 64.0 Senility 50.2 Bronchitis 40.3 All Causes 1,719.1 Pneumonia and Influenza 202.2 Tuberculosis 194.4 Diarrhea 142.7 Heart Disease 137.4 Intracranial Lesions 106.9 Nephritis 88.6 Accidents 72.3 Cancer 64.0 Senility 50.2 Bronchitis 40.3 All Causes 848.5 Heart Disease 245.8 Malignant Neoplasms 194.4 Cerebrovascular Disease 57.4 Respiratory Disease s 43.2 Accidents 35.7 Diabetes Mellitus 25.1 Pneumonia and Influenza 21.8 Alzheimer’s Disease 18.9 Nephritis 13.9 Septicemia 11.3

  5. Fatal injury rate, by age and sex– United States, 2001 450 Male Female 400 350 300 250 Rate per 100,000 population 200 150 100 50 0 0-4 5-9 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75-84 85+ Age (in years)

  6. Nonfatal injury rate, by age and sex– United States, 2001 20000 Male Female 18000 16000 14000 12000 Rate per 100,000 population 10000 8000 6000 4000 2000 0 0-4 5-9 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75-84 85+ Age (in years)

  7. Leading causes of fatal and nonfatal unintentional injuries for persons ages 15-24 years—United States, 2001 FatalNonfatal MV traffic (64%) Struck by/against (18%) Poisoning (9%) MV traffic (17%) Motorcyclist (6%) Fall (16%) Pedestrian (5%) Overexertion (16%) Drowning (5%) Cut/Pierce (10%) All Other (11%) All Other (23%)

  8. Leading causes of fatal and nonfatal unintentional injuries for persons ages > 65 years—United States, 2001 FatalNonfatal Fall (36%) Fall (63%) MV traffic (18%) MV traffic (7%) Suffocation (11%) Struck by/against (7%) Pedestrian (4%) Overexertion (6%) Fire/Burn (4%) Cut/Pierce (4%) All Other (27%) All Other (13%)

  9. Case fatality rate, by age and sex—United States, 2001 4.00 3.50 Males Females 3.00 2.50 Percent 2.00 1.50 1.00 0.50 0.00 0-4 5-9 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75-84 85+ Age (in years)

  10. Case fatality rate by intent of injury and sex—United States, 2001 16.0 Male Female 14.0 12.0 10.0 8.0 Percent 6.0 4.0 2.0 0.0 Assault Self Harm Unintentional Intent of Injury

  11. Self harm-related injury case fatality rate, by mechanism of injury and sex—United States, 2001 100.0 Male Female 90.0 80.0 70.0 60.0 Percent 50.0 40.0 30.0 20.0 10.0 0.0 Fall Firearm Cut/Pierce Suffocation/ Inhalation Poisoning Mechanism of Injury

  12. How are the data being used? Examples • Cost of injury report • Firearm-related injuries • Sports and recreational injuries, all ages • Drowning in recreational water settings • Motor-vehicle animal crash-related injuries • Nonwork-related amputations

  13. Economic Burden of Injury, 2000 Presented to CDC Presented by Eric Finkelstein, RTI Ted Miller, PIRE Phaedra Corso, CDC July 16, 2004 P.O. Box 12194 · 3040 Cornwallis Road · Research Triangle Park, NC 27709Phone: 919-541-8074 · Fax: 919-541-6683 · finkelse@rti.org · www.rti.org

  14. Incidence: Data Sources

  15. Per-Injury and Total Medical Costs: Data

  16. Per-Injury Medical Costs: Overview • Avg. Cost per Fatal injury: $7,463 • Fatal injuries among women cost 44% more than fatal injuries among men • Avg. Cost per Hospitalized injury: $18,040 • Non-hospitalized injury cost: $944 • All-injury avg. cost: $1,601 Average Cost ($) Per Injury

  17. Total Medical Costs: Overview • Total medical costs: $80.2 billion • Males: $44. 4 billion • Females: $35.8 billion • Fatal injuries: $1.1 billion, 2% of total • Hospitalized injuries: $33.8 billion, 42% of total • Non-hospitalized injuries: $45.4 billion, 56% of total Total Medical Costs ($millions)

  18. Total Medical Costs: Age and Gender • Males have significantly higher total costs up to age 65 • 75+: 5% of population, 16% of total medical costs: $12.6 billion • 2/3rds of costs born by females

  19. Injury Burden: Overview • Total burden: $405 billion • Long-term wage loss, 50%, 203 billion • Medical costs, 20%, $80.2 billion • Long-term household productivity loss, 14%, $55.8 billion • Short-term wage loss, 12%, $47.8 billion • Short-term household productivity loss, 4%, $17.8 billion

  20. Injury Burden: Cause • 23% ($91 billion) of total burden MV • 20% ($79 billion) of total burden falls • 12% ($48 billion) of total burden struck by/ against • 9% ($36 billion) of total burden firearm

  21. Injury Burden: Body Region • Lower extremity burden: 17% of total, $68 billion • Upper extremity burden: 16% of total, $67 billion • Traumatic brain injury burden: 15% of total, $60 billion • System-wide injury burden: 13% of total, $52 billion

  22. Trends in Age-Adjusted Fatal and Nonfatal Firearm-related Injury Rates United States, 1981 - 2001 Nonfatal Firearm Injury Fatal Firearm Injury Fatal Injury Rate/100,000 Population Nonfatal Injury Rate/100,000 Population Year Data Sources: CPSC’s NEISS for nonfatal injuries; NCHS’s National Vital Statistics System for fatal injuries.

  23. Ratio Injury Tower* for Firearm-Related Injuries 29,573 Deaths *excludes 444 observed/unknown Data Sources: For deaths, 2001National Vital Statistical System, NCHC; for nonfatal injuries, 2001 National Electronic Injury Surveillance Systems, CPSC 1.00 28,556 Hospitalized or Transferred 0.97 27,609 Treated and Released 0.93

  24. Distribution of Fatal and Nonfatal Firearm-Related Injuries by Intent of Injury, United States, 1993-1998 100 Intentionally Suicide Self-Inflicted Homicide 80 (Nonfatal) 60 Percentage Assault 40 20 Nonfatal Unintentional 0 65+ 0-14 20-24 25-34 35-44 45-64 15-19 Age (Years) Fatal Unintentional Data Sources: National Vital Statistics System, NCHS for deaths, CDC's Firearm Injury Surveillance Study for nonfatal injuries.

  25. *Age adjusted to the Year 2000 standard U.S. population Data sources: National Vital Statistics System, NCHS for deaths; CDC's Firearm Injury Surveillance Study for nonfatal injuries; U.S. Bureau of Census for population estimates. Fatal and Nonfatal Firearm-Related Injury Rates by Gender and Race/Ethnicity, United States, 1993-1998 200 Non-Fatal Fatal 150 100 Age-adjusted* Annualized Rate per 100,000 Population 50 0 White Non-Hispanic Male Black Male Hispanic Male White Non-Hispanic Female Black Female Hispanic Female

  26. Sports & recreational injuries Summary of findings • 4.3 million people (1 out of 65 people or one visit every 7.4 seconds) treated in US hospital EDs each year • More people are treated for sports/rec injuries than MV-related injuries (3.4 million) • Persons of all ages affected; injury rates higher for males and females; males 10-14 years had the highest injury rate • Activities accounting for the most injuries were basketball and bicycling; leading causes differed by age group

  27. Sports & recreational injuries Prevention message • Physical activity brings risk for injury along with substantial health benefits. Participants in sports/rec activities should employ safety measures that can reduce the risk of injury

  28. Fatal and nonfatal drowning Summary of findings • In 2001, more than 4,100 people sought care in an emergency department for nonfatal drowning injuries, of which over 50% required hospitalization; 3,300 drowned in recreational water settings • Fatal and nonfatal drowning rates were highest for children ages 4 years or younger • The fatal drowning rate for males was 5 times higher than for females; the nonfatal drowning rate for males was 2 times higher than for females • Younger children were more likely to drown in pools; older teenagers/adults are more likely to drown in natural bodies of water.

  29. Nonfatal and fatal recreation-related drowning, by location and age group—United States, 2001-2002 Private Pool Public Pool Unspecified Pool Natural Water Unspecified 100% 80% 60% Percentage 40% 20% 0% 0-4 years 5-14 years 15+ years 0-4years 5-14 years 15+ years Nonfatal Fatal

  30. Fatal and nonfatal drowning Prevention message • The best treatment for drowning is to prevent the event in the first place by being aware of hazards and following prevention strategies; environmental protective measures such as four-sided pool fencing and life guarding should be adopted; alcohol use should be avoided while swimming, boating, or water skiing, and while supervising children in aquatic settings; all participants, care-givers and supervisors should be knowledgeable about water safety skills and seek training in cardio-pulmonary resuscitation (CPR)

  31. MV Animal Crash-Related Injuries Summary of findings • Each year, more than 26,600 MV occupants who were involved in crash from an encounter with an animal in the roadway are treated in US hospital EDs. • About 85% of these injuries resulted from crashes involving large animals • Teenagers/young adults ages 15-24 years had the highest rate (21.2 per 100,000 population. A majority (64%) of younger drivers swerved to avoid the animal; almost half of those treated were driving the vehicle. • Most nonfatal injuries resulted from crashes with deer (86.9% of large animal crashes). One fourth of these injuries were treated in October/November at the height of fall deer hunting, mating and migration season.

  32. Age distribution of persons injured* in MV-large animal crashes compared to those injured* in all other MV crashes, United States, 2001-2002 40 Large Animal All Other 35 30 25 Percentage 20 15 10 5 0 0-14 15-24 25-34 35-44 45-54 55+ Age Group (in years) *Nonfatal injuries treated in U.S. hospital emergency departments

  33. MV Animal Crash-related Injuries Prevention message • Currently, there is limited research on whether it is better to try to avoid the animal or not in order to avoid MV crashes and related injuries. The right choice would likely relate to size of animal, vehicle speed, road conditions, traffic, type of roadside obstacles, and other factors. There usually isn’t enough time to consider these factors. A driver’s best bet is to create as much time as possible to avoid a crash. This is best accomplished by our general crash deterrents such as following speed limits, avoiding drinking and driving, and avoiding distracted driving. All MV occupants should use proper restraints to prevent injury if a crash occurs.

  34. What’s in the future? Injury reports in the works • Fatal and nonfatal Injuries in the United States, 2001 (MMWR surveillance summary report) • Non-work-related amputations • Motorcyclist injuries • Horseback riding • Violence-related sports/recreation injuries • Motor vehicle backover injuries • Schoolbus-related injuries

  35. Traumatic finger amputations treated in hospital EDs by type of consumer product involved and age of patient, United States, 2001-2002 *other house structures, appliances, furniture, motor vehicle parts, sports/recreation equipment, animal bites, and other specified

  36. United States Fatal and Nonfatal Injurieshttp://www.cdc.gov/ncipc/wisqars

  37. Questions? Discussion time…

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