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Robert N. Anderson, Ph.D.Mortality Statistics BranchDivision of Vital Statistics
National Center for Health Statistics
Analyzing Injury Mortality Data for Analyzing Injury Mortality Data for the U.S.the U.S.
Strengthening Partnerships: Shaping the FutureNAPHSIS and VSCP Project Directors Joint Meeting
Portland, OregonJune 6-10, 2004
New Report on Injury Mortality in the U.S.
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
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
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
Injuries in the List of 113 Selected Causes of Death
Intent of death
Injuries in the List of 113 Selected Causes of Death
Injuries in the List of 113 Selected Causes of Death
Mechanism of death
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
External Cause of Injury Mortality Matrix
External Cause of Injury Mortality Matrix
Intent of death
External Cause of Injury Mortality Matrix
Mechanism of death
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
Leading Mechanisms of Injury Death
Mechanism of injury death
Deaths Percent
All injury 157,078 100.0
Motor vehicle traffic 42,443 27.0
Firearm 29,573 18.8
Poisoning 22,242 14.2
Fall 15,764 10.0
Suffocation 12,574 8.0
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
Common Nature of Injury Categories (any mention)
0
5
10
15
20
25
30
35
Head Poisoningand toxic
effects
Multiple sites Unspecifiedsite
Thorax Asphyxiation Lowerextremity
Neck
Pe
rce
nt
of
all
in
jury
de
ath
s
Nature of Injury by Intent (any mention)
0%
20%
40%
60%
80%
100%
Head Poisoningand toxic
effects
Multiple sites Unspecifiedsite
Thorax Asphyxiation Lowerextremity
Neck
Unintentional Suicide Homicide Undetermined intent
Number of injuries reported
0 10 20 30 40 50 60 70
0
1
2
3
4 +
Nu
mb
er o
f in
juri
e d
iag
no
ses
Percent of total injury deaths
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
Poisoning – Underlying External Cause
Percent of all injury deaths
Intent of death Total Drugs
Alcohol
Gases and
vapors
Unintentional 63.3 67.2 84.9 27.8
Suicide 23.3 18.4 7.3 67.7
Homicide 0.3 0.2 0.0 0.8
Undetermined 13.1 14.3 7.8 3.7
Poisoning – Nature of Injury
Percent of all injury deaths
Substance Total Unintentional
Suicide
Undetermined
Drugs 77.5 77.7 69.4 93.9
Narcotics 45.2 50.5 19.8 63.8
Heroin 6.9 9.6 0.6 3.5
Cocaine 15.2 19.0 2.4 17.5
Barbiturates 1.1 0.6 2.5 0.9
Benzodiazepines
6.4 6.1 8.0 5.5
Antidepressants
8.0 5.5 15.8 8.5
Nondrugs 29.4 29.9 36.4 10.6
Alcohol 7.6 9.0 4.7 4.8
Carbon monoxide
10.5 6.7 26.5 2.7
Poisoning – Natural Cause
Substance Total
Acute intoxicati
onHarmful use
Dependence
syndromeWithdrawal state
Alcohol 6,627 633 1,718 3,529 164
Drugs 1,931 16 1,313 323 10
Opioids 211 2 120 48 2
Cocaine 401 11 241 35 1
Volatile solvents 9 1 5 3 0
Multiple drug use 1,265 1 931 227 6
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
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
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
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)
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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