Injury and Violence Prevention The Road Ahead: Getting from Here to There Healthy Carolinians Vision Sept 30 th, 2010

From a public health perspective what we have learned to date: Injuries & Violence are NOT: “random acts of nature” “accidental” “destiny” “chance” “bad luck” “unavoidable” Injuries & Violence ARE: Predictable Preventable Have known risk factors Opportunities for prevention

6,275 Deaths 869,614 ED Visits ???,??? Outpatient Visits ?,???,??? Medically Unattended Injury (home, work, school) Leading Causes of Chronic Disease and Injury Death and Years of Life Lost: N.C., 2009 Cause of DeathTotal Deaths Average Years of Life Lost * Total Years of Life Lost * Cancer 17, ,420 Heart Disease17, ,269 Injury6, ,143 Stroke4, ,602 Chronic Lower Respiratory Diseases (Asthma, COPD) 4, ,646 Alzheimer's disease2, Diabetes Mellitus2, ,165 Hypertension ,912 Atherosclerosis Total Deaths (all causes)76, ,358 Chronic Disease Deaths51, ,294 * Based on deaths that occurred prior to age 65 Source: N.C. State Center for Health Statistics, 2009

???,??? Outpatient Visits ?,???,??? Medically Unattended Injury (home, work, school) Deaths from Injury and Violence are Only the Tip of the Iceberg The vast majority of injuries in North Carolina go unreported. * 2008 death file, hospitalization discharge and NC DETECT (Emergency Department visits) 6,275* Deaths 159,645* Hospitalizations 869,435* ED Visits Despite N.C.’s excellent reporting systems, the total burden of injury to the state is unknown. ???,??? EMS

Unintentional Injury Defined Occurs in a relatively short period of time. Harmful outcome was not sought. Unintentional injuries account for more than 2/3 of all injury deaths

Intentional Injury Defined The active, deliberate use of force over another person or against one's self Intentional injuries account for less than 1/3 of all injury deaths

Source: NC State Center for Health Statistics, Death file 2009; Analysis by Injury Epidemiology and Surveillance Unit Leading Causes of Injury Deaths (by Number of Deaths, All Ages, North Carolina Residents: 2009) Motor Vehicle Crashes Suicides Unintentional Poisoning Unintentional Falls Homicides Unintentional, Other & Unspecified * Unintentional Suffocation Unintentional Fire/Burn Total Deaths = 6,074 * Unintentional Other and Unintentional Unspecified are two separate categories. Other comprises several smaller defined causes of death, while Unspecified refers to unintentional deaths that were not categorized due to coding challenges.

Age Groups < All Ages Low Birthweight 209 Unintentional Injury 35 Unintentional Injury 15 Unintentional Injury 17 Motor Vehicle Injury 344 Unintentional Injury 264 Heart Disease 419 Cancer 1,633 Cancer 3,445 Heart Disease 13,321 Heart Disease 17,417 Congenital Anomalies 203 Motor Vehicle Injury 18 Cancer 15 Motor Vehicle Injury 17 Unintentional Injury 196 Motor Vehicle Injury 263 Cancer 414 Heart Disease 1,249 Heart Disease 2,248 Cancer 11,717 Cancer 17,403 SIDS 136 Congenital Anomalies 15 Motor Vehicle Injury 15 Cancer 16 Homicide 177 Homicide 183 Unintentional Injury 340 Unintentional Injury 457 Chronic Lower Respiratory Disease 513 Chronic Lower Respiratory Disease 3,802 Chronic Lower Respiratory Disease 4,527 Pregnancy Related 75 Homicide 13 Homicide 5 Homicide 7 Suicide 136 Suicide 181 Motor Vehicle Injury 240 Suicide 258 Diabetes Mellitus 399 Cerebro- Vascular Disease 3,761 Cerebro- Vascular Disease 4,477 Placental, Cord, & Other Complications 43 Cancer 9 Congenital Anomalies 5 Suicide 5 Cancer 43 Cancer 111 Suicide 233 Chronic Liver Disease & Cirrhosis 248 Cerebro- Vascular Disease 373 Alzheimer's Disease 2,585 Unintentional Injury 2,713 Unintentional Injury 31 Heart Disease 7 In-situ/ Benign Neoplasms 5 Heart Disease 4 Heart Disease 36 Heart Disease 111 HIV 103 Motor Vehicle Injury 242 Chronic Liver Disease & Cirrhosis 267 Diabetes Mellitus 1,487 Alzheimer's Disease 2,620 Top 6 Leading Causes of Death (All Races, Both Sexes) by Age Groups, North Carolina: 2008 Source: NC State Center for Health Statistics, Death file 2008; Analysis by Injury Epidemiology and Surveillance Unit

Percent Change in Rates Between 1999 and 2009 Leading Causes of Injury Deaths: N.C to 2009* Source: N.C. State Center for Health Statistics, Vital Statistics-Deaths, Analysis by Injury Epidemiology and Surveillance Unit *Provisional data.

An ‘average’ injury day in NC 17 deaths 423 hospitalizations 2,383 ED visits ??? unattended

Unt. Motor Vehicle Traffic (MVT) Related Injuries

A Comparison of the Rates of MVT-Related Deaths Between Male and Females: N.C., 2009 (N=1,342 Deaths) Males have higher rates of death due to MVT-related injuries than females for all age groups. Source: N.C. State Center for Health Statistics, Vital Statistics- Deaths, 2009 Analysis by Injury Epidemiology and Surveillance Unit

A Comparison of the Rates of MVT-Related Deaths by Age: N.C., 2002 & 2009 In December, 2002, N.C. enacted a graduated driver’s license program. For a sixteen year- old, the rate decreased by 40% since Source: N.C. State Center for Health Statistics, Vital Statistics- Deaths, 2002, 2009 Analysis by Injury Epidemiology and Surveillance Unit *<20 deaths; rates may be statistically unreliable.

Reportable Crashes: N.C., 2008 Source: UNC Highway Safety Research Center, N.C. Crash Data, 2008 Analysis by Injury Epidemiology and Surveillance Unit N = 214,358 Reportable Crashes

Alcohol Involvement in Reportable Crashes: N.C., 2008 (N = 214,358 Crashes) Source: UNC Highway Safety Research Center, N.C. Crash Data, 2008 Analysis by Injury Epidemiology and Surveillance Unit

Unintentional Falls

Rate of Deaths due to Unintentional Falls Since 2000: N.C., Source: N.C. State Center for Health Statistics, Vital Statistics- Deaths, Analysis by Injury Epidemiology and Surveillance Unit

Rate of Deaths due to Unintentional Falls by Age: N.C., 2009 Source: N.C. State Center for Health Statistics, Vital Statistics- Deaths, 2009 Analysis by Injury Epidemiology and Surveillance Unit

Rates Deaths, Hospitalizations, and Emergency Department (ED) Visits Due to Unintentional Falls by Age: N.C., 2009 Source: N.C. State Center for Health Statistics, Vital Statistics- Deaths, 2008; Vital Statistics-Hospital Discharge, 2008 NC DETECT-ED, 2008 Analysis by Injury Epidemiology and Surveillance Unit

Outcome of Patients Hospitalized due to an Unintentional Fall, N.C., 2008 Source: N.C. State Center for Health Statistics-Vital Statistics- Hospital Discharge, 2008 Analysis by Injury Epidemiology and Surveillance Unit

Unintentional Poisoning

Poisoning Deaths: N.C., Source: CDCWISQARS-2006 Analysis by the Injury Epidemiology and Surveillance Unit In 1999, the number of unintentional poisoning deaths was 279; in 2008, the number of deaths was 1,016.

North Carolina – Violent Death Reporting System (NC-VDRS)

Percent of Deaths Due to Violence by Manner/Intent: North Carolina Violent Death Reporting System, * Suicide: 61% Homicide: 35% Unintentional Firearm: 1% Legal Intervention: 1% Undetermined Intent: 3% * 2008 and 2009 data are provisional

* 2008 data are provisional Percent of Deaths by Method of Fatal Injury: North Carolina Violent Death Reporting System, * Homicide Suicide

From Data to Action Living lives to their full potential

North Carolina Institute of Medicine (NC IOM)

Recent NC IOM Task Forces Prevention Task Force (2010) Adolescent Health Task Force (2009) Substance Abuse Task Force (2009) Child Abuse Prevention (2005) Healthy NC 2020 (2010)

You've got to be very careful if you don't know where you are going, because you might not get there. Yogi Berra

NC Healthy People 2020 Injury & Violence Objectives –Homicide –Suicide –Unt. Poisoning* –Unt. Falls –DWI/impaired driving –Occupational injuries *priority topic

North Carolina Strategic Plan for Prevention Injury and Violence

North Carolina’s first Strategic Plan for Preventing Injuries and Violence Reduce the rate of morbidity and mortality from injury and violence by 15%.

More than 60 agencies and individuals worked over the course of a year to develop. Focuses efforts on leading causes of death and morbidity.

Statewide Objectives Unt. Motor Vehicle Unt. Poisoning Unt. Falls Homicide Suicide

North Carolina Resources for Injury and Violence

Themes for this year From data to action Putting injury on the map The road ahead Everyone has an injury story

Putting Injury & Violence prevention on the public health map injury

Everyone has an injury story. What’s yours…

My Injury Story

Healthy Carolinians is and will be an increasing critical partner in preventing injury and violence in North Carolina

¿Preguntas? Scott Proescholdbell, MPH Injury and Violence Prevention Branch Chronic Disease and Injury Section NC Division of Public Health