# Presentation: 265041

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

**Centers for Disease Control and Prevention**
**National Center for Health Statistics**

**Robert N. Anderson**
**Arialdi M. Miniño**
**Lois A. Fingerhut**
**Margaret Warner**

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

## New Report on Injury Mortality in the U.S.

**Notes:**
Acknowledge coauthors

## 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

**Notes:**
ICEHS stands for Injury Control and Emergency Health Services
ICE stands for International Collaborative Effort – sponsored by NCHS with funding from NICHD

## External Cause of Injury Mortality Matrix

## External Cause of Injury Mortality Matrix

## External Cause of Injury Mortality Matrix

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

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

## 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

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

## 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

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

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

## Poisoning – Natural Causes: U.S., 2001

## Combining External and Natural Poisonings

## 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)

**Notes:**
Barell Matrix – takes into account the 2-dimensionality of the nature of injury classification, tabulating data by body site and type of injury sustained.
Selecting a main injury involves choosing the one injury that contributed most to death.  It would make tabulation of nature of injury data much more straightforward.
NVDRS is run by NCIPC and currently has cooperative agreements with 13 states

## Questions?

**Bob Anderson**
**RNAnderson@cdc.gov**

- Injury Report URL
- _[http://www.cdc.gov/nchs/](http://www.cdc.gov/nchs/)_
- Go to:
- Publications and Information Products
- National Vital Statistics Reports
- Vol 52 No 21