# Presentation: 307257

## Injury Surveillance Activities of the National Center for Injury Prevention and ControlData Issues

- Lee Annest, Ph.D.
- Director, Office of Statistics and Programming
- National Center for Injury Prevention and Control
- Coordinating Center for Environmental Health
- and Injury Prevention
- Centers for Disease Control and Prevention
- September 7, 2006

## National Violent Death Reporting System(NVDRS) 

- Use of multiple data sources (death certificates, medical examiner/coroner records, police reports, crime lab reports, hospital records)
- 17 States participating
-  All violent deaths (including homicide, suicide, deaths of undetermined intent and unintentional firearm-related injuries)
- Child fatality review module (New Jersey, Oregon, South Carolina)

## NVDRS States as of August, 2006

**FY 02 (6 states)**

**FY 03 (7 states)**

** ****FY 04 (4 states)**

## National Violent Death Reporting System(NVDRS) – Data Issues

- How do we provide timely access to data? WISQARS – NVDRS in the works
- How do we streamline the data collection and still provide valuable details?
- How do we expand to all states?

## Child MaltreatmentImproving National/State Surveillance Systems

- Lessons Learned from 5 state cooperative agreements (Minnesota, Rhode Island, Missouri, California, Michigan) – completed
- Uniform Definitions & Recommended Data Elements – scheduled for release in Fall 2006
- Model State-based Child Maltreatment Surveillance System – being developed
- CDC’s cooperative agreements (NY state, Pennsylvania) – shaken baby syndrome/abusive head trauma

## Definition of Child Maltreatment

- Any act or series of acts of commission or omission by a parent or other caregiver that results in harm, potential for harm or threat of harm to a child, including physical abuse, sexual abuse, psychological abuse, failure to provide (neglect)

- Number of Injuries among Children < 18 Years, US, 2004

- Deaths = 1,490 (est. from NCANDS)
- Victimizations = 872,000 (est. from NCANDS)

## Child MaltreatmentMortality and Incidence Data Sources

- National Child Abuse and Neglect Data System (NCANDS) – current best national/state data source
- Child abuse/neglect reported by child protective services (CPS) in all 50 states, DC, and US territories and armed services
- State CPS offices voluntarily submit aggregate data to the Administration of Children and Families (ACF)
- Use data to estimate CM deaths, investigation rates, victimization rates
- Likely an undercount because only based on children investigated for alleged maltreatment (neglect, physical abuse, sexual abuse, medical neglect, and emotional or psychological maltreatment)

## Child MaltreatmentMortality and Incidence Data Sources

- CDC’s National Violent Death Reporting System (NVDRS) – Child Fatality Review Module – current state data limited
- NCHS’ National Vital Statistics System (NVSS) – undercount CM deaths
- Using ICD-10 external-cause-of-injury codes – Y06 (neglect and abandonment) and Y07 (other maltreatment syndrome such as sexual abuse, mental cruelty, torture), there were 200 deaths for children < 18 years or 13% of the 1,500 deaths per year estimated using NCANDS data.

## Child MaltreatmentData Issues

- How do we get more complete reporting of incidents?
- How do we get more complete coding on death certificates?

## Drug-induced Mortality SurveillanceSharply on the Rise

- Recent increase mostly likely due to overuse of opioid analgesics as pain killers
- Use of ICD-10 T codes to investigate increase
- Reference: Paulozzi L, Budnitz D, Xi L.  Increasing deaths from Opioid analgesics in the United States.  Pharmacoepidemiology and Drug Safety (online) at www.interscience.wiley.com

## Source:  NVSS mortality  files, NCHS

## Source:  NVSS mortality  files, NCHS

## Deaths from “narcotics and psychodysleptics” (X42) and “other and unspecified drugs,” (X44) US, 1999-2002

**Deaths from “narcotics and psychodysleptics” (X42) and “other and unspecified drugs,” (X44) US, 1999-2002**

| Drug Type
Involved | 1999 | 2002 | % Increase |
| --- | --- | --- | --- |
| Opioid analgesics | 2,891 | 5,528 | 91.2 |
| Cocaine | 3,182 | 3,909 | 22.8 |
| Heroin | 1,723 | 1,937 | 12.4 |
| Other specified | 1,666 | 1,790 | 7.4 |
| Unspecified | 2,255 | 3,635 | 61.2 |

## Deaths by type of opioid analgesic, US, 2002

**Deaths by type of opioid analgesic, US, 2002**

| Type | Number | Percent of total drugs listed |
| --- | --- | --- |
| Other opioid (hydrocodone, oxycodone) | 3,967 | 54.3 |
| Methadone | 2,361 | 32.3 |
| Other synthetic narcotic (fentanyl) | 982 | 13.4 |

## Drug-induced Mortality SurveillanceData Issues

- How do we get more timely monitoring of fatal, specific drug-induced poisonings?  Electronic death record system?
- How do we monitor nonfatal, specific drug-induced poisonings?  Drug Abuse Warning Network (DAWN)? Toxic Exposure Surveillance System (TESS)? National Electronic Injury Surveillance System All Injury Program (NEISS AIP)?

## Disaster-Related Injury SurveillanceCDC Emergency Preparedness

- Director’s Emergency Operations Center (DEOC) – Assessment and Surveillance Unit for Natural Disasters
- CDC Emergency Preparedness and Response Web site

## Slide 17

## Slide 18

## Where is Injury

- _Where is Injury_
- _Surveillance??_

## Disaster-Related Injury SurveillanceData Issues

- Can multi-purpose data collection forms be developed as models for use by states? and other countries?
- How do we collect timely population-based data on fatal and nonfatal injuries during or within a few weeks of a disaster event?
- Could an electronic death record system be useful?

## Cross-tabulation of mechanism and intent of injury deaths (proposed release in 2007)
WISQARS-State injury mortality maps (prototype)
WISQARS-NVDRS (design stage)

**Fatal and Nonfatal Injuries in the United States**_** **__**http://www.cdc.gov/ncipc/wisqars**_

- Cross-tabulation of mechanism and intent of injury deaths (proposed release in 2007)
- WISQARS-State injury mortality maps (prototype)
- WISQARS-NVDRS (design stage)

**New Features**