State-Specific Unintentional-Injury Deaths --- United States, 1999--2004

Deaths from unintentional injuries account for approximately two thirds of deaths from all injuries in the United States (1). Among persons aged 1--44 years, unintentional injuries are the leading cause of death and the leading cause of potential years of life lost before age 65 years (1). A Healthy People 2010 national objective calls for reducing the rate of deaths caused by unintentional injuries to 17.5 per 100,000 population from a baseline of 35.0 in 1998 (objective 15-13) (2). A second objective calls for reducing the rate of deaths caused by unintentional injuries involving motor-vehicle traffic to 9.2 per 100,000 population from a 1998 baseline of 15.6 (objective 15-15) (2). To determine the progress of states toward meeting these objectives, CDC analyzed vital statistics data for the period 1999--2004. This report summarizes the results of that analysis, which determined that, as of 2004, none of the states had achieved the first Healthy People 2010 objective, and four states and the District of Columbia (DC) had achieved the second. From 1999 to 2004, a total of 13 states reduced their unintentional-injury death rates, and 19 states reduced their motor-vehicle--traffic death rates. Overall in the United States, the rate of deaths caused by unintentional injuries increased 7%, from 35.3 per 100,000 population in 1999 to 37.7 in 2004. These findings underscore the need for states to continue to develop, implement, and evaluate injury-prevention programs and policies to reduce the number of deaths from unintentional injuries.

Annual state-specific and national data on unintentional-injury deaths in the United States were obtained via WISQARS^™ (1) from the National Vital Statistics System, which compiles data from death certificates submitted by the vital records offices of all 50 states and DC. Causes of death are recorded on death certificates by attending physicians, medical examiners, or coroners, using codes from the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) (3). CDC analyzed data regarding unintentional-injury deaths that occurred during 1999--2004, the most recent years for which data were available, and calculated average annual age-adjusted rates per 100,000 population and percentage changes in rates from 1999 to 2004. Negative binomial regression was used to determine the significance (at p<0.05) of changes in rates throughout the study period. Because motor-vehicle--traffic injuries are the leading cause of unintentional-injury deaths, CDC examined this cause separately. Data from years before 1999, when ICD-10 took effect, were not included in this analysis. Because cause-of-death categories changed in 1999 with the introduction of ICD-10, CDC recommends that data from 1998 and earlier years not be combined with later data for trend analyses (4).

During 1999--2004, a total of 625,328 unintentional injury deaths occurred in the United States, with motor-vehicle--traffic injuries accounting for 256,239 (41.0%) of the deaths. Poisoning (94.7% were drug related in 2004) accounted for 96,978 (15.5%) deaths, followed by falls (93,796 [15.0%]) and suffocation (33,693 [5.4%]). Overall in the United States, the average annual age-adjusted unintentional-injury death rate for this period was 36.3 deaths per 100,000 population; the annual rate increased 7% from 35.3 in 1999 to 37.7 in 2004 (Table 1). By type of injury, the average annual rates were as follows: motor vehicles, 14.9 deaths per 100,000 population; poisoning, 5.7; falls, 5.5; and suffocation, 2.0. Rates for males (50.8 deaths per 100,000 population) were more than double the rates for females (23.1).

Among states, during 1999--2004, New Mexico reported the highest average annual unintentional-injury death rate (60.9), followed by Alaska (58.6) and Mississippi (58.1) (Table 1). Massachusetts recorded the lowest rate (20.4). West Virginia recorded the greatest percentage increase (40%) in rates from 1999 to 2004, followed by DC (32%), Kentucky (25%), and Florida (24%).

Analysis of unintentional deaths from motor-vehicle--traffic injuries during 1999--2004 indicated an average annual national rate of 14.9 per 100,000 population (Table 2). As of 2004, four states (Massachusetts, New Jersey, New York, and Rhode Island) and DC had met the Healthy People 2010 objective to reduce their motor-vehicle--traffic death rates to 9.2 per 100,000 population. The average annual death rates from motor-vehicle--traffic injuries during 1999--2004 ranged from 30.6 per 100,000 population in Mississippi to 7.7 in Massachusetts.

Reported by: N Adekoya, DrPH, National Center for Public Health Informatics; DB Moffett, PhD, National Center for Injury Prevention and Control, CDC.

Editorial Note:

The findings in this report indicate that substantial additional measures are needed if states are to meet the Healthy People 2010 targets for unintentional-injury death rates (17.5 per 100,000 population) and motor-vehicle--traffic death rates (9.2). As of 2004, no state had met the first target, and rates in only 13 states had decreased from 1999 to 2004. Only four states and DC had met the second target, and rates in 19 states had decreased from 1999 to 2004.

Overall in the United States, the rate of unintentional-injury deaths increased by 7% from 1999 to 2004, despite no change in the motor-vehicle--traffic death rate during the study period. Although this analysis was not designed to determine the causes of the increase in unintentional-injury deaths, either at the state level or nationally, a previous report indicated that much of the increase can be attributed to an increase in unintentional poisoning deaths from 12,186 in 1999 to 20,950 in 2004, which resulted in a 62.5% increase in the age-adjusted death rate, from 4.4 per 100,000 population to 7.1 (5). The largest increases in poisonings (nearly all drug related) were among females, whites, persons living in the southern United States, and persons aged 15--24 years. Larger increases in poisoning deaths occurred in states with mostly rural populations. Strategies to prevent drug overdoses, including regulation, educational programs, and treatment measures, were recommended (5).

Because motor-vehicle--traffic deaths made up 41% of all unintentional-injury deaths in the United States during 1999--2004, progress toward reducing unintentional-injury deaths depends heavily on reductions in motor-vehicle--traffic deaths. Previously, substantial progress toward reducing motor-vehicle--traffic injuries has resulted from enactment of laws such as those limiting blood-alcohol content for persons operating motor vehicles (6) and requiring use of vehicle safety belts. However, although safety belts are the most effective means of reducing motor-vehicle--traffic injuries, 29 states have not implemented primary--enforcement laws (i.e., allowing police to stop and ticket motorists solely for not wearing a safety belt). Such laws have been more effective in increasing safety-belt use and reducing fatalities than secondary laws (i.e., allowing police to issue a safety-belt citation only if a vehicle is stopped for another reason) (7,8).

Additional strengthening of state injury-prevention programs also might help reduce unintentional injuries. A 2005 assessment of capacity among state injury programs conducted by the State and Territorial Injury Prevention Directors Association (STIPDA) determined that only 12 states had injury-prevention programs mandated by law, certain injury-prevention programs lacked access to vital-record datasets, and funding and programmatic support for injury prevention often were lacking (9). STIPDA made multiple recommendations to strengthen state injury programs (9).

The findings in this report are subject to at least two limitations. First, narrative text from death certificates is not retained in public-use datasets; therefore, the circumstances surrounding the deaths could not be analyzed. When available, these circumstances can be reviewed to ensure that the causes of death are correctly classified. Second, determining whether certain injuries (e.g., drug overdoses) are unintentional or intentional often is difficult for a coroner or medical examiner and might result in misclassification.

In addition to public health interventions, progress toward Healthy People 2010 objectives will require better tracking of types of injuries, improved targeting of areas and risk factors related to injuries, and better assessments of needs and program effectiveness at state and local levels. Interactive Internet-based query systems* at the state level can be helpful; however, only 27 states have developed such systems (10). To increase research and intervention-development capabilities, since 1992 CDC has funded the Assessment Initiative program^† to develop new methodologies for conducting community health assessments. Fifteen states^§ have collaborated with local health jurisdictions and communities to improve 1) access to data, 2) skills to accurately interpret and understand data, and 3) use of data so that assessment findings drive public health program and policy decisions.

References

1. CDC. Web-based Injury Statistics Query and Reporting System (WISQARS^™). Atlanta, GA: US Department of Health and Human Services, CDC; 2007. Available at http://www.cdc.gov/ncipc/wisqars/default.htm.
2. US Department of Health and Human Services. Healthy people 2010 (conference ed. in 2 vols). Washington, DC: US Department of Health and Human Services; 2000. Available at http://www.healthypeople.gov.
3. World Health Organization. International statistical classification of diseases and related health problems. 10th revision. Geneva, Switzerland: World Health Organization; 1992.
4. Hoyert DL, Freedman MA, Strobino DM, Guyer B. Annual summary of vital statistics: 2000. Pediatrics 2001;108:1241--55.
5. CDC. Unintentional poisoning deaths---United States, 1994--2004 MMWR 2007;56:93--6.
6. Shults RA, Elder RW, Sleet DA, et al, Task Force on Community Preventive Services. Reviews of evidence regarding interventions to reduce alcohol-impaired driving. Am J Prev Med 2001;21(Suppl 4):66--88.
7. Liu C, Lindsey T, Chen CL, Utter D. Traffic safety facts: research note. States with primary enforcement laws have lower fatality rates. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration; 2006. Available at http://www-nrd.nhtsa.dot.gov/pubs/810557.pdf.
8. Shults RA, Nichols JL, Dinh-Zarr TB, Sleet DA, Elder RW. Effectiveness of primary enforcement safety belt laws and enhanced enforcement of safety belt laws: a summary of the Guide to Community Preventive Services systematic reviews. J Safety Res 2004;35:189--96.
9. State and Territorial Injury Prevention Directors Association. STIPDA 2005 state of the states highlights report. Atlanta, GA: State and Territorial Injury Prevention Directors Association; 2006. Available at http://www.stipda.org/displaycommon.cfm?an=8.
10. Friedman DJ, Parrish RG. Characteristics, desirable functionalities, and datasets of state web-based data query systems. J Public Health Manag Pract 2006;12:119--29.

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Date last reviewed: 11/1/2007