WISQARS Fatal's mortality reports provide tables of the
total numbers of injury-related deaths and the death rates per
100,000 population. The reports lists deaths according
to cause (mechanism) and intent (manner) of injury by state,
race, Hispanic origin, sex, and age groupings.
Mortality data come from the National Center for Heath
Statistics (NCHS), CDC annual mortality data files. NCHS mortality
data are derived from the Multiple Cause of Death data.1
For more information, contact NCHS at (301)436-8500 or
nchsquery@cdc.gov -- or visit the NCHS website.
The system calculates age-adjusted rates by the direct
method and standardizes them to the total U.S. population.
You may select one of five standard years: 1940, 1970, 1980, 1990,
and 2000. Using 1940 as a standard year is consistent with
data reported by National Center for Health Statistics (NCHS).
Using 1940 and 2000 also is consistent with data being tracked for the
year 2000 objectives of the U.S. Public Health Service.2
WISQARS Fatal's age-adjusted death rates may differ slightly
from those of NCHS. WISQARS uses 5-year age categories
for calculations while NCHS used 10-year age groups.1
For your convenience, WISQARS provides death and death rate
data for as many categories as possible. However, be advised NCHS
considers rates based on 20 or fewer deaths to be
statistically unreliable. For
further details on reliability and other statistical issues,
please refer to the National Vital Statistics Report,
1998.1 (To obtain a copy of this report, contact NCHS
at (301)436-8500 or nchsquery@cdc.gov
-- or visit the NCHS website.)
Between 1989-1995, some states' annual counts of deaths
differed from those of NCHS. Differences between state and
NCHS counts occur among selected causes of death, principally
symptoms, signs, and ill-defined conditions (ICD-9 Nos.
780-799) and external causes (homicides, suicides and
unintentional injuries). These differences happened mainly
because NCHS did not receive changes from modified death
records. The states affected were Alaska, 1989-1995;
Alabama, 1991-1992; Hawaii, 1991; and New Jersey, 1991-1993.3
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Since 1999, mortality data has been coded using International Classification of
Disease-10th Revision (ICD-10).
Mechanism and cause of injury are based on ICD-10 external
cause of injury codes. These codes are no longer considered
supplemental codes as they were in ICD-9, and they are no
longer referred to as "E-codes." The external cause
of injury codes have been incorporated into the ICD-10
alphanumeric classification system as Chapter 20. ICD-10
external cause of injury codes begin with the letter V, W, X,
or Y followed by a two-digit whole number (e.g., W25). Some
external cause of injury codes also have a decimal followed by
another number (e.g., V30.4).
Be aware that ICD-10 is a completely different coding
system than ICD-9. Cause (mechanism) of injury categories
defined using ICD-9 E-codes for deaths in 1981 through 1998
are different from those defined by ICD-10 external cause of
injury codes for deaths in 1999. ICD-10 has many changes from
ICD-9, including considerably greater detail; shifts of
inclusion terms and titles from one category section or
chapter to another; regroupings of diseases; new titles and
sections; and modifications in coding rules.3
National Center for Health Statistics does not
recommend combining 1999 and later data in WISQARS with previous years
by cause (mechanism) categories to obtain average annual
numbers of death and death rates. Also, when looking at trends
in annual numbers of deaths and death rates by mechanism/cause
of injury, you should consider that changes in results from
1998 to 1999 could be a result of the change in code
definitions and coding rules.1
The Preliminary External Cause of Injury Mortality Matrix
for ICD-10 is changed from the Recommended Framework for
Presenting Injury Mortality data based on ICD-9 codes.5,8,9
For example, the subcategory of "Bites and Stings"
in the ICD-9 framework was dropped from the ICD-10 matrix
because in ICD-10 "bitten by" has been combined with
"contact with" and/or "struck by" for some
relevant codes. Also, ICD-10 transportation-related codes have
been expanded considerably, including the addition of a new
category called "Other land transport." To see
other important changes, visit the NCHS
web pages on the ICD-10 matrix.
Because of the distinct changes in code definitions and
coding rules from ICD-9 to ICD-10, WISQARS Fatal presents
mortality data for 1999 and beyond separately from data for
1998 and earlier. NCHS is currently conducting an ICD-10
Comparability Study to assess the impact of the change to the
new classification system.7
ICD-10 codes are being
assigned to approximately 2.3 million resident deaths that
occurred in the United States in 1996. These deaths have
previously been coded using ICD-9. These dual-coded data can
be used to calculate comparability ratios to adjust the number
of deaths and death rates for 1999 based on ICD-10 so they
will be comparable to the number of deaths and death rates
based on ICD-9 for 1979 through 1998.
Change in WISQARS made on March 7, 2003 to accommodate revisions to the ICD-10 Injury Mortality Matrix
In December of 2002, NCHS revised the ICD-10 Injury Mortality Matrix
to finalize groupings of ICD-10 external cause of injury classifications. These changes resulted in shifting of a few deaths from one transportation-related injury grouping to another.
Among the transportation-related injury groupings in WISQARS, the following changes were made:
- Codes were moved from the MV Traffic-Occupant category to the MV Traffic-Other category, and
- The following new groupings were added: Other Land Transport, Suicide; Other Land Transport, Homicide; Other Land Transport, Homicide/legal intervention; Other Land Transport, Violence-related; and Other Land Transport, Undertermined Intent.
These new groupings also affect the
numbers of deaths and rates for the Overall Motor Vehicle grouping and subgroupings including:
- Overall Motor
Vehicle, Suicide
- Overall Motor Vehicle,
Homicide
- Overall Motor Vehicle, Homicide/Legal
Intervention
- Overall Motor Vehicle,
Violence-Related
- Overall Motor Vehicle, Undetermined Intent.
Note:
Table 5.1.1 : Valid Cause and Intent Combinations for 1999 and Later Data has been updated to reflect the shift in ICD-10 codes in the ICD-10 external cause of injury matrix for injury death data presented in WISQARS.
6.3.1
1999 and Later Data
All 1999
and later mortality statistics in WISQARS Fatal are
based on codes in the International Classification of
Disease-10th Revision (ICD-10).4 ICD-10 is used
in various countries worldwide for coding death. The ICD-10 codes include code
sets for types of disease, medical procedures, and external
causes of injury. The numbers of deaths by external cause of
injury were determined using the underlying cause of death
codes from the annual mortality data file of the National
Vital Statistics System, National Center for Health Statistics
(NCHS), Centers for Disease Control and Prevention. For
more information, visit the NCHS
web page on mortality data.
WISQARS Fatal's available causes of injury are consistent
with proposed standard ICD-10 external cause of injury
groupings for reporting injury mortality data.5
NCHS has been collaborating with the National Center for
Injury Prevention and Control (NCIPC) and members of the
Injury Control and Emergency Health Services section of the
American Public Health Association to develop these
groupings. WISQARS presents national mortality data by
cause of death or mechanism of injury (e.g., fall,
fire/flames, firearm, poisoning, and suffocation) and by
intent or manner of death (e.g., suicide, homicide,
unintentional injury).
Note: The
external cause of injury coding for 1999 and later, based on the ICD-10
classification system, is notably different from external
cause coding for 1998 and earlier years, based on the ICD-9
classification system. You may not be able to compare numbers
of deaths and deaths rates computed for some external causes
of injury based on 1999 and later data to those based on data from 1998
and earlier. Consequently, use caution when doing trend
analysis of numbers of deaths and death rates across these
years. A comparability study to assess the effects of the
change from ICD-9 to ICD-10 is underway by NCHS. Some
preliminary comparability ratios are available from two
reports:
Hoyert
DL, Arias E, Smith B, Murphy SL, Kochanek KD. Deaths: Final
Data for 1999. National vital statistics reports; 49(8).
Hyattsville, Maryland: National Center for Health
Statistics; 2001. Available from URL: http://www.cdc.gov/nchs/data/nvsr/nvsr49/nvsr49_08.pdf
Anderson RN,
Minino AM, Hoyert DL, Rosenberg HM. Comparability of cause
of death between ICD-9 and ICD-10: Preliminary estimates.
National vital statistics reports; 49(2). Hyattsville,
Maryland: National Center for Health Statistics; 2001.
Available from: http://www.cdc.gov/nchs/data/nvsr/nvsr49/nvsr49_02.pdf
.6.3.2
1998
and Earlier Data
All 1998 and earlier statistics in WISQARS Fatal are based on
codes in the International Classification of Disease-9th
Revision (ICD-9).4 ICD-9 is used in various
countries worldwide in
medical reports. The ICD-9 codes include code sets for
types of disease, injuries, and poisonings as well as external cause of
injury (E codes). The numbers of deaths by external cause of
injury come from annual mortality data of the National Center
for Health Statistics (NCHS), Centers for Disease Control and
Prevention. For more information, visit the NCHS
web page on mortality data.
WISQARS Fatal's available causes of injury are consistent
with proposed standard ICD-9 code groupings for reporting
injury mortality data.5,7 CDC's National Center for
Injury Prevention and Control (NCIPC) has been collaborating
with NCHS and members of the Injury Control and Emergency
Health Services section of the American Public Health
Association to develop these groupings. WISQARS Fatal
displays national data by cause of death or mechanism of
injury (e.g., fall, fire/flames, firearm, poisoning, and
suffocation) and by intent or manner of death (e.g., suicide,
homicide, unintentional injury).
Note: The
external cause of injury coding for years 1999 and later, based on the ICD-10
classification system, is notably different from external
cause coding for 1998 and earlier years, based on the ICD-9
classification system. You may not be able to compare numbers
of deaths and deaths rates computed for some external causes
of injury based on 1999 and later data to those based on data from 1998
and earlier. Consequently, use caution when doing trend
analysis of numbers of deaths and death rates across these
years. A comparability study to assess the effects of the
change from ICD-9 to ICD-10 is underway by NCHS. Some
preliminary comparability ratios are available from two
reports:
Hoyert
DL, Arias E, Smith B, Murphy SL, Kochanek KD. Deaths: Final
Data for 1999. National vital statistics reports; 49(8).
Hyattsville, Maryland: National Center for Health
Statistics; 2001. Available at URL: http://www.cdc.gov/nchs/data/nvsr/nvsr49/nvsr49_08.pdf
Anderson RN,
Minino AM, Hoyert DL, Rosenberg HM. Comparability of cause
of death between ICD-9 and ICD-10: Preliminary estimates.
National vital statistics reports; 49(2). Hyattsville,
Maryland: National Center for Health Statistics. 2001.
Available at URL: http://www.cdc.gov/nchs/data/nvsr/nvsr49/nvsr49_02.pdf
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