Analyzing Injury Mortality Data for the U'S'

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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
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New Report on Injury Mortality in the U.S.
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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

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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

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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

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

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External Cause of Injury Mortality Matrix
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External Cause of Injury Mortality Matrix
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External Cause of Injury Mortality Matrix
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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

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Leading Mechanisms of Injury Death
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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

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Common Nature of Injury Categories (any mention)
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Nature of Injury by Intent (any mention)
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Number of injuries reported
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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

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Poisoning Underlying External Cause
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Poisoning Nature of Injury
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Poisoning Natural Cause
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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, Alzheimers 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

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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

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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

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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)

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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
  /