NCHS Data Brief ■ No. 199 ■ May 2015

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Deaths From Unintentional Injury Among Adults Aged 65

and Over: United States, 2000–2013

Ellen Kramarow, Ph.D.; Li-Hui Chen, Ph.D.; Holly Hedegaard, M.D., M.S.P.H.; and Margaret Warner, Ph.D.

Key findings 

Data from the National 

Vital Statistics System 

(Mortality)

● In 2012–2013, 55% of all 

unintentional injury deaths 

among adults aged 65 and over 

were due to falls.

● From 2000 through 2013, 

the age-adjusted fall injury 

death rate among adults aged 

65 and over nearly doubled 

from 29.6 per 100,000 to 56.7 

per 100,000.

● In 2012–2013, the death rate 

due to suffocation was more 

than 8 times higher among 

adults aged 85 and over (26.5 

per 100,000) compared with 

adults aged 65–74 (3.1 per 

100,000).

● Among adults aged 65 and 

over, the death rate due to fire 

was more than twice as high 

for non-Hispanic black adults 

as for non-Hispanic white and 

Hispanic adults.

● The death rate from motor 

vehicle traffic crashes among 

adults aged 65 and over was 1.7 

times higher in nonmetropolitan 

areas compared with 

metropolitan areas. 

Injury deaths place a large burden on society, and many of these deaths are 

preventable (1). Reducing fatal injuries is a Healthy People 2020 Leading 

Health Indicator, emphasizing its importance as a high-priority public health 

issue (2). In 2013, unintentional injuries were the eighth leading cause of death 

among U.S. adults aged 65 and over, resulting in nearly 46,000 deaths (3). This 

report describes trends in unintentional injury deaths among this age group 

from 2000 through 2013, highlighting differences by age, race and ethnicity, 

and urbanization for the five leading causes of unintentional injury death: falls, 

motor vehicle traffic crashes, suffocation, poisoning, and fire.

Keywords: falls • older adults • National Vital Statistics System (NVSS)

Unintentional injuries accounted for 85% of all injury deaths 

among adults aged 65 and over in the United States in 

2012–2013; suicide and homicide accounted for 13% and 2%, 

respectively. 

Figure 1. Percent distribution of injury deaths, by intent and cause among adults aged 65 and over: United States, 

2012–2013

Unintentional

injuries

85%

Suicide

13%

Homicide

2%

Undetermined

and legal

intervention or 

operation of war

1%

Number of deaths 2012–2013 = 107,232

All injuries, by intent Unintentional injuries, by cause

Number of deaths 2012–2013 = 90,640

Other

7%

Unspecified

10%

Fire

2%

Poisoning

4%

Suffocation

8%

Motor vehicle

traffic

14%

Fall

55%

NOTE: Percents may not total 100% due to rounding.

SOURCE: CDC/NCHS, National Vital Statistics System, Mortality.
NCHS Data Brief ■ No. 199 ■ May 2015

■  2  ■

● More than one-half (55%) of all unintentional injury deaths among adults aged 65 and over 

were due to falls (Figure 1).

● Fourteen percent of unintentional injury deaths for this age group were caused by motor 

vehicle traffic crashes, resulting in more than 6,000 deaths per year.

● Suffocation, including deaths from positional asphyxia and choking on food or other 

objects, was the third leading cause of unintentional injury death among adults aged 65 and 

over, accounting for 8% of unintentional injury deaths.

● Ten percent of unintentional injury deaths among adults aged 65 and over were coded as 

“cause unspecified.” 

The total age-adjusted unintentional injury death rate among adults aged 

65 and over increased 15% from 2000 to 2013, but rates for some causes of 

death, including motor vehicle traffic crashes, suffocation, and fire declined 

during the same time period.

● The age-adjusted fall injury death rate among adults aged 65 and over increased from 29.6 

per 100,000 in 2000 to 56.7 per 100,000 in 2013 (Figure 2).

Figure 2. Age-adjusted death rates, by cause of death among adults aged 65 and over: United States, 2000–2013

1

Significant positive linear trend (p < 0.05).

2

Significant negative linear trend from 2000 to 2009 (p < 0.05).

3

Significant negative linear trend (p < 0.05).

 SOURCE: CDC/NCHS, National Vital Statistics System, Mortality. Deaths per 100,000

Year

0

20

40

60

80

100

120

Fire3

Poisoning Suffocation3 1

Motor vehicle traffic2

Fall1

All unintentional1

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

● The age-adjusted death rate due to motor vehicle traffic crashes was lower in 2013 than in 

2000, with significant declines occurring until 2009. Since 2009, rates have remained steady 

at approximately 15 deaths per 100,000.
NCHS Data Brief ■ No. 199 ■ May 2015

■  3  ■

● The age-adjusted death rate for unintentional poisoning among the population aged 65 and 

over increased on average by 6% per year from 2000 through 2013.

● Age-adjusted death rates for suffocation and fire declined from 2000 through 2013, from 9.6 

to 8.1 per 100,000 for suffocation and from 3.3 to 2.4 per 100,000 for fire. 

Death rates for falls, motor vehicle traffic crashes, suffocation, and fire 

increased with age for the population aged 65 and over. 

● In 2012–2013, the fall death rate among adults aged 85 and over (226.1 per 100,000) was 

nearly 4 times higher than among people aged 75–84 (59.0 per 100,000) and 16 times higher 

than among people aged 65–74 (14.1 per 100,000) (Figure 3).

Figure 3. Death rates, by age group and cause of death among adults aged 65 and over: United States, 2012–2013

NOTE: Death rates are significantly different for all age group comparisons for each cause of death.

SOURCE: CDC/NCHS, National Vital Statistics System, Mortality. Deaths per 100,000

65–74 75–84 85 and over

0

20

40

60

80

Motor vehicle Suffocation Poisoning Fire

traffic

All unintentional Fall

Cause of death

43.7

14.1

59.0

11.9

16.8

19.9

3.1

8.6

26.5

4.7 2.8 3.7 1.7 3.0 3.6

107.6 338.5 226.1

● The death rate due to motor vehicle traffic crashes was 1.7 times higher among adults aged 

85 and over (19.9 per 100,000) compared with adults aged 65–74 (11.9 per 100,000).

● The death rate due to suffocation was more than 8 times higher among adults aged 85 and 

over (26.5 per 100,000) compared with adults aged 65–74 (3.1 per 100,000).

● The unintentional poisoning death rate for adults aged 75–84 (2.8 per 100,000) was lower 

than the rates for people aged 65–74 (4.7 per 100,000) and 85 and over (3.7 per 100,000).

● The rate of death due to fire among people aged 85 and over (3.6 per 100,000) was more 

than twice as high as the rate among people aged 65–74 (1.7 per 100,000).
NCHS Data Brief ■ No. 199 ■ May 2015

■  4  ■

Age-adjusted unintentional injury death rates varied by race and ethnicity 

among the population aged 65 and over.

● Age-adjusted fall injury death rates among those aged 65 and over were higher for nonHispanic white persons (61.4 per 100,000) compared with non-Hispanic black persons (23.3 

per 100,000) and Hispanic persons (36.2 per 100,000) (Figure 4).

Figure 4. Age-adjusted death rates, by race and ethnicity and cause of death among adults aged 65 and over: 

United States, 2012–2013

NOTES: Age-adjusted death rates are significantly different for non-Hispanic white persons compared with non-Hispanic black persons for all causes except 

Suffocation. Age-adjusted death rates are significantly different for non-Hispanic white persons compared with Hispanic persons for all causes. Age-adjusted death 

rates are significantly different for non-Hispanic black persons compared with Hispanic persons for all causes except All unintentional and Motor vehicle traffic. 

SOURCE: CDC/NCHS, National Vital Statistics System, Mortality. Deaths per 100,000

Non-Hispanic white Non-Hispanic black Hispanic

Motor vehicle Suffocation Poisoning Fire

traffic

All unintentional Fall

Cause of death

0

20

40

60

80

100

120

110.0

67.268.3

61.4

23.3

36.2

15.1

12.1 12.7

8.2 8.5

5.3 3.9 5.4 3.0 2.2

4.8

1.7

● The age-adjusted death rate for motor vehicle traffic crashes was higher for non-Hispanic 

white persons (15.1 per 100,000) compared with non-Hispanic black (12.1 per 100,000) and 

Hispanic persons (12.7 per 100,000).

● For adults aged 65 and over, the age-adjusted death rate for suffocation was lower among 

Hispanic persons (5.3 per 100,000) than among non-Hispanic black persons (8.5 per 

100,000) and non-Hispanic white persons (8.2 per 100,000). 

● The death rate for unintentional poisoning for non-Hispanic black persons aged 65 and 

over (5.4 per 100,000) was higher than the rate for non-Hispanic white (3.9 per 100,000) or 

Hispanic persons (3.0 per 100,000).
NCHS Data Brief ■ No. 199 ■ May 2015

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● Among adults aged 65 and over, the age-adjusted rate of death due to fire for non-Hispanic 

black persons (4.8 per 100,000) was more than twice as high as the rate among nonHispanic white persons (2.2 per 100,000) and Hispanic persons (1.7 per 100,000).

For many causes of death due to injury, the age-adjusted death rates 

among adults aged 65 and over were higher in nonmetropolitan areas than 

in metropolitan areas. 

● The age-adjusted death rate from motor vehicle traffic crashes among adults aged 65 and 

over was 1.7 times higher in nonmetropolitan areas (22.4 per 100,000) than in metropolitan 

areas (12.9 per 100,000) (Figure 5).

Figure 5. Age-adjusted death rates, by urbanization and cause of death among adults aged 65 and over: United States, 

2012–2013

NOTE: Age-adjusted death rates are significantly different for metropolitan locations compared with nonmetropolitan locations for all causes except Fall and 

Poisoning.

SOURCE: CDC/NCHS, National Vital Statistics System, Mortality. Deaths per 100,000

Metropolitan Nonmetropolitan

Motor vehicle Suffocation Poisoning Fire

traffic

All unintentional Fall

Cause of death

0

20

40

60

80

100

120

140

98.0

123.8

56.0 56.1

12.9

22.4

7.7 9.5

3.9 4.0 2.0 3.9

● The age-adjusted death rate from fire among people aged 65 and over was nearly 2 times 

higher in nonmetropolitan areas (3.9 per 100,000) than in metropolitan areas (2.0 per 

100,000).

● The age-adjusted death rate due to suffocation was higher in nonmetropolitan areas (9.5 per 

100,000) compared with metropolitan areas (7.7 per 100,000).

● Among adults aged 65 and over, the age-adjusted death rates due to falls and unintentional 

poisoning did not vary by metropolitan location. 
NCHS Data Brief ■ No. 199 ■ May 2015

■  6  ■

Summary

During 2012–2013, 90,640 adults aged 65 and over died from unintentional injuries (3). Slightly 

more than one-half of these injury deaths were due to falls. Age-adjusted death rates for all 

unintentional injuries have been increasing since 2000, although the rates for some causes have 

declined. Motor vehicle traffic crashes as a cause of death among people aged 65 and over 

decreased, as they have for younger ages, from a rate of 20.6 deaths per 100,000 in 2000 to 14.3 

per 100,000 in 2013 (3,4). Age-adjusted death rates for unintentional poisonings and falls have 

increased, drawing the attention of public health experts and resulting in ongoing prevention 

activities (5). Fatal falls among the older population may be increasing for many reasons. Some 

research suggests that at least a portion of this increase is due to improved reporting of falls (6). 

Among adults aged 65 and over, injury death rates vary by age, race and ethnicity, and level of 

urbanization. Death rates for the population aged 85 and over were higher than rates among adults 

aged 65–84 for each of the leading causes of unintentional injury death except unintentional 

poisoning. The death rate for falls was higher among older non-Hispanic white persons than 

among older non-Hispanic black or Hispanic persons; the death rate for fire was higher among 

non-Hispanic black persons than among non-Hispanic white or Hispanic persons. Similar to other 

age groups, the motor vehicle traffic crash death rate for adults aged 65 and over was higher in 

nonmetropolitan areas compared with metropolitan areas (7). 

Many public health initiatives are directed toward preventing injury deaths among the older 

population. Among its injury and violence prevention objectives, Healthy People 2020 has 

identified specific targets for fall and suffocation deaths among the population aged 65 and over 

(see Healthy People 2020 Injury and Violence Prevention Objectives 23.2 and 24.3) (2). 

Definitions

Age-adjusted death rates: Age-adjusted death rates are useful when comparing different 

populations because they remove the potential bias that can occur when the populations being 

compared have different age structures. The National Center for Health Statistics (NCHS) uses 

the direct method of standardization. For more discussion, see Appendix II, Definitions and 

Methods of “Health, United States, 2013” (8).

Cause-of-death classification: Medical information from death certificates, including injury 

diagnoses and external causes of injury, that is classified and coded in accordance with the 

International Statistical Classification of Diseases and Related Health Problems, 10th Revision

(ICD–10) (9). Corresponding cause-of-death categories and ICD–10 codes presented in this 

report are as follows:

Homicide: U01–U02, X85–Y09, Y87.1

Legal intervention or operation of war: Y35–Y36, Y89(.0,.1)

Suicide: U03, X60–X84, Y87.0

Undetermined: Y10–Y34, Y87.2, Y89.9

Unintentional: V01–X59, Y85–Y86
NCHS Data Brief ■ No. 199 ■ May 2015

■  7  ■

Fall: W00–W19

Fire: X00–X09

Motor vehicle traffic: [V02–V04](.1,.9), V09.2, [V12–V14](.3–.9), V19(.4–.6), [V20–

V28](.3–.9), [V29–V79](.4–.9), V80(.3–.5), V81.1, V82.1, [V83–V86](.0–.3), 

 V87(.0–.8), V89.2

Poisoning: X40–X49

Suffocation: W75–W84

Unspecified: X59

Injury deaths: Includes deaths that are caused by forces external to the body. 

Mechanism of injury: Classifies the external cause of the injury death (e.g., drowning, fall, fire, 

firearm, motor vehicle traffic crash, poisoning, or suffocation).

Urbanization: NCHS developed a six-level urban–rural classification scheme for the 3,143 U.S. 

counties and county-equivalents. Each death is associated with a category based on the county of 

the person’s legal residence. Metropolitan areas include counties in metro areas with 50,000 or 

greater population, including surrounding areas with strong economic ties to the central county 

(10). 

Data source and methods

All data are from the 2000–2013 mortality files of the National Vital Statistics System. Trends in 

death rates were evaluated using the Joinpoint Regression Program (11). Text statements were 

tested for statistical significance using methods described elsewhere (12), and a statement that 

a given death rate is higher or lower than another rate indicates that the difference in the rates is 

statistically significant.

About the authors

Ellen Kramarow, Li-Hui Chen, and Holly Hedegaard are with CDC’s National Center for Health 

Statistics (NCHS), Office of Analysis and Epidemiology; Margaret Warner is with NCHS’ 

Division of Vital Statistics.

References

1. Bergen G, Chen LH, Warner M, Fingerhut LA. Injury in the United States: 2007 Chartbook. 

Hyattsville, MD: National Center for Health Statistics. 2008.

2. HHS. Office of Disease Prevention and Health Promotion. Healthy People 2020. Washington, 

DC. Available from: http://www.healthypeople.gov/2020. 

3. NCHS. Mortality multiple cause files, 2000–2013. Available from: http://www.cdc.gov/nchs/

data_access/vitalstatsonline.htm.
U.S. DEPARTMENT OF

HEALTH & HUMAN SERVICES

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NCHS Data Brief ■ No. 199 ■ May 2015

4. U.S. Department of Transportation. National Highway Traffic Safety 

Administration. 2013 Motor vehicle crashes: Overview. 2014. Available 

from: http://www-nrd.nhtsa.dot.gov/Pubs/812101.pdf. 

5. CDC. STEADI (Stopping Elderly Accidents, Deaths & Injuries) 

toolkit for health care providers. Available from: http://www.cdc.gov/

homeandrecreationalsafety/Falls/steadi/index.html. 

6. Stevens JA, Rudd RA. Circumstances and contributing causes of fall 

deaths among persons aged 65 and older: United States, 2010. J Am Geriatr 

Soc 62(3):470–5. 2014.

7. Myers SR, Branas CC, French BC, Nance ML, Kallan MJ, Wiebe DJ, 

Carr BG. Safety in numbers: Are major cities the safest places in the United 

States? Ann Emerg Med 62(4):408–18. 2013.

8. National Center for Health Statistics. Health, United States, 2013: With 

Special Feature on Prescription Drugs. Hyattsville, MD. 2014.

9. WHO. International statistical classification of diseases and related health 

problems, 10th revision (ICD–10). 2nd ed. Geneva, Switzerland. 2004.

10. Ingram DD, Franco SJ. 2013 NCHS urban–rural classification scheme 

for counties. National Center for Health Statistics. Vital Health Stat 2(166). 

2014.

11. National Cancer Institute. Joinpoint Regression Program (Version 3.4.3.) 

[computer software]. 2010. 

12. Murphy SL, Xu J, Kochanek KD. Deaths: Final data for 2010. National 

vital statistics reports; vol 61 no 4. Hyattsville, MD: National Center for 

Health Statistics. 2013.

Suggested citation

Kramarow E, Chen LH, Hedegaard H, 

Warner M. Deaths from unintentional injury 

among adults aged 65 and over: United 

States, 2000–2013. NCHS data brief, no 

199. Hyattsville, MD: National Center for 

Health Statistics. 2015.

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

Charles J. Rothwell, M.S., M.B.A., Director

Nathaniel Schenker, Ph.D., Deputy Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Office of Analysis and Epidemiology

Irma E. Arispe, Ph.D., Director

Division of Vital Statistics

Delton Atkinson, M.P.H., M.P.H., P.M.P., 

Director

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CS255808