NCHS Data Brief ■ No. 255 ■ July 2016

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Increases in Medically Attended Nonfatal Injury Episodes 

Among Females in the United States

Yahtyng Sheu, M.P.H., Ph.D., and Holly Hedegaard, M.D., M.S.P.H.

Key findings

Data from the National 

Health Interview Survey

● From 2005–2008 to 

2011–2014, the nonfatal injury 

rate increased for females but 

remained unchanged for males.

● In 2005–2008, males had 

a higher nonfatal injury rate 

than females; however, in 

2011–2014, the rates for males 

and females were similar. 

● From 2005–2008 to 

2011–2014, the nonfatal injury 

rate increased significantly for 

women aged 45–64 and for 

non-Hispanic white females.

● The increase in the nonfatal 

injury rate among females over 

time could not be attributed to a 

specific cause or place of injury 

occurrence. 

Analysis of mortality and emergency department (ED) data have historically 

shown higher injury rates among males than females. In 2014, the injuryrelated death rate was 85.5 per 100,000 population for males and 36.3 

for females (1). In 2013, 10,746 injury-related ED visits were made per 

100,000 population for males and 8,957 for females (2). The National Health 

Interview Survey (NHIS) collects information on medically attended nonfatal 

injury episodes, providing national estimates beyond deaths and ED visits. 

This report describes changes in injury episodes in the female population, 

comparing estimates in 2005–2008 and 2011–2014 by age group, race and 

ethnicity, cause of injury, and location of injury. 

Keyword: National Health Interview Survey

From 2005–2008 to 2011–2014, the rate of medically attended 

nonfatal injury episodes among females increased 16%, 

while the rate for males did not change.

1

Significant difference between males and females (p < 0.05). 2

Significant difference between 2005–2008 and 2011–2014 (p < 0.05).

NOTES: Data are based on 4-year averages for each time period. Annualized numbers of injury episodes are 17.5 million for 

males and 16.0 million for females in 2005–2008, and 19.0 million for males and 19.7 million for females in 2011–2014. Access 

data table for Figure 1 at: http://www.cdc.gov/nchs/data/databriefs/db255_table.pdf#1.

SOURCE: NCHS, National Health Interview Survey, 2005–2008 and 2011–2014.

Figure 1. Age-adjusted rate of nonfatal injury episodes, by sex: United States, 2005–2008 and 

2011–2014 
NCHS Data Brief ■ No. 255 ■ July 2016

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● In 2005–2008, the age-adjusted injury rate was higher for males (121.3 episodes per 1,000 

population) than for females (105.4) (Figure 1). 

● From 2005–2008 to 2011–2014, the injury rate among females increased 16%, from 105.4 

to 122.0 episodes per 1,000 population, while the rate among males did not change. 

● The increase in the nonfatal injury rate among females in 2011–2014 resulted in a narrowing 

of the difference in rates between the sexes, with similar rates seen for males (126.5 

episodes per 1,000 population) and females (122.0) in the later time period.

The rate of medically attended nonfatal injury episodes among females 

aged 45–64 increased significantly from 2005–2008 to 2011–2014.

● Among all age groups, women aged 65 and over had the highest nonfatal injury rate in both 

2005–2008 and 2011–2014 (151.6 and 163.7 episodes per 1,000 population, respectively) 

(Figure 2).

● From 2005–2008 to 2011–2014, a significant increase in the rate of injury episodes was 

observed for the 45–64 age group. For women aged 45–64, the rate increased 32%, from 

103.4 episodes per 1,000 population in 2005–2008 to 136.4 in 2011–2014. The change in 

rates for other age groups was not statistically significant.

Figure 2. Rate of nonfatal injury episodes for females, by age group: United States, 2005–2008 and 2011–2014

1

Significantly lower than age group 65 and over for same time period (p < 0.05). 2

Significantly lower than age group 45–64 for same time period (p < 0.05). 3

Significant difference between 2005–2008 and 2011–2014 (p < 0.05).

NOTES: Data are based on 4-year averages for each time period. Access data table for Figure 2 at: http://www.cdc.gov/nchs/data/databriefs/db255_table.pdf#2.

SOURCE: NCHS, National Health Interview Survey, 2005–2008 and 2011–2014.

 
NCHS Data Brief ■ No. 255 ■ July 2016

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From 2005–2008 to 2011–2014, the rate of medically attended nonfatal 

injury episodes among non-Hispanic white females increased. 

● In 2005–2008, the age-adjusted nonfatal injury rate was highest among non-Hispanic 

white females (123.6 episodes per 1,000 population), while lower rates were observed for 

Hispanic and non-Hispanic black females (62.2 and 78.1 episodes per 1,000, respectively) 

(Figure 3). 

● In 2011–2014, the rate continued to be highest among non-Hispanic white females (144.8 

episodes per 1,000 population), however, the rate among non-Hispanic black females was 

significantly higher than the rate among Hispanic females. 

● For both time periods, the injury rate among non-Hispanic white females was twice that of 

Hispanic females. 

● From 2005–2008 to 2011–2014, increases in injury rates were observed for females of all 

race and ethnicity groups, however, the increase was significantly higher only for nonHispanic white females (17% increase). 

Figure 3. Age-adjusted rate of nonfatal injury episodes for females, by race and ethnicity: United States, 2005–2008 and 

2011–2014 

1

Significantly lower than non-Hispanic white females for same time period (p < 0.05). 2

Significantly different from non-Hispanic black females for same time period (p < 0.05). 3

Significant difference between 2005–2008 and 2011–2014 (p < 0.05).

NOTES: Data are based on 4-year averages for each time period. Access data table for Figure 3 at: http://www.cdc.gov/nchs/data/databriefs/db255_table.pdf#3.

SOURCE: NCHS, National Health Interview Survey, 2005–2008 and 2011–2014.

 
NCHS Data Brief ■ No. 255 ■ July 2016

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Among females, the nonfatal injury rates for major causes of injury did not 

change from 2005–2008 to 2011–2014.

● Falls were the leading cause of nonfatal injury among females in both 2005–2008 and 2011–

2014. During both time periods, the rate of injury episodes from falls was approximately 

four times higher than the rates for causes such as being struck by or hitting against an 

object or person; injuries resulting from land, water, or air transportation; and overexertion 

(Figure 4).

● No significant changes were seen in injury rates from 2005–2008 to 2011–2014 for falls; 

being struck by or hitting against an object or person; injuries resulting from land, water, 

or air transportation; overexertion; cutting or piercing by sharp objects; and other specified 

injury causes (poisoning, fire and burn, animal and insect bites, and accidents from use of 

machinery). 

Figure 4. Age-adjusted rate of nonfatal injury episodes for females, by cause of injury: United States, 2005–2008 and 

2011–2014 

1

Significantly higher than all other causes for same time period (p < 0.05).

NOTES: Data are based on 4-year averages for each time period. Transportation includes injuries involving motor and nonmotor land transport vehicles, 

watercraft, or aircraft. Other specified includes poisoning, fire and burn, animal and insect bites, and accidents from use of machinery. Access data table for 

Figure 4 at: http://www.cdc.gov/nchs/data/databriefs/db255_table.pdf#4.

SOURCE: NCHS, National Health Interview Survey, 2005–2008 and 2011–2014.

 
NCHS Data Brief ■ No. 255 ■ July 2016

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In both 2005–2008 and 2011–2014, the place where females were most 

frequently injured was inside the home. 

● Inside the home was the leading place of nonfatal injury occurrence in both 2005–2008 

(37.2% of injury episodes) and 2011–2014 (38.4%), followed by outside the home, street, 

recreation area, school, and commercial area (Figure 5). 

● From 2005–2008 to 2011–2014, no significant change was seen in the distribution of place 

of injury occurrence among females.

Figure 5. Percent distribution of injury episodes among females, by place of occurrence: United States, 2005–2008 and 

2011–2014 

1

Significantly higher than any other category (p < 0.05).

NOTES: Data are based on 4-year averages for each time period. Respondents were asked to select up to two locations from a predefined response list to the 

question, “Where were you when the injury/poisoning happened?” Only the first response was included in the analysis. Access data table for Figure 5 at: 

http://www.cdc.gov/nchs/data/databriefs/db255_table.pdf#5.

SOURCE: NCHS, National Health Interview Survey, 2005–2008 and 2011–2014.

 
NCHS Data Brief ■ No. 255 ■ July 2016

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Summary

NHIS provides self- or proxy-reported information on medically attended injury episodes, 

including calls to medical care providers; treatment at the scene by emergency personnel; visits to 

a medical provider’s office, school nurse, or other clinic; ED visits; and hospitalizations. Unlike 

other sources of information on nonfatal injury episodes, such as data from EDs, the injury 

episodes reported in NHIS reflect all levels of injury severity.

Analysis of NHIS data shows a recent narrowing in the disparity in rates of nonfatal injury 

episodes among males and females. In 2005–2008, the age-adjusted nonfatal injury rate was 

higher among males than females. In contrast, during 2011–2014, the rate and number of nonfatal 

injury episodes for males and females did not differ. This change resulted from a 16% increase in 

the nonfatal injury rate among females, while the rate among males remained stable. 

From 2005–2008 to 2011–2014, a significant increase in the nonfatal injury rate was seen among 

females aged 45–64 (32%) and non-Hispanic white females (17%). Injury rates for major causes 

such as falls; being struck by or hitting against an object or person; injuries resulting from land, 

water, or air transportation; overexertion; and cutting or piercing by sharp objects did not change. 

In addition, from 2005–2008 to 2011–2014, no change was seen in the distribution of injury 

episodes by place of injury. 

Definitions

Cause of injury: The external force that resulted in physical or physiological harm. Examples of 

causes of injury include falling; being struck by or hitting against an object or person; injuries 

resulting from land, water, or air transportation; overexertion; cutting or piercing by sharp 

objects; fire and burn; animal or insect bite; and poisoning.

Injury episode: An event in which a person was 1) nonfatally injured from an external cause (e.g., 

a fall or a motor vehicle traffic accident), or 2) nonfatally poisoned from ingestion, inhalation, or 

contact with a harmful substance, including overdose or wrongful use of a drug or medication. 

Medically attended: An injury episode for which a trained health care professional was contacted 

for advice or treatment. This advice or treatment may be given over the phone, at the scene or in 

an informal setting, or in a formal office setting, emergency department, or hospital. A trained 

health care professional includes such providers as a medical doctor, nurse, emergency medical 

technician, physical or occupational therapist, homoeopath, dentist, or specialist.

Data source and methods

Injury estimates in this report are based on NHIS data from 2005–2008 and 2011–2014. NHIS is a 

nationally representative, cross-sectional household interview survey that is fielded continuously 

by the National Center for Health Statistics (NCHS) and produces annual estimates of the health 

of the U.S. civilian noninstitutionalized population. Interviews are conducted in respondents’

homes, with occasional follow-up by telephone to complete an interview. Information on sample 

design and data weighting procedures can be found elsewhere (3). 
NCHS Data Brief ■ No. 255 ■ July 2016

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Injury-related information is captured from questions in the Family Core section (4). These 

questions ask about medically attended nonfatal injuries that occurred for any family member 

within 3 months prior to the interview. For this analysis, a reference period of 5 weeks was used 

to provide national estimates, based on earlier findings demonstrating that a shorter reference 

period provided a better estimation of the annual total number for all injuries and for less severe 

injuries (5). An injury episode must have been assigned at least one International Classification of 

Diseases, Ninth Revision, Clinical Modification (ICD–9–CM) nature of injury code of 800–909.2, 

909.9, 910–994.9, 995–995.59, or 998.80–995.85, and one external cause of injury code of E800–

E848, E850–E869.9, E880–E929.9, or E950–E999. 

NHIS is designed to provide national estimates by applying weights to a nationally representative 

sample. Point estimates and the corresponding variances for this analysis were calculated using 

SUDAAN software (6) to account for the complex sample design of NHIS. The Taylor series 

linearization method was used for variance estimation. All estimates shown meet the current 

NCHS standard for reliability (i.e., having a relative standard error less than or equal to 30%). 

Differences between percentages were evaluated using two-sided significance tests at the 0.05 

level. All differences reported are statistically significant unless stated otherwise. All estimates are 

based on 4-year averages for each time period. In 2005–2008, a sample of 1,617 injury episodes 

for males and 1,563 injury episodes for females were included in the analysis. In 2011–2014, a 

sample of 2,438 injury episodes for males and 2,600 injury episodes for females were included in 

the analysis.

About the authors

Yahtyng Sheu and Holly Hedegaard are with the National Center for Health Statistics, Office of 

Analysis and Epidemiology.

References

1. National Center for Health Statistics. CDC WONDER: About multiple cause of death, 

1999–2014. 2015. Available from: http://wonder.cdc.gov/mcd-icd10.html. 

2. National Center for Injury Prevention and Control. Injury prevention & control: Data & 

statistics (WISQARS). Available from: www.cdc.gov/injury/wisqars.

3. Parsons VL, Moriarity C, Jonas K, et al. Design and estimation for the National Health 

Interview Survey, 2006–2015. National Center for Health Statistics. Vital Health Stat 2(165). 

2014.

4. Chen LH, Warner M, Fingerhut L, Makuc D. Injury episodes and circumstances: National 

Health Interview Survey, 1997–2007. National Center for Health Statistics. Vital Health Stat 

10(241). 2009.

5. Warner M, Schenker N, Heinen MA, Fingerhut LA. The effects of recall on reporting injury 

and poisoning episodes in the National Health Interview Survey. Inj Prev 11(5):282–7. 2005. 

6. RTI International. SUDAAN (Release 11.0) [computer software]. 2009.
NCHS Data Brief ■ No. 255 ■ July 2016

Suggested citation

Sheu Y, Hedegaard H. Increases in 

medically attended nonfatal injury episodes 

among females in the United States. NCHS 

data brief, no 255. Hyattsville, MD: National 

Center for Health Statistics. 2016.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

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Jennifer H. Madans, Ph.D., Associate 

Director for Science

Office of Analysis and Epidemiology

Irma E. Arispe, Ph.D., Director

Makram Talih, Ph.D., Associate Director for 

Science

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