Centers for Disease Control and PreventionNational Center for Health Statistics

Robert N. AndersonArialdi M. MiniñoLois A. FingerhutMargaret Warner

Presenting and Analyzing Injury Presenting and Analyzing Injury Mortality Data in the U.S.Mortality Data in the U.S.

New Report on Injury Mortality in the U.S.

Highlights

• Introduces the External Cause of Injury Mortality Matrix for ICD-10

•Presents data by age, race, sex and state

•Nature of injury data•Detailed data on poisoning deaths•Deaths with natural underlying cause

and mention of external cause

Intent and Mechanism of Death• ICD codes for external causes are two-

dimensional, indicating both intent and mechanism

• 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)

External Cause of Injury Mortality Matrix•Development

•Collaboration involving ICE on Injury Statistics

•Recently modified and updated to be consistent with ICD-10

•Rationale•Provide a standard framework to facilitate

national and international comparability•Present information by both mechanism and

intent

External Cause of Injury Mortality Matrix

External Cause of Injury Mortality Matrix

Intent of death

External Cause of Injury Mortality Matrix

Mechanism of death

Deaths for Selected Mechanisms by Intent: U.S., 2001

0%

20%

40%

60%

80%

100%

Fall Firearm Poisoning Suffocation

Unintentional Suicide Homicide Undetermined

Deaths for Intent Categories by Mechanism: U.S., 2001

0%

20%

40%

60%

80%

100%

Unintentional Suicide Homicide Undetermined

Fall Firearm Motor vehicle traffic Poisoning Suffocation

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

•Nature of injury codes are two-dimensional• Type of injury sustained• Body site injured

Number of injuries reported: U.S., 2001

0 10 20 30 40 50 60 70

0

1

2

3

4 +N

umbe

r of i

njur

ie d

iagn

oses

Percent of total injury deaths

Common Nature of Injury Categories: U.S., 2001

0

5

10

15

20

25

30

35

Head Poisoningand toxic

effects

Multiple sites Unspecifiedsite

Thorax Asphyxiation Lowerextremity

Neck

Perc

ent o

f all

inju

ry d

eath

s

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

Poisoning deaths – Underlying External Cause: U.S., 2001

0

10

20

30

40

50

60

70

Unintentional Suicide Homicide Undetermined

Perc

ent o

f dea

ths

Poisoning deaths – Underlying External Cause: U.S., 2001

0%

20%

40%

60%

80%

100%

Unintentional Suicide Homicide Undetermined

Perc

ent o

f dea

ths

Drugs Alcohol Gases and Vapors Other

Poisoning – Nature of Injury: U.S., 2001

0

10

20

30

40

50

Narcotics Barbiturates Benzo-diazepines

Anti-depressants

Alcohol Carbonmonoxide

Substance

Perc

ent o

f dea

ths

Poisoning – Natural Causes: U.S., 2001

01,0002,0003,0004,000

5,0006,0007,000

Num

ber o

f dea

ths

Alcohol(F10)

Opioids(F11)

Cocaine(F14)

Volatilesolvents

(F18)

Multipledrug use

(F19)

Combining External and Natural Poisonings

0 5000 10000 15000 20000 25000

Alcohol

Drugs

ExternalNatural

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

•Some are likely 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)

Questions?

Bob AndersonRNAnderson@cdc.gov

Injury Report URLhttp://www.cdc.gov/nchs/

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National Vital Statistics Reports Vol 52 No 21