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State of the State: Injury and Violence Overview INJURY DATA 101

State of the State: Injury and Violence Overview INJURY DATA 101. Healthy Carolinians & IOM Summit October 8, 2009 Scott K. Proescholdbell, MPH Injury Epidemiology and Surveillance Unit Injury and Violence Prevention Branch Chronic Disease and Injury Section N.C. Division of Public Health.

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State of the State: Injury and Violence Overview INJURY DATA 101

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  1. State of the State:Injury and Violence OverviewINJURY DATA 101 Healthy Carolinians & IOM Summit October 8, 2009 Scott K. Proescholdbell, MPH Injury Epidemiology and Surveillance Unit Injury and Violence Prevention Branch Chronic Disease and Injury Section N.C. Division of Public Health

  2. 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).

  3. 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:

  4. NC Division of Public Health Annual Report 2008- Oct. 2008

  5. Combined = 4th at 4,333, slightly less than stroke. If you combined all injury = 6,247 – solid third.

  6. Injury Epidemiology & Surveillance Unit Injury & Violence Prevention Branch Chronic Disease and Injury Section N.C. Division of Public Health North Carolina’s Injury Iceberg- NC Residents All Intents Ratio Editable iceberg 1 6,247* Deaths We are fortunate in NC to have some of the best systems in the nation but… 154,348# Hospitalizations 24.7 812,193* ED Visits 130.0 ???,??? Outpatient Visits ??? ??? ?,???,??? Medically Unattended Injury (home, work, school) * 2007 death file and 2007 NC DETECT # 2007 Hospitalization Discharge

  7. 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

  8. 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

  9. 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.

  10. Proportion of Unintentional and Intentional Injury Deaths, NC: 2007 N= 6,247 Other includes: legal intervention, undetermined, and all others not classified Source: NC State Center for Health Statistics, Death file 2007; Analysis by Injury Epidemiology and Surveillance Unit

  11. Source: NC SCHS Vital Records, 2007

  12. Mortality Indicators, 2005 Percent YPLL <65, 2005 Percent of Deaths, 2005 Unintentional Unintentional Intentional 31% Injury-related 5% Injury-related Total= 74,376 Resident Deaths Years of potential life lost (YPLL) is a measure of premature mortality. Source: NC State Center for Health Statistics & CDC WISQARS

  13. 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

  14. Source: NC State Center for Health Statistics, Death file 2007; Analysis by Injury Epidemiology and Surveillance Unit

  15. Leading Causes of Injury Death Rates per 100,000, NC 1999-2007 Unt Motor Vehicle Unt Poisoning Suicide-Firearm Unt Falls Homicide-Firearm NC State Center for Health Statistics Death file 1999-2007; NC Injury Epidemiology & Surveillance Unit

  16. Percentage change in Rates per 100,000 of Injury Deaths NC 1999-2007 Increase from 3.53 per 100,000 in 1999 to 9.9 in 2007 Unt=unintentional 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 NC State Center for Health Statistics Death file 2006-2007; NC Injury Epidemiology & Surveillance Unit

  17. Unadjusted for age

  18. Age Adjusted Injury Death Rates, North Carolina and US: 1995-2006 Overall NC US NC Unintentional US Intentional 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

  19. 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) Total Injury Hospitalizations 2007: 154,348 Source: NC State Center for Health Statistics, Hospital file 2007; Analysis by Injury Epidemiology and Surveillance Unit

  20. 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

  21. 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) Total Injury ED visits 2007: 812,193 Source: NC DETECT, Emergency Department file 2007; Analysis by Injury Epidemiology and Surveillance Unit

  22. 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

  23. Injury Death Rates (per 100,000) by Age Group, NC Residents, 2007 Injury overall Drowning Falls Fire Fire-arms Homicide Motor Vehicle Poisoning TBI Data source: Death file 2007, N.C. State Center for Health Statistics. Analysis by Injury Epidemiology and Surveillance Unit

  24. Injury and Violence are costly Finkelstein EA, Corso PS, Miller TR, Associates. Incidence and Economic Burden of Injuries in the United States. New York: Oxford University Press; 2006.

  25. 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.

  26. 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.

  27. Socially unacceptable: Flight 1549Continental Connections Flight 3407 What if all injuries were viewed through the same perspective? And investigated the same way?

  28. injury Putting Injury & Violence prevention on the public health map

  29. Questions/Discussion www.injuryfreenc.ncdhhs.gov Scott Proescholdbell, MPH Injury Epidemiology and Surveillance Unit Scott.proescholdbell@ncmail.net 919-707-5442

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