Injury Surveillance Activities of the National Injury Surveillance Activities of the National Center for Injury Prevention and ControlCenter for Injury Prevention and Control

Data IssuesData Issues

Lee Annest, Ph.D.Director, Office of Statistics and ProgrammingDirector, Office of Statistics and Programming

National Center for Injury Prevention and ControlNational Center for Injury Prevention and Control

Coordinating Center for Environmental Health Coordinating Center for Environmental Health

and Injury Preventionand Injury Prevention

Centers for Disease Control and PreventionCenters for Disease Control and Prevention

September 7, 2006September 7, 2006

National Violent Death Reporting SystemNational Violent Death Reporting System(NVDRS) (NVDRS)

Use of multiple data sources (death Use of multiple data sources (death certificates, medical examiner/coroner records, certificates, medical examiner/coroner records, police reports, crime lab reports, hospital police reports, crime lab reports, hospital records)records)17 States participating17 States participating All violent deaths (including homicide, suicide, All violent deaths (including homicide, suicide, deaths of undetermined intent and deaths of undetermined intent and unintentional firearm-related injuries)unintentional firearm-related injuries)Child fatality review module (New Jersey, Child fatality review module (New Jersey, Oregon, South Carolina)Oregon, South Carolina)

NVDRS States as of August, 2006

FY 02 (6 states)

FY 03 (7 states)

FY 04 (4 states)

National Violent Death Reporting SystemNational Violent Death Reporting System(NVDRS) – (NVDRS) – Data IssuesData Issues

How do we provide timely access to data? How do we provide timely access to data? WISQARS – NVDRS in the worksWISQARS – NVDRS in the works

How do we streamline the data collection and How do we streamline the data collection and still provide valuable details?still provide valuable details?

How do we expand to all states?How do we expand to all states?

Child MaltreatmentChild MaltreatmentImproving National/State Surveillance SystemsImproving National/State Surveillance Systems

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

Definition of Child MaltreatmentDefinition of Child Maltreatment

Any act or series of acts of Any act or series of acts of commissioncommission or or omissionomission by a by a parent or other caregiver that results in harm, potential parent or other caregiver that results in harm, potential for harm or threat of harm to a child, including physical for harm or threat of harm to a child, including physical abuse, sexual abuse, psychological abuse, failure to abuse, sexual abuse, psychological abuse, failure to provide (neglect)provide (neglect)

Number of Injuries among Children < 18 Years, US, 2004

Deaths = 1,490 (est. from NCANDS)

Victimizations = 872,000 (est. from NCANDS)

Child MaltreatmentChild MaltreatmentMortality and Incidence Data SourcesMortality and Incidence Data Sources

National Child Abuse and Neglect Data System National Child Abuse and Neglect Data System (NCANDS) – (NCANDS) – current best national/state data sourcecurrent best national/state data source– Child abuse/neglect reported by child protective services (CPS) Child abuse/neglect reported by child protective services (CPS)

in all 50 states, DC, and US territories and armed servicesin all 50 states, DC, and US territories and armed services– State CPS offices voluntarily submit aggregate data to the State CPS offices voluntarily submit aggregate data to the

Administration of Children and Families (ACF)Administration of Children and Families (ACF)– Use data to estimate CM deaths, investigation rates, Use data to estimate CM deaths, investigation rates,

victimization ratesvictimization rates– Likely an undercount because only based on children Likely an undercount because only based on children

investigatedinvestigated for alleged maltreatment (neglect, physical abuse, for alleged maltreatment (neglect, physical abuse, sexual abuse, medical neglect, and emotional or psychological sexual abuse, medical neglect, and emotional or psychological maltreatment)maltreatment)

Child MaltreatmentChild MaltreatmentMortality and Incidence Data SourcesMortality and Incidence Data Sources

CDC’s National Violent Death Reporting System CDC’s National Violent Death Reporting System (NVDRS) – Child Fatality Review Module – (NVDRS) – Child Fatality Review Module – current state current state data limiteddata limited

NCHS’ National Vital Statistics System (NVSS) – NCHS’ National Vital Statistics System (NVSS) – undercount CM deathsundercount CM deaths– Using ICD-10 external-cause-of-injury codes – Y06 (neglect and Using ICD-10 external-cause-of-injury codes – Y06 (neglect and

abandonment) and Y07 (other maltreatment syndrome such as abandonment) and Y07 (other maltreatment syndrome such as sexual abuse, mental cruelty, torture), there were 200 deaths for sexual abuse, mental cruelty, torture), there were 200 deaths for children < 18 years or 13% of the 1,500 deaths per year children < 18 years or 13% of the 1,500 deaths per year estimated using NCANDS data.estimated using NCANDS data.

Child MaltreatmentChild MaltreatmentData IssuesData Issues

How do we get more complete How do we get more complete reporting of incidents?reporting of incidents?How do we get more complete How do we get more complete coding on death certificates?coding on death certificates?

Drug-induced Mortality SurveillanceDrug-induced Mortality SurveillanceSharply on the RiseSharply on the Rise

Recent increase mostly likely due to overuse of opioid Recent increase mostly likely due to overuse of opioid analgesics as pain killers analgesics as pain killers

Use of ICD-10 T codes to investigate increaseUse of ICD-10 T codes to investigate increase

Reference: Paulozzi L, Budnitz D, Xi L. Increasing Reference: Paulozzi L, Budnitz D, Xi L. Increasing deaths from Opioid analgesics in the United States. deaths from Opioid analgesics in the United States. Pharmacoepidemiology and Drug Safety (online) at Pharmacoepidemiology and Drug Safety (online) at www.interscience.wiley.comwww.interscience.wiley.com

Unintentional, age-adjusted injury mortality rates, by selected mechanisms of injury, United States, 1979-2003

1

10

100

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03

Year

Rat

e p

er 1

00,0

00

MV Total

Fall

Poisoning

Drowning

Fire/burn

Suffocation

Source: NVSS mortality files, NCHS

Unintentional and undetermined poisoning mortality counts and age-adjusted rates, US, 1979-2003

0

5000

10000

15000

20000

25000

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03

Year

Nu

mb

er

0

100

200

300

400

500

600

700

800

900

Rat

e p

er 1

0 m

illi

on

Death Count Age-Adjusted Rate

Source: NVSS mortality files, NCHS

Source: NVSS mortality files, NCHS

Deaths from “narcotics and psychodysleptics” (X42) Deaths from “narcotics and psychodysleptics” (X42) and “other and unspecified drugs,” (X44) US, 1999-2002and “other and unspecified drugs,” (X44) US, 1999-2002

Drug TypeDrug Type

InvolvedInvolved

19991999 20022002 % % IncreaseIncrease

Opioid Opioid analgesicsanalgesics

2,8912,891 5,5285,528 91.291.2

CocaineCocaine 3,1823,182 3,9093,909 22.822.8

HeroinHeroin 1,7231,723 1,9371,937 12.412.4

Other Other specifiedspecified

1,6661,666 1,7901,790 7.47.4

UnspecifiedUnspecified 2,2552,255 3,6353,635 61.261.2

Source: NVSS mortality files, NCHS

Deaths by type of opioid analgesic, US, 2002Deaths by type of opioid analgesic, US, 2002

TypeType NumberNumber Percent of Percent of total drugs total drugs

listedlisted

Other opioid Other opioid (hydrocodone, (hydrocodone, oxycodone)oxycodone)

3,9673,967 54.354.3

MethadoneMethadone 2,3612,361 32.332.3

Other synthetic Other synthetic narcotic narcotic (fentanyl)(fentanyl)

982982 13.413.4

Drug-induced Mortality SurveillanceDrug-induced Mortality SurveillanceData IssuesData Issues

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

Disaster-Related Injury SurveillanceDisaster-Related Injury SurveillanceCDC Emergency PreparednessCDC Emergency Preparedness

Director’s Emergency Operations Center (DEOC) – Director’s Emergency Operations Center (DEOC) – Assessment and Surveillance Unit for Natural Assessment and Surveillance Unit for Natural DisastersDisastersCDC Emergency Preparedness and Response Web CDC Emergency Preparedness and Response Web sitesite

Where is Injury

Surveillance??

Disaster-Related Injury SurveillanceDisaster-Related Injury SurveillanceData IssuesData Issues

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

Fatal and Nonfatal Injuries in the United States http://www.cdc.gov/ncipc/wisqars

Cross-tabulation of Cross-tabulation of mechanism and intent of mechanism and intent of injury deaths injury deaths (proposed (proposed release in 2007)release in 2007)WISQARS-State injury WISQARS-State injury mortality maps mortality maps (prototype)(prototype)WISQARS-NVDRS WISQARS-NVDRS (design (design stage)stage)

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