1. Healthy People 2010 Focus Area 15: Injury and Violence Prevention Progress Review August 16, 2007

2. Leading Causes of Death, 2004 Source: Source: National Vital Statistics System—Mortality (NVSS-M), NCHS, CDC.

3. Leading Causes of Unintentional Injury Deaths, 2004 Note: Fires/burns includes all fire deaths, not just those that occurred in residences. Healthy People 2010 objective 15-25, highlighted later in this presentation, focuses exclusively on residential fire deaths. Source: Source: National Vital Statistics System—Mortality (NVSS-M), NCHS, CDC.

4. Injuries are the leading cause of death for people ages 1-44. Injuries and violence resulted in 167,000 deaths in 2004. Each year: –50 million injury episodes require medical attention, costing $406 billion in medical expenses and lost productivity. –1.4 million people sustain a traumatic brain injury. –396,000 residential fires result in 3,000 deaths and nearly 14,000 ED visits for injuries. –1 in 3 adults 65 years and over fall, resulting in about 15,000 deaths. –More than 1 in 7 children experience maltreatment. –Approximately 200,000 people are victims of rape or sexual assault. Burden of Injury and Violence

5. 15-1. Traumatic brain injury hospitalizations 15-2. Nonfatal spinal cord injury hospitalizations 15-3. Firearm-related deaths 15-4. Improper firearm storage in homes 15-5. Nonfatal firearm-related injuries 15-6. State-level child fatality review Status of Injury Prevention Objectives Improving Getting worseLittle or no change* Target met/exceeded Baseline only 15-7. Nonfatal poisonings 15-8. Deaths from poisoning 15-9. Deaths from suffocation 15-10. Emergency department surveillance of external causes of injury 15-11. Hospital discharge surveillance of external causes of injury 15-12. Emergency department visits due to injury or poisoning * Percent of targeted change achieved is between -10% and 10%.

6. 15-13. Deaths from unintentional injuries 15-14. Nonfatal unintentional injuries 15-15a. Motor vehicle crash deaths (per 100,000) population 15-15b. Motor vehicle crash deaths (per million miles traveled) 15-16. Pedestrian deaths 15-17. Nonfatal motor vehicle injuries 15-18. Nonfatal pedestrian injuries 15-19. Safety belt use 15-20. Child restraint use 15-21. Motorcycle helmet use 15-22. Graduated driver licensing laws Status of Unintentional Injury Prevention Objectives 15-23a-b. Bicycle helmet use 15-24. Bicycle helmet laws 15-25. Residential fire deaths 15-26a. Functioning smoke alarms in residences (prop. of persons) 15-26a. Functioning smoke alarms in residences (prop. of homes) 15-27. Deaths from falls 15-28a. Hip fractures in older females 15-28b. Hip fractures in older males 15-29. Drownings 15-30. ED visits for dog bite injuries 15-31a-c. Protective gear in school sports Improving Getting worseLittle or no change* Target met/exceeded Baseline only * Percent of targeted change achieved is between -10% and 10%.

7. 15-32. Homicides 15-33a. Child maltreatment incidents 15-33b. Child maltreatment fatalities 15-34. Physical assault by intimate partners 15-35. Rape or attempted rape 15-36. Sexual assault other than rape 15-37. Physical assaults 15-38. Physical fighting among adolescents 15-39. Weapon carrying by adolescents on school property Status of Violence and Abuse Prevention Objectives Improving Getting worseLittle or no change* Target met/exceeded Baseline only * Percent of targeted change achieved by most recent data point is between -10% and 10%.

8. Status of Injury and Violence Prevention Objectives * Percent of targeted change achieved is between -10% and 10%. 2010 Target Injury Prevention Unintentional Injury Prevention Violence Prevention Met/exceeded023 Improving4123 Little or no change* 222 Getting worse 441 No trend data250

9. Status of Highlighted Objectives * Percent of targeted change achieved is between -10% and 10%. 2010 Target Injury Prevention Unintentional Injury Prevention Violence Prevention Met/exceeded Sexual violence Improving Child maltreatment Little or no change* Residential fire deaths Getting worse TBI hospitalizations Deaths from falls Child maltreatment deaths No trend data

10. Male Traumatic Brain Injury (TBI) Hospitalizations Obj. 15-1 * Data for males 15-24 years are not age adjusted. Note: TBI is defined as an injury to the head that is documented in a medical record, with one or more of the following conditions attributed to head injury: observed or self-reported decreased level of consciousness, amnesia, skull fracture, objective neurological or neuropsychological abnormality, or diagnoses intracranial lesion. Data are age adjusted to the 2000 standard population. Source: National Hospital Discharge Survey (NHDS), NCHS, CDC. Age-adjusted rate per 100,000 population Female Male 15-24 yrs* Decrease desired 2010 Target: 41.2

11. <65 yrs 75+ yrs 65-74 yrs Rate per 100,000 population TBI Hospitalizations Note: TBI is defined as an injury to the head that is documented in a medical record, with one or more of the following conditions attributed to head injury: observed or self-reported decreased level of consciousness, amnesia, skull fracture, objective neurological or neuropsychological abnormality, or diagnoses intracranial lesion. Source: National Hospital Discharge Survey (NHDS), NCHS, CDC. Obj. 15-1 Decrease desired

12. 0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 Total Female Male Less than high school High school At least some college Obj. 15-25 = 95% confidence interval. Note: Based on ICD-10 codes X00-X09 (location = HOME). Data are age adjusted to the 2000 standard population. Education estimates are based on persons aged 25-64 years. Source: National Vital Statistics System—Mortality (NVSS-M), NCHS, CDC. Unintentional Residential Fire Deaths, 2004 Age-adjusted rate per 100,000 population Decrease desired 2010 Target: 0.2 Age-adjusted rate per 100,000 population 8% decrease (1999-2004)

13. 0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 Total American Indian Asian Hispanic White Black Black females Black males Unintentional Residential Fire Deaths, 2004 Obj. 15-25 = 95% confidence interval. Note: Based on ICD-10 codes X00-X09 (location = HOME). Data are age adjusted to the 2000 standard population. American Indian includes Alaska Native. Asian includes Pacific Islander. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be of any race. One or more races could be recorded. Data by single race categories are for persons for whom only one racial group was recorded. Source: National Vital Statistics System—Mortality (NVSS-M), NCHS, CDC. Age-adjusted rate per 100,000 population Decrease desired 2010 Target: 0.2

14. Rate per 100,000 population Unintentional Residential Fire Deaths, 2004 I = 95% confidence interval. Decrease desired Note: Based on ICD-10 codes X00-X09 (location = HOME). Source: National Vital Statistics System—Mortality (NVSS-M), NCHS, CDC. Obj. 15-25 5-18 yrs 85+ yrs 45-64 yrs 19-44 yrs 65-74 yrs 75-84 yrs 0-4 yrs

15. D.C. Unintentional Residential Fire Deaths, 2000-2004 N = 2,803/year * Rate is based on fewer than 20 deaths. Note: Based on ICD-10 codes X00-X09 (location = HOME). Data are age adjusted to the 2000 standard population. Source: National Vital Statistics System—Mortality (NVSS-M), NCHS, CDC. Obj. 15-25 1.33-3.05 0.98-1.32 0.77-0.97 0.28-0.76 Unreliable* Age-adjusted rate per 100,000 (by quartiles)

16. Rate per 100,000 population 19992004 Deaths Due to Unintentional Falls I = 95% confidence interval. Decrease desired Note: Based on ICD-10 codes W00-W19. Trend data shown in insert are adjusted to the 2000 standard population. Source: National Vital Statistics System—Mortality (NVSS-M), NCHS, CDC. Obj. 15-27 0-18 yrs 85+ yrs 45-64 yrs 19-44 yrs 65-74 yrs 75-84 yrs Age-adjusted rate per 100,000 population

17. Obj. 15-27 0 2 4 6 8 10 Total American Indian Asian Black White Hispanic Female Male Less than high school High school At least some college = 95% confidence interval. Note: Based on ICD-10 codes W00-W19. Data are age adjusted to the 2000 standard population. American Indian includes Alaska Native. Asian includes Pacific Islander. Black and White exclude persons of Hispanic origin. Persons of Hispanic origin may be of any race. One or more races could be recorded. Data by single race categories are for persons for whom only one racial group was recorded. Education estimates are based on persons aged 25-64 years. Source: National Vital Statistics System—Mortality (NVSS-M), NCHS, CDC. Deaths Due to Unintentional Falls, 2004 Age-adjusted rate per 100,000 population Decrease desired 2010 Target: 3.3

18. D.C. N = 12,667/year Note: Based on ICD-10 codes W00-W19. Data are age adjusted to the 2000 standard population. Source: National Vital Statistics System—Mortality (NVSS-M), NCHS, CDC. 49.0-80.4 35.7-48.9 29.3-35.6 16.5-29.2 Age-adjusted rate per 100,000 (by quartiles) Deaths Due to Unintentional Falls Among Persons 65 and Over, 2000-2004 Obj. 15-27

19. Source: National Child Abuse and Neglect System (NCANDS), ACF. Note: Children are defined as persons under 18 years of age or persons considered minors under State law. Incidents rate includes some child maltreatment deaths. Number of reporting States varies by year. Child Maltreatment Incidents and Deaths Obj. 15-33a,b Incidents per 1,000 children Deaths per 100,000 children Decrease desired 2010 Target: 10.1 2010 Target: 1.5 Females Males

20. Incidents per 1,000 children Child Maltreatment Incidents, 2005 Decrease desired Obj. 15-33a 0-3 yrs 8-11 yrs 4-7 yrs 12-15 yrs 16-17 yrs Source: National Child Abuse and Neglect System (NCANDS), ACF. Note: Children are defined as persons under 18 years of age or persons considered minors under State law. Incidents rate includes some child maltreatment deaths. Rates are based on data from 51 States.

21. Source: National Child Abuse and Neglect System (NCANDS), ACF. Note: Percentages are based on data from 36 reporting States. 0-3 yrs 77% 4-7 years 13% 8-11 yrs 4% Child Maltreatment Deaths, 2005 Obj. 15-33b 12-17 yrs* 6% 17% 12% 3 yr 42% 2 yr 1 yr < 1 yr 6% * Includes some deaths to children 18 years or older who were considered minors under State law.

22. Source: National Child Abuse and Neglect System (NCANDS), ACF. Note: Children are defined as persons under 18 years of age or persons considered minors under State law. Percentages are based on data from 34 reporting States. 29% 16% 20% Mother Mother and father Non-parental perpetrator Father and other Child Maltreatment Deaths by Perpetrator’s Relationship to Child, 2005 Obj. 15-33b Father Mother and other 10% 13% 2% Unknown or missing 10%

23. Sexual Violence Obj. 15-35 & 15-36 Incidents per 1,000 population aged 12 years and over Sexual assault other than rape Rape or attempted rape Source: National Crime Victimization Survey (NCVS), U.S. Department of Justice, Bureau of Justice Statistics. Decrease desired 2010 Target

24. 0 1.0 2.0 3.0 4.0 5.0 White Black Other race Two or more races Hispanic Female Male 12-15 yrs. 16-19 yrs. 20-24 yrs. 25-34 yrs. 35-49 yrs. 50-64 yrs. Rape/Sexual Assault Incidents, 2004-2005 Incidents per 1,000 population aged 12 years and over Decrease desired * * * * Based on 10 or fewer sample cases; rate should be interpreted with caution. = 95% confidence interval. Note: The categories White, Black and Other race exclude persons of Hispanic origin. Other race includes American Indian, Alaska Native, Asian, and Native Hawaiian and Pacific Islander. Persons of Hispanic origin may be of any race. One or more races could be recorded. Data by single race categories are for persons for whom only one racial group was recorded. Source: National Crime Victimization Survey (NCVS), U.S. Department of Justice, Bureau of Justice Statistics. Obj. 15-35/15-36

25. * Based on 10 or fewer sample cases; percent should be interpreted with caution. 28% 26% 7%* Intimate partner Other relative Relationship unknown Stranger Friend or acquaintance 38% 2% Obj. 15-35/15-36 Note: Percentages sum to greater than 100% due to rounding. Source: National Crime Victimization Survey (NCVS), U.S. Department of Justice, Bureau of Justice Statistics. Rape/Sexual Assault Against Females by Perpetrator’s Relationship to Victim, 2005

26. About half (24/46) of the objectives have met or are moving toward their targets. Rape and sexual assault have decreased since the baseline; both objectives have met their targets. Disparities by age, gender, education and geographic location persist for many objectives. Summary

27. Progress review data and slides are available on the web at: http://www.cdc.gov/nchs/hphome.htm