1 healthy carolinians 10/08/09 state of the state: injury and violence overview injury data 101...
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Healthy Carolinians 10/08/09
State of the State:Injury and Violence Overview
INJURY DATA 101Healthy Carolinians & IOM Summit
October 8, 2009
Scott K. Proescholdbell, MPHInjury Epidemiology and Surveillance Unit
Injury and Violence Prevention BranchChronic Disease and Injury Section
N.C. Division of Public Health
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Healthy Carolinians 10/08/09
Overview
• Injury and violence are major public health problems.
• Scope and magnitude of the injury problem in North Carolina.
• Injuries are common risk factors and predictable thus preventable.
• Making injuries and violence socially unacceptable (changing social norms).
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Injuries are NOT:
• “random acts of nature”
• “accidental”• “destiny”• “chance”• “bad luck”• “unavoidable”
Injuries ARE:
• Predictable• Preventable• Have known risk
factors• Opportunities for
prevention
From a public health perspective what we have learned to date:
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Combined = 4th at 4,333, slightly less than stroke. If you combined all injury= 6,247 – solid third.
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Editable iceberg
INJ URY ICEBERGINJ URY ICEBERG
6,247*Deaths
154,348#
Hospitalizations
812,193*ED Visits
???,??? Outpatient Visits
?,???,??? Medically Unattended Injury(home, work, school)
North Carolina’s Injury Iceberg- NC ResidentsAll Intents
Ratio
1
24.7
130.0
???
???
Injury Epidemiology & Surveillance UnitInjury & Violence Prevention BranchChronic Disease and Injury SectionN.C. Division of Public Health
* 2007 death file and 2007 NC DETECT # 2007 Hospitalization Discharge
We are fortunate in NC to have some of the best systems in the nationbut…
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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
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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
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Color Coding for Tables & Charts
• Blue = Unintentional Injury
• Red = Intentional Injury- assault
• Green = Intentional Injury- self-inflicted
• Yellow = Missing E-code
• Gray = Other injuries
The presentation is data heavy. Please focus on overall trends and themes rather than on any one set of specific numbers.
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Proportion of Unintentional and Intentional Injury Deaths, NC: 2007
68%
11%
18%3%
Unintentional
Intentional-Homicide
Intentional-Suicide
Other/Unk
Other includes: legal intervention, undetermined, and all others not classifiedSource: NC State Center for Health Statistics, Death file 2007; Analysis by Injury Epidemiology and Surveillance Unit
N= 6,247
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Leading Causes of Death, All Ages, North Carolina: 2007 (Total Deaths = 75,803)
25.7
2.3
2.3
2.4
2.8
3.2
3.4
5.6
5.7
23.0
23.1
0.0 5.0 10.0 15.0 20.0 25.0 30.0
All other causes
Pnuemonia and influenza
Nephritis, nephrotic syndrome, nephosis
Motor vehicle injuries
Diabetes mellitus
Alzhheimer's disease
Other uninentional injuries
Chronic lower respiratory disease
Cerebrovascular disease
Diseases of the heart
Cancer
Source: NC SCHS Vital Records, 2007
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Cancer22%
Diseases of the heart24%
Motor vehicle injuries2%
All other causes49%
Other unitentional injuries
3%
Percent of Deaths, 2005 Percent YPLL <65, 2005
Total= 74,376 Resident Deaths
Source: NC State Center for Health Statistics & CDC WISQARS
Percent YPLL >65
Unintentional Injury21%
Cancer15%
Heart Disease12%
Homicide5%
Suicide5%
All Others42%
5% Injury-related 31% Injury-related
Years of potential life lost (YPLL) is a measure of premature mortality.
Unintentional
Unintentional
Intentional
Mortality Indicators, 2005
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Age Groups
<1 1-4 5-9 10-14 15-24 25-34 35-44 45-54 55-64 65+ All Ages
PrenatalConditions
585
UnintentionalInjury
27
Motor VehicleInjury
20
Motor VehicleInjury
33
Motor VehicleInjury416
Motor VehicleInjury349
Cancer480
Cancer1,702
Cancer3,544
HeartDisease 13,742
HeartDisease 17,858
CongenitalAnomalies
209
Motor VehicleInjury
21
UnintentionalInjury
20
UnintentionalInjury
15
UnintentionalInjury 190
UnintentionalInjury 242
HeartDisease
444
HeartDisease
1,279
HeartDisease
2,210
Cancer11,848
Cancer 17,762
Unintentional Injury
43
CongenitalAnomalies
20
Cancer10
Cancer13
Homicide177
Homicide180
UnintentionalInjury 379
UnintentionalInjury 420
Chronic LowerRespiratory
Disease 514
Cerebro-Vascular Disease
3,728
Cerebro-VascularDisease
4,461
HeartDisease
21
Cancer 13
Heart Disease
7
Homicide 11
Suicide124
Suicide160
Motor VehicleInjury285
Motor VehicleInjury282
Cerebro-Vascular Disease
412
Chronic LowerRespiratory
Disease 3,553
Chronic LowerRespiratory
Disease 4,286
Septicemia12
Heart Disease12
CongenitalAnomalies
6
HeartDisease
6
Cancer52
HeartDisease
110
Suicide 243
Chronic Liver Disease & Cirrhosis
254
DiabetesMellitus
387
Alzheimer'sDisease
2,430
UnintentionalInjury 2,651
Homicide12
Homicide9
In-situ/ Benign
Neoplasms5
Suicide6
HeartDisease
27
Cancer99
HIV129
Cerebro-Vascular Disease
228
UnintentionalInjury 261
DiabetesMellitus 1,496
Alzheimer'sDisease
2,471
Top 6 Leading Causes of Death (All Races, Both Sexes) by Age Groups, North Carolina: 2007
Source: NC State Center for Health Statistics, Death file 2007; Analysis by Injury Epidemiology and Surveillance Unit
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Healthy Carolinians 10/08/09 Source: NC State Center for Health Statistics, Death file 2007; Analysis by Injury Epidemiology and Surveillance Unit
Leading Causes of Injury Deaths, All Ages, North Carolina Residents: 2007 (Total Deaths = 6,268)
14.03
2.26
3.04
3.12
3.55
5.10
7.28
9.70
9.98
14.42
27.52
0 5 10 15 20 25 30
All Others
Unintentional Fire/Burn
Suicide Suffocation
Unintentional Suffocation
Suicide Poisoning
Unintentional Unspecified
Homicide Firearm
Suicide Firearm
Unintentional Fall
Unintentional Poisoning
Unintentional MV Traffic
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0
5
10
15
20
25
1999 2000 2001 2002 2003 2004 2005 2006 2007
Motor Vehicle Deaths Unt Poisoning Deaths Suicide-Firearm Unt Fall Deaths Homicide-Firearm
Unt Motor Vehicle
Suicide-Firearm
Unt FallsHomicide-Firearm
Unt Poisoning
Leading Causes of Injury Death Rates per 100,000, NC 1999-2007
NC State Center for Health Statistics Death file 1999-2007; NC Injury Epidemiology & Surveillance Unit
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-4.7
180.5
-4.8
30.4
-13.3
-25 25 75 125 175 225
Unt Motor Vehicle Deaths
Unt Poisoning Deaths
Suicide-Firearm
Unt Fall Deaths
Homicide-Firearm
Percentage change in Rates per 100,000 of Injury Deaths NC 1999-2007
WISQARSTM Produced By: Office of Statistics and Programming, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention Data Source: National Center for Health Statistics (NCHS), National Vital Statistics SystemNC State Center for Health Statistics Death file 2006-2007; NC Injury Epidemiology & Surveillance Unit
Unt=unintentional
Increase from 3.53 per 100,000 in1999 to 9.9 in 2007
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North Carolina Injury Death Rates per 100,000, by County: North Carolina, 2007
Injury Epidemiology and Surveillance Unit (IESU)Injury and Violence Prevention BranchNC Division of Public Health
Pitt
Wake
Bladen
Duplin
Hyde
Bertie
Pender
Wilkes
Moore
Union
Halifax
Nash
Robeson
Surry
Onslow
Sampson
Iredell
Columbus
Swain
Burke
Johnston
Ashe
Anson
Guilford
Randolph
Harnett
Brunswick
Jones
Wayne
Chatham
Macon
Rowan
Martin
Hoke
Stokes
LeeStanly
Lenoir Craven
Granville
Franklin
Tyrrell
Warren
BuncombeHaywood
Davidson
Person
Jackson
Gates
Dare
Carteret
Caswell
Forsyth
Caldwell
Beaufort
Cumberland
Madison
Orange
Rutherford
Wilson
Polk
Yadkin
Gaston
Cherokee
Rockingham
Catawba
Richmond
Davie
McDowell
Hertford
Cleveland
Northampton
Clay
Vance
Avery
Mecklenburg
Alamance EdgecombeYancey
Montgomery
PamlicoCabarrus
Durham
Graham
Greene
Scotland
Watauga
Henderson
Washington
Transylvania
Camden
Alexander
CurrituckAlleghany
Chowan
New Hanover
Pitt
Wake
Bladen
Duplin
Hyde
Bertie
Pender
Wilkes
Moore
Union
Halifax
Nash
Robeson
Surry
Onslow
Sampson
Iredell
Columbus
Swain
Burke
Johnston
Ashe
Anson
Guilford
Randolph
Harnett
Brunswick
Jones
Wayne
Chatham
Macon
Rowan
Martin
Hoke
Stokes
LeeStanly
Lenoir Craven
Granville
Franklin
Tyrrell
Warren
BuncombeHaywood
Davidson
Person
Jackson
Gates
Dare
Carteret
Caswell
Forsyth
Caldwell
Beaufort
Cumberland
Madison
Orange
Rutherford
Wilson
Polk
Yadkin
Gaston
Cherokee
Rockingham
Catawba
Richmond
Davie
McDowell
Hertford
Cleveland
Northampton
Clay
Vance
Avery
Mecklenburg
Alamance EdgecombeYancey
Montgomery
PamlicoCabarrus
Durham
Graham
Greene
Scotland
Watauga
Henderson
Washington
Transylvania
Camden
Alexander
CurrituckAlleghany
Chowan
New Hanover
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N
NC Counties
Rate All Injury Deaths66 or less67 - 8283 - 9394 - 148
? = count less than 20 and rate unstable
State Average = 68.9 per 100,000
Unadjusted for age
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0
10
20
30
40
50
60
70
80
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
NC Injury Overall US Injury Overall NC Intentional US Intentional NC Unintentional US Unintentional
Age Adjusted Injury Death Rates, North Carolina and US: 1995-2006
Overall
Unintentional
Intentional
NC
US
NC
US
NC
US
WISQARSTM Produced By: Office of Statistics and Programming, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention Data Source: National Center for Health Statistics (NCHS), National Vital Statistics System
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Leading Causes of Injury Hospitalizations
• 1) Adverse Effects of Medical Care (52,437)• 2) Falls- Unintentional (25,608)• 3) Motor Vehicle- Unintentional (8,235)• 4) Poisoning- Self-inflicted (5,143)• 5) Unspecified- Unintentional (5,010)• 6) Poisoning- Unintentional (3445)
Source: NC State Center for Health Statistics, Hospital file 2007; Analysis by Injury Epidemiology and Surveillance Unit
Total Injury Hospitalizations 2007: 154,348
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Age Groups
<1 1-4 5-9 10-14 15-24 25-34 35-44 45-54 55-64 65+ All Ages
Medical Care
Adverse Effects
552
Medical Care
Adverse Effects
528
Medical CareAdverse Effects
353
Medical CareAdverse Effects
421
MVTUnt
1,881
Medical CareAdverse Effects 2,717
Medical CareAdverse Effects 5,318
Medical CareAdverse Effects 8,461
Medical CareAdverse Effects 10,835
Medical CareAdverse Effects 21,804
Medical CareAdverse Effects
52,437
Missing E-Code 484
Missing E-Code 245
FallUnt 222
Missing E-Code 287
Medical CareAdverse Effects 1,468
Missing E-Code 1,667
Missing E-Code 2,788
Missing E-Code 4,538
Missing E-Code 6,133
FallsUnt
18,137
Missing E-Code 36,749
FallUnt 74
FallUnt 175
Missing E-Code 176
FallsUnt223
Missing E-Code 1,155
MVTUnt
1,368
PoisoningIntentional
1,381
FallsUnt
1,818
FallsUnt
2,835
Missing E-Code 19,276
FallUnint 25,608
UnspecUnt73
Fire/BurnUnt131
MVTUnt161
MVTUnt182
PoisoningUnt
1,065
PoisoningIntentional
1,102
MVTUnt
1,304
MVTUnt
1,265
MVTUnt848
UnspecUnt
2,511
MVTUnt
8,235
Other specified –
Assault38
PoisoningUnt127
StruckUnt49
PoisoningIntentional
92
FallsUnt476
FallsUnt625
FallsUnt
1,023
PoisoningIntentional
1,011
UnspecUnt748
MVTUnt
1,122
PoisoningIntentional
5,143
Other Spec Class Unt
32
Other Spec Class Unt
94
Natul/EnvrUnt49
StruckUnt89
Other specUnt 342
Other specUnt389
PoisoningUnt584
PoisoningUnt725
PoisoningUnt527
Other specUnt889
Unspecified Unt5,010
Top 6 Leading Causes of Injury Hospital Visits (All Races, Both Sexes) by Age Groups, North Carolina: 2007
Source: NC State Center for Health Statistics, Hospital file 2007; Analysis by Injury Epidemiology and Surveillance Unit
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Leading Causes of Injury ED Visits
• 1) Falls – Unintentional (150,157)
• 2) MVT- Unintentional (74,616)
• 3) Struck- Unintentional (62,745)
• 4) Overexertion- Unintentional (53,529)
• 5) Unspecified- Unintentional (47,323)
• 6) Cut/pierce- Unintentional (37,226)
Source: NC DETECT, Emergency Department file 2007; Analysis by Injury Epidemiology and Surveillance Unit
Total Injury ED visits 2007: 812,193
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Age Groups
<1 1-4 5-9 10-14 15-24 25-34 35-44 45-54 55-64 65+ All Ages
FallUnint 1,929
FallUnint
15,269
FallUnint 12,405
FallUnint 11,886
MVTUnint 26,680
MVTUnint 19,567
Missing E-Code 17,939
FallUnint
17,154
FallUnint 14,568
FallUnint 44,831
FallsUnintentional
168,803
Missing E-Code 776
Missing E-Code 6,153
StruckUnint 6,998
StruckUnint 10,442
Missing E-Code 20,924
Missing E-Code 18,992
FallUnint
17,111
Missing E-Code 16,084
Missing E-Code 12,475
Missing E-Code 29,512
Missing E-Code 135,494
UnspecUnint 470
StruckUnint 5,875
Missing E-Code 5,647
Missing E-Code 6,992
StruckUnint 17,801
FallUnint 16,734
MVTlUnint 15,613
MVTlUnint 11,884
MVTlUnint 6,396
Adverse Effects- Medical8,530
MVTUnintentional
92,459
StruckUnint450
Other specified –
Unt 3,962
Cut/pierceUnt
2,856
OverexertionUnt
4,414
FallUnt
16,892
OverexertionUnt
15,010
OverexertionUnt
13,303
OverexertionUnt
8,872
Adverse Effects- Other
4,562
UnspecUnt
5,794
StruckUnintentional
73,918
Other specified –
Unt389
Natul/EnvrUnt
2,730
Natul/EnvrUnt
2,730
MVTUnt
3,392
OverexertionUnt
13,716
StruckUnt
11,329
UnspecUnt
9,493
UnspecUnt
7,396
UnspecUnt
3,974
MVTlUnt
5,062
OverexertionUnintentional
64,706
Natul/EnvrUnt
292
UnspecUnint2,599
Other specified – Unt
2,506
Cut/pierceUnt
3,266
Cut/pierceUnt
10,087
UnspecUnt
10,226
StruckUnt
8,915
StruckUnt
5.,850
OverexertionUnt
3,734
Struck Unt
3,314
UnspecifiedUnintentional
53,133
Top 6 Leading Causes of Injury ED Visits (All Races, Both Sexes) by Age Groups, North Carolina: 2007
Source: NC DETECT, Emergency Department file 2007; Analysis by Injury Epidemiology and Surveillance Unit
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Injury Death Rates (per 100,000) by Age Group, NC Residents, 2007
20 15 10 5 0 5 10 15 20
<1yr
1-4yr
5-14yr
15-24yr
25-34
35-44
45-54
55-64
65-74
75-84
85+
Ag
e G
rou
ps
Rates per 100,000
MALES FEMALES
Drowning Death Rates (per 100,000) by Age Group: NC Residents, 2007
7 6 5 4 3 2 1 0 1 2 3 4 5 6 7
<1yr
1-4yr
5-14yr
15-24yr
25-34
35-44
45-54
55-64
65-74
75-84
85+
Ag
e G
rou
ps
Rates per 100,000
MALES FEMALES
Fall Death Rates (per 100,000) by Age Group: NC Residents, 2007
7 5 3 1 1 3 5 7
<1yr
1-4yr
5-14yr
15-24yr
25-34
35-44
45-54
55-64
65-74
75-84
85+
Ag
e G
rou
ps
Rates per 100,000
MALES FEMALES
Fire Death Rate (per 100,000) by Age Group: NC Residents, 2007
7 6 5 4 3 2 1 0 1 2 3 4 5 6 7
<1yr
1-4yr
5-14yr
15-24yr
25-34
35-44
45-54
55-64
65-74
75-84
85+
Ag
e G
rou
ps
Rates per 100,000
MALES FEMALES
Fire-arm Death Rate (per 100,000) by Age Group: NC Residents, 2007
7 5 3 1 1 3 5 7
<1yr
1-4yr
5-14yr
15-24yr
25-34
35-44
45-54
55-64
65-74
75-84
85+
Ag
e G
rou
ps
Rates per 100,000
MALES FEMALES
Homicide Death Rate (per 100,000) by Age Group: NC Residents, 2007
7 6 5 4 3 2 1 0 1 2 3 4 5 6 7
<1yr
1-4yr
5-14yr
15-24yr
25-34
35-44
45-54
55-64
65-74
75-84
85+
Ag
e G
rou
ps
Rates per 100,000
MALES FEMALES
Motor Vehicle Death Rate (per 100,000) by Age Group: NC Residents, 2007
7 6 5 4 3 2 1 0 1 2 3 4 5 6 7
<1yr
1-4yr
5-14yr
15-24yr
25-34
35-44
45-54
55-64
65-74
75-84
85+
Ag
e G
rou
ps
Rates per 100,000
MALES FEMALES
Poisoning Death Rate (per 100,000) by Age Group: NC Residents, 2007
7 6 5 4 3 2 1 0 1 2 3 4 5 6 7
<1yr
1-4yr
5-14yr
15-24yr
25-34
35-44
45-54
55-64
65-74
75-84
85+
Ag
e G
rou
ps
Rates per 100,000
MALES FEMALES
Tramatic Brain Injury (TBI) Death Rate (per 100,000) by Age Group: NC Residents, 2007
7 6 5 4 3 2 1 0 1 2 3 4 5 6 7
<1yr
1-4yr
5-14yr
15-24yr
25-34
35-44
45-54
55-64
65-74
75-84
85+
Ag
e G
rou
ps
Rate per 100,000
MALES FEMALES
Injury Death Rates (per 100,000) by Age Group, NC Residents, 2007
Data source: Death file 2007, N.C. State Center for Health Statistics. Analysis by Injury Epidemiology and Surveillance Unit
Injury overall Drowning Falls
Fire Fire-arms Homicide
Motor Vehicle TBIPoisoning
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Injury and Violence are costly
Cost in $Billions per year nationally
Medical Costs
Productivity Costs Total Costs
Total $80 $326 $406
MV/ Road $14 $75 $89
Falls $26 $54 $80
Struck by/ Against $11 $37 $48
Cut/ Pierce $3 $12 $16
Fire/ Burn $1 $6 $7
Poisoning $2 $23 $25
Drowning/ Submersion $1 $5 $6
Firearm/ Gunshot $1 $35 $36
Other/ Unclassified $19 $76 $96
Finkelstein EA, Corso PS, Miller TR, Associates. Incidence and Economic
Burden of Injuries in the United States. New York: Oxford University Press; 2006.
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Injury and Violence
• Injuries are the leading cause of death for ages 1-44 in North Carolina.
• The vast majority of injuries are preventable.• Injury-related DEATHS, 2007: 1) unintentional
motor vehicle, followed by 2) unintentional poisoning, 3) unintentional falls.
• Injury-related HOSPITALIZATIONS, 2007: 1) adverse effects of medical care 2) unt. falls; 3) unt. motor vehicle.
• Injury-related EMERGENCY VISITS, 2007: 1) unt. falls; 2) unt. motor vehicle; 3) unt. struck.
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Injury and violence are major public health problems
• Prevention opportunities are available.• Need to make injury socially unacceptable.• Increasing injury awareness is critical.• Put injury squarely on the public health map.• Resources for surveillance and programs
essential.• Understanding the scope of the problem can help
us reduce all types of injury-related morbidity and mortality in North Carolina.
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Socially unacceptable: Flight 1549Continental Connections Flight 3407
What if all injuries were viewed through the same perspective?And investigated the same way?
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Putting Injury & Violence prevention on the public health map
injuryinjury
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Questions/Discussion
www.injuryfreenc.ncdhhs.gov
Scott Proescholdbell, MPH
Injury Epidemiology and Surveillance Unit
919-707-5442