Addendum to Injury Morbidity and Mortality in Indiana Injury Prevention Advisory Council Meeting June 21 2012 Julie Wirthwein Injury Prevention Epidemiologist Division of Trauma and Injury Prevention ID: 773807
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Addendum to Injury Morbidity and Mortality in Indiana Injury Prevention Advisory Council MeetingJune 21, 2012Julie Wirthwein—Injury Prevention Epidemiologist Division of Trauma and Injury Prevention
OverviewBackground of State Injury Indicators ReportInjury mortality, hospitalization and emergency department (ED) dataInjury by intent Fall-related injuries by typeFire and hot object/substance injuriesMotor vehicle crash injuries by injured person typeCauses/mechanisms of traumatic brain injuriesLeading causes of injury death by age group 2
Data SourcesIndiana Mortality Reports (http://www.in.gov/isdh/19096.htm) Published by: Indiana State Department of Health (ISDH), Data Analysis Team (DAT) Hospital Discharge Datasets (HDD), Inpatient and Emergency Department (ED)Overseen by: ISDH, DAT; Indiana Hospital AssociationWeb-based Injury Statistics Query and Reporting System (WISQARS) ( http://www.cdc.gov/injury/wisqars/index.html ) Centers for Disease Control and Prevention, 2006–2009 3
State Injury IndicatorsAn injury indicator describes a health outcome of an injury, such as a hospitalization or death, or a factor known to be associated with an injury, such as a risk or protective factor among a specified population Guidelines for injury surveillance developed by the State and Territorial Injury Prevention Directors Association (STIPDA) and the Council of State and Territorial Epidemiologists (CSTE)Provides state injury programs with a standardized method for evaluating injury data that is comparable across states, the United States and territories 4
State Injury Indicators—Injury CategoriesCauses of InjuryUnintentional Drowning (Drowning) Unintentional Fall-related (Falls)Unintentional Fire-related (Fire)Firearm-relatedHomicide/AssaultPoisoningMotor Vehicle TrafficSuicide/Suicide Attempt 5 Types of Injury Traumatic Brain Injury (TBI) Hip Fracture Admissions, aged 65 years and older
State Injury IndicatorsOverlaps exist among injury categoriesExample: A firearm-related homicide could be included in the firearm-related, homicide and traumatic brain injury (TBI) death indicator totals Mortality data include only Indiana residents whether or not the death occurred in-stateHDD characteristicsRestricted to non-federal, non-state, acute care facilitiesNo psychiatric, rehab, or long-term hospitals are includedReadmissions, transfers, and in-hospital deaths are included 6
Injury CodingMortality Data: International Classification of Disease, Tenth Revision (ICD-10), (See Appendix A) Hospital Discharge Data: International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM), (See Appendix B)External causes of injury and poisoning codes (E-codes) Capture how the injury or poisoning happened (cause), the intent (unintentional, intentional, undetermined), and the place where the event occurredAre intended to provide data for injury research and evaluation of injury prevention strategies Quality of data is dependent on the completeness and accuracy of E-codes Indiana’s E-code percentage (Inpatient HDD) in 2009: 62.44% Injury Hospitalization and Emergency Department Subsets were produced by searching principal diagnosis field for appropriate codes 7
Overview of Mortality Data—Indiana, 2007–2009 Death rate for all injuries combined was 60.0 deaths per 100,000 from 2007 to 2009, claiming 11,640 lives Males were 2.4 times more likely than females to be fatally injured (86.2 versus 35.5 per 100,000)Injury death rates were highest among those aged 85 years and older (286.1 per 100,000)8 Source: ISDH, Epidemiology Resource Center, DAT
Overview of Mortality Data—Indiana, 2007–2009 Leading causes of injury deaths among both sexes combined were poisonings (15.0 per 100,000), suicides (12.5 per 100,000), and motor vehicle crashes (12.3 per 100,000) Leading causes of injury deaths among males were suicides (20.8 per 100,000), firearm-related incidents (19.4 per 100,000), and poisonings (18.8 per 100,000)Leading causes of injury deaths among females were poisonings (11.2 per 100,000), motor vehicle crashes (6.9 per 100,000), and suicides (4.8 per 100,000) 9 Source: ISDH, Epidemiology Resource Center, DAT
Overview of Inpatient Hospital Discharge Data—Indiana, 2007–2009 Leading causes of injury-related hospitalizations among both sexes combined were falls (163.2 per 100,000), poisonings (68.8 per 100,000), and motor vehicle crashes (45.2 per 100,000) Males were 1.1 times more likely than females to be hospitalized because of an injury (496.8 versus 468.7 per 100,000)10 Source: ISDH, Epidemiology Resource Center
Overview of Inpatient Hospital Discharge Data—Indiana, 2007–2009 Leading causes of injury-related hospitalizations among males were falls (134.7 per 100,000), poisonings (62.1 per 100,000), and motor vehicle crashes (57.5 per 100,000) Leading causes of injury-related hospitalizations among females were falls (178.6 per 100,000), poisonings (75.4 per 100,000), and suicides (47.2 per 100,000) 11 Source: ISDH, Epidemiology Resource Center
Overview of ED Hospital Discharge Data—Indiana, 2007–2009 Leading causes of injury-related ED visits among both sexes combined were falls (1,900.5 per 100,000), motor vehicle crashes (604.2 per 100,000), and assaults (248.8 per 100,000) Males were 1.1 times more likely than females to visit an ED because of an injury (9,407.3 versus 8,204.4 per 100,000)12 Source: ISDH, Epidemiology Resource Center
Overview of ED Hospital Discharge Data—Indiana, 2007–2009 Leading causes of injury ED visits among males were falls (1,730.3 per 100,000), motor vehicle crashes (566.2 per 100,000), and assaults (302.8 per 100,000) Leading causes of injury ED visits among females were falls (2,035.3 per 100,000), motor vehicle crashes (643.3 per 100,000), and assaults (193.4 per 100,000)13 Source: ISDH, Epidemiology Resource Center
Overview of ED Hospital Discharge Data—Indiana, 2007–2009 Leading causes of injury ED visits among males were falls (1,730.3 per 100,000), motor vehicle crashes (566.2 per 100,000), and assaults (302.8 per 100,000) Leading causes of injury ED visits among females were falls (2,035.3 per 100,000), motor vehicle crashes (643.3 per 100,000), and assaults (193.4 per 100,000)14 Source: ISDH, Epidemiology Resource Center
Injury Fatality ICD-10 Codes15 V01–Y36Y85–Y87Y89 Injury and poisoning
Overview of Injury Death Rates—Indiana, 2007–2009 16 *Age-adjusted
Age-Adjusted Injury Death Rates by Cause/Type—Indiana, 2007–2009 17 Source: ISDH, Epidemiology Resource Center, DAT
18 Source: ISDH, Epidemiology Resource Center, DAT Age-Adjusted Injury Death Rates by Sex and Cause/Type—Indiana, 2007–2009
19 Source: ISDH, Epidemiology Resource Center, DAT Age-Adjusted Injury Death Rates by Sex— Indiana, 2007–2009
20 Source: ISDH, Epidemiology Resource Center, DAT Injury Death Rates by Sex and Age—Indiana, 2007–2009
Hospitalizations for All Injuries ICD-9-CM Codes21 800–909.2909.4909.9–994.9995.5–995.59995.80–995.85 Injury and poisoning
Overview of Injury Hospitalization Rates— Indiana, 2007–2009 22
Age-Adjusted Injury Hospitalization Rates by Cause/Type —Indiana, 2007–2009 23 Source: ISDH, Epidemiology Resource Center
Age-Adjusted Injury Hospitalization Rates by Sex and Cause/Type —Indiana, 2007–2009 24 Source: ISDH, Epidemiology Resource Center
Age-Adjusted Injury Hospitalization Rates by Sex—Indiana, 2007–2009 25 Source: ISDH, Epidemiology Resource Center
Injury Hospitalization Rates by Age and Sex— Indiana, 2007–2009 26 Source: ISDH, Epidemiology Resource Center
ED Visits for All Injuries ICD-9-CM Codes27 800–909.2909.4909.9–994.9995.5–995.59995.80–995.85 Injury and poisoning
Overview of Injury ED Visit Rates—Indiana, 2007–2009 28 *Age-adjusted
Age-Adjusted Injury ED Visit Rates by Cause/Type—Indiana, 2007–2009 29 Source: ISDH, Epidemiology Resource Center
Age-Adjusted Injury ED Visit Rates by Cause/Type and Sex— Indiana, 2007–2009 30 Source: ISDH, Epidemiology Resource Center
Injury ED Visit Rates by Age and Sex—Indiana, 2007–2009 31 Source: ISDH, Epidemiology Resource Center
Injury Deaths by Intent—Indiana, 2007–2009 32 N=11,643 Source: ISDH, Epidemiology Resource Center, DAT
Intentional Injury Deaths by Type—Indiana, 2007–2009 33 N=3,447 Source: ISDH, Epidemiology Resource Center, DAT
34 Injury Hospitalizations by Intent—Indiana, 2007–2009 N=68,041 Source: ISDH, Epidemiology Resource Center
Intentional Injury Hospitalizations by Type—Indiana, 2007–2009 35 N=10,009 Source: ISDH, Epidemiology Resource Center
Unintentional Fall-Related Deaths by Type—Indiana, 2007–2009 36 N=1,008 Source: ISDH, Epidemiology Resource Center, DAT
37 Unintentional Fall-Related Hospitalizations by Type—Indiana, 2007–2009 N=32,912 Source: ISDH, Epidemiology Resource Center
38 Unintentional Fall-Related ED Visits by Type—Indiana, 2007–2009 N=364,498 Source: ISDH, Epidemiology Resource Center
Fire/Burn* Hospitalizations—Indiana, 2007–2009 39 N=1,370 Source: ISDH, Epidemiology Resource Center
40 *Hot object/substance burns excluded from State Injury Indicators Report Fire/Burn* ED Visits—Indiana, 2007–2009 N=20,267 Source: ISDH, Epidemiology Resource Center
Motor Vehicle Crash Deaths by Injured Person Type—Indiana, 2007–200941 N=2,364 Source: ISDH, Epidemiology Resource Center, DAT
42Motor Vehicle Crash Hospitalizations by Injured Person Type—Indiana, 2007–2009 N=8,639 Source: ISDH, Epidemiology Resource Center
43 Motor Vehicle Crash ED Visits by Injured Person Type—Indiana, 2007–2009 N=113,553 Source: ISDH, Epidemiology Resource Center
Causes/Mechanisms of TBI Deaths—Indiana, 2009 44 Cause/ Mechanism* TBI (N=1,012) Falls 209 Fire 1 Firearms 453 Homicide 111 MVT 202 Poisoning 2 Suicide 360 Cause/ Mechanism* TBI (%) Falls 20.7% Fire 0.1% Firearms 44.8% Homicide 11.0% MVT 20.0% Poisoning 0.2% Suicide 35.6% *Causes/mechanisms not mutually exclusive Source: ISDH, Epidemiology Resource Center, DAT
Firearm-Related TBI Deaths by Selected Cause—Indiana, 200945 Source: ISDH, Epidemiology Resource Center, DAT Cause Firearm-Related TBI (N=452) Suicide by Discharge of Firearms 355 Homicide by Discharge of Firearms 78 Accidental Discharge of Firearms 14 Undetermined Discharge of Firearms 5 Cause Firearm -Related TBI (%) Suicide by Discharge of Firearms 78.4% Homicide by Discharge of Firearms 17.2% Accidental Discharge of Firearms 3.1% Undetermined Discharge of Firearms 1.1%
Causes/Mechanisms of TBI Hospitalizations—Indiana, 200946 Cause/ Mechanism* TBI (N=4,245) Falls 1,618 Fire 4 Firearms 59 Homicide 230 MVT 935 Poisoning 27 Suicide 33 Cause/ Mechanism* TBI (%) † Falls 38.1% Fire 0.1% Firearms 1.4% Homicide 5.4% MVT 22.0% Poisoning 0.6% Suicide 0.8% Source: ISDH, Epidemiology Resource Center *Causes/mechanisms not mutually exclusive † Total less than 100% due to lack of e-codes and other unlisted causes/mechanisms (TBI e-code percentage: 76.1%)
47Source: WISQARS *Note change in years Death Rates among Children Under Age One Year by Mechanism of Injury—Indiana and United States, 2000–2009*
48Source: WISQARS Death Rates among Children Ages 1–4 Years by Mechanism of Injury—Indiana and United States, 2000–2009
49 Source: WISQARS Death Rates among Children Ages 5–14 Years by Mechanism of Injury—Indiana and United States, 2000–2009
50 Source: WISQARSDeath Rates among 15–24 Year Olds by Mechanism of Injury—Indiana and United States, 2007–2009 *Note change in years
51 Source: WISQARS Death Rates among Adults Ages 25–34 Years by Mechanism of Injury—Indiana and United States, 2007–2009
52 Source: WISQARS Death Rates among Adults Ages 35–44 Years by Mechanism of Injury—Indiana and United States, 2007–2009
53 Source: WISQARS Death Rates among Adults Ages 45–54 Years by Mechanism of Injury—Indiana and United States, 2007–2009
54 Source: WISQARS Death Rates among Adults Ages 55–64 Years by Mechanism of Injury—Indiana and United States, 2007–2009
55 Source: WISQARS Death Rates among Adults Ages 65–74 Years by Mechanism of Injury—Indiana and United States, 2007–2009
56 Source: WISQARS Death Rates among Adults Ages 75–84 Years by Mechanism of Injury—Indiana and United States, 2007–2009*
57 Source: WISQARS Death Rates among Adults Ages 85+ Years by Mechanism of Injury—Indiana and United States, 2007–2009
58
59 *Age-adjusted rates Source: WISQARS Percent Change in Leading Causes of Injury Death*— Indiana, 1999–2009
Leading Causes of Injury Death*—Indiana, 1999–2009 60 * Age-adjusted rates Source: WISQARS
ConclusionsLeading causes of injury mortality among all ages combined:Unintentional Poisoning SuicideMotor Vehicle CrashesLeading causes of injury hospitalization and ED visits among all ages combined:FallsUnintentional PoisoningMotor Vehicle Crashes Assault 61
62 Diagnosis CodeV01–Y36, Y85–Y87, Y89 All Injury and Poisoning W65–W74, V90, V92 Unintentional Drowning S01.0–S01.9, S02.0, S02.1, S02.3, S02.7-S02.9, S04.0, S06.0–S06.9, S07.0, S07.1, S07.8, S07.9, S09.7–S09.9, T90.1, T90.2, T90.4, T90.5, T90.8, T90.9 Traumatic Brain Injury (TBI) X40–X49, X60–X69, X85–X90, Y10–Y19, Y35.2 Poisoning V02–V04 (.1, .9), V09.2, V12–V14 (.3–.9), V19 (.4–.6), V20–V28 (.3–.9), V29 (.4–.9), V30–V39 (.4–.9), V40–V49 (.4–.9), V50–V59 (.4–.9), V60–V69 (.4–.9), V70–V79 (.4–.9), V80 (.3-.5), V81.1, V82.1, V83–V86 (.0-.3), V87 (.0–.8), V89.2 Motor Vehicle Traffic X60–X84, Y87.0 Suicide W32–W34, X72–X74, X93–X95, Y22–Y24, Y35.0 Firearm-related X85–Y09, Y87.1 Homicide W00–W19 Unintentional Falls X00–X09 Unintentional Fire Appendix A Injury Fatality ICD-10 Codes
Appendix BInjury Hospitalization and ED Visit Codes Principal Diagnosis800–909.2, 909.4, 909.9–994.9, 995.5–995.59, 995.80–995.85 All Injury and Poisoning 994.1 Drowning 820 Hip Fracture 800.00–801.99, 803.00–804.99, 850.0–850.9, 851.00–854.19, 950.1–950.3, 959.01, 995.55 Traumatic Brain Injury (TBI) E-Code E850–E858, E860–E869, E950–E952, E962, E972, E980–E982, E979 (.6–.7) Poisoning E810–E819 Motor Vehicle Traffic E950–E959 Suicide Attempt E922.0–E922.3, E922.8, E922.9, E955.0–E955.4, E965.0–E965.4, E985.0–E985.4, E970, E979.4 Firearm-related E960–E969, E979, E999.1 Assault E880–E886, E888 Unintentional Falls E890–E899 Unintentional Fire 63