1. What can we learn about injury data from NCHS ? U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics Lois A. Fingerhut NCIPC Conference, May 2005

2. The ‘bureaucracy’ pyramid DHHS CDC COCHIS NCHS Office of Analysis & Epidemiology Special Projects Branch Injury, Disability & Record linkage

3. Where to find Injury Data from NCHS Injury Fact sheet & Pamphlet Website Published reports Downloadable data files

4. New NCHS Injury web pages NCHS Injury Data and Resources The purpose of this Web site is to provide an overview of the sources of national level injury data available from the National Center for Health Statistics (NCHS) and to provide details on the injury morbidity and mortality data collection systems, surveys and coding schemes used to collect and categorize the data. Links to other injury data Web sites are provided. www.cdc.gov/nchs/injury.htm

5. ICE on Injury Statistics The International Collaborative Effort (ICE) on Injury Statistics is one of several international activities sponsored by CDC’s NCHS. The goal is to provide a forum for international exchange and collaboration among injury researchers who develop and promote international standards in injury data collection and analysis. A secondary goal is to produce products of the highest quality to facilitate the comparability and improved quality of injury data.

6. ICE on Injury Statistics began in May 1994….. Australia, Austria, Canada, Denmark, England, France, Greece, Israel, The Netherlands, New Zealand, Norway, South Africa, Spain, Sweden, Switzerland, Thailand, Trinidad and the US World Health Organization Pan American Health Organization

7. “Active” projects Indicators group ICECI and WHO Diagnosis matrix- conversion to ICD-10 Multiple injury profiles Main injury from multiple cause of death Household surveys Occupational injury

8. Newer projects.. Injury severity and administrative datasets Poisoning definition Next meeting – Cuernavaca, Mexico June 1-2, 2005 with focus on Latin American participation

9. AdvICE list… Open to all interested… go to www.cdc.gov/nchs/about/otheract/ice/listserv.htm

10. NCHS data sources with injury information  Mortality National Vital Statistics System  Morbidity National Health Care Surveys National Hospital Discharge Survey National Hospital Ambulatory Medical Care Survey National Health Interview Survey National Health and Nutrition Examination Survey

11. NCHS Data Strengths National coverage (census or sample) State and county for vital statistics Fully accessible, free of charge Well-documented ICD coded Limitations Lack of timeliness Lack of detail- ICD Coded Hard to get state/county level data for surveys

12. Burden of Injury, 2002 Deaths: 161 thousand Deaths: 161 thousand Hospital Discharges: 1.8 million Hospital Discharges: 1.8 million ED Visits: 33.0 million ED Visits: 33.0 million Other Outpatient visits: 82.3 million Other Outpatient visits: 82.3 million All other??? All other???

13. Issues to consider with injury mortality data Know what you want to analyze Underlying cause of death [external cause of death codes– motor vehicle crashes, firearm deaths] Multiple causes of death [injury diagnosis codes— internal organ injuries, penetrating wounds, poisoning substances or agents] Timeliness of the data (or lack thereof….)

14. Limitation of death certificates Little or no information on … Details on the circumstances, Other persons involved, Drug and alcohol involvement, Weapon type (if applicable)

15. Data dissemination Annual published reports Deaths: Injuries (2001 was 1 st year) Deaths: Final data for (year) Deaths: Leading causes for (year) Health US & Chart books Tabulated data Interactive data sources WISQARS, WONDER Public Use data

16. Frameworks for Presentation External Cause of Injury Matrix Collaboration between Injury ICE and APHA Injury Section-began in late ’90’s. Classifies external causes by cause and intent For morbidity and mortality ICD-9, 9-CM and ICD-10

17. External Cause of Injury Matrix (in part) Intent of injury Mechanism UnintentionalSuicideHomicideUndeterminedLegal/ Other Cut Firearm External cause codes ICD-9, 9-CM & ICD-10 Poisoning Struck by/ against Suffocation Etc…..

18. The Barell Matrix Classifies body region by nature of injury Developed for morbidity (ICD-9-CM)

19. ICD-10 Mortality Injury Diagnosis Matrix Similar structure to Barell matrix Changes made in axis for diagnosis codes made this a challenge! Mortality issues: Any mention vs total mention of an injury Weighted average of mentions

20. ICD-10 Injury Mortality Diagnosis Matrix ICD-10 ‘S’ & ‘T’ codes

21. Injury deaths according to matrix : US, 2002 Source: National Vital Statistics System

22. But..... deaths are only the “tip” of the injury problem

23. Morbidity data from NCHS

24. NCHS data sources with injury information Morbidity National Health Care Surveys National Hospital Discharge Survey National Hospital Ambulatory Medical Care Surveys National Health Interview Survey [National Health and Nutrition Exam Survey-Interview Component]

25. New publication... National Trends in Injury Hospitalizations 1979- 2001 Presents data using new tools available to categorize and analyze injury hospitalization data STIPDA recommendations Barell matrix External cause matrix

26. NHAMCS-ED injury specific variables 1995-2002 Related to injury or poisoning? Place of injury occurrence Intent of injury Work-related Cause of injury - verbatim Cause of injury (up to 3 ICD-9-CM or External cause codes)

27. National Health Interview Survey (NHIS) Provides data on nonfatal, intentional and unintentional injuries for all family members Medical treatment or advice Collected annually since 1958 with the most recent redesign in 1997 National probability sample

28. NHIS - Variables Demographics for all family members Injury episodes (3) Verbatim about injury/poisoning event External cause of the injury/poisoning episode (3) Injury/poisoning ICD-9-CM diagnosis (4)

29. NHIS – Variables (cont.) What person was doing at time of injury/poisoning Where person was (home, school, etc.) Detailed follow-up questions related to certain external cause groups Motor vehicle, falls, etc. Seat belt, safety seat, helmet use Treatment locale (hospitalized, office visit, ed, phone call, etc.) Missed work and/or school days

30. Injury rates: Visits, Discharges and Deaths, 2001-2002 ED visits Hospital discharges Deaths Log scale Source: NCHS- NVSS, NHDS,NHAMCS

31. Tools to Access NCHS Data

32. Future… Encourage you to look on the web before you begin analyses….. http://www.cdc.gov/nchs/ Data warehouses are appearing on all different topics some include injury data– for example, women’s health, aging, mortality statistics Much more attention to multiple cause of death data……

33. Thanks & please feel free to email.. LFingerhut@cdc.gov or NCHSINJURY@ CDC.GOV www.cdc.gov/nchs/injury.htm