1. External Cause of Injury Mortality Matrix Lois A. Fingerhut on behalf on the ICE on Injury Statistics October 2004 Centers for Disease Control and Prevention National Center for Health Statistics

2. Current WHO Tabulation Lists Not ideal for the analysis of injury data Mechanisms missing for intentional deaths –Suicides Firearm, poisoning, suffocation –Homicides Firearm, cut/pierce Undetermined intent not included

3. External Cause Categories from the WHO Special Tabulation Lists External causes of morbidity and mortality Transport accidents Falls Accidental drowning and submersion Other accidental threats to breathing Exposure to smoke, fire and flames Accidental poisoning by and exposure to noxious substances Intentional self-harm Assault All other external causes

4. External Cause Categories from the WHO Special Tabulation Lists External causes of morbidity and mortality Transport accidents Falls Accidental drowning and submersion Other accidental threats to breathing Exposure to smoke, fire and flames Accidental poisoning by and exposure to noxious substances Intentional self-harm Assault All other external causes

5. External Causes in the WHO Mortality Database Tabulation List Accidents and adverse effects Motor vehicle traffic accidents Other transport accidents Accidental poisoning Accidental falls Accidents caused by fire and flames Accidental drowning and submersion Accidents caused by firearm missile All other accidents, including late effects Drugs, medicaments causing adverse effects in therapeutic use Suicide and self-inflicted injury Homicide and injury purposely inflicted by other persons Other external causes

6. External Causes in the WHO Mortality Database Tabulation List Accidents and adverse effects Motor vehicle traffic accidents Other transport accidents Accidental poisoning Accidental falls Accidents caused by fire and flames Accidental drowning and submersion Accidents caused by firearm missile All other accidents, including late effects Drugs, medicaments causing adverse effects in therapeutic use Suicide and self-inflicted injury Homicide and injury purposely inflicted by other persons Other external causes

7. What if we need to look at specific mechanisms of injury? Firearms? –No categories in the special tabulation lists –Only accidental firearm deaths in the Mortality Database list Poisonings? –Only accidental poisonings shown in both lists

8. Proposed Modifications and Additions to Current Lists Current lists modified to include all intent categories –Add undetermined intent –Add legal intervention/operations of war –Ensure unintentional categories sum to total unintentional deaths

9. External Causes in the WHO Mortality Database Tabulation List Accidents and adverse effects Motor vehicle traffic accidents Other transport accidents Accidental poisoning Accidental falls Accidents caused by fire and flames Accidental drowning and submersion Accidents caused by firearm missile All other accidents, including late effects Drugs, medicaments causing adverse effects in therapeutic use Suicide and self-inflicted injury Homicide and injury purposely inflicted by other persons Events of undetermined intent Other external causes or Legal intervention/operations of war

10. Proposed Modifications and Additions to Current Lists (cont.) Add External Cause of Injury Mortality Matrix as additional list –Developed by the ICE on Injury Statistics –Internationally accepted

11. External Cause of Injury Mortality Matrix

12. Intent of death

13. External Cause of Injury Mortality Matrix Mechanism of death

14. Two Proposed Levels of Detail Level 1 –Based on mechanism or cause only Level 2 –Includes each combination of mechanism and intent

15. Injury deaths by mechanism: US, 2002 (Level 1)

16. Injury Deaths according to matrix: US, 2002 (Level 2)

17. Relationship between ICECI and ICD-10 Chapter XX ICECI Intent, Mechanism, Transport module Bridge Intent Mechanism External cause matrix categories ICD Chapter XX – External causes

18. Questions? Lois Fingerhut US National Center for Health Statistics LFingerhut@cdc.gov