# Presentation: 679263

## Trends and patterns of injury deaths using the ICE matrix, England and Wales, 1979­2004

- Cleo Rooney, Clare Griffiths & Oliver Wright
- Office for National Statistics, London, England

- England and Wales data from start ICD-9 till now
- What Matrix tells us that traditional grouping doesn’t
- General issues re includions/ exclusions in definition of injury death
- Country specific data issues
- Issues for ICD-11?

## Trends in injury mortality rates by intent, males, England and Wales, 1979-2004

**Notes:**
Trends in mortality RATES 1979- 2004
From beginning of ICD-9 in E&W

Shows 
Fairly traditional  view of injury mortality by intent
Large declines in unintentional deaths, flattening out in more recent years. Remain commonest intent 
Modest rise and fall in next  most common, suicide

## ICE Matrix + F10­F19 + M80­M81 2004

|  | Unintentional | Suicide | Undetermined | Homicide | F10­F19 | M80­M81 | Total |
| --- | --- | --- | --- | --- | --- | --- | --- |
| Cut/pierce | 13 | 110 | 18 | 141 | 0 | 0 | 282 |
| Drowning | 169 | 87 | 148 | 5 | 0 | 0 | 409 |
| Fall | 2,915 | 99 | 55 | 0 | 0 | 1,478 | 4,547 |
| Fire/flame | 283 | 39 | 31 | 14 | 0 | 0 | 367 |
| Firearm | 2 | 81 | 14 | 18 | 0 | 0 | 115 |
| Machinery | 10 | 0 | 0 | 0 | 0 | 0 | 10 |
| Transport | 2,728 | 6 | 0 | 1 | 0 | 0 | 2,735 |
| Natural/Env. | 139 | 0 | 0 | 0 | 0 | 0 | 139 |
| Overexertion | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Poisoning | 927 | 888 | 514 | 9 | 1,260 | 0 | 3,598 |
| Struck by | 49 | 0 | 1 | 7 | 0 | 0 | 57 |
| Suffocation | 480 | 1,748 | 309 | 28 | 0 | 0 | 2,565 |
| Other spec. | 123 | 145 | 60 | 5 | 0 | 0 | 334 |
| Unspecified | 2,897 | 103 | 140 | 530 | 0 | 0 | 3,670 |
| Total | 10,735 | 3,306 | 1,290 | 758 | 1,260 | 1,478 | 18,828 |

**Notes:**
England and Wales numbers of deaths in 2004, by ICE Matrix – columms 1-4, 

Suggested additions from outside chapter XX-  columns 5 and 6 

First -deaths coded to substance  misuse or dependence – around half of all poisoning deaths. InE&W these are acute poisonings with verdict abuse/ dependence

Second– Deaths coded to osteoporosis. Nearly all have fracture of long bone (femur),  some of vertebra
Should ICD-11 deal with these differently?

Also, country specific modifications
First,  ‘probable homicides’, deaths registered after an adjourned inquest with intent pending investigation, > ‘probable homicides’. Details in paper in Health Statisics Quarterly vol 3. means large number have ‘unspecified’ mechanism

Shows No modification, commonest mechanism is UNSPECIFIED, second is falls, 

Add outside chapter, Falls then UNSPECIFIED; poisoning, transport, suffocation, drwoning 

Don’t like unspecified in the top 5 – what else do we know about these deaths? 

## Mechanisms in descending order: X59 + fracture moved 

**Notes:**
2,042 of unspecified mechanism are X59 – unintentional exposure to unspecied event, but have a fracture as their main injury. 
Have re-allocated these to ‘falls and fractures’ group, as in ICD-9 E887
F&F, already top, now almost twice the next group, poisoning and 2 1⁄2 times transport
Can we do better in ICD-11? 
Better coding of osteoporosis with fracture?
Fracture of unspecified cause?
Better grouping?
More querying?

Suffocation- includes hanging and plastic bags as well as choking etc
Unspecified still number  5 – 
All other mechanisms dwarfed.  Fireams at number 11 , below natural and environmental factors, but above ‘struck by’ and machinery [latter probably badly underreported]

## Intent by mechanism, males 2004

## Mechanism by intent, males 2004

**Notes:**
Shows
Unintentional dominate most mechanisms
Exceptions - 
But > half of drownings as suicide / open verdict
70% of firearm deaths are suicides, and 70% of suffocation, which includes hangings and plastic bags

Again shows that large proportion of unspecified intent are ‘probable homicides’ after adjourned inquest
Cut/pierce – very few unintentional,  suicide/homicide equal proportions

## injury mortality rates by mechanism, top 5 in 2004, males, E&W, 1979-2004

**Notes:**
Trends by mechanism very varied

Downward trends in transport deaths from 79 to early 90s are dramatic

Rise then fall in poisoning ; opposite in falls and fractures

Gradual rise suffocation and 
Unspecified – data quality issues

## injury mortality rates by mechanism, top 5 in 2004, females, E&W, 1979-2004

## injury mortality rates by mechanism, less common mechs, males, E&W, 1979-2004

## injury mortality rates by mechanism, less common mechs, females, E&W, 1979-2004

## Should we widen definition of injury deaths? 

- Add F10-19 to poisoning?
- Osteoporosis with fracture?
- How would we do it?
- In ICE matrix?
- Through WHO MRG coding rules ICD-10?
- Through ICD-11 ?
- Explore other countries data
- Are these acute poisonings? Falls?

## Future work

- Improve international comparability
- Explore multicountry data on
- Trends and patterns by mechanism
- osteoporosis / falls
- X59
- F10-F19
- ICE
- Eurostat
- WHO