Injury and Violence Prevention The Road Ahead:
Getting from Here to There
Healthy Carolinians- 2020 VisionSept 30th, 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
6,275Deaths
869,614ED Visits
???,??? Outpatient Visits
?,???,??? Medically Unattended Injury(home, work, school)
Leading Causes of Chronic Disease and Injury Deathand Years of Life Lost: N.C., 2009
Cause of Death Total Deaths Average Years of Life Lost *
Total Years of Life Lost *
Cancer 17,476 3.46 60,420
Heart Disease 17,133 2.70 46,269
Injury 6,074 19.29 117,143
Stroke 4,391 1.96 8,602
Chronic Lower Respiratory Diseases (Asthma, COPD) 4,324 1.31 5,646
Alzheimer's disease 2,645 0.04 112
Diabetes Mellitus 2,107 3.40 7,165
Hypertension 796 2.40 1,912
Atherosclerosis 215 0.78 168
Total Deaths (all causes) 76,948 5.06 389,358
Chronic Disease Deaths 51,846 2.73 141,294
* Based on deaths that occurred prior to age 65
Source: N.C. State Center for Health Statistics, 2009
INJ URY ICEBERGINJ URY ICEBERG
???,??? 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 isunknown.
???,??? 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
108
202
562
826
837
1,036
1,161
1,342
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
<1 1-4 5-9 10-14 15-24 25-34 35-44 45-54 55-64 65+ All Ages
LowBirthweight
209
UnintentionalInjury
35
UnintentionalInjury
15
UnintentionalInjury
17
Motor VehicleInjury344
UnintentionalInjury264
Heart Disease
419
Cancer1,633
Cancer3,445
HeartDisease 13,321
HeartDisease 17,417
CongenitalAnomalies
203
Motor VehicleInjury
18
Cancer15
Motor Vehicle Injury
17
UnintentionalInjury 196
Motor VehicleInjury 263
Cancer414
HeartDisease
1,249
HeartDisease
2,248
Cancer11,717
Cancer 17,403
SIDS136
CongenitalAnomalies
15
Motor VehicleInjury
15
Cancer16
Homicide177
Homicide183
UnintentionalInjury 340
UnintentionalInjury 457
Chronic LowerRespiratory
Disease 513
Chronic LowerRespiratory
Disease 3,802
Chronic LowerRespiratory
Disease4,527
PregnancyRelated
75
Homicide13
Homicide5
Homicide 7
Suicide136
Suicide181
Motor VehicleInjury240
Suicide258
DiabetesMellitus
399
Cerebro-VascularDisease
3,761
Cerebro-VascularDisease
4,477
Placental, Cord, &
Other Complications
43
Cancer9
CongenitalAnomalies
5
Suicide 5
Cancer43
Cancer111
Suicide 233
Chronic Liver Disease & Cirrhosis
248
Cerebro-VascularDisease
373
Alzheimer'sDisease
2,585
UnintentionalInjury 2,713
Unintentional Injury
31
Heart Disease
7
In-situ/ Benign
Neoplasms5
Heart Disease
4
HeartDisease
36
HeartDisease
111
HIV103
Motor VehicleInjury 242
Chronic Liver Disease & Cirrhosis
267
DiabetesMellitus
1,487
Alzheimer'sDisease
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. 1999 to 2009*
Source: N.C. State Center for Health Statistics, Vital Statistics-Deaths, 1999-2009Analysis by Injury Epidemiology and Surveillance Unit
Motor Vehicle, -28.8%
Unintentional Poisoning, +212.7%
Firearm - Self-Inflicted, +1.7%
Unintentional Falls, +68.1%
Firearm - Assault, -25.3%
-50 0 50 100 150 200 250
Inju
ry M
ech/
Inte
nt
Percent Difference
*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)
0
10
20
30
40
50
00-15 16-20 21-25 26-35 36-45 46-55 56-65 66-75 >75
Age Group
Rate
per
N.C
. Res
iden
ts
Male Female
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, 2009Analysis 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 2002.
Source: N.C. State Center for Health Statistics, Vital Statistics-Deaths, 2002, 2009Analysis by Injury Epidemiology and Surveillance Unit
0
10
20
30
40
50
<15 15* 16 17* 18 19 20 21 22 23 24 25+
Age (Years)
Rate
per
100
,000
N.C
. Res
iden
ts
2002 2009
*<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
Non-Fatal Injury, 71,773,
33%
Fatal Injury, 1,340,
1%
Property Damage
Only, 141,245,
66%
376,209
214,358
539,760
0
100,000
200,000
300,000
400,000
500,000
600,000
Crashes Vehicles People
Num
ber o
f Cra
shes
/Veh
icle
s/Pe
ople
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
6%
30%
70%
94%
0%
25%
50%
75%
100%
All reportable crashes Fatal crashes
Perc
ent o
f cra
shes
No alcohol involved
Alcohol involved
202, 376 Crashes
11, 982 Crashes
938 Crashes
402Crashes
Unintentional Falls
Rate of Deaths due to Unintentional Falls Since 2000: N.C., 2000-2009
5.4 5.25.6
5.9
7.1 7.2
6.1
6.9
8.1
8.9
0
2
4
6
8
10
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Year
Rate
per
100
,000
N.C
. Res
iden
ts
Source: N.C. State Center for Health Statistics, Vital Statistics-Deaths, 2000-2009Analysis 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, 2009Analysis by Injury Epidemiology and Surveillance Unit
0
50
100
150
200
250
300
350
00-04 5-9 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
Age Group
Rate
per
100
,000
N.C
. Res
iden
ts
Females
Males
BothSexes
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, 2008NC DETECT-ED, 2008Analysis by Injury Epidemiology and Surveillance Unit
0
2,000
4,000
6,000
8,000
10,000
00-04 5-9 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
Age Group
Rate
per
100
,000
N.C
. Res
iden
ts
Deaths
Hospitalizations
ED
Outcome of Patients Hospitalized due to an Unintentional Fall, N.C., 2008
Source: N.C. State Center for Health Statistics-Vital Statistics-Hospital Discharge, 2008Analysis by Injury Epidemiology and Surveillance Unit
10,220
7,682
3,725
1,804
886456 244 207
731
0
3,000
6,000
9,000
12,000
SkilledNursingFacility
Home Home Health Rehab Death Transfer Floor-MedicareSwing Bed
IntermediateCare Facility
Other
Outcome
Num
ber
of H
ospi
tal D
isch
arge
s
Unintentional Poisoning
Poisoning Deaths: N.C., 1999-2008
Source: CDCWISQARS-2006Analysis 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.
1 2 4 0 2 2 1 2 3 2
279
367437
547
690728
872 902 901
1016
184 196 222 212184151155186169141
4819 22 11 20 25 22 27 28 41
1278
116711281084
936868
722638
560
440
0
300
600
900
1200
1500
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Year
Num
ber o
f Dea
ths Unintentional
Suicide
Homicide
Undetermined
All Poisonings
North Carolina – Violent Death Reporting System (NC-VDRS)
Percent of Deaths Due to Violence by Manner/Intent: North Carolina Violent Death Reporting System, 2004-2009*
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, 2004-2008*
3%
5%
4%
0%
6%
68%
14%
60%
1%
0%
19%
17%
0%
3%
Firearm
Sharp Inst
Blunt
Poison
Hanging
Unarmed
Other
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
injuryinjury
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?
www.injuryfreenc.ncdhhs.gov
Scott Proescholdbell, MPHInjury and Violence Prevention Branch
Chronic Disease and Injury SectionNC Division of Public Health
919-707-5442