Injury and Violence Prevention The Road Ahead:

Getting from Here to There

Healthy Carolinians- 2020 VisionSept 30th, 2010

From a public health perspective what we have learned to date:

Injuries & Violence are NOT:

• “random acts of nature”

• “accidental”• “destiny”• “chance”• “bad luck”• “unavoidable”

Injuries & Violence ARE:

• Predictable• Preventable• Have known risk

factors• Opportunities for

prevention

6,275Deaths

869,614ED Visits

???,??? Outpatient Visits

?,???,??? Medically Unattended Injury(home, work, school)

Leading Causes of Chronic Disease and Injury Deathand Years of Life Lost: N.C., 2009

Cause of Death Total Deaths Average Years of Life Lost *

Total Years of Life Lost *

Cancer 17,476 3.46 60,420

Heart Disease 17,133 2.70 46,269

Injury 6,074 19.29 117,143

Stroke 4,391 1.96 8,602

Chronic Lower Respiratory Diseases (Asthma, COPD) 4,324 1.31 5,646

Alzheimer's disease 2,645 0.04 112

Diabetes Mellitus 2,107 3.40 7,165

Hypertension 796 2.40 1,912

Atherosclerosis 215 0.78 168

Total Deaths (all causes) 76,948 5.06 389,358

Chronic Disease Deaths 51,846 2.73 141,294

* Based on deaths that occurred prior to age 65

Source: N.C. State Center for Health Statistics, 2009

INJ URY ICEBERGINJ URY ICEBERG

???,??? Outpatient Visits

?,???,??? Medically Unattended Injury(home, work, school)

Deaths from Injury and Violence are Only the Tip of the Iceberg

The vast majority of injuries in North

Carolina go unreported.

* 2008 death file, hospitalization discharge and NC DETECT (Emergency Department visits)

6,275*Deaths

159,645*Hospitalizations

869,435*ED Visits

Despite N.C.’s excellent reporting systems, the total burden of injury

to the state isunknown.

???,??? EMS

Unintentional Injury Defined

• Occurs in a relatively short period of time.

• Harmful outcome was not sought.

Unintentional injuries account for more than

2/3 of all injury deaths

Intentional Injury Defined

• The active, deliberate use of force over another person or against one's self

• Intentional injuries account for less than 1/3 of all injury deaths

Source: NC State Center for Health Statistics, Death file 2009; Analysis by Injury Epidemiology and Surveillance Unit

108

202

562

826

837

1,036

1,161

1,342

Leading Causes of Injury Deaths (by Number of Deaths, All Ages, North Carolina Residents: 2009)

Motor Vehicle Crashes

Suicides

Unintentional Poisoning

Unintentional Falls

Homicides

Unintentional, Other & Unspecified *

Unintentional Suffocation

Unintentional Fire/Burn Total Deaths = 6,074

* Unintentional Other and Unintentional Unspecified are two separate categories. Other comprises several smaller defined causes of death, while Unspecified refers to unintentional deaths that were not categorized due to coding challenges.

Age Groups

<1 1-4 5-9 10-14 15-24 25-34 35-44 45-54 55-64 65+ All Ages

LowBirthweight

209

UnintentionalInjury

35

UnintentionalInjury

15

UnintentionalInjury

17

Motor VehicleInjury344

UnintentionalInjury264

Heart Disease

419

Cancer1,633

Cancer3,445

HeartDisease 13,321

HeartDisease 17,417

CongenitalAnomalies

203

Motor VehicleInjury

18

Cancer15

Motor Vehicle Injury

17

UnintentionalInjury 196

Motor VehicleInjury 263

Cancer414

HeartDisease

1,249

HeartDisease

2,248

Cancer11,717

Cancer 17,403

SIDS136

CongenitalAnomalies

15

Motor VehicleInjury

15

Cancer16

Homicide177

Homicide183

UnintentionalInjury 340

UnintentionalInjury 457

Chronic LowerRespiratory

Disease 513

Chronic LowerRespiratory

Disease 3,802

Chronic LowerRespiratory

Disease4,527

PregnancyRelated

75

Homicide13

Homicide5

Homicide 7

Suicide136

Suicide181

Motor VehicleInjury240

Suicide258

DiabetesMellitus

399

Cerebro-VascularDisease

3,761

Cerebro-VascularDisease

4,477

Placental, Cord, &

Other Complications

43

Cancer9

CongenitalAnomalies

5

Suicide 5

Cancer43

Cancer111

Suicide 233

Chronic Liver Disease & Cirrhosis

248

Cerebro-VascularDisease

373

Alzheimer'sDisease

2,585

UnintentionalInjury 2,713

Unintentional Injury

31

Heart Disease

7

In-situ/ Benign

Neoplasms5

Heart Disease

4

HeartDisease

36

HeartDisease

111

HIV103

Motor VehicleInjury 242

Chronic Liver Disease & Cirrhosis

267

DiabetesMellitus

1,487

Alzheimer'sDisease

2,620

Top 6 Leading Causes of Death (All Races, Both Sexes) by Age Groups, North Carolina: 2008

Source: NC State Center for Health Statistics, Death file 2008; Analysis by Injury Epidemiology and Surveillance Unit

Percent Change in Rates Between 1999 and 2009 Leading Causes of Injury Deaths: N.C. 1999 to 2009*

Source: N.C. State Center for Health Statistics, Vital Statistics-Deaths, 1999-2009Analysis by Injury Epidemiology and Surveillance Unit

Motor Vehicle, -28.8%

Unintentional Poisoning, +212.7%

Firearm - Self-Inflicted, +1.7%

Unintentional Falls, +68.1%

Firearm - Assault, -25.3%

-50 0 50 100 150 200 250

Inju

ry M

ech/

Inte

nt

Percent Difference

*Provisional data.

An ‘average’ injury day in NC

• 17 deaths

• 423 hospitalizations

• 2,383 ED visits

• ??? unattended

Unt. Motor Vehicle Traffic (MVT) Related Injuries

A Comparison of the Rates of MVT-Related Deaths Between Male and Females: N.C., 2009 (N=1,342 Deaths)

0

10

20

30

40

50

00-15 16-20 21-25 26-35 36-45 46-55 56-65 66-75 >75

Age Group

Rate

per

N.C

. Res

iden

ts

Male Female

Males have higher rates of death due to MVT-related injuries than females for all age groups.

Source: N.C. State Center for Health Statistics, Vital Statistics-Deaths, 2009Analysis by Injury Epidemiology and Surveillance Unit

A Comparison of the Rates of MVT-Related Deaths by Age: N.C., 2002 & 2009

In December, 2002, N.C. enacted a graduated driver’s license program. For a sixteen year-old, the rate decreased by 40% since 2002.

Source: N.C. State Center for Health Statistics, Vital Statistics-Deaths, 2002, 2009Analysis by Injury Epidemiology and Surveillance Unit

0

10

20

30

40

50

<15 15* 16 17* 18 19 20 21 22 23 24 25+

Age (Years)

Rate

per

100

,000

N.C

. Res

iden

ts

2002 2009

*<20 deaths; rates may be statistically unreliable.

Reportable Crashes: N.C., 2008

Source: UNC Highway Safety Research Center, N.C. Crash Data, 2008 Analysis by Injury Epidemiology and Surveillance Unit

Non-Fatal Injury, 71,773,

33%

Fatal Injury, 1,340,

1%

Property Damage

Only, 141,245,

66%

376,209

214,358

539,760

0

100,000

200,000

300,000

400,000

500,000

600,000

Crashes Vehicles People

Num

ber o

f Cra

shes

/Veh

icle

s/Pe

ople

N = 214,358 Reportable Crashes

Alcohol Involvement in Reportable Crashes: N.C., 2008 (N = 214,358 Crashes)

Source: UNC Highway Safety Research Center, N.C. Crash Data, 2008 Analysis by Injury Epidemiology and Surveillance Unit

6%

30%

70%

94%

0%

25%

50%

75%

100%

All reportable crashes Fatal crashes

Perc

ent o

f cra

shes

No alcohol involved

Alcohol involved

202, 376 Crashes

11, 982 Crashes

938 Crashes

402Crashes

Unintentional Falls

Rate of Deaths due to Unintentional Falls Since 2000: N.C., 2000-2009

5.4 5.25.6

5.9

7.1 7.2

6.1

6.9

8.1

8.9

0

2

4

6

8

10

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Year

Rate

per

100

,000

N.C

. Res

iden

ts

Source: N.C. State Center for Health Statistics, Vital Statistics-Deaths, 2000-2009Analysis by Injury Epidemiology and Surveillance Unit

Rate of Deaths due to Unintentional Falls by Age: N.C., 2009

Source: N.C. State Center for Health Statistics, Vital Statistics-Deaths, 2009Analysis by Injury Epidemiology and Surveillance Unit

0

50

100

150

200

250

300

350

00-04 5-9 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

Age Group

Rate

per

100

,000

N.C

. Res

iden

ts

Females

Males

BothSexes

Rates Deaths, Hospitalizations, and Emergency Department (ED) Visits Due to Unintentional Falls by Age: N.C., 2009

Source: N.C. State Center for Health Statistics, Vital Statistics-Deaths, 2008; Vital Statistics-Hospital Discharge, 2008NC DETECT-ED, 2008Analysis by Injury Epidemiology and Surveillance Unit

0

2,000

4,000

6,000

8,000

10,000

00-04 5-9 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

Age Group

Rate

per

100

,000

N.C

. Res

iden

ts

Deaths

Hospitalizations

ED

Outcome of Patients Hospitalized due to an Unintentional Fall, N.C., 2008

Source: N.C. State Center for Health Statistics-Vital Statistics-Hospital Discharge, 2008Analysis by Injury Epidemiology and Surveillance Unit

10,220

7,682

3,725

1,804

886456 244 207

731

0

3,000

6,000

9,000

12,000

SkilledNursingFacility

Home Home Health Rehab Death Transfer Floor-MedicareSwing Bed

IntermediateCare Facility

Other

Outcome

Num

ber

of H

ospi

tal D

isch

arge

s

Unintentional Poisoning

Poisoning Deaths: N.C., 1999-2008

Source: CDCWISQARS-2006Analysis by the Injury Epidemiology and Surveillance Unit

•In 1999, the number of unintentional poisoning deaths was 279; in 2008, the number of deaths was 1,016.

1 2 4 0 2 2 1 2 3 2

279

367437

547

690728

872 902 901

1016

184 196 222 212184151155186169141

4819 22 11 20 25 22 27 28 41

1278

116711281084

936868

722638

560

440

0

300

600

900

1200

1500

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Year

Num

ber o

f Dea

ths Unintentional

Suicide

Homicide

Undetermined

All Poisonings

North Carolina – Violent Death Reporting System (NC-VDRS)

Percent of Deaths Due to Violence by Manner/Intent: North Carolina Violent Death Reporting System, 2004-2009*

Suicide: 61%

Homicide: 35%

Unintentional Firearm: 1%

Legal Intervention: 1%Undetermined Intent: 3%

* 2008 and 2009 data are provisional

* 2008 data are provisional

Percent of Deaths by Method of Fatal Injury: North Carolina Violent Death Reporting System, 2004-2008*

3%

5%

4%

0%

6%

68%

14%

60%

1%

0%

19%

17%

0%

3%

Firearm

Sharp Inst

Blunt

Poison

Hanging

Unarmed

Other

Homicide Suicide

From Data to Action

Living lives to their full potential

North Carolina Institute of Medicine (NC IOM)

Recent NC IOM Task Forces

• Prevention Task Force (2010)

• Adolescent Health Task Force (2009)

• Substance Abuse Task Force (2009)

• Child Abuse Prevention (2005)

• Healthy NC 2020 (2010)

You've got to be very careful if you don't know where you are going, because you

might not get there.

Yogi Berra

NC Healthy People 2020

• Injury & Violence Objectives –Homicide–Suicide–Unt. Poisoning*–Unt. Falls–DWI/impaired driving–Occupational injuries

*priority topic

North Carolina Strategic Plan for Prevention Injury and Violence

• North Carolina’s first Strategic Plan for Preventing Injuries and Violence

• Reduce the rate of morbidity and mortality from injury and violence by 15%.

• More than 60 agencies and individuals worked over the course of a year to develop.

• Focuses efforts on leading causes of death and morbidity.

Statewide Objectives

• Unt. Motor Vehicle

• Unt. Poisoning

• Unt. Falls

• Homicide

• Suicide

North Carolina Resources for Injury and Violence

Themes for this year

• From data to action

• Putting injury on the map

• The road ahead• Everyone has an injury story

Putting Injury & Violence prevention on the public health map

injuryinjury

Everyone has an injury story. What’s yours…

My Injury Story

Healthy Carolinians is and will be an increasing critical partner

in preventing injury and violence in North Carolina

¿Preguntas?

www.injuryfreenc.ncdhhs.gov

Scott Proescholdbell, MPHInjury and Violence Prevention Branch

Chronic Disease and Injury SectionNC Division of Public Health

919-707-5442