# Presentation: 410952

## What can we learn about injury data from NCHS ?

**Lois A. Fingerhut**
**NCIPC Conference, May 2005**

## The ‘bureaucracy’ pyramid

## Where to find Injury Data from NCHS

**Where to find Injury Data from NCHS**

**Injury Fact sheet & Pamphlet**
**Website **
**Published reports**
**Downloadable data files**

## New NCHS Injury web pages

- _NCHS Injury Data and Resources__ _
**	**The purpose of this Web site is to provide an overview of the sources of national level injury data available from the National Center for Health Statistics (NCHS) and to provide details on the injury morbidity and mortality data collection systems, surveys and coding schemes used to collect and categorize the data. Links to other injury data Web sites are provided.

**www.cdc.gov/nchs/injury.htm**

## ICE on Injury Statistics  
   The International Collaborative Effort (ICE) on Injury Statistics is one of several international activities sponsored by CDC’s NCHS. The goal is to provide a forum for international exchange and collaboration among injury researchers who develop and promote international standards in injury data collection and analysis. A secondary goal is to produce products of the highest quality to facilitate the comparability and improved quality of injury data.

**   **The International Collaborative Effort (ICE) on Injury Statistics is one of several international activities sponsored by CDC’s NCHS. The goal is to provide a forum for international exchange and collaboration among injury researchers who develop and promote international standards in injury data collection and analysis. A secondary goal is to produce products of the highest quality to facilitate the comparability and improved quality of injury data.

## ICE on Injury Statisticsbegan in May 1994.....

**Australia, Austria, Canada, Denmark, England, France, Greece, Israel, The Netherlands, New Zealand, Norway, South Africa, Spain, Sweden, Switzerland, Thailand, Trinidad and the US**
**World Health Organization**
**Pan American Health Organization**

## “Active” projects

- Indicators group
- ICECI and WHO
- Diagnosis matrix- conversion to ICD-10
- Multiple injury profiles
- Main injury from multiple cause of death
- Household surveys
- Occupational injury

## Newer projects..

- Injury severity and administrative datasets
- Poisoning definition

- Next meeting –
- Cuernavaca, Mexico June 1-2, 2005
- with focus on Latin American
- participation

## AdvICE list...

- Open to all interested... go to
- www.cdc.gov/nchs/about/otheract/ice/listserv.htm

## NCHS data sources with injury information

- Mortality
- National Vital Statistics System
- Morbidity
- National Health Care Surveys
- National Hospital Discharge Survey
- National Hospital Ambulatory Medical Care Survey
- National Health Interview Survey
- National Health and Nutrition Examination Survey

## NCHS Data

**Strengths**
- National coverage (census or sample)
- State and county for vital statistics
- Fully accessible, free of charge
- Well-documented
- ICD coded
**Limitations**
- Lack of timeliness
- Lack of detail- ICD Coded
- Hard to get state/county level data for surveys

## Burden of Injury, 2002

- Deaths: 161  thousand
- Hospital Discharges: 1.8 million
- ED Visits: 33.0 million
- Other Outpatient visits: 82.3 million
- All other???

** **

## Issues to consider with injury mortality data

- Know what you want to analyze
- 	Underlying cause of death  [external cause of death codes– motor vehicle crashes, firearm deaths]
- 	Multiple causes of death [injury diagnosis codes—internal organ injuries, penetrating wounds, poisoning substances or agents]
- Timeliness of the data (or lack thereof....)

## Limitation of death certificates

- Little or no information on ...
-  Details on the circumstances,
-  Other persons involved,
- Drug and alcohol involvement,
- Weapon type (if applicable)

## Data dissemination

- Annual published reports
- Deaths: Injuries (2001 was 1st year)
- Deaths: Final data for (year)
- Deaths: Leading causes for (year)
- Health US & Chart books
- Tabulated data
- Interactive data sources
- WISQARS, WONDER
- Public Use data

## Frameworks for Presentation

- External Cause of Injury Matrix
- Collaboration between Injury ICE and APHA Injury Section-began in late ’90’s.
- Classifies external causes by cause and intent
- For morbidity and mortality
- ICD-9, 9-CM and ICD-10

## External Cause of Injury Matrix  (in part)

|  | Intent of injury |  |  |  |  |
| --- | --- | --- | --- | --- | --- |
| Mechanism
 | Unintentional | Suicide | Homicide | Undetermined | Legal/Other |
| Cut |  |  |  |  |  |
| Firearm |  | External cause codes
ICD-9, 9-CM & ICD-10 |  |  |  |
| Poisoning |  |  |  |  |  |
| Struck by/
against |  |  |  |  |  |
| Suffocation
Etc..... |  |  |  |  |  |

## The Barell Matrix

- Classifies body region by nature of injury
- Developed for morbidity  (ICD-9-CM)

## ICD-10 Mortality Injury Diagnosis Matrix 

- Similar structure to Barell matrix
- Changes made in axis for diagnosis codes made this a challenge!
- Mortality issues:
- Any mention vs total mention of an injury
- Weighted average of mentions

## ICD-10 Injury Mortality Diagnosis Matrix

**ICD-10 Injury Mortality Diagnosis Matrix**

**ICD-10 ‘S’ & ‘T’ codes**

## Injury deaths according to matrix : US, 2002

**Source: National Vital Statistics System**

- But**.....**
**deaths are only the “tip” of the injury problem**

## Morbidity data from NCHS

## NCHS data sources with injury information

- Morbidity
- National Health Care Surveys
- National Hospital Discharge Survey
- National Hospital Ambulatory Medical Care Surveys
- National Health Interview Survey
- [National Health and Nutrition Exam Survey-Interview Component]

## New publication. . .

- National Trends in Injury Hospitalizations 1979-2001** **
- Presents data using new tools available to categorize and analyze injury hospitalization data** **
- STIPDA recommendations
- Barell matrix
- External cause matrix

## NHAMCS-ED injury specific variables1995-2002

- Related to injury or poisoning?
- Place of injury occurrence
- Intent of injury
- Work-related
- Cause of injury - verbatim
- Cause of injury (up to 3 ICD-9-CM or External cause codes)

## National Health Interview Survey (NHIS)

- Provides data on nonfatal, intentional and unintentional injuries for all family members
- Medical treatment or advice
- Collected annually since 1958 with the most recent redesign in 1997
- National probability sample

## NHIS - Variables

- Demographics for all family members
- Injury episodes (3)
- Verbatim about injury/poisoning event
- External cause of the injury/poisoning episode (3)
- Injury/poisoning ICD-9-CM diagnosis (4)

## NHIS – Variables (cont.)

- What person was doing at time of injury/poisoning
- Where person was (home, school, etc.)
- Detailed follow-up questions related to certain external cause groups
- Motor vehicle, falls, etc.
- Seat belt, safety seat, helmet use
- Treatment locale (hospitalized, office visit, ed, phone call, etc.)
- Missed work and/or school days

## Injury rates: Visits, Discharges and Deaths, 2001-2002

**ED visits**

**Hospital discharges**

**Deaths**

**Log scale**

**Source: NCHS- NVSS, NHDS,NHAMCS**

## Tools to Access NCHS Data

**Tools to Access NCHS Data**

## Future...

- Encourage you to look on the web before you begin analyses.....
- http://www.cdc.gov/nchs/
- Data warehouses are appearing on all different topics some include injury data– for example, women’s health, aging, mortality statistics
- Much more attention to multiple cause of death data......

## Thanks &please feel free to email..

- LFingerhut@cdc.gov
- or
- NCHSINJURY@ CDC.GOV

**www.cdc.gov/nchs/injury.htm**