firearm deaths and injuries among youth in north carolina...−number of relevant injury codes...
TRANSCRIPT
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 1
Firearm Deaths and Injuries among Youth in North Carolina
Scott K. Proescholdbell, MPHNorth Carolina Division of Public HealthChronic Disease and Injury SectionInjury and Violence Prevention Branch
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 2
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 3
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 4
Firearm-related Violence in US & NC
NC Firearm-related deaths in 2017NC= 1,403 NC ages 0-17= 42
NC Firearm-related deaths in 2018*NC= 1,345 NC ages 0-17= 61
* 2018 data is provisionalAnalysis by Injury Epidemiology and Surveillance Unit (as of Nov 2019)
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 5
North Carolina Violent Death Reporting System (NC-VDRS)
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 6
Data and Surveillance • Since 2004, abstract approximately 2,000 violent deaths per year
(homicides, suicides, firearm deaths)
• Data Sources and Collaborators –Death certificate data- State Center for Health Statistics–NC Office of the Chief Medical Examiner (OCME)–NC-IBRS (SBI)–Decentralized law enforcement
•More than 650 law enforcement agencies in NC•~250 in a given year experience violent death
• Data can differ slightly due to case definition, data closeout dates, and other factors
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 7
Types of Information Gathered• Demographics (victim and suspect)
• Circumstances of the event
• Alcohol/drug use by the victim
• Type of location where the event happened
• Type of weapon used
• Relationship between the victim and suspect
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 8
North Carolina Violent Death Reporting System
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 9
Deaths by Manner/Intent: Resident and Occurrence DeathsNorth Carolina Violent Death Reporting System, 2004-2018*
* 2018 data is provisionalAnalysis by Injury Epidemiology and Surveillance Unit (as of Nov 2019)
18,373
8,871
219 326 927
19,000
9,281
235 345 961
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
Suicide Homicide UnintentionalFirearm
LegalIntervention
UndeterminedIntent
Resident Occurrence
Total resident deaths = 29,966
Total occurrence deaths = 31,123
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 10
Deaths by Manner/Intent: Resident and Occurrence DeathsNorth Carolina Violent Death Reporting System, age 0-17, 2004-2018
511
758
7110
71
520
780
7210
71
0
100
200
300
400
500
600
700
800
900
Suicide Homicide UnintentionalFirearm
LegalIntervention
UndeterminedIntent
Resident Occurrence
Total resident deaths = 1,421
Total occurrence deaths = 1,453
* 2018 data is provisionalAnalysis by Injury Epidemiology and Surveillance Unit (as of Nov 2019)
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 11
Firearm Deaths in North Carolina
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 12
Firearm Death Rates by Sex, Age, and Race: NC-VDRS, 2017
Data Source: North Carolina Violent Death Reporting System, 2017 ; Analysis conducted by Injury Epidemiology and Surveillance Unit
*Technical Note: 1,403 violent deaths caused by firearms in 2017- using May 2019 datafile
* Rate per 100,000 NC population; † <5 deaths; rate suppressed** Non-Hispanic
3.0
18.0
38.9 38.2
29.1
23.4 23.8 24.3
42.6
60.8
1.85.4 5.4 5.4 5.5 4.5 4.7 2.6
0
10
20
30
40
50
60
70
Male
Female
† † ††
* Rate per 100,000 NC population; † <5 deaths; rate suppressed
†
10.1
22.4
37.5
25.4
5.71.9
4.4 3.5† 1.2
0
10
20
30
40
50
60
70
Hispanic White** Black** AI/NA** Asian**
Male
Female
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 13
Firearm-Related Deaths by Manner and Firearm Type: NC-VDRS, 2017
Manner by Percent Firearm Type by Percent
Data Source: North Carolina Violent Death Reporting System, 2017 ; Analysis conducted by Injury Epidemiology and Surveillance Unit
Technical Note: 1,403 violent deaths caused by firearms in 2017- using may 2019 datafile
65.4
29.8
0.9 3.9
SuicideHomicideLegal InterventionUndetermined/Unintenional Firearm
76.6
7.3
10.25.9
Handgun RifleShotgun Other/Unknown
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 14
Firearm-Related Deaths by Manner and Firearm Type, ages 0-17:NC-VDRS, 2017
Manner by Percent Firearm Type by Percent
Data Source: North Carolina Violent Death Reporting System, 2017 ; Analysis conducted by Injury Epidemiology and Surveillance Unit
Technical Note: 42 violent deaths caused by firearms in 2017 for ages 0-17- using Dec 2019 datafile
5042.86
7.14
Homicide Suicide Unintentional firearm
88.1
4.767.14
Handgun Rifle Shotgun
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 15
Circumstances
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 16
Firearm-related Suicide
Circumstances
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 17
Firearm Suicides: Percent of Circumstances: NC-VDRS age 0-17, 2016-2017
Analysis by Injury Epidemiology and Surveillance Unit- using Dec 2019 datafile
25.0
39.3
21.4
10.7
21.4
28.6
3.6
16.7
33.3 33.3
0.0
33.3 33.3
0.00
5
10
15
20
25
30
35
40
45
Depressed Mood Current MentalHealth Problem
Current MentalHealth Treatment
History of SuicideAttempt(s)
Left a SuicideNote
Disclosed Intent Physical HealthProblem
PER
CEN
T
Male Female
N= 38: total number suicide firearm deaths 0-17N= 34: At least 1 known circumstance (89%)
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 18
Firearm-related Homicide
Circumstances
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 19
Firearm-related Homicide: Percent of Circumstances for age 0-17: NC-VDRS, 2016-2017
Analysis by Injury Epidemiology and Surveillance Unit- using Dec 2019 datafile
29.41
38.24
8.82
17.65
8.8212.50 12.50 12.50 12.50 12.50
0
5
10
15
20
25
30
35
40
45
Argument Crime Drug Gang IPV
PER
CEN
T
Male Female
N= 47: total number homicide firearm deaths 0-17N= 42: At least 1 known circumstance (89%)
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 20
Firearm-Related Hospitalizations
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 21
Quick Note: ICD-10-CM Transition• The International Classification of Diseases, 10th revision, Clinical Modification replaced ICD-9-CM in
2015− Affects Hospital Discharge (HD), Emergency Department (ED), and outpatient diagnosis coding
• ICD-10-CM captures more detail than ICD-9-CM− Contains almost 5 times as many codes− Number of relevant injury codes jumped from 2,600 (ICD-9-CM) to 43,000− ICD-10-CM data is not comparable to ICD-9-CM data
• Case definitions and external cause of injury categories are still being evaluated and are subject to change
• Current nonfatal firearm-related injury case definition includes any mention of the following codes:
W32.0, W33.0, W34.00, W.34.09 Accidental Discharge of Firearm
X72, X73, X74.8, X74.9 Intentional Self-Harm by Firearm
X93, X94, X95.8, X95.9 Assault by Firearm
Y38.4 Terrorism Involving Firearms
Y22, Y23, Y24.8, Y24.9 Firearm Discharge of Undetermined Intent
Y35.0 Legal Intervention Involving Firearm Discharge
*With a 7th character of A or missing (Initial encounter/active treatment)
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 22
Firearm-Related Hospitalization Rates per 100,000 in North Carolina, all ages (2016-2018)
Data Source: State Center for Health Statistics: Hospitalization Discharge Data, 2016-2018; Analyses conducted by Injury and Epidemiology Surveillance Unit
Technical Note: Analysis includes only NC Resident cases WITH a valid NC FIPS code using CDC/CSTE case definitions.
2016: 1,074 Firearm-Related Hospitalizations2017: 1,100 Firearm-Related Hospitalizations2018: 1,076 Firearm-Related HospitalizationsTotal: 3,250 Firearm-Related Hospitalizations
* Rate per 100,000 NC population; † <5 deaths; rate suppressed ** Non-Hispanic
19.0
2.4
18.5
0.8
29.9
5.0 4.31.2 1.7
26.024.6
12.5
7.6
3.92.3 2.1 2.2
0
5
10
15
20
25
30
35
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 23
Insurance Type by Percent Among Firearm-Related Hospitalizations, 2016-2018
Data Source: State Center for Health Statistics: Hospitalization Discharge Data, 2016-2018; Analyses conducted by Injury and Epidemiology Surveillance Unit
*Other insurance types include but are not limited to: Workers Comp, Veterans Admin, Health Maintenance Organization (HMO), Commercial Insurance Co., Champus
5.2
9.2
17.0
27.4
41.1
0 5 10 15 20 25 30 35 40 45
Medicare Part A or B
Blue Cross/Blue Shield
Other*
Medicaid
Self-pay
Technical Note: Analysis includes only NC Resident cases WITH a valid NC FIPS code using CDC/CSTE case definitions.
2016: 1,074 Firearm-Related Hospitalizations2017: 1,100 Firearm-Related Hospitalizations2018: 1,076 Firearm-Related HospitalizationsTotal: 3,250 Firearm-Related Hospitalizations
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 24
5.9
1.3 1.4 1.4
9.4
7.8
* *1.2 0.7
2.5
13.8
0
2
4
6
8
10
12
14
16
Rat
e pe
r 100
,000
Firearm-Related Hospitalization (0-17) Rates, 2016-2018
*NC Residents, 2016-2018; NH: Non-HispanicSource: NC State Center for Health Statistics, Hospitalization Discharge Data (2016-2018) [Excludes Deaths]Analysis by Injury Epidemiology and Surveillance Unit
N = 275 Hospitalizations
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 25
Primary Payer Information for Firearm-Related Hospitalizations (0-17), 2016-2018
*NC Residents, 2016-2018Source: NC State Center for Health Statistics, Hospitalization Discharge Data (2016-2018) [Excludes Deaths]Analysis by Injury Epidemiology and Surveillance Unit
5.6
2.4
2.8
6.8
82.4
0 10 20 30 40 50 60 70 80 90
Other
Self-Pay
Private Insurance
Blue Cross & Blue Shield
Medicaid
Percent (%)N = 275 Hospitalizations
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 26
Firearm-Related Hospitalization (0-17) Charges, 2016-2018
•$96,239 average charge
•$3,477 minimum charge
•$1,479,954 maximum charge
*NC Residents, 2016-2018Source: NC State Center for Health Statistics, Hospitalization Discharge Data (2016-2018) [Excludes Deaths]Analysis by Injury Epidemiology and Surveillance Unit
N = 275 Hospitalizations
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 27
Firearm-Related ED Visits
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 28
Firearm-Related ED Visit Rates per 100,000 in North Carolina, all ages (2016-2018)
Data Source: NC DETECT, Emergency Department Visits, 2016-2018; Analysis conducted by Injury Epidemiology and Surveillance Unit
2016: 3,175 Firearm-Related ED Visits2017: 3,218 Firearm-Related ED Visits2018: 3,178 Firearm-Related ED VisitsTotal: 9,571 Firearm-Related ED Visits
* Rate per 100,000 NC population; † <5 deaths; rate suppressed ** Non-Hispanic
19.0
2.4
18.5
0.8
29.9
5.0 4.3
1.2 1.7
26.024.6
12.5
7.6
3.92.3 2.1 2.2
0
5
10
15
20
25
30
35
Technical Note: Analysis includes only NC Resident cases WITH a valid NC county FIPS code using CDC/CSTE case definitions.
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 29
Insurance Type Among Firearm-Related ED Cases, 2016-2018
Data Source: NC DETECT, Emergency Department Visits, 2016-2018; Analysis conducted by Injury Epidemiology and Surveillance Unit
0.6
2.1
5.1
8.4
16.3
23.1
44.2
0 5 10 15 20 25 30 35 40 45 50
Workers Comp
Other Gov
Medicare
Other/Unknown
Insurance
Medicaid
Self-pay
2016: 3,175 Firearm-Related ED Visits2017: 3,218 Firearm-Related ED Visits2018: 3,178 Firearm-Related ED VisitsTotal: 9,571 Firearm-Related ED Visits
Technical Note: Analysis includes only NC Resident cases WITH a valid NC FIPS code using CDC/CSTE case definitions.
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 30
Firearm-Related ED Visit (0-17) Rates, 2016-2018
20.5
3.8 4.7 4.5
20.3
8.9
* 1.7 2.4 2.9
9.4
47.7
0
10
20
30
40
50
60
Rat
e pe
r 100
,000
*NC Residents, 2016-2018; NH: Non-HispanicSource: NC State Center for Health Statistics, Hospitalization Discharge Data (2016-2018) [Excludes Deaths]Analysis by Injury Epidemiology and Surveillance Unit
N = 855 ED Visits
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 31
*NC Residents, 2016-2018; Source: NC State Center for Health Statistics, Hospitalization Discharge Data (2016-2018) [Excludes Deaths]Analysis by Injury Epidemiology and Surveillance Unit
N = 855 ED Visits
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 32
Prevention
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 33
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 34
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 35
Data Source: NC Child Health Assessment and Monitoring Program (NC CHAMP), 2011Analysis by Injury Epidemiology and Surveillance Unit
Percent of NC Parents Firearm Practices (Do you use a gun or chamber lock?)
NC CHAMP (ages 0-17), 201132.8% Have firearm in or around home25.4% Keep firearms loaded29.2% Keep firearms unlocked17.3% Unlocked & loaded
62.5
37.5
0
10
20
30
40
50
60
70
No Yes
NC Division of Public Health | Injury and Violence Prevention Branch | Child Fatality Task Force- Intentional Death Subcommittee | January 13th, 2020 36
Scott ProescholdbellInjury Epidemiologist, Injury and Violence Prevention Branch
Dana Dandeneau Injury Epidemiology Fellow, Injury and Violence Prevention Branch
Tammy NorwoodProgram Manager, NC-VDRS, Injury and Violence Prevention Branch