1. Injury Surveillance Activities of the National Center for Injury Prevention and Control Data Issues Lee Annest, Ph.D. Director, Office of Statistics and Programming National Center for Injury Prevention and Control Coordinating Center for Environmental Health and Injury Prevention Centers for Disease Control and Prevention September 7, 2006

2. National Violent Death Reporting System (NVDRS) Use of multiple data sources (death certificates, medical examiner/coroner records, police reports, crime lab reports, hospital records) 17 States participating All violent deaths (including homicide, suicide, deaths of undetermined intent and unintentional firearm-related injuries) All violent deaths (including homicide, suicide, deaths of undetermined intent and unintentional firearm-related injuries) Child fatality review module (New Jersey, Oregon, South Carolina)

3. NVDRS States as of August, 2006 FY 02 (6 states) FY 03 (7 states) FY 04 (4 states)

4. National Violent Death Reporting System (NVDRS) – Data Issues How do we provide timely access to data? WISQARS – NVDRS in the works How do we streamline the data collection and still provide valuable details? How do we expand to all states?

5. Child Maltreatment Improving National/State Surveillance Systems Lessons Learned from 5 state cooperative agreements (Minnesota, Rhode Island, Missouri, California, Michigan) – completed Uniform Definitions & Recommended Data Elements – scheduled for release in Fall 2006 Model State-based Child Maltreatment Surveillance System – being developed CDC’s cooperative agreements (NY state, Pennsylvania) – shaken baby syndrome/abusive head trauma

6. Definition of Child Maltreatment Any act or series of acts of commission or omission by a parent or other caregiver that results in harm, potential for harm or threat of harm to a child, including physical abuse, sexual abuse, psychological abuse, failure to provide (neglect) Number of Injuries among Children < 18 Years, US, 2004 Deaths = 1,490 (est. from NCANDS) Victimizations = 872,000 (est. from NCANDS)

7. Child Maltreatment Mortality and Incidence Data Sources National Child Abuse and Neglect Data System (NCANDS) – current best national/state data source –Child abuse/neglect reported by child protective services (CPS) in all 50 states, DC, and US territories and armed services –State CPS offices voluntarily submit aggregate data to the Administration of Children and Families (ACF) –Use data to estimate CM deaths, investigation rates, victimization rates –Likely an undercount because only based on children investigated for alleged maltreatment (neglect, physical abuse, sexual abuse, medical neglect, and emotional or psychological maltreatment)

8. Child Maltreatment Mortality and Incidence Data Sources CDC’s National Violent Death Reporting System (NVDRS) – Child Fatality Review Module – current state data limited NCHS’ National Vital Statistics System (NVSS) – undercount CM deaths –Using ICD-10 external-cause-of-injury codes – Y06 (neglect and abandonment) and Y07 (other maltreatment syndrome such as sexual abuse, mental cruelty, torture), there were 200 deaths for children < 18 years or 13% of the 1,500 deaths per year estimated using NCANDS data.

9. Child Maltreatment Data Issues How do we get more complete reporting of incidents? How do we get more complete coding on death certificates?

10. Drug-induced Mortality Surveillance Sharply on the Rise Recent increase mostly likely due to overuse of opioid analgesics as pain killers Use of ICD-10 T codes to investigate increase Reference: Paulozzi L, Budnitz D, Xi L. Increasing deaths from Opioid analgesics in the United States. Pharmacoepidemiology and Drug Safety (online) at www.interscience.wiley.com

11. Source: NVSS mortality files, NCHS

13. Deaths from “narcotics and psychodysleptics” (X42) and “other and unspecified drugs,” (X44) US, 1999-2002 Drug Type Involved19992002 % Increase Opioid analgesics 2,8915,52891.2 Cocaine3,1823,90922.8 Heroin1,7231,93712.4 Other specified 1,6661,7907.4 Unspecified2,2553,63561.2

14. Source: NVSS mortality files, NCHS Deaths by type of opioid analgesic, US, 2002 TypeNumber Percent of total drugs listed Other opioid (hydrocodone, oxycodone) 3,96754.3 Methadone2,36132.3 Other synthetic narcotic (fentanyl) 98213.4

15. Drug-induced Mortality Surveillance Data Issues How do we get more timely monitoring of fatal, specific drug-induced poisonings? Electronic death record system? How do we monitor nonfatal, specific drug- induced poisonings? Drug Abuse Warning Network (DAWN)? Toxic Exposure Surveillance System (TESS)? National Electronic Injury Surveillance System All Injury Program (NEISS AIP)?

16. Disaster-Related Injury Surveillance CDC Emergency Preparedness Director’s Emergency Operations Center (DEOC) – Assessment and Surveillance Unit for Natural Disasters CDC Emergency Preparedness and Response Web site

19. Where is Injury Surveillance??

20. Disaster-Related Injury Surveillance Data Issues Can multi-purpose data collection forms be developed as models for use by states? and other countries? How do we collect timely population-based data on fatal and nonfatal injuries during or within a few weeks of a disaster event? Could an electronic death record system be useful?

21. Fatal and Nonfatal Injuries in the United States http://www.cdc.gov/ncipc/wisqars Cross-tabulation of mechanism and intent of injury deaths (proposed release in 2007) WISQARS-State injury mortality maps (prototype) WISQARS-NVDRS (design stage) New Features