1 healthy carolinians 10/08/09 state of the state: injury and violence overview injury data 101...

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1 Healthy Carolinians 10/08/09 State of the State: Injury and Violence Overview INJURY DATA 101 Healthy Carolinians & IOM Summit October 8, 2009 Scott K. Proescholdbell, MPH Injury Epidemiology and Surveillance Unit Injury and Violence Prevention Branch Chronic Disease and Injury Section N.C. Division of Public Health

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1

Healthy Carolinians 10/08/09

State of the State:Injury and Violence Overview

INJURY DATA 101Healthy Carolinians & IOM Summit

October 8, 2009

Scott K. Proescholdbell, MPHInjury Epidemiology and Surveillance Unit

Injury and Violence Prevention BranchChronic Disease and Injury Section

N.C. Division of Public Health

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Healthy Carolinians 10/08/09

Overview

• Injury and violence are major public health problems.

• Scope and magnitude of the injury problem in North Carolina.

• Injuries are common risk factors and predictable thus preventable.

• Making injuries and violence socially unacceptable (changing social norms).

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Healthy Carolinians 10/08/09

Injuries are NOT:

• “random acts of nature”

• “accidental”• “destiny”• “chance”• “bad luck”• “unavoidable”

Injuries ARE:

• Predictable• Preventable• Have known risk

factors• Opportunities for

prevention

From a public health perspective what we have learned to date:

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Healthy Carolinians 10/08/09

NC Division of Public Health Annual Report 2008- Oct. 2008

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Healthy Carolinians 10/08/09

Combined = 4th at 4,333, slightly less than stroke. If you combined all injury= 6,247 – solid third.

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Healthy Carolinians 10/08/09

Editable iceberg

INJ URY ICEBERGINJ URY ICEBERG

6,247*Deaths

154,348#

Hospitalizations

812,193*ED Visits

???,??? Outpatient Visits

?,???,??? Medically Unattended Injury(home, work, school)

North Carolina’s Injury Iceberg- NC ResidentsAll Intents

Ratio

1

24.7

130.0

???

???

Injury Epidemiology & Surveillance UnitInjury & Violence Prevention BranchChronic Disease and Injury SectionN.C. Division of Public Health

* 2007 death file and 2007 NC DETECT # 2007 Hospitalization Discharge

We are fortunate in NC to have some of the best systems in the nationbut…

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Healthy Carolinians 10/08/09

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

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Healthy Carolinians 10/08/09

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

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Healthy Carolinians 10/08/09

Color Coding for Tables & Charts

• Blue = Unintentional Injury

• Red = Intentional Injury- assault

• Green = Intentional Injury- self-inflicted

• Yellow = Missing E-code

• Gray = Other injuries

The presentation is data heavy. Please focus on overall trends and themes rather than on any one set of specific numbers.

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Healthy Carolinians 10/08/09

Proportion of Unintentional and Intentional Injury Deaths, NC: 2007

68%

11%

18%3%

Unintentional

Intentional-Homicide

Intentional-Suicide

Other/Unk

Other includes: legal intervention, undetermined, and all others not classifiedSource: NC State Center for Health Statistics, Death file 2007; Analysis by Injury Epidemiology and Surveillance Unit

N= 6,247

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Healthy Carolinians 10/08/09

Leading Causes of Death, All Ages, North Carolina: 2007 (Total Deaths = 75,803)

25.7

2.3

2.3

2.4

2.8

3.2

3.4

5.6

5.7

23.0

23.1

0.0 5.0 10.0 15.0 20.0 25.0 30.0

All other causes

Pnuemonia and influenza

Nephritis, nephrotic syndrome, nephosis

Motor vehicle injuries

Diabetes mellitus

Alzhheimer's disease

Other uninentional injuries

Chronic lower respiratory disease

Cerebrovascular disease

Diseases of the heart

Cancer

Source: NC SCHS Vital Records, 2007

12

Healthy Carolinians 10/08/09

Cancer22%

Diseases of the heart24%

Motor vehicle injuries2%

All other causes49%

Other unitentional injuries

3%

Percent of Deaths, 2005 Percent YPLL <65, 2005

Total= 74,376 Resident Deaths

Source: NC State Center for Health Statistics & CDC WISQARS

Percent YPLL >65

Unintentional Injury21%

Cancer15%

Heart Disease12%

Homicide5%

Suicide5%

All Others42%

5% Injury-related 31% Injury-related

Years of potential life lost (YPLL) is a measure of premature mortality.

Unintentional

Unintentional

Intentional

Mortality Indicators, 2005

13

Healthy Carolinians 10/08/09

Age Groups

<1 1-4 5-9 10-14 15-24 25-34 35-44 45-54 55-64 65+ All Ages

PrenatalConditions

585

UnintentionalInjury

27

Motor VehicleInjury

20

Motor VehicleInjury

33

Motor VehicleInjury416

Motor VehicleInjury349

Cancer480

Cancer1,702

Cancer3,544

HeartDisease 13,742

HeartDisease 17,858

CongenitalAnomalies

209

Motor VehicleInjury

21

UnintentionalInjury

20

UnintentionalInjury

15

UnintentionalInjury 190

UnintentionalInjury 242

HeartDisease

444

HeartDisease

1,279

HeartDisease

2,210

Cancer11,848

Cancer 17,762

Unintentional Injury

43

CongenitalAnomalies

20

Cancer10

Cancer13

Homicide177

Homicide180

UnintentionalInjury 379

UnintentionalInjury 420

Chronic LowerRespiratory

Disease 514

Cerebro-Vascular Disease

3,728

Cerebro-VascularDisease

4,461

HeartDisease

21

Cancer 13

Heart Disease

7

Homicide 11

Suicide124

Suicide160

Motor VehicleInjury285

Motor VehicleInjury282

Cerebro-Vascular Disease

412

Chronic LowerRespiratory

Disease 3,553

Chronic LowerRespiratory

Disease 4,286

Septicemia12

Heart Disease12

CongenitalAnomalies

6

HeartDisease

6

Cancer52

HeartDisease

110

Suicide 243

Chronic Liver Disease & Cirrhosis

254

DiabetesMellitus

387

Alzheimer'sDisease

2,430

UnintentionalInjury 2,651

Homicide12

Homicide9

In-situ/ Benign

Neoplasms5

Suicide6

HeartDisease

27

Cancer99

HIV129

Cerebro-Vascular Disease

228

UnintentionalInjury 261

DiabetesMellitus 1,496

Alzheimer'sDisease

2,471

Top 6 Leading Causes of Death (All Races, Both Sexes) by Age Groups, North Carolina: 2007

Source: NC State Center for Health Statistics, Death file 2007; Analysis by Injury Epidemiology and Surveillance Unit

14

Healthy Carolinians 10/08/09 Source: NC State Center for Health Statistics, Death file 2007; Analysis by Injury Epidemiology and Surveillance Unit

Leading Causes of Injury Deaths, All Ages, North Carolina Residents: 2007 (Total Deaths = 6,268)

14.03

2.26

3.04

3.12

3.55

5.10

7.28

9.70

9.98

14.42

27.52

0 5 10 15 20 25 30

All Others

Unintentional Fire/Burn

Suicide Suffocation

Unintentional Suffocation

Suicide Poisoning

Unintentional Unspecified

Homicide Firearm

Suicide Firearm

Unintentional Fall

Unintentional Poisoning

Unintentional MV Traffic

15

Healthy Carolinians 10/08/09

0

5

10

15

20

25

1999 2000 2001 2002 2003 2004 2005 2006 2007

Motor Vehicle Deaths Unt Poisoning Deaths Suicide-Firearm Unt Fall Deaths Homicide-Firearm

Unt Motor Vehicle

Suicide-Firearm

Unt FallsHomicide-Firearm

Unt Poisoning

Leading Causes of Injury Death Rates per 100,000, NC 1999-2007

NC State Center for Health Statistics Death file 1999-2007; NC Injury Epidemiology & Surveillance Unit

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Healthy Carolinians 10/08/09

-4.7

180.5

-4.8

30.4

-13.3

-25 25 75 125 175 225

Unt Motor Vehicle Deaths

Unt Poisoning Deaths

Suicide-Firearm

Unt Fall Deaths

Homicide-Firearm

Percentage change in Rates per 100,000 of Injury Deaths NC 1999-2007

WISQARSTM Produced By: Office of Statistics and Programming, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention Data Source: National Center for Health Statistics (NCHS), National Vital Statistics SystemNC State Center for Health Statistics Death file 2006-2007; NC Injury Epidemiology & Surveillance Unit

Unt=unintentional

Increase from 3.53 per 100,000 in1999 to 9.9 in 2007

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Healthy Carolinians 10/08/09

North Carolina Injury Death Rates per 100,000, by County: North Carolina, 2007

Injury Epidemiology and Surveillance Unit (IESU)Injury and Violence Prevention BranchNC Division of Public Health

Pitt

Wake

Bladen

Duplin

Hyde

Bertie

Pender

Wilkes

Moore

Union

Halifax

Nash

Robeson

Surry

Onslow

Sampson

Iredell

Columbus

Swain

Burke

Johnston

Ashe

Anson

Guilford

Randolph

Harnett

Brunswick

Jones

Wayne

Chatham

Macon

Rowan

Martin

Hoke

Stokes

LeeStanly

Lenoir Craven

Granville

Franklin

Tyrrell

Warren

BuncombeHaywood

Davidson

Person

Jackson

Gates

Dare

Carteret

Caswell

Forsyth

Caldwell

Beaufort

Cumberland

Madison

Orange

Rutherford

Wilson

Polk

Yadkin

Gaston

Cherokee

Rockingham

Catawba

Richmond

Davie

McDowell

Hertford

Cleveland

Northampton

Clay

Vance

Avery

Mecklenburg

Alamance EdgecombeYancey

Montgomery

PamlicoCabarrus

Durham

Graham

Greene

Scotland

Watauga

Henderson

Washington

Transylvania

Camden

Alexander

CurrituckAlleghany

Chowan

New Hanover

Pitt

Wake

Bladen

Duplin

Hyde

Bertie

Pender

Wilkes

Moore

Union

Halifax

Nash

Robeson

Surry

Onslow

Sampson

Iredell

Columbus

Swain

Burke

Johnston

Ashe

Anson

Guilford

Randolph

Harnett

Brunswick

Jones

Wayne

Chatham

Macon

Rowan

Martin

Hoke

Stokes

LeeStanly

Lenoir Craven

Granville

Franklin

Tyrrell

Warren

BuncombeHaywood

Davidson

Person

Jackson

Gates

Dare

Carteret

Caswell

Forsyth

Caldwell

Beaufort

Cumberland

Madison

Orange

Rutherford

Wilson

Polk

Yadkin

Gaston

Cherokee

Rockingham

Catawba

Richmond

Davie

McDowell

Hertford

Cleveland

Northampton

Clay

Vance

Avery

Mecklenburg

Alamance EdgecombeYancey

Montgomery

PamlicoCabarrus

Durham

Graham

Greene

Scotland

Watauga

Henderson

Washington

Transylvania

Camden

Alexander

CurrituckAlleghany

Chowan

New Hanover

ö

öö

öö

ö

ö

ö

ö

ö ö

ö

ö

ö

ö

ö

ö

ö

öö

ö

N

NC Counties

Rate All Injury Deaths66 or less67 - 8283 - 9394 - 148

? = count less than 20 and rate unstable

State Average = 68.9 per 100,000

Unadjusted for age

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Healthy Carolinians 10/08/09

0

10

20

30

40

50

60

70

80

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

NC Injury Overall US Injury Overall NC Intentional US Intentional NC Unintentional US Unintentional

Age Adjusted Injury Death Rates, North Carolina and US: 1995-2006

Overall

Unintentional

Intentional

NC

US

NC

US

NC

US

WISQARSTM Produced By: Office of Statistics and Programming, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention Data Source: National Center for Health Statistics (NCHS), National Vital Statistics System

19

Healthy Carolinians 10/08/09

Leading Causes of Injury Hospitalizations

• 1) Adverse Effects of Medical Care (52,437)• 2) Falls- Unintentional (25,608)• 3) Motor Vehicle- Unintentional (8,235)• 4) Poisoning- Self-inflicted (5,143)• 5) Unspecified- Unintentional (5,010)• 6) Poisoning- Unintentional (3445)

Source: NC State Center for Health Statistics, Hospital file 2007; Analysis by Injury Epidemiology and Surveillance Unit

Total Injury Hospitalizations 2007: 154,348

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Healthy Carolinians 10/08/09

Age Groups

<1 1-4 5-9 10-14 15-24 25-34 35-44 45-54 55-64 65+ All Ages

Medical Care

Adverse Effects

552

Medical Care

Adverse Effects

528

Medical CareAdverse Effects

353

Medical CareAdverse Effects

421

MVTUnt

1,881

Medical CareAdverse Effects 2,717

Medical CareAdverse Effects 5,318

Medical CareAdverse Effects 8,461

Medical CareAdverse Effects 10,835

Medical CareAdverse Effects 21,804

Medical CareAdverse Effects

52,437

Missing E-Code 484

Missing E-Code 245

FallUnt 222

Missing E-Code 287

Medical CareAdverse Effects 1,468

Missing E-Code 1,667

Missing E-Code 2,788

Missing E-Code 4,538

Missing E-Code 6,133

FallsUnt

18,137

Missing E-Code 36,749

FallUnt 74

FallUnt 175

Missing E-Code 176

FallsUnt223

Missing E-Code 1,155

MVTUnt

1,368

PoisoningIntentional

1,381

FallsUnt

1,818

FallsUnt

2,835

Missing E-Code 19,276

FallUnint 25,608

UnspecUnt73

Fire/BurnUnt131

MVTUnt161

MVTUnt182

PoisoningUnt

1,065

PoisoningIntentional

1,102

MVTUnt

1,304

MVTUnt

1,265

MVTUnt848

UnspecUnt

2,511

MVTUnt

8,235

Other specified –

Assault38

PoisoningUnt127

StruckUnt49

PoisoningIntentional

92

FallsUnt476

FallsUnt625

FallsUnt

1,023

PoisoningIntentional

1,011

UnspecUnt748

MVTUnt

1,122

PoisoningIntentional

5,143

Other Spec Class Unt

32

Other Spec Class Unt

94

Natul/EnvrUnt49

StruckUnt89

Other specUnt 342

Other specUnt389

PoisoningUnt584

PoisoningUnt725

PoisoningUnt527

Other specUnt889

Unspecified Unt5,010

Top 6 Leading Causes of Injury Hospital Visits (All Races, Both Sexes) by Age Groups, North Carolina: 2007

Source: NC State Center for Health Statistics, Hospital file 2007; Analysis by Injury Epidemiology and Surveillance Unit

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Healthy Carolinians 10/08/09

Leading Causes of Injury ED Visits

• 1) Falls – Unintentional (150,157)

• 2) MVT- Unintentional (74,616)

• 3) Struck- Unintentional (62,745)

• 4) Overexertion- Unintentional (53,529)

• 5) Unspecified- Unintentional (47,323)

• 6) Cut/pierce- Unintentional (37,226)

Source: NC DETECT, Emergency Department file 2007; Analysis by Injury Epidemiology and Surveillance Unit

Total Injury ED visits 2007: 812,193

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Healthy Carolinians 10/08/09

Age Groups

<1 1-4 5-9 10-14 15-24 25-34 35-44 45-54 55-64 65+ All Ages

FallUnint 1,929

FallUnint

15,269

FallUnint 12,405

FallUnint 11,886

MVTUnint 26,680

MVTUnint 19,567

Missing E-Code 17,939

FallUnint

17,154

FallUnint 14,568

FallUnint 44,831

FallsUnintentional

168,803

Missing E-Code 776

Missing E-Code 6,153

StruckUnint 6,998

StruckUnint 10,442

Missing E-Code 20,924

Missing E-Code 18,992

FallUnint

17,111

Missing E-Code 16,084

Missing E-Code 12,475

Missing E-Code 29,512

Missing E-Code 135,494

UnspecUnint 470

StruckUnint 5,875

Missing E-Code 5,647

Missing E-Code 6,992

StruckUnint 17,801

FallUnint 16,734

MVTlUnint 15,613

MVTlUnint 11,884

MVTlUnint 6,396

Adverse Effects- Medical8,530

MVTUnintentional

92,459

StruckUnint450

Other specified –

Unt 3,962

Cut/pierceUnt

2,856

OverexertionUnt

4,414

FallUnt

16,892

OverexertionUnt

15,010

OverexertionUnt

13,303

OverexertionUnt

8,872

Adverse Effects- Other

4,562

UnspecUnt

5,794

StruckUnintentional

73,918

Other specified –

Unt389

Natul/EnvrUnt

2,730

Natul/EnvrUnt

2,730

MVTUnt

3,392

OverexertionUnt

13,716

StruckUnt

11,329

UnspecUnt

9,493

UnspecUnt

7,396

UnspecUnt

3,974

MVTlUnt

5,062

OverexertionUnintentional

64,706

Natul/EnvrUnt

292

UnspecUnint2,599

Other specified – Unt

2,506

Cut/pierceUnt

3,266

Cut/pierceUnt

10,087

UnspecUnt

10,226

StruckUnt

8,915

StruckUnt

5.,850

OverexertionUnt

3,734

Struck Unt

3,314

UnspecifiedUnintentional

53,133

Top 6 Leading Causes of Injury ED Visits (All Races, Both Sexes) by Age Groups, North Carolina: 2007

Source: NC DETECT, Emergency Department file 2007; Analysis by Injury Epidemiology and Surveillance Unit

23

Healthy Carolinians 10/08/09

Injury Death Rates (per 100,000) by Age Group, NC Residents, 2007

20 15 10 5 0 5 10 15 20

<1yr

1-4yr

5-14yr

15-24yr

25-34

35-44

45-54

55-64

65-74

75-84

85+

Ag

e G

rou

ps

Rates per 100,000

MALES FEMALES

Drowning Death Rates (per 100,000) by Age Group: NC Residents, 2007

7 6 5 4 3 2 1 0 1 2 3 4 5 6 7

<1yr

1-4yr

5-14yr

15-24yr

25-34

35-44

45-54

55-64

65-74

75-84

85+

Ag

e G

rou

ps

Rates per 100,000

MALES FEMALES

Fall Death Rates (per 100,000) by Age Group: NC Residents, 2007

7 5 3 1 1 3 5 7

<1yr

1-4yr

5-14yr

15-24yr

25-34

35-44

45-54

55-64

65-74

75-84

85+

Ag

e G

rou

ps

Rates per 100,000

MALES FEMALES

Fire Death Rate (per 100,000) by Age Group: NC Residents, 2007

7 6 5 4 3 2 1 0 1 2 3 4 5 6 7

<1yr

1-4yr

5-14yr

15-24yr

25-34

35-44

45-54

55-64

65-74

75-84

85+

Ag

e G

rou

ps

Rates per 100,000

MALES FEMALES

Fire-arm Death Rate (per 100,000) by Age Group: NC Residents, 2007

7 5 3 1 1 3 5 7

<1yr

1-4yr

5-14yr

15-24yr

25-34

35-44

45-54

55-64

65-74

75-84

85+

Ag

e G

rou

ps

Rates per 100,000

MALES FEMALES

Homicide Death Rate (per 100,000) by Age Group: NC Residents, 2007

7 6 5 4 3 2 1 0 1 2 3 4 5 6 7

<1yr

1-4yr

5-14yr

15-24yr

25-34

35-44

45-54

55-64

65-74

75-84

85+

Ag

e G

rou

ps

Rates per 100,000

MALES FEMALES

Motor Vehicle Death Rate (per 100,000) by Age Group: NC Residents, 2007

7 6 5 4 3 2 1 0 1 2 3 4 5 6 7

<1yr

1-4yr

5-14yr

15-24yr

25-34

35-44

45-54

55-64

65-74

75-84

85+

Ag

e G

rou

ps

Rates per 100,000

MALES FEMALES

Poisoning Death Rate (per 100,000) by Age Group: NC Residents, 2007

7 6 5 4 3 2 1 0 1 2 3 4 5 6 7

<1yr

1-4yr

5-14yr

15-24yr

25-34

35-44

45-54

55-64

65-74

75-84

85+

Ag

e G

rou

ps

Rates per 100,000

MALES FEMALES

Tramatic Brain Injury (TBI) Death Rate (per 100,000) by Age Group: NC Residents, 2007

7 6 5 4 3 2 1 0 1 2 3 4 5 6 7

<1yr

1-4yr

5-14yr

15-24yr

25-34

35-44

45-54

55-64

65-74

75-84

85+

Ag

e G

rou

ps

Rate per 100,000

MALES FEMALES

Injury Death Rates (per 100,000) by Age Group, NC Residents, 2007

Data source: Death file 2007, N.C. State Center for Health Statistics. Analysis by Injury Epidemiology and Surveillance Unit

Injury overall Drowning Falls

Fire Fire-arms Homicide

Motor Vehicle TBIPoisoning

24

Healthy Carolinians 10/08/09

Injury and Violence are costly

Cost in $Billions per year nationally

Medical Costs

Productivity Costs Total Costs

Total $80 $326 $406

MV/ Road $14 $75 $89

Falls $26 $54 $80

Struck by/ Against $11 $37 $48

Cut/ Pierce $3 $12 $16

Fire/ Burn $1 $6 $7

Poisoning $2 $23 $25

Drowning/ Submersion $1 $5 $6

Firearm/ Gunshot $1 $35 $36

Other/ Unclassified $19 $76 $96

Finkelstein EA, Corso PS, Miller TR, Associates. Incidence and Economic

Burden of Injuries in the United States. New York: Oxford University Press; 2006.

25

Healthy Carolinians 10/08/09

Injury and Violence

• Injuries are the leading cause of death for ages 1-44 in North Carolina.

• The vast majority of injuries are preventable.• Injury-related DEATHS, 2007: 1) unintentional

motor vehicle, followed by 2) unintentional poisoning, 3) unintentional falls.

• Injury-related HOSPITALIZATIONS, 2007: 1) adverse effects of medical care 2) unt. falls; 3) unt. motor vehicle.

• Injury-related EMERGENCY VISITS, 2007: 1) unt. falls; 2) unt. motor vehicle; 3) unt. struck.

26

Healthy Carolinians 10/08/09

Injury and violence are major public health problems

• Prevention opportunities are available.• Need to make injury socially unacceptable.• Increasing injury awareness is critical.• Put injury squarely on the public health map.• Resources for surveillance and programs

essential.• Understanding the scope of the problem can help

us reduce all types of injury-related morbidity and mortality in North Carolina.

27

Healthy Carolinians 10/08/09

Socially unacceptable: Flight 1549Continental Connections Flight 3407

What if all injuries were viewed through the same perspective?And investigated the same way?

28

Healthy Carolinians 10/08/09

Putting Injury & Violence prevention on the public health map

injuryinjury

29

Healthy Carolinians 10/08/09

Questions/Discussion

www.injuryfreenc.ncdhhs.gov

Scott Proescholdbell, MPH

Injury Epidemiology and Surveillance Unit

[email protected]

919-707-5442