james c. turner, md university of virginia past president, american college health association
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Leading causes of mortality among American college students at 4-year institutions. James C. Turner, MD University of Virginia Past President, American College Health Association Adrienne Keller, PhD. University of Virginia National Social Norms Institute. Disclosures. - PowerPoint PPT PresentationTRANSCRIPT
James C. Turner, MD University of Virginia
Past President, American College Health Association
Adrienne Keller, PhD. University of Virginia
National Social Norms Institute
Leading causes of mortality among American college students at 4-year institutions.
DisclosuresDisclosures• This project received no specific grant funds from either the
University of Virginia or the American College Health Association.
• The co-investigators are all salaried employees of their respective institutions/organizations.
• The American College Health Association is a non-profit professional association.
• This study was commissioned by JCT while President of the American College Health Association.
• The University of Virginia Department of Student Health has received grants and/or gifts from Merck, GSK, NCAA, Anheuser Busch Foundation, Gordie Foundation, Clay Foundation, and the CDC. None of these entities specifically contributed resources to this project.
ACHA College StudentACHA College StudentMortality RatesMortality Rates
• No published study of college student mortality rates among multiple institutions since 1939.
• No existing data regarding leading causes of mortality among 18 million college students.
• Student deaths uncommon, tragic, newsworthy.• ACHA conducted a survey of 1154 institutions
regarding deaths Aug 1, 2009-May 31, 2010. • 157 four year schools responded representing
1.36M enrolled 18-24 year old students.
ACHA College StudentACHA College StudentMortality RatesMortality Rates
• Sources of death information: o Dean of students (33%) o Student health/counseling services (26.3%) o Campus security (15%) o Registrar (8.4%) o Central administration (7.2%) o Public affairs (6.6%)o Miscellaneous (3.5%)
Table 1. Comparison of enrollment of 18-24 year olds in sample schools vs. in all 4 year institutions, by gender, institutional control, Census Bureau region and urbanization.
ENROLLMENT (18-24 year olds)*
SAMPLE POPULATION
number percent number percent
By Gendermales 640,829 47.07% 3533683 45.09%
females 720,475 52.93% 4303070 54.91%Total 1361304 100.00% 7700741
By Institutional Controlpublic 1078861 79.25% 5206725 66.44%
private 282443 20.75% 2630028 33.56%
Total 1361304 100.00% 7836753 100.00%By Census Bureau Region
Region 1: Northeast 303151 22.27% 1654795 21.12%Region 2: Midwest 316837 23.27% 1878057 23.96%
Region 3: South 557568 40.96% 2696910 34.41%Region 4: West 182213 13.39% 1470979 18.77%
Territories 1535 .11% 136012 1.74%
Total 1361304 100.00% 7836753 100.00%By Urbanization
Large urban 675063 49.59% 3435585 43.84%Small urban/Suburban 440385 32.35% 2949559 37.64%
Rural 245450 18.03% 1451609 18.52%Other/Not assigned 406 .03% 0 0
Total 1361304 100% 7836753 100%
Table 1. Comparison of enrollment of 18-24 year olds in sample schools vs. in all 4 year institutions, by gender, institutional control, Census Bureau region and urbanization.
ENROLLMENT (18-24 year olds)*
SAMPLE POPULATION
number percent number percent
By Gendermales 640,829 47.07% 3533683 45.09%
females 720,475 52.93% 4303070 54.91%Total 1361304 100.00% 7700741
By Institutional Controlpublic 1078861 79.25% 5206725 66.44%
private 282443 20.75% 2630028 33.56%
Total 1361304 100.00% 7836753 100.00%By Census Bureau Region
Region 1: Northeast 303151 22.27% 1654795 21.12%Region 2: Midwest 316837 23.27% 1878057 23.96%
Region 3: South 557568 40.96% 2696910 34.41%Region 4: West 182213 13.39% 1470979 18.77%
Territories 1535 .11% 136012 1.74%
Total 1361304 100.00% 7836753 100.00%By Urbanization
Large urban 675063 49.59% 3435585 43.84%Small urban/Suburban 440385 32.35% 2949559 37.64%
Rural 245450 18.03% 1451609 18.52%Other/Not assigned 406 .03% 0 0
Total 1361304 100% 7836753 100%
Table 2. Comparison of enrollment of undergraduates among
sample and all undergraduates by ethnicity.*
RACE/ETHNICITYUndergraduates in all 4
Year Institutions
Undergraduates in
Sample Schools
N Percent N Percent
white 6,982,692 60% 979,518 69%
black 1,253,626 11% 114,592 8%
Hispanic 1,176,294 10% 88,520 6%
Asian/Pacific 716,915 6% 95,483 7%
American Indian/Alaska
Native94,695 1% 10,231 1%
Non-resident alien 560,158 5% 43,601 3%
Unknown 843,006 7% 84,219 6%
2 or more 560,158 5% 5,687 0%
Total 11,627,386 100.00% 1,421,851 100%
* Ethnicity is not available for age groups, but is available by enrollment in undergraduate or graduate/professional programs. Comparison limited to undergraduate populations.
Table 2. Comparison of enrollment of undergraduates among
sample and all undergraduates by ethnicity.*
RACE/ETHNICITYUndergraduates in all 4
Year Institutions
Undergraduates in
Sample Schools
N Percent N Percent
white 6,982,692 60% 979,518 69%
black 1,253,626 11% 114,592 8%
Hispanic 1,176,294 10% 88,520 6%
Asian/Pacific 716,915 6% 95,483 7%
American Indian/Alaska
Native94,695 1% 10,231 1%
Non-resident alien 560,158 5% 43,601 3%
Unknown 843,006 7% 84,219 6%
2 or more 560,158 5% 5,687 0%
Total 11,627,386 100.00% 1,421,851 100%
* Ethnicity is not available for age groups, but is available by enrollment in undergraduate or graduate/professional programs. Comparison limited to undergraduate populations.
MethodologyMethodology
• Annualized data• Ten month data converted to twelve months
• Imputation to estimate alcohol as factor• 49% of all vehicular deaths assumed related
to alcohol (Hingson et al. JSAD 2009)• 38% of all non-vehicular accidents assumed
related to alcohol (Hingson et al. JSAD 2009)
Table 3. Mortality rates for 18-24 year olds at 4 year institutions (n=157)
Category of Death NumberImputedCases
12 months
Sample n Rate/10000095% CI for rate
Predicted Rate/100000
ReferenceLower Upper
Vehicular Injury78 94 1,361,304 6.88 5.6 8.15 29.21+ CDC-
WISQARS
Non-Alcohol Related*40 48 1,361,304 3.51 2.6 4.41
Alcohol Related*38 46 1,361,304 3.37 2.48 4.26 14.1++ Hingson et al
Suicide70 84 1,361,304 6.17 4.97 7.38 11.72+ CDC-
WISQARS
Non-traffic injury 44 53 1,361,304 3.88 2.92 4.83 14.71+ CDC-WISQARS
Non-Alcohol Related** 27 32 1,361,304 2.39 1.64 3.13
Alcohol Related**17 20 1,361,304 1.49 0.90 2.09 4.9++ Hingson et al
Unknown34 41 1,361,304 3.00 2.16 3.84 1.72+ CDC-
WISQARS
Cancer22 26 1,361,304 1.94 1.27 2.62 2.7 to 5.4*** NCI
Homicide 6 7 1,361,304 0.53 0.18 0.8815.78+ .315++
+
CDC-WISQARS
DOE
Total254 305
*Cases of alcohol related injury are imputed from the number of vehicular injury using 49% alcohol related. 6
**Cases of alcohol related injury are imputed from the number of non-traffic injury using 38.5% alcohol related. 6
*** NCI provides mortality rates for general population ages 15-19 and 20-24 only. Range reflects two age groups.
+ 18-24 year old general population
++ 18-24 year old college students
+++ All four year colleges all incidents of murder (includes students and nonstudents).
Table 3. Mortality rates for 18-24 year olds at 4 year institutions (n=157)
Category of Death NumberImputedCases
12 months
Sample n Rate/10000095% CI for rate
Predicted Rate/100000
ReferenceLower Upper
Vehicular Injury78 94 1,361,304 6.88 5.6 8.15 29.21+ CDC-
WISQARS
Non-Alcohol Related*40 48 1,361,304 3.51 2.6 4.41
Alcohol Related*38 46 1,361,304 3.37 2.48 4.26 14.1++ Hingson et al
Suicide70 84 1,361,304 6.17 4.97 7.38 11.72+ CDC-
WISQARS
Non-traffic injury 44 53 1,361,304 3.88 2.92 4.83 14.71+ CDC-WISQARS
Non-Alcohol Related** 27 32 1,361,304 2.39 1.64 3.13
Alcohol Related**17 20 1,361,304 1.49 0.90 2.09 4.9++ Hingson et al
Unknown34 41 1,361,304 3.00 2.16 3.84 1.72+ CDC-
WISQARS
Cancer22 26 1,361,304 1.94 1.27 2.62 2.7 to 5.4*** NCI
Homicide 6 7 1,361,304 0.53 0.18 0.8815.78+ .315++
+
CDC-WISQARS
DOE
Total254 305
*Cases of alcohol related injury are imputed from the number of vehicular injury using 49% alcohol related. 6
**Cases of alcohol related injury are imputed from the number of non-traffic injury using 38.5% alcohol related. 6
*** NCI provides mortality rates for general population ages 15-19 and 20-24 only. Range reflects two age groups.
+ 18-24 year old general population
++ 18-24 year old college students
+++ All four year colleges all incidents of murder (includes students and nonstudents).
Table 3. Mortality rates for 18-24 year olds at 4 year institutions (n=157)
Category of Death NumberImputedCases
12 months
Sample n Rate/10000095% CI for rate
Predicted Rate/100000
ReferenceLower Upper
Vehicular Injury78 94 1,361,304 6.88 5.6 8.15 29.21+ CDC-
WISQARS
Non-Alcohol Related*40 48 1,361,304 3.51 2.6 4.41
Alcohol Related*38 46 1,361,304 3.37 2.48 4.26 14.1++ Hingson et al
Suicide70 84 1,361,304 6.17 4.97 7.38 11.72+ CDC-
WISQARS
Non-traffic injury 44 53 1,361,304 3.88 2.92 4.83 14.71+ CDC-WISQARS
Non-Alcohol Related** 27 32 1,361,304 2.39 1.64 3.13
Alcohol Related**17 20 1,361,304 1.49 0.90 2.09 4.9++ Hingson et al
Unknown34 41 1,361,304 3.00 2.16 3.84 1.72+ CDC-
WISQARS
Cancer22 26 1,361,304 1.94 1.27 2.62 2.7 to 5.4*** NCI
Homicide 6 7 1,361,304 0.53 0.18 0.8815.78+ .315++
+
CDC-WISQARS
DOE
Total254 305
*Cases of alcohol related injury are imputed from the number of vehicular injury using 49% alcohol related. 6
**Cases of alcohol related injury are imputed from the number of non-traffic injury using 38.5% alcohol related. 6
*** NCI provides mortality rates for general population ages 15-19 and 20-24 only. Range reflects two age groups.
+ 18-24 year old general population
++ 18-24 year old college students
+++ All four year colleges all incidents of murder (includes students and nonstudents).
Table 3. Mortality rates for 18-24 year olds at 4 year institutions (n=157)
Category of Death NumberImputedCases
12 months
Sample n Rate/10000095% CI for rate
Predicted Rate/100000
ReferenceLower Upper
Vehicular Injury78 94 1,361,304 6.88 5.6 8.15 29.21+ CDC-
WISQARS
Non-Alcohol Related*40 48 1,361,304 3.51 2.6 4.41
Alcohol Related*38 46 1,361,304 3.37 2.48 4.26 14.1++ Hingson et al
Suicide70 84 1,361,304 6.17 4.97 7.38 11.72+ CDC-
WISQARS
Non-traffic injury 44 53 1,361,304 3.88 2.92 4.83 14.71+ CDC-WISQARS
Non-Alcohol Related** 27 32 1,361,304 2.39 1.64 3.13
Alcohol Related**17 20 1,361,304 1.49 0.90 2.09 4.9++ Hingson et al
Unknown34 41 1,361,304 3.00 2.16 3.84 1.72+ CDC-
WISQARS
Cancer22 26 1,361,304 1.94 1.27 2.62 2.7 to 5.4*** NCI
Homicide 6 7 1,361,304 0.53 0.18 0.8815.78+ .315++
+
CDC-WISQARS
DOE
Total254 305
*Cases of alcohol related injury are imputed from the number of vehicular injury using 49% alcohol related. 6
**Cases of alcohol related injury are imputed from the number of non-traffic injury using 38.5% alcohol related. 6
*** NCI provides mortality rates for general population ages 15-19 and 20-24 only. Range reflects two age groups.
+ 18-24 year old general population
++ 18-24 year old college students
+++ All four year colleges all incidents of murder (includes students and nonstudents).
Table 3. Mortality rates for 18-24 year olds at 4 year institutions (n=157)
Category of Death NumberImputedCases
12 months
Sample n Rate/10000095% CI for rate
Predicted Rate/100000
ReferenceLower Upper
Vehicular Injury78 94 1,361,304 6.88 5.6 8.15 29.21+ CDC-
WISQARS
Non-Alcohol Related*40 48 1,361,304 3.51 2.6 4.41
Alcohol Related*38 46 1,361,304 3.37 2.48 4.26 14.1++ Hingson et al
Suicide70 84 1,361,304 6.17 4.97 7.38 11.72+ CDC-
WISQARS
Non-traffic injury 44 53 1,361,304 3.88 2.92 4.83 14.71+ CDC-WISQARS
Non-Alcohol Related** 27 32 1,361,304 2.39 1.64 3.13
Alcohol Related**17 20 1,361,304 1.49 0.90 2.09 4.9++ Hingson et al
Unknown34 41 1,361,304 3.00 2.16 3.84 1.72+ CDC-
WISQARS
Cancer22 26 1,361,304 1.94 1.27 2.62 2.7 to 5.4*** NCI
Homicide 6 7 1,361,304 0.53 0.18 0.8815.78+ .315++
+
CDC-WISQARS
DOE
Total254 305
*Cases of alcohol related injury are imputed from the number of vehicular injury using 49% alcohol related. 6
**Cases of alcohol related injury are imputed from the number of non-traffic injury using 38.5% alcohol related. 6
*** NCI provides mortality rates for general population ages 15-19 and 20-24 only. Range reflects two age groups.
+ 18-24 year old general population
++ 18-24 year old college students
+++ All four year colleges all incidents of murder (includes students and nonstudents).
Summary of Mortality Rates/100KSummary of Mortality Rates/100K18-24 years old 18-24 years old
4-Year institutions4-Year institutions
• Leading causes– Suicide (6.18, CI 4.97-7.38 ) – Non-Alcohol vehicular (3.51, CI 2.6-4.41)– Alcohol related vehicular (3.37, CI 2.48-4.26)– Non-alcohol non-traffic injury (2.39, CI 1.64-3.13)– Cancer (1.94, CI 1.27-2.62)– Alcohol related non-traffic injury (1.49, CI 0.90-2.09)– Homicide (0.53, CI 0.18-0.88)
Mortality Rates by Demographic Mortality Rates by Demographic CharacteristicsCharacteristics
• Males had a significantly higher rate of suicide than females (OR 4.43, CI 2.6-7.55)
• No differences by institutional control (public vs. private) or Census Bureau Regions in mortality rates for suicide, alcohol vehicular and non-traffic injuries.
• Rural schools had higher rates of alcohol related vehicular accidents than large urban schools (OR 1.96, CI 1.01-3.8) and small urban/suburban schools (OR 2.99, CI 1.21-6.83).
LimitationsLimitations
• Does not constitute a probability sample of schools (only those schools with access to the data, or willingness to respond to the survey participated).
• Slight over-representation of males, whites, large urban locations, and public schools may contribute to different mortality rates.
• No standardized methodology for tracking and reporting student deaths.
• Imputation of alcohol-related deaths.
LimitationsLimitations
• Despite limitations, mortality rates are similar to published data:– Suicide (Schwartz. JACH. 2006.)– Alcohol-related vehicular deaths in Virginia
(Turner et al. JACH. 2011.)– Cancer (Altekruse et al. SEER cancer
statistics. 2007.)– Homicide (US DOE Post Secondary
Education. Campus safety and security statistics. 2011.)
CommentsComments• First mortality study of college students since 1939.• Suicide 47% lower and alcohol related deaths 60-76%
lower than same-aged general population.– Effective education, detection, and intervention– Accessible medical and counseling services– Less driving– Socioeconomic status– Morbidity related to alcohol still a critical public health issue
• Homicide 97% lower than predicted rate for general population.– Campus security and crime prevention– Behavior intervention teams
CommentsComments
• Campuses may afford much safer and protective environments than previously recognized. Further study needed to replicate findings and assess contributory factors.
• Future epidemiologic data needs to be campus generated. – Estimates from national population statistics may not
account for environmental factors or interventions.
• Suicide prevention needs more attention.• Powerful statement about the public health value
of college health, counseling, security, and other student support services.
Thanks to the American College Health Association and to E. Victor Leino, PhD, Director of Research.