5. Motor Vehicle Indicators
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5. Motor Vehicle Indicators In 1999, motor vehicle crashes (MVCs) were the cause of more than 42,000 deaths1 and more than four million emergency department visits.2 Among persons ages 1 to 34, MVC injuries are the leading cause of death in the United States.1 In all age groups, MVC injuries are the leading cause of years of potential life lost (YPLL) and deaths from unintentional injuries.1 Alcohol-impaired driving increases the risk of death and is a major public health concern in the United States. In 1999, 38% of traffic fatalities were alcohol-related; either the driver or an affected person (e.g., a pedestrian or a bicyclist) had a blood alcohol concentration of at least 0.01 g/dL.3 In 1993, about 1.5 million arrests were made for impaired driving. That same year there were over 120 million episodes of alcohol-impaired driving among adults in the United States; nearly 10 million of these episodes involved underage youth 18 to 20 years of age.4 Failure to use a safety belt or child restraint is another major risk factor for fatalities and injuries to motor vehicle occupants. It is estimated that among front seat occupants, lap/shoulder belt use reduces the risk for fatal injury by approximately 45% and the risk for moderate to critical injury by 45% to 50%. Child safety seat use reduces the likelihood of fatal injury by an estimated 71% for infants and 54% for toddlers.3 For 1999 only, MVC fatalities are not displayed because they would not be comparable among states. As mentioned in the Methods section of the Introduction, the change from ICD-9 to ICD-10 coding for death data produced an artifactual change in rates for certain conditions. In the comparability study performed by the National Center for Health Statistics (NCHS), the rate for MVC-related deaths appeared lower when ICD-10 coding was used. The initial comparability ratio was 0.8527. The reason for this 15% decrease was that, in ICD-10, it must be explicit that the injury involved a “motor” vehicle. In ICD-9, in the absence of the term “motor” or when a vehicle crash was reported as occurring on a highway or road, the assumption was to classify the crash as involving a motor vehicle. The ICD-10 convention does not allow this assumption and classifies such crashes as involving unspecified vehicles. However, as a result of previously mentioned initial results, NCHS decided that, for U.S. data, if the crash occurred on a highway or road, classification to MVC is appropriate.5 While this adjustment was made to the 1999 national data set, and NCHS recommended these adjustments to all state and territorial Vital Registrars for state death data sets, some states elected not to re-open their 1999 death files to make this adjustment. As this report used state-based data sets, there would have been an artificial variation in rates among states of 15%, confusing the true picture. To view state MVC death rates calculated from the corrected national death data files, go to the WISQARS website.1 Figures 5a, 5b, and 5c present data from 22 states on hospitalizations for MVC. The rate varied almost 2.6 times from the lowest state rate (43.4 per 100,000) to the highest (110.5 per 100,000). Rates are higher for males than females, Motor Vehicle Indicators – 49 and the highest rates are generally found among 15 to 24 year olds, and those over 75 years of age. Overall, MVC hospitalizations occur at three to eight times the rate of MVC deaths (calculated from the national death data files). Information about two motor vehicle-related risk behaviors are available for 1999, “driving after perhaps having too much to drink” is available from the Behavioral Risk Factor Surveillance System (BRFSS), and “high school students reporting always using safety belts” from the Youth Risk Behavior Survey (YRBS). Questions about seat belt use were not asked on the BRFSS questionnaires in 1999. Figures 5d, 5e, and 5f present data showing that between 2.6% and 9% of adults in the participating states reported driving after perhaps having had too much to drink in the past month. Figures 5g and 5h present data on self-reported safety belt use among high school students (YRBS) in 1999. The highest reported use of safety belts in high school students was 50.5%. In all but four of the 14 states with weighted YRBS data, fewer than 40% of high school students reported using safety belts. Males reported a higher rate of both risk behaviors than females. 2. McCaig LF, Burt CW. National hospital ambulatory medical care survey: 1999 emergency department summary. Advance data from vital and health statistic, No. 320. Hyattsville (MD): National Center for Health Statistics; 2001. 3. Department of Transportation (US), National High way Traffic Safety Administration. Traffic safety facts 1999 occupant protection; 2000; Publication No.: DOT HS 809 090. 4. Liu S, Siegel PZ, Brewer RB, Mokdad AH, Sleet DA, Serdula M. The prevalence of alcohol impaired driving in the U.S.: results from a national self- reported survey of health behaviors. JAMA 1997;277(2):122–5. 5. Anderson RN, Minino AM, Hoyert DL, Rosenberg HM. Comparability of cause of death between ICD-9 and and ICD-10: preliminary estimates. National vital statistics reports. Hyattsville, (MD): National Center for Health Statistics 2001;49:2. References 1. Centers for Disease Control and Prevention. Webbased injury statistics query and reporting system (WISQARS) [Online]. 2001. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (producer). [accessed 2001 Jul 28]. Available from URL: www.cdc.gov/ncipc/ wisqars. Motor Vehicle Indicators – 50 Motor Vehicle Indicators Figures 5a. Motor Vehicle Traffic and Non-Traffic Hospitalizations (Overall), 1999 5b. Motor Vehicle Traffic and Non-Traffic Hospitalizations by Sex, 1999 5c. Motor Vehicle Traffic and Non-Traffic Hospitalizations by Age, 1999 5d. Percentage of Adults Reporting Driving After Perhaps Having Too Much to Drink, in the Past Month, 1999, Behavioral Risk Factor Surveillance System 5e. Percentage of Adults Reporting Driving After Perhaps Having Too Much to Drink, in the Past Month, by Sex, 1999, Behavioral Risk Factor Surveillance System 5f. Percentage of Adults Reporting Driving After Perhaps Having Too Much to Drink, in the Past Month, by Age, 1999, Behavioral Risk Factor Surveillance System 5g. Percentage of High School Students Reporting Always Using Safety Belts, 1999 Youth Risk Behavior Survey 5h. Percentage of High School Students Reporting Always Using Safety Belts, by Sex, 1999, Youth Risk Behavior Survey 5i. Alcohol-Related Crash Deaths, 1999 Motor Vehicle Indicators – 51 FIGURE 5a. Motor Vehicle Indicator: Motor Vehicle Traffic and Non-Traffic Hospitalizations (Overall), 1999 Factors Affecting Representativeness of State Hospital Discharge Data Sets for Injury Surveillance Age Adjusted Rate per 100,000 Number Rate State Percentage of HDD Injury Records with External Cause Coding* Inclusion of Readmission and Transfers? Cross-Border † Hospitalization Incomplete Hospital Participation Arizona 5,234 110.4 AZ 84.0% Yes No No California 27,532 83.4 CA 100.0% Yes No No Colorado 4,199 99.5 CO 98.8% Yes No No Delaware 835 110.5 DE 76.0% Yes No No Florida 12,851 83.4 FL 74.0% Yes No No Georgia 7,247 93.7 GA 91.8% Yes Unknown No Hawaii 518 43.4 HI 52.9% Yes No No Kansas 1,668 61.7 KS 58.0% Yes Unknown No Kentucky 2,129 KY 68.0% Yes Yes Yes Louisiana — LA ‡ ‡ ‡ ‡ MA 95.3% Yes No No Massachusetts 54.0 ‡ — ‡ 52.3 3,372 Michigan 8,347 84.6 MI 82.3% Yes No No Minnesota 3,179 66.2 MN 78.4% Yes No Yes Nebraska 836 NE 100.0% No Yes No NM 48.3% Yes Unknown No NC 89.1% Yes No No ‡ ‡ ‡ ‡ 49.4 ‡ New Mexico — North Carolina 6,796 North Dakota — ‡ Ohio — ‡ Oklahoma 2,614 76.7 — ‡ 84.9 — ‡ ND — ‡ OH ‡ ‡ ‡ ‡ OK 65.9% Yes No No Yes No No Oregon 2,862 85.9 OR 67.5% South Carolina 4,152 105.3 SC 94.1% ‡ Yes No Texas 9,734 48.4 TX 62.7% Yes Yes Yes Utah UT 89.2% Yes No No 1,731 80.0 Vermont 426 70.2 VT 85.0% Yes Yes No Washington 3,581 61.6 WA 98.9% Yes No No Wisconsin 4,034 76.0 WI 97.3% Yes No No 0 20 40 60 80 100 120 * Incompleteness can lead to bias. § Rate=[(male rate*pop) + (female rate*pop)] / (male+female pop). † Subjective assessment by health department staff that a substantial proportion of state residents injured in-state who require hospitalization are hospitalized in a neighboring state. ll Rates are suppressed if fewer than 20 cases were reported. ‡ No data available. ¶ Case counts are suppressed if fewer than 5 cases were reported. FIGURE 5b. Motor Vehicle Indicator: Motor Vehicle Traffic and Non-Traffic Hospitalizations by Sex, 1999 Males Number of Cases Age Adjusted Rate per 100,000 Females Females Males Age Adjusted Rate per 100,000 Arizona 135.7 3,181 2,053 Arizona 85.6 California 101.7 16,853 10,679 California 65.1 Colorado 117.7 1,691 Colorado 81.1 Delaware 132.9 485 350 Delaware 89.4 Florida 103.8 7,678 5,169 Florida 64.1 Georgia 113.7 4,267 2,974 Georgia 74.7 Hawaii 54.6 326 192 Hawaii 32.2 Kansas 75.5 996 672 Kansas 48.4 Kentucky 67.6 838 Kentucky 41.1 2,507 1,291 ‡ ‡ Louisiana ‡ — Louisiana ‡ Massachusetts 65.1 1,991 1,381 Massachusetts 40.4 Michigan 102.6 4,931 3,415 Michigan 67.5 Minnesota 79.9 1,880 1,298 Minnesota 52.9 Nebraska 59.2 484 352 Nebraska 40.0 New Mexico ‡ — New Mexico ‡ North Carolina 103.6 4,037 North Dakota ‡ — ‡ Ohio ‡ — ‡ Oklahoma 87.0 1,436 1,164 Oklahoma 66.8 Oregon 106.4 1,746 1,116 Oregon 65.7 South Carolina 133.1 2,531 1,621 South Carolina 79.3 Texas 54.9 5,427 4,280 Texas 42.1 Utah 96.4 1,052 679 Utah 63.7 Vermont 94.9 279 147 Vermont 46.5 Washington 75.1 2,169 1,411 Washington 48.1 Wisconsin 93.0 2,406 1,628 Wisconsin 59.5 0 20 40 60 80 100 120 ‡ — — ‡ North Carolina 66.9 — ‡ North Dakota ‡ — ‡ Ohio ‡ 2,751 140 ‡ No data available. ll Rates are suppressed if fewer than 20 cases were reported. ¶ Case counts are suppressed if fewer than 5 cases were reported. 0 20 40 60 80 100 FIGURE 5C. Motor Vehicle Indicator: Motor Vehicle Traffic and Non-Traffic Hospitalizations by Age**, 1999 State AZ CA CO DE FL GA HI KS KY LA MA MI MN NE NM NC ND OH OK OR SC TX UT VT WA WI <1 5-14 1-4 †† N Rate 32 67 7 ¶ — 24 23 ¶ — ¶ — 5 ‡ — ¶ — 23 ¶ — ¶ — ‡ — 24 —‡ —‡ 6 8 11 44 9 ¶ — 7 6 41.7 13.3 —ll —ll 12.1 19.3 —ll —ll —ll ‡ — —ll 17.3 —ll —ll ‡ — 22.1 —‡ —‡ —ll —ll —ll 13.2 —ll —ll —ll —ll N Rate 153 663 58 8 194 149 18 39 46 ‡ — 34 137 42 7 ‡ — 118 —‡ —‡ 60 63 81 236 43 ¶ — 62 51 49.5 33.2 24.8 —ll 25.7 32.3 —ll 26.6 22.3 ‡ — 10.6 25.4 16.3 —ll ‡ — 27.9 —‡ —‡ 32.5 35.9 39.9 18.1 25.3 —ll 19.4 19.2 N 396 6,125 272 43 839 583 42 125 133 ‡ — 163 604 214 53 ‡ — 407 —‡ —‡ 202 196 257 738 155 21 230 252 15-24 Rate N Rate 53.6 121.1 44.7 42.1 42.7 51.1 25.9 32.2 24.9 —‡ 20.2 42.0 29.7 21.4 —‡ 37.0 —‡ —‡ 41.4 42.4 47.8 23.5 40.8 24.5 26.7 32.9 1,324 4,722 1,063 223 2,729 1,746 113 456 574 ‡ — 743 1,944 859 236 —‡ 1,610 —‡ —‡ 717 675 992 2,574 558 114 900 1,064 197.9 100.8 176.8 224.6 147.7 157.2 67.9 114.5 99.5 ‡ — 84.1 145.3 125.6 93.7 ‡ — 145.1 —‡ —‡ 142.2 147.3 178.0 84.6 137.5 136.2 112.1 104.7 25-34 N 940 4,517 727 145 2,192 1,308 78 219 365 ‡ — 544 1,360 490 123 ‡ — 1,238 —‡ —‡ 397 443 772 1,647 262 63 590 666 ‡ No data available. ll Rates are suppressed if fewer than 20 cases were reported. ¶ Case counts are suppressed if fewer than 5 cases were reported. Rate 149.5 88.3 110.0 128.1 111.0 108.5 53.1 64.3 67.3 ‡ — 54.1 94.8 77.8 59.6 ‡ — 101.8 —‡ —‡ 95.1 104.3 137.8 59.4 79.5 82.7 69.8 96.8 45-54 35-44 N 858 3,491 762 135 2,048 1,189 94 273 357 ‡ — 582 1,452 535 110 ‡ — 1,119 —‡ —‡ 397 482 705 1,481 237 68 599 635 55-64 65-74 75-84 85+ Rate N Rate N Rate N Rate N Rate N Rate 116.6 62.4 105.5 103.7 88.1 88.9 47.4 63.9 55.7 ‡ — 57.1 90.6 65.8 42.1 —‡ 88.3 —‡ —‡ 78.1 91.5 112.0 45.4 76.0 67.4 61.4 73.2 581 2,215 539 103 1,498 853 67 164 220 ‡ — 392 1,024 363 89 —‡ 776 —‡ —‡ 289 387 505 1,062 155 49 429 434 98.8 53.9 91.5 106.1 74.6 83.3 40.4 47.9 40.6 ‡ — 47.9 77.6 57.9 41.3 ‡ — 73.7 —‡ —‡ 65.8 79.2 96.1 41.6 67.4 54.0 53.1 62.3 306 1,998 293 55 1,030 537 37 123 144 ‡ — 252 608 190 68 ‡ — 475 —‡ —‡ 174 223 308 670 109 32 273 275 76.0 81.9 88.3 87.0 68.9 85.3 35.6 56.0 38.6 ‡ — 50.9 73.0 48.2 48.2 ‡ — 67.2 —‡ —‡ 54.5 74.0 88.2 41.4 80.0 57.3 56.8 61.1 283 1,714 208 52 920 417 30 109 145 ‡ — 259 567 207 59 —‡ 497 —‡ —‡ 177 167 260 624 82 37 199 266 83.0 88.8 92.9 95.5 63.5 99.5 34.1 62.2 54.2 ‡ — 58.6 87.8 71.2 51.9 —‡ 94.2 —‡ —‡ 74.3 76.5 97.0 56.3 83.0 91.8 58.0 76.2 297 1,536 205 54 996 306 32 109 119 ‡ — 297 472 207 64 —‡ 437 —‡ —‡ 150 154 200 476 86 31 198 292 134.0 118.8 148.4 161.1 94.1 119.3 56.6 85.6 70.8 ‡ — 99.2 108.7 98.4 79.7 —‡ 135.5 —‡ —‡ 97.9 96.0 126.0 70.6 134.1 117.6 84.6 117.9 64 484 65 15 381 136 6 50 21 ‡ — 105 154 70 26 —‡ 95 —‡ —‡ 45 64 61 182 35 6 93 93 97.1 114.1 138.6 —ll 118.6 159.4 —ll 96.8 36.6 ‡ — 87.1 107.2 82.9 75.8 —‡ 92.0 —‡ —‡ 78.7 113.7 130.6 77.9 168.5 —ll 113.8 98.2 ** Age in years. †† Rate per 100,000 population. FIGURE 5d. Motor Vehicle Indicator: Percentage of Adults Reporting Driving After Perhaps Having Too Much to Drink, in the Past Month, 1999, Behavioral Risk Factor Surveillance System Percent Arizona 5.5 California 3.9 Colorado 5.6 Delaware 5.4 Florida 3.6 Georgia 3.1 Hawaii 4.7 Kansas 6.2 Kentucky 4.5 Louisiana 8.1 Massachusetts 4.5 Michigan 5.2 Minnesota 8.0 Nebraska 7.1 New Mexico 4.3 North Carolina 4.1 North Dakota 8.0 Ohio 2.6 Oklahoma 9.0 Oregon 3.3 South Carolina 5.1 Texas 5.2 Utah 3.8 Vermont 4.0 Washington 2.7 Wisconsin 6.9 0 1 2 3 4 5 6 7 8 9 FIGURE 5e. Motor Vehicle Indicator: Percentage of Adults Reporting Driving After Perhaps Having Too Much to Drink, in the Past Month, by Sex, 1999, Behavioral Risk Factor Surveillance System Males Females Percent Percent Arizona 6.9 Arizona 3.0 California 5.2 California 2.0 Colorado 6.9 Colorado 3.9 Delaware 7.5 Delaware 2.7 Florida 5.0 Florida 1.8 Georgia 4.1 Georgia 1.8 Hawaii 5.9 Hawaii 2.7 Kansas 8.1 Kansas 3.3 Kentucky 5.9 Kentucky 2.5 Louisiana 10.2 Louisiana 4.9 Massachusetts 6.7 Massachusetts 2.0 Michigan 7.7 Michigan 2.3 Minnesota 11.9 Minnesota 3.6 Nebraska 9.9 Nebraska 3.3 New Mexico 6.6 New Mexico 1.3 North Carolina 4.8 North Carolina 3.0 North Dakota 11.5 North Dakota 3.2 Ohio 4.1 Ohio 0.7 Oklahoma 9.1 Oklahoma 8.7 Oregon 4.4 Oregon 1.9 South Carolina 6.9 South Carolina 2.4 Texas 6.5 Texas 3.0 Utah 5.5 Utah 1.6 Vermont 5.8 Vermont 1.9 Washington 4.1 Washington 1.3 Wisconsin 9.2 Wisconsin 4.0 0 1 2 3 4 5 6 7 8 9 10 11 12 ‡ No data available. ll Rates are suppressed if fewer than 20 cases were reported. ¶ Case counts are suppressed if fewer than 5 cases were reported. 0 1 2 3 4 5 6 7 8 9 10 FIGURE 5f. Motor Vehicle Indicator: Percentage of Adults Reporting Driving After Perhaps Having Too Much to Drink, in the Past Month, by Age**, 1999, Behavioral Risk Factor Surveillance System State AZ CA CO DE FL GA HI KS KY LA MA MI MN NE NM NC ND OH OK OR SC TX UT VT WA WI 18-24 25-34 35-44 45-54 55-64 65+ Percent Percent Percent Percent Percent Percent 4.1 6.5 13.9 9.9 7.8 4.3 12.2 12.8 7.6 14.9 9.7 7.6 13.4 14.5 7.9 4.2 13.2 0.7 6.3 5.1 9.9 8.2 6.3 9.6 8.3 7.1 9.2 5.9 6.4 9.8 7.0 4.7 3.0 8.5 5.2 8.0 6.4 10.5 10.9 7.7 3.8 8.5 10.7 2.9 9.5 5.0 8.6 7.8 7.3 5.7 2.9 10.0 ‡ No data available. ll Rates are suppressed if fewer than 20 cases were reported. ¶ Case counts are suppressed if fewer than 5 cases were reported. 8.9 3.5 4.1 4.4 3.1 2.9 4.9 4.3 4.3 9.0 4.3 5.5 6.6 9.6 5.3 4.1 7.9 6.0 12.6 3.4 2.1 3.9 2.4 3.1 2.6 9.3 11.9 1.6 2.6 5.3 0.0 0.8 2.5 2.9 3.0 4.3 1.3 2.7 7.8 1.8 2.4 0.0 3.9 0.0 8.7 0.0 0.9 3.2 0.3 0.5 1.4 6.3 0.6 2.0 5.5 1.8 3.3 2.8 2.7 3.3 3.0 5.0 3.4 1.0 5.8 4.1 3.9 2.5 5.1 2.7 9.4 4.3 3.8 3.6 2.5 2.0 2.0 4.3 ** Age in years. †† Rate per 100,000 population. 0.6 1.9 1.4 0.3 0.8 0.0 3.8 1.6 1.7 2.0 1.2 0.9 3.6 1.3 0.9 0.0 2.9 0.0 3.0 0.0 2.6 1.5 1.7 0.9 0.5 2.4 FIGURE 5g. Motor Vehicle Indicator: Percentage of High School Students Reporting Always Using Safety Belts, 1999, Youth Risk Behavior Survey Percent Arizona ‡ California ‡ Colorado ‡ Delaware 40.2 Florida 37.9 Georgia ‡ Hawaii 42.7 Kansas ‡ Kentucky 31.6 Louisiana ‡ Massachusetts 31.4 Michigan ‡ Minnesota 30.1 Nebraska 25.7 New Mexico 47.6 North Carolina ‡ North Dakota 16.7 Ohio 38.6 Oklahoma ‡ Oregon ‡ South Carolina 32.0 Texas ‡ Utah 38.0 Vermont 50.5 Washington ‡ Wisconsin 23.7 0 10 20 30 40 50 60 Note: No data available for Arizona, California, Colorado, Georgia, Kansas, Louisiana, Michigan, North Carolina, Oklahoma, Oregon, Texas, and Washington. FIGURE 5h. Motor Vehicle Indicator: Percentage of High School Students Reporting Always Using Safety Belts by Sex, 1999, Youth Risk Behavior Survey Males Females Percent Percent Arizona ‡ Arizona ‡ California ‡ California ‡ Colorado ‡ Colorado ‡ Delaware 37.6 Delaware 43.0 Florida 33.4 Florida 42.8 Georgia ‡ Georgia ‡ Hawaii 41.0 Hawaii 44.2 Kansas ‡ Kansas ‡ Kentucky 27.4 Kentucky 35.5 Louisiana ‡ Louisiana ‡ Massachusetts 27.1 Massachusetts 36.0 Michigan ‡ Michigan ‡ Minnesota 26.0 Minnesota 34.4 Nebraska 21.0 Nebraska 29.9 New Mexico 43.9 New Mexico 51.1 North Carolina ‡ North Carolina ‡ North Dakota 12.5 North Dakota 21.0 Ohio 32.6 Ohio 44.9 Oklahoma ‡ Oklahoma ‡ Oregon ‡ Oregon ‡ South Carolina 27.1 South Carolina 36.8 Texas ‡ Texas ‡ Utah 31.9 Utah 44.3 Vermont 45.1 Vermont 56.5 Washington ‡ Washington ‡ Wisconsin 20.0 Wisconsin 27.7 0 10 20 30 40 50 0 10 20 Note: No data available for Arizona, California, Colorado, Georgia, Kansas, Louisiana, Michigan, North Carolina, Oklahoma, Oregon, Texas, and Washington. 30 40 50 60 FIGURE 5i. Motor Vehicle Indicator: Alcohol-Related Crash Deaths, 1999 Age Adjusted Rate per 100,000 Number Rate Arizona 406 8.5 California 1,351 4.1 Colorado 220 5.2 Delaware 40 5.3 Florida 1,043 6.8 Georgia 506 6.5 Hawaii 43 3.6 Kansas 186 7.0 Kentucky 281 7.1 Louisiana 427 9.8 Massachusetts 203 3.2 Michigan 547 5.5 Minnesota 201 4.2 Nebraska 125 7.5 New Mexico 206 11.3 North Carolina 536 6.8 North Dakota 56 8.8 Ohio 458 4.1 Oklahoma 245 7.3 Oregon 170 5.1 South Carolina 333 8.6 Texas 1,734 8.7 Utah 74 3.4 Vermont 34 5.6 Washington 265 4.5 Wisconsin 309 5.8 0 2 4 6 8 10 12 Traffic Safety Facts 1999 (US Department of Transportation, National Highway Traffic Safety Administration). 6. Poisoning Indicators Poisoning is the damaging effect of exposure to a broad range of chemicals (e.g., gases, pesticides, heavy metals, drugs, and a variety of common household substances such as bleach and ammonia). In 1999, 19,741 people died from poisoning in the United States.1 Drug overdoses, specifically misuse of medications and recreational drugs, caused about three-fourths of these deaths.2 Nationally, over 60% of poisonings nationally in 1999 were unintentional, 25% were suicides, less than 1% were homicides, and 13% were of undetermined intent.1 Rates of poisoning by suicide and homicide have not increased in the past decade. In contrast, the rates of unintentional poisoning deaths and poisoning deaths with undetermined intent have increased since 1990.2 Males have more than two times the risk for poisoning death compared to females. The largest difference is in the category of unintentional poisoning death, where mortality rates among men are more than three times that of women. In suicide poisoning deaths, males have about one and a half times the rate of females. Blacks have the highest mortality from all poisoning (B:W 1.2:1), unintentional poisoning (B:W 1.7:1), and undetermined poisoning (B:W 1.6:1). In suicide poisoning, blacks have lower rates than whites (B:W 1:3.1). Asian American/Pacific Islanders had the lowest rates of poisoning in all categories. Most poisoning deaths (84%) occur among people ages 25 to 54. Poisoning deaths in children under the age of five account for only 0.4% of all poisoning mortality.1 Since 1960, poisoning deaths of children younger than five years have decreased dramatically. A steep decline occurred after childproof packaging was required on all drugs and medications beginning in 1973.3 Figures 6a, 6b, and 6c present the poisoning-related hospitalization data for 21 states in 1999. Figure 6a illustrates a more than two-fold difference between the lowest and highest rates. Figures 6d, 6e, and 6f present the poisoning death rates for 25 states in 1999. Figure 6d shows a four-andone-half-fold difference between the lowest and highest rates. Overall, individual state hospitalization rates were four to fifteen times higher than death rates for poisoningrelated injuries. Males had higher rates than females in poisoning deaths, while females had higher rates of hospitalization. The highest poisoning mortality rates were among people 35 to 54 years of age. Age-specific rates could not be calculated for many age categories due to small numbers. References 1. Centers for Disease Control and Prevention. Webbased Injury Statistics Query and Reporting System (WISQARS) [online]. 2002. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (producer). [accessed 2003 Jul 29]. Available from URL: www.cdc.gov/ncipc/wisqars. 2. Fingerhut LA, Cox CS. Poisoning mortality: 1985–1995. Public Health Reports 1998;113:218–33. 3. Baker SP, O’Neill B, Ginsburg MJ, Li G, editors. The injury fact book. New York: Oxford University Press; 1992. Poisoning Indicators – 63 Poisoning Indicators Figures 6a. Poisoning Hospitalizations (Overall), 1999 6b. Poisoning Hospitalizations by Sex, 1999 6c. Poisoning Hospitalizations by Age, 1999 6d. Poisoning Fatalities (Overall), 1999 6e. Poisoning Fatalities by Sex, 1999 6f. Poisoning Fatalities by Age, 1999 Poisoning Indicators – 65 FIGURE 6a. Poisoning Indicator: Poisoning Hospitalizations (Overall), 1999 Factors Affecting Representativeness of State Hospital Discharge Data Sets for Injury Surveillance Age Adjusted Rate per 100,000 Number Rate State Percentage of HDD Injury Records with External Cause Coding* Inclusion of Readmission and Transfers? Cross-Border † Hospitalization Incomplete Hospital Participation Arizona 1,916 41.4 AZ 84.0% Yes No No California 22,107 66.9 CA 100.0% Yes No No Colorado 2,733 CO 98.8% Yes No No Delaware — DE 76.0% Yes No No Florida 10,306 69.5 FL 74.0% Yes No No Georgia 3,397 43.3 GA 91.8% Yes Unknown No Hawaii 582 49.4 HI 52.9% Yes No No Kansas 1,300 49.2 KS 58.0% Yes Unknown No Kentucky 1,295 KY 68.0% Yes Yes Yes Louisiana — LA ‡ ‡ ‡ ‡ Massachusetts 3,361 52.3 MA 95.3% Yes No No Michigan 5,579 56.5 MI 82.3% Yes No No Minnesota 2,368 49.5 MN 78.4% Yes No Yes Nebraska 507 NE 100.0% No Yes No NM 48.3% Yes Unknown No NC 89.1% Yes No No ‡ ‡ ‡ ‡ 63.7 ‡ — ‡ 32.9 ‡ — ‡ 30.8 ‡ New Mexico — North Carolina 4,108 North Dakota — ‡ Ohio — ‡ Oklahoma 2,072 62.3 — ‡ 51.3 — ‡ ND — ‡ OH ‡ ‡ ‡ ‡ OK 65.9% Yes No No Yes No No Oregon 2,370 71.8 OR 67.5% South Carolina 1,353 34.7 SC 94.1% ‡ Yes No Texas 6,307 31.2 TX 62.7% Yes Yes Yes Utah UT 89.2% Yes No No 1,038 49.1 Vermont 332 55.2 VT 85.0% Yes Yes No Washington 2,552 43.6 WA 98.9% Yes No No Wisconsin 3,376 64.4 WI 97.3% Yes No No 0 10 20 30 40 50 60 70 80 * Incompleteness can lead to bias. § Rate=[(male rate*pop) + (female rate*pop)] / (male+female pop). † Subjective assessment by health department staff that a substantial proportion of state residents injured in-state who require hospitalization are hospitalized in a neighboring state. ll Rates are suppressed if fewer than 20 cases were reported. ‡ No data available. ¶ Case counts are suppressed if fewer than 5 cases were reported. FIGURE 6b. Poisoning Indicator: Poisoning Hospitalizations by Sex, 1999 Males Number of Cases Age Adjusted Rate per 100,000 Females Females Males Age Adjusted Rate per 100,000 Arizona 31.9 738 1,178 Arizona 50.8 California 55.2 9,134 12,972 California 78.7 Colorado 54.4 1,556 Colorado 73.2 1,177 ‡ ‡ Delaware ‡ — Delaware ‡ Florida 61.1 4,494 5,809 Florida 77.5 Georgia 37.6 1,420 1,976 Georgia 48.7 Hawaii 41.4 246 336 Hawaii 57.4 Kansas 39.5 519 781 Kansas 58.6 Kentucky 28.6 744 Kentucky 37.0 551 ‡ — ‡ Louisiana ‡ — Louisiana ‡ Massachusetts 47.6 1,481 1,880 Massachusetts 56.6 Michigan 51.3 2,468 3,111 Michigan 61.5 Minnesota 41.6 983 1,385 Minnesota 57.2 Nebraska 21.0 171 338 Nebraska 40.1 New Mexico ‡ — New Mexico ‡ North Carolina 42.3 1,664 North Dakota ‡ — ‡ Ohio ‡ — ‡ Oklahoma 52.2 849 Oregon 57.3 940 South Carolina 32.0 Texas Utah Vermont ‡ — — ‡ North Carolina 59.9 — ‡ North Dakota ‡ — ‡ Ohio ‡ 1,214 Oklahoma 72.0 1,430 Oregon 86.1 599 754 South Carolina 37.3 21.1 2,089 4,170 Texas 41.1 39.7 414 624 Utah 58.5 51.8 152 180 Vermont 58.4 Washington 36.2 1,049 1,502 Washington 50.9 Wisconsin 53.4 1,378 1,998 Wisconsin 75.0 0 10 20 30 40 50 60 2,443 70 ‡ No data available. ll Rates are suppressed if fewer than 20 cases were reported. ¶ Case counts are suppressed if fewer than 5 cases were reported. 0 10 20 30 40 50 60 70 80 90 FIGURE 6C. Poisoning Indicator: Poisoning Hospitalizations by Age**, 1999 State <1 AZ CA CO DE FL GA HI KS KY LA MA MI MN NE NM NC ND OH OK OR SC TX UT VT WA WI ¶ — 73 6 ‡ — 42 16 ¶ — ¶ — 8 ‡ — 7 22 ¶ — ¶ — ‡ — 10 —‡ —‡ 18 5 19 38 5 ¶ — 9 16 5-14 1-4 Rate N —ll 15 —ll ‡ — 21 —ll —ll —ll —ll ‡ — —ll 17 —ll —ll ‡ — —ll —‡ —‡ —ll —ll —ll 11 —ll —ll —ll —ll †† N 34 892 61 ‡ — 385 95 27 57 75 ‡ — 49 294 67 20 ‡ — 162 ‡ — ‡ — 141 66 122 209 40 11 45 181 15-24 Rate N Rate N Rate 11 45 26 ‡ — 51 21 42 39 36 ‡ — 15 55 26 22 ‡ — 38 —‡ —‡ 76 2 60 16 24 —ll 14 68 74 3,417 96 ‡ — 334 122 17 65 39 ‡ — 68 206 125 25 ‡ — 146 —‡ —‡ 69 68 72 292 31 13 73 119 10 68 16 —‡ 17 11 —ll 17 7 —‡ 8 14 17 10 —‡ 13 —‡ —‡ 14 2 13 9 8 —ll 9 16 404 3,831 560 ‡ — 1,835 575 137 306 241 ‡ — 646 963 572 109 —‡ 679 —‡ —‡ 448 445 229 1,611 258 73 439 672 60 82 93 ‡ — 99 52 82 77 42 ‡ — 73 72 84 43 —‡ 61 —‡ —‡ 89 14 41 53 64 87 55 89 25-34 N 414 5,370 539 ‡ — 1,904 707 100 261 248 ‡ — 714 1,001 426 97 —‡ 844 —‡ —‡ 378 470 216 1,202 187 66 473 637 ‡ No data available. ll Rates are suppressed if fewer than 20 cases were reported. ¶ Case counts are suppressed if fewer than 5 cases were reported. Rate 66 105 82 ‡ — 96 59 68 77 46 ‡ — 71 70 68 47 —‡ 69 —‡ —‡ 91 15 39 43 57 87 56 93 45-54 35-44 N 507 3,726 692 ‡ — 2,567 854 120 309 345 ‡ — 881 1,398 545 114 —‡ 1,028 —‡ —‡ 482 633 241 1,257 230 72 672 846 Rate 69 67 96 ‡ — 111 64 61 72 54 ‡ — 86 87 67 44 —‡ 81 —‡ —‡ 95 20 38 39 74 71 69 98 N Rate 310 690 419 ‡ — 1,575 506 94 142 167 ‡ — 495 816 333 60 —‡ 592 —‡ —‡ 248 375 159 720 149 60 401 446 53 17 71 ‡ — 78 49 57 41 31 ‡ — 61 62 53 28 —‡ 56 —‡ —‡ 57 10 30 28 65 66 50 64 55-64 N 77 1,552 128 ‡ — 593 219 38 54 69 ‡ — 165 336 103 31 —‡ 241 —‡ —‡ 114 125 107 319 67 12 153 152 ** Age in years. †† Rate per 100,000 population. Rate 19 64 39 ‡ — 40 35 37 25 19 ‡ — 33 40 26 22 —‡ 34 —‡ —‡ 36 4 31 20 49 —ll 32 34 65-74 N 47 1,163 99 ‡ — 465 141 25 42 46 ‡ — 135 228 85 25 —‡ 212 —‡ —‡ 69 78 95 318 34 15 118 123 75-84 Rate N Rate 14 60 44 ‡ — 32 34 28 24 17 ‡ — 31 36 29 22 —‡ 40 —‡ —‡ 29 2 36 29 34 —ll 34 35 34 1,011 97 ‡ — 422 122 23 46 49 ‡ — 139 221 67 20 —‡ 141 —‡ —‡ 72 75 74 236 25 7 114 121 15 78 70 ‡ — 40 48 41 36 29 ‡ — 46 51 32 25 —‡ 44 —‡ —‡ 47 2 47 35 39 —ll 49 49 85+ N 11 382 36 ‡ — 184 40 ¶ — 14 8 ‡ — 62 94 41 6 —‡ 53 —‡ —‡ 33 30 19 105 11 —¶ 54 63 Rate —ll 90 77 ‡ — 57 47 —ll —ll —ll ‡ — 52 65 49 —ll —‡ 51 —‡ —‡ 58 1 —ll 45 —ll —ll 66 67 FIGURE 6d. Poisoning Indicator: Poisoning Fatalities (Overall), 1999 Age Adjusted Rate per 100,000 Number Arizona —‡ Rate —‡ California 2,848 8.7 Colorado 432 10.0 Delaware 61 7.9 Florida 1,328 8.7 Georgia 354 4.5 Hawaii 89 7.4 Kansas 123 4.7 Kentucky 252 6.4 Louisiana 214 5.0 Massachusetts 533 8.1 Michigan 592 6.0 Minnesota 216 4.5 Nebraska 64 3.9 New Mexico 293 17.6 North Carolina 440 5.6 North Dakota 5 —ll Ohio 616 5.5 Oklahoma 138 4.2 Oregon 257 7.7 South Carolina 191 4.8 Texas 1,235 6.1 Utah 250 12.7 Vermont 31 5.0 Washington 633 10.6 Wisconsin 304 5.8 0 4 8 12 16 § 20 * Incompleteness can lead to bias. § Rate=[(male rate*pop) + (female rate*pop)] / (male+female pop). † Subjective assessment by health department staff that a substantial proportion of state residents injured in-state who require hospitalization are hospitalized in a neighboring state. ll Rates are suppressed if fewer than 20 cases were reported. ‡ No data available. ¶ Case counts are suppressed if fewer than 5 cases were reported. FIGURE 6e. Poisoning Indicator: Poisoning Fatalities by Sex, 1999 Males Number of Cases Age Adjusted Rate per 100,000 Females Females Males Age Adjusted Rate per 100,000 Arizona ‡ Arizona ‡ California 12.0 1,965 883 California 5.4 Colorado 12.9 283 149 Colorado 7.0 Delaware 11.0 41 20 Delaware 5.0 Florida 11.6 856 472 Florida 6.0 Georgia 5.8 225 129 Georgia 3.2 Hawaii 10.0 60 29 Hawaii 4.9 Kansas 6.5 85 38 Kansas 2.9 Kentucky 8.7 167 85 Kentucky 4.2 —‡ —‡ Louisiana 6.5 133 81 Louisiana 3.7 Massachusetts 11.4 363 170 Massachusetts 5.1 Michigan 7.9 377 215 Michigan 4.2 Minnesota 6.3 147 69 Minnesota 2.8 Nebraska 5.1 40 24 Nebraska 2.8 New Mexico 27.1 226 67 New Mexico 7.8 North Carolina 7.1 267 North Carolina 4.2 North Dakota ll — Ohio 7.7 417 Oklahoma 5.8 91 Oregon 10.7 176 South Carolina 6.9 Texas Utah Vermont ll 17 Washington 14.3 426 Wisconsin 7.2 185 0 173 ¶,ll ¶,ll North Dakota ll 199 Ohio 3.4 47 Oklahoma 2.7 81 Oregon 4.8 132 59 South Carolina 2.9 8.2 809 426 Texas 4.2 18.8 186 64 Utah 6.7 Vermont ll 207 Washington 7.0 119 Wisconsin 4.4 5 10 15 20 25 ll — 14 ll 30 ‡ No data available. ll Rates are suppressed if fewer than 20 cases were reported. ¶ Case counts are suppressed if fewer than 5 cases were reported. 0 2 4 6 8 FIGURE 6f. Poisoning Indicator: Poisoning Fatalities by Age**, 1999 State <1 N AZ CA CO DE FL GA HI KS KY LA MA MI MN NE NM NC ND OH OK OR SC TX UT VT WA WI ‡ — ¶ — ¶ — ¶ — ¶ — 5 ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — —¶ 5-14 1-4 Rate ‡ — —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll †† Rate N ‡ — 5 ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — —¶ ‡ — —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll 15-24 Rate N ‡ — ¶ — ¶ — ¶ — 5 6 ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — 7 ¶ — ¶ — ¶ — —¶ ‡ — —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll 25-34 Rate N ‡ — 157 26 6 120 29 ¶ — 11 18 16 43 36 22 ¶ — 19 31 ¶ — 37 9 13 19 126 24 ¶ — 54 21 ‡ — 3.4 4.3 —ll 6.5 2.6 —ll —ll —ll —ll 4.9 2.7 3.2 —ll —ll 2.8 —ll 2.4 —ll —ll —ll 4.1 5.9 —ll 6.7 2.8 ‡ — 470 76 11 226 61 14 18 54 49 140 95 26 13 52 64 ¶ — 101 28 54 28 266 48 ¶ — 117 61 ‡ No data available. ll Rates are suppressed if fewer than 20 cases were reported. ¶ Case counts are suppressed if fewer than 5 cases were reported. 45-54 35-44 Rate N ‡ — 9.2 11.5 —ll 11.4 5.1 —ll —ll 10.0 8.6 13.9 6.6 4.1 —ll 24.7 5.3 —ll 6.6 6.7 12.7 5.0 10.0 14.6 —ll 13.8 8.9 Rate N ‡ — 1,002 157 19 448 110 33 42 93 68 204 208 78 22 117 161 ¶ — 228 47 93 67 418 92 12 218 95 ‡ — 17.9 21.7 —ll 19.3 8.2 16.6 9.8 14.5 10.1 20.0 13.0 9.6 8.4 42.1 12.7 —ll 12.5 9.2 17.6 10.7 12.8 29.5 —ll 22.4 10.9 55-64 Rate N ‡ — 809 114 14 298 89 30 34 50 51 97 156 48 11 80 110 ¶ — 156 25 65 48 244 66 5 162 62 ‡ — 19.7 19.4 —ll 14.8 8.7 18.1 9.9 9.2 9.0 11.8 11.8 7.7 —ll 34.9 10.4 —ll 10.4 5.7 13.3 9.1 9.6 28.7 —ll 20.1 8.9 ‡ — 237 32 5 85 22 ¶ — 10 25 17 30 44 16 ¶ — 16 36 ¶ — 38 11 11 19 84 11 ¶ — 47 20 ** Age in years. †† 65-74 Rate N Rate per 100,000 population. ‡ — 9.7 9.6 —ll 5.7 3.5 —ll —ll 6.7 —ll 6.1 5.3 —ll —ll —ll 5.1 —ll 3.8 —ll —ll —ll 5.2 —ll —ll 9.8 4.4 75-84 Rate N ‡ — 85 7 ¶ — 59 12 ¶ — 5 9 5 8 19 8 5 ¶ — 12 ¶ — 25 ¶ — 8 8 39 ¶ — ¶ — 16 15 ‡ — 4 —ll —ll 4 —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll 3 —ll —ll —ll 4 —ll —ll —ll —ll N ‡ — 54 12 ¶ — 51 11 ¶ — ¶ — ¶ — 6 ¶ — 23 11 5 ¶ — 16 ¶ — 18 10 7 ¶ — 30 ¶ — ¶ — 12 35 85+ Rate N —‡ 4 —ll —ll 5 —ll —ll —ll —ll —ll —ll 5 —ll —ll —ll —ll —ll —ll —ll —ll —ll 5 —ll —ll —ll 7 — 22 5 ¶ — 29 6 ¶ — ¶ — ¶ — ¶ — 7 7 6 ¶ — ¶ — 8 ¶ — 7 5 5 ¶ — 15 ¶ — ¶ — ¶ — 10 Rate ‡ ‡ — 5 —ll —ll 9 —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll 7. Firearm-Related Indicators Firearm-related injuries are the second leading cause of injury-related death in the United States, accounting for approximately 29,000 deaths in 1999.1 In 1994, treatment of gunshot injuries in the United States cost an estimated $2.3 billion in lifetime medical costs, of which $1.1 billion was paid by the federal government.3 Both fatal and nonfatal firearm-related injury rates are highest among persons ages 15 to 24 years; black males in that age group have the highest risk. Fatal and nonfatal firearm-related injury rates for Hispanics are generally less than those for blacks, but higher than those for white nonHispanics. Nationally, the firearm-related death rate for males is six times higher than that of females; the nonfatal firearm-related injury rate for males is eight times higher. The proportion of persons who die from firearm-related injuries increases with age. Of those who survive a gunshot wound and are treated in a hospital emergency department (ED), approximately 55% are hospitalized or transferred, and the other 45% are treated and released. Nationally, the case-fatality rate and hospitalization rate is higher for firearm-related injuries than for any other cause of injury.2 This means that a person is more likely to die or be hospitalized for a firearm-related injury than any other injury. Nationally, fatal firearm-related injury rates declined 29%, and nonfatal firearm-related injury rates declined 47% during 1993-1998.1 Although the reasons for these changes are unknown, certain factors may have contributed to the decrease. For example, the decline in assault firearm injuries is consistent with a 27% decrease in violent crime4 and a 20% decline in non-firearm homicides during the same period.1 Possible contributors include improvements in economic conditions; aging of the population; decline of the cocaine market; changes in legislation, sentencing guidelines, and law-enforcement practices; and violence prevention programs.5 However, the importance and relative contribution of each of these factors have not been determined. The majority of fatal and nonfatal firearm-related injuries among teenagers and young adults result from violence. In contrast, firearm-related injuries among older adults are predominantly self-inflicted. Although unintentional firearm-related deaths represent less than 4% of all firearm deaths, approximately one-fifth of nonfatal firearm-related injuries treated in U.S. hospital EDs are unintentional.2 Figures 7a, 7b, and 7c represent firearm-related hospitalization data submitted by 22 states for 1999. In two states, the number of hospitalization cases was too small to allow calculation of a stable rate. There is an approximately fivefold difference between the lowest and highest rates for hospitalization. Figures 7d, 7e, and 7f represent firearmrelated death rates in 25 states in 1999, and illustrate more than a six-fold difference between the lowest and highest rates. In almost all states, the highest rates of firearm death are seen among people ages 15 to 34 years, with a second peak among those over 75. For hospitalizations, the highest rates again are found among those ages 15 to 34 years, but Firearm-Related Indicators – 73 there is no second peak in the oldest age group. This is probably because fire-arm injuries among the elderly are often self-inflicted and usually lethal. The ratio of hospitalization to death ranges from 0.3:1 to 1.1:1. Firearm fatality and hospitalization rates are much higher for males than females. References 1. Centers for Disease Control and Prevention. Webbased Injury Statistics Query and Reporting System (WISQARS) [online]. 2002. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (producer). [accessed July 31, 2003]. Available from URL: www.cdc.gov/ncipc/wisqars. 2. Gotsch KE, Annest JL, Mercy JA, Ryan GW. Surveillance for fatal and nonfatal firearm-related injuries–United States, 1993–1998. In: CDC surveillance summaries; 2001 Apr 13. MMWR 2001; 50(No. SS-2). 3. Cook PJ, Lawrence BA, Ludwig J, Miller TR. Medical costs of gunshot injuries in the United States. JAMA 1999;282:447–54. 4. Rennison CM. Criminal victimization 1998: changes 1997–98 with trends 1993–98. Washington (DC): Department of Justice (US), Bureau of Justice Statistics 1998; 1999 Jul. NCJ 176353. 5. Blumstein A, Wallman J, editors. Crime drop in America. New York (NY): Cambridge University Press; 2000. Firearm-Related Indicators – 74 Firearm-Related Indicators Figures 7a. Firearm-Related Hospitalizations (Overall), 1999 7b. Firearm-Related Hospitalizations by Sex, 1999 7c. Firearm-Related Hospitalizations by Age, 1999 7d. Firearm-Related Fatalities (Overall), 1999 7e. Firearm-Related Fatalities by Sex, 1999 7f. Firearm-Related Fatalities by Age, 1999 Firearm-Related Indicators – 75 FIGURE 7a. Firearm-Related Indicator: Firearm-Related Hospitalizations (Overall), 1999 Factors Affecting Representativeness of State Hospital Discharge Data Sets for Injury Surveillance Age Adjusted Rate per 100,000 Number Rate State Percentage of HDD Injury Records with External Cause Coding* Inclusion of Readmission and Transfers? Cross-Border † Hospitalization Incomplete Hospital Participation Arizona 663 13.9 AZ 84.0% Yes No No California 3,590 10.2 CA 100.0% Yes No No Colorado 283 6.3 CO 98.8% Yes No No Delaware 60 8.0 DE 76.0% Yes No No Florida 1,171 7.9 FL 74.0% Yes No No Georgia 993 12.1 GA 91.8% Yes Unknown No Hawaii 8 HI 52.9% Yes No No Kansas 165 KS 58.0% Yes Unknown No Kentucky 136 KY 68.0% Yes Yes Yes Louisiana — LA ‡ ‡ ‡ ‡ Massachusetts 223 3.3 MA 95.3% Yes No No Michigan 1,172 11.9 MI 82.3% Yes No No Minnesota 189 3.9 MN 78.4% Yes No Yes Nebraska 60 2.7 NE 100.0% No Yes No NM 48.3% Yes Unknown No NC 89.1% Yes No No ‡ ‡ ‡ ‡ § — ll 6.0 3.4 ‡ — ‡ New Mexico — North Carolina 980 North Dakota — ‡ Ohio — ‡ Oklahoma 328 9.5 — ‡ § ‡ 11.7 — ‡ ND — ‡ OH ‡ ‡ ‡ ‡ OK 65.9% Yes No No Yes No No Oregon 178 5.5 OR 67.5% South Carolina 484 12.0 SC 94.1% ‡ Yes No Texas 926 4.6 TX 62.7% Yes Yes Yes Utah 110 4.9 UT 89.2% Yes No No Vermont 15 — VT 85.0% Yes Yes No Washington 269 4.5 WA 98.9% Yes No No Wisconsin 429 7.9 WI 97.3% Yes No No 0 2 4 6 8 10 12 ll 14 * Incompleteness can lead to bias. § Rate=[(male rate*pop) + (female rate*pop)] / (male+female pop). † Subjective assessment by health department staff that a substantial proportion of state residents injured in-state who require hospitalization are hospitalized in a neighboring state. ll Rates are suppressed if fewer than 20 cases were reported. ‡ No data available. ¶ Case counts are suppressed if fewer than 5 cases were reported. FIGURE 7b. Firearm-Related Indicator: Firearm-Related Hospitalizations by Sex, 1999 Males Number of Cases Age Adjusted Rate per 100,000 Females Females Males Age Adjusted Rate per 100,000 Arizona 24.7 585 78 Arizona 3.4 California 18.3 3,243 347 California 2.1 Colorado 10.8 38 Colorado 1.8 245 ll Delaware 14.5 54 6 Delaware ll R Florida 14.1 1,017 153 Florida 2.1 Georgia 21.6 130 Georgia 3.2 863 Hawaii ll R 5 Kansas 10.5 143 Kentucky 5.8 ll 112 ‡ ¶,ll Hawaii ll R 22 Kansas 1.7 24 Kentucky 1.2 — ‡ Louisiana ‡ — Louisiana ‡ Massachusetts 6.2 203 20 Massachusetts 0.6 Michigan 21.7 1,045 127 Michigan 2.5 Minnesota 6.7 161 28 Nebraska 5.9 49 11 New Mexico ‡ — North Carolina 20.7 857 North Dakota ‡ — ‡ Ohio ‡ — ‡ Oklahoma 16.4 272 Oregon 9.1 148 South Carolina 20.6 Texas Utah ‡ — — Minnesota 1.2 ll Nebraska ll R ‡ New Mexico ‡ North Carolina 3.0 — ‡ North Dakota ‡ — ‡ Ohio ‡ 50 Oklahoma 3.0 30 Oregon 1.9 406 78 South Carolina 3.9 8.1 805 119 Texas 1.2 8.0 90 20 Utah 1.9 Vermont ll R 14 ll Vermont ll R Washington 7.8 234 35 Washington 1.2 Wisconsin 14.5 388 41 Wisconsin 1.6 0 5 10 15 20 25 123 — ¶,ll 30 ‡ No data available. ll Rates are suppressed if fewer than 20 cases were reported. ¶ Case counts are suppressed if fewer than 5 cases were reported. 0 1 2 3 4 5 FIGURE 7C. Firearm-Related Indicator: Firearm-Related Hospitalizations by Age**, 1999 State <1 N AZ CA CO DE FL GA HI KS KY LA MA MI MN NE NM NC ND OH OK OR SC TX UT VT WA WI ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ‡ — ¶ — ¶ — ¶ — ¶ — ‡ — ¶ — —‡ —‡ ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — —¶ 5-14 1-4 Rate —ll —ll —ll —ll —ll —ll —ll —ll —ll ‡ — —ll —ll —ll —ll ‡ — —ll —‡ —‡ —ll —ll —ll —ll —ll —ll —ll —ll †† N ¶ — 11 ¶ — ¶ — ¶ — 7 ¶ — ¶ — ¶ — ‡ — ¶ — ¶ — ¶ — ¶ — ‡ — 5 —‡ —‡ ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — —¶ 15-24 Rate N Rate —ll —ll —ll —ll —ll —ll —ll —ll —ll ‡ — —ll —ll —ll —ll —‡ —ll —‡ —‡ —ll —ll —ll —ll —ll —ll —ll —ll 19 115 8 ¶ — 33 28 ¶ — ¶ — ¶ — ‡ — ¶ — 26 8 ¶ — ‡ — 17 —‡ —‡ 18 7 15 34 ¶ — ¶ — 9 26 —ll 2.3 —ll —ll 1.7 2.5 —ll —ll —ll —‡ —ll 1.8 —ll —ll —‡ —ll —‡ —‡ —ll —ll —ll 1.1 —ll —ll —ll 3.4 N 282 1,821 123 29 414 364 ¶ — 84 34 ‡ — 118 445 77 31 —‡ 379 —‡ —‡ 118 55 184 384 38 ¶ — 94 218 25-34 45-54 35-44 Rate N Rate N Rate N 42.1 38.9 20.5 29.2 22.4 32.8 —ll 21.1 5.9 ‡ — 13.4 33.3 11.3 12.3 —‡ 34.2 —‡ —‡ 23.4 12.0 33.0 12.6 9.3 —ll 11.7 28.8 173 848 78 11 291 271 ¶ — 34 27 ‡ — 58 363 38 16 —‡ 281 —‡ —‡ 69 44 145 231 27 ¶ — 74 94 27.5 16.6 11.8 —ll 14.7 22.5 —ll 10.0 5.0 ‡ — 5.8 25.3 6.0 —ll —‡ 23.1 —‡ —‡ 16.5 10.4 25.9 8.3 8.1 —ll 8.8 13.7 109 466 34 12 207 182 ¶ — 24 35 ‡ — 33 186 36 ¶ — —‡ 168 —‡ —‡ 65 42 76 132 26 —¶ 49 42 14.8 8.3 4.7 —ll 8.9 13.6 —ll 5.6 5.5 ‡ — 3.2 11.6 4.4 —ll ‡ — 13.3 —‡ —‡ 12.8 8.0 12.1 4.0 8.3 —ll 5.0 4.8 52 178 19 ¶ — 115 79 ¶ — ¶ — 20 ‡ — 7 87 16 ¶ — ‡ — 82 —‡ —‡ 26 12 41 71 7 ¶ — 26 30 ‡ No data available. ll Rates are suppressed if fewer than 20 cases were reported. ¶ Case counts are suppressed if fewer than 5 cases were reported. Rate 8.8 4.3 —ll —ll 5.7 7.7 —ll —ll 3.7 ‡ — —ll 6.6 —ll —ll ‡ — 7.8 —‡ —‡ 5.9 —ll 7.8 2.8 —ll —ll 3.2 4.3 55-64 75-84 Rate N Rate N 13 77 11 ¶ — 56 34 ¶ — 8 9 ‡ — ¶ — 18 5 ¶ — ‡ — 30 —‡ —‡ 8 6 11 35 ¶ — ¶ — —¶ 9 —ll 3.2 —ll —ll 3.7 5.4 —ll —ll —ll ‡ — —ll —ll —ll —ll —‡ 4.3 —‡ —‡ —ll —ll —ll 2.2 —ll —ll —ll —ll 6 33 ¶ — ¶ — 26 13 ¶ — ¶ — ¶ — ‡ — ¶ — 12 7 ¶ — —‡ 12 —‡ —‡ 10 ¶ — 8 18 ¶ — ¶ — 6 7 —ll 1.7 —ll —ll 1.8 —ll —ll —ll —ll ‡ — —ll —ll —ll —ll —‡ —ll —‡ —‡ —ll —ll —ll —ll —ll —ll —ll —ll 5 33 ¶ — ¶ — 16 7 ¶ — ¶ — ¶ — ‡ — ¶ — 13 ¶ — ¶ — —‡ ¶ — —‡ —‡ 8 ¶ — ¶ — 9 ¶ — —¶ 7 —¶ ** Age in years. †† 65-74 N Rate per 100,000 population. 85+ Rate —ll 2.6 —ll —ll —ll —ll —ll —ll —ll ‡ — —ll —ll —ll —ll —‡ —ll —‡ —‡ —ll —ll —ll —ll —ll —ll —ll —ll Rate N ¶ — 7 ¶ — ¶ — 9 6 ¶ — ¶ — ¶ — ‡ — ¶ — 15 ¶ — ¶ — —‡ ¶ — —‡ —‡ ¶ — ¶ — ¶ — 8 ¶ — —¶ —¶ —¶ —ll —ll —ll —ll —ll —ll —ll —ll —ll ‡ — —ll —ll —ll —ll —‡ —ll —‡ —‡ —ll —ll —ll —ll —ll —ll —ll —ll FIGURE 7d. Firearm-Related Indicator: Firearm-Related Fatalities (Overall), 1999 Age Adjusted Rate per 100,000 Number Arizona —‡ Rate —‡ California 3,009 9.4 Colorado 443 10.9 Delaware 68 8.9§ Florida 1,720 11.0 Georgia 1,092 14.4 Hawaii 41 3.5§ Kansas 274 10.4 Kentucky 515 13.7 Louisiana 765 18.3 Massachusetts 182 2.9 Michigan 1,077 11.0 Minnesota 298 6.4 Nebraska 146 8.8 New Mexico 290 17.6 North Carolina 1,048 13.1 North Dakota 50 Ohio 964 8.8 Oklahoma 501 15.2 Oregon 7.6§ 391 11.9 South Carolina 549 14.1 Texas 2,112 10.6 Utah 193 9.7 Vermont 57 9.3 Washington 583 10.4 Wisconsin 470 9.0 0 4 8 12 16 § 20 * Incompleteness can lead to bias. § Rate=[(male rate*pop) + (female rate*pop)] / (male+female pop). † Subjective assessment by health department staff that a substantial proportion of state residents injured in-state who require hospitalization are hospitalized in a neighboring state. ll Rates are suppressed if fewer than 20 cases were reported. ‡ No data available. ¶ Case counts are suppressed if fewer than 5 cases were reported. FIGURE 7e. Firearm-Related Indicator: Firearm-Related Fatalities by Sex, 1999 Males Number of Cases Age Adjusted Rate per 100,000 Males Females Arizona ‡ California 16.3 2,610 399 Colorado 18.4 371 72 —‡ Females Age Adjusted Rate per 100,000 —‡ Delaware 16.0 60 8 Florida 18.5 1,414 306 Georgia 24.7 905 187 ll ¶,ll Arizona ‡ California 2.4 Colorado 3.4 Delaware ll Florida 3.9 Georgia 4.6 Hawaii 6.4 38 — Hawaii ll Kansas 18.0 233 41 Kansas 3.0 Kentucky 23.7 480 85 Kentucky 4.2 Louisiana 32.2 641 124 Louisiana 5.5 Massachusetts 5.3 160 22 Massachusetts 0.7 Michigan 19.7 939 137 Michigan 2.8 Minnesota 11.9 275 23 Minnesota 1.0 Nebraska 15.5 126 20 Nebraska 2.4 New Mexico 30.4 251 39 New Mexico 4.5 North Carolina 22.2 866 182 North Carolina 4.4 North Dakota 12.8 40 Ohio 15.7 832 Oklahoma 25.9 419 Oregon 20.8 336 South Carolina 23.5 Texas 18.0 Utah 17.4 172 Vermont 16.6 47 10 Washington 18.1 500 Wisconsin 16.3 419 0 5 10 15 20 25 30 10ll North Dakota ll 132 Ohio 2.3 82 Oklahoma 4.9 55 Oregon 3.2 440 109 South Carolina 5.4 1,776 336 Texas 3.3 21 Utah 2.0 Vermont ll 83 Washington 2.8 51 Wisconsin 1.9 ll 35 ‡ No data available. ll Rates are suppressed if fewer than 20 cases were reported. ¶ Case counts are suppressed if fewer than 5 cases were reported. 0 1 2 3 4 5 6 FIGURE 7f. Firearm-Related Indicator: Firearm-Related Fatalities by Age**, 1999 State <1 N AZ CA CO DE FL GA HI KS KY LA MA MI MN NE NM NC ND OH OK OR SC TX UT VT WA WI ‡ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — —¶ 5-14 1-4 Rate ‡ — —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll †† Rate N ‡ — 8 ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — 5 ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — 5 ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — —¶ ‡ — —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll 15-24 Rate N ‡ — 41 11 ¶ — 22 16 ¶ — ¶ — ¶ — 15 ¶ — 15 6 ¶ — 5 11 ¶ — 11 7 7 11 46 ¶ — ¶ — 7 13 ‡ — 0.8 —ll —ll 1.1 —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll — 1.5 —ll —ll —ll —ll 25-34 Rate N ‡ — 808 90 10 281 229 ¶ — 73 81 182 42 262 72 43 81 240 13 191 120 62 113 471 48 10 122 131 ‡ — 17.2 15.0 —ll 15.2 20.6 —ll 18.3 14.0 26.1 4.8 19.6 10.5 17.1 30.8 21.6 —ll 12.2 23.8 13.5 20.3 15.5 11.8 —ll 15.2 17.3 ‡ — 586 91 16 306 279 11 56 107 182 31 286 50 27 55 231 12 186 96 53 109 410 39 9 96 79 ‡ No data available. ll Rates are suppressed if fewer than 20 cases were reported. ¶ Case counts are suppressed if fewer than 5 cases were reported. 45-54 35-44 Rate N Rate N ‡ — 11.5 13.8 —ll 15.5 23.1 —ll 16.4 19.7 31.8 3.1 19.9 7.9 13.1 26.1 19.0 —ll 12.1 23.0 12.5 19.5 14.8 11.8 —ll 11.4 11.5 ‡ — 487 82 18 322 204 11 44 114 140 35 181 63 25 53 200 7 181 90 77 118 413 41 12 104 76 ‡ — 8.7 11.4 —ll 13.9 15.2 —ll 10.3 17.8 20.7 3.4 11.3 7.7 9.6 19.1 15.8 —ll 9.9 17.7 14.6 18.8 12.7 13.2 —ll 10.7 8.8 55-64 Rate N ‡ — 389 67 12 249 124 6 33 69 100 24 132 39 20 37 148 ¶ — 121 65 62 75 301 23 10 91 72 ‡ — 9.5 11.4 —ll 12.4 12.1 —ll 9.6 12.7 17.6 2.9 10.0 6.2 9.3 16.1 14.0 —ll 8.1 14.8 12.7 14.3 11.8 10.0 —ll 11.3 10.3 ‡ — 211 35 8 154 94 ¶ — 25 45 50 25 76 21 15 19 83 6 81 44 32 60 161 19 ¶ — 47 35 ** Age in years. †† 65-74 Rate N Rate per 100,000 population. ‡ — 8.6 10.6 —ll 10.3 14.9 —ll 11.4 12.1 13.0 5.0 9.1 5.3 —ll —ll 11.7 —ll 8.2 13.8 10.6 17.2 10.0 —ll —ll 9.8 7.8 75-84 Rate N ‡ — 209 33 ¶ — 176 75 ¶ — 15 41 43 ¶ — 61 19 8 16 75 ¶ — 90 31 43 35 159 17 ¶ — 51 32 ‡ — 10.8 14.7 —ll 12.2 17.9 —ll —ll 15.3 15.5 —ll 9.4 —ll —ll —ll 14.2 —ll 11.4 13.0 19.7 13.1 14.3 —ll —ll 14.9 9.2 85+ Rate N ‡ — 194 25 ¶ — 155 59 ¶ — 18 35 37 17 42 24 8 18 47 ¶ — 76 34 41 21 118 ¶ — 6 47 17 Rate N ‡ — 15.0 18.1 —ll 14.6 23.0 —ll —ll 20.8 22.0 —ll 9.7 11.4 —ll —ll 14.6 —ll 14.2 22.2 25.6 13.2 17.5 —ll —ll 20.1 —ll ‡ — 76 8 ¶ — 47 9 ¶ — 7 18 11 ¶ — 20 ¶ — ¶ — 6 11 ¶ — 26 7 13 5 29 ¶ — ¶ — 17 15 ‡ — 17.9 —ll —ll 14.6 —ll —ll —ll —ll —ll —ll 13.9 —ll —ll —ll —ll —ll 14.7 —ll —ll —ll 12.4 —ll —ll —ll —ll 8. Homicide Indicators Homicide is the fourteenth leading cause of death overall in the United States, and it is the second most common cause of death among people ages 15 to 24 years. In 1999, 16,889 people were killed in homicides. Firearms were used in 64.1% of these homicides. The next most commonly reported mechanism (11.1%), was cutting and stabbing with sharp instruments, such as knives.1 Figure 8a presents the homicide data for 25 states in 1999 and illustrates a more than four-fold difference between the lowest and highest rates. Males are three times more likely than females (Figure 8b) to die from homicide. The highest rates are seen among people ages 15 to 34 years (Figure 8c). References 1. Centers for Disease Control and Prevention. Webbased Injury Statistics Query and Reporting System (WISQARS) [online]. 2001. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (producer). [accessed 2001 Jul 31]. Available from URL: www.cdc.gov/ncipc/wisqars. 2. Cubbin C, Pickle LW, Fingerhut L. Social context and geographic patterns of homicide among U.S. black and white males. Am J Public Health 2000;90:579–87. Black males ages 20 to 24 have the highest homicide rate of any group in the United States: 110.6 per 100,000 in 1999.1 Homicide rates are lowest for Asian Americans, with whites having only slightly higher rates. Rates for Native Americans are three times higher than those of Asian Americans, and rates for blacks are more than six times higher than those of Asian Americans.1 Homicide rates are higher in the southern United States than in the northern part of the country, and rates in metropolitan areas are higher than elsewhere. Homicide is associated with high urbanization and socioeconomic deprivation.2 These factors are thought to underlie the observed variation in risk by race. Homicide Indicators – 83 Homicide Indicators Figures 8a. Homicide (Overall), 1999 8b. Homicide by Sex, 1999 8c. Homicide by Age, 1999 Homicide Indicators – 85 FIGURE 8a. Homicide Indicator: Homicide (Overall), 1999 Age Adjusted Rate per 100,000 Number ‡ Rate Arizona — California 2,035 5.9 Colorado 198 4.4 Delaware 24 3.1 —‡ § Florida 974 6.5 Georgia 617 7.6 Hawaii 38 3.2 5.1 § Kansas 138 Kentucky 212 5.3 Louisiana 469 10.5 Massachusetts 128 2.0 Michigan 749 7.4 Minnesota 136 2.8 Nebraska 61 3.6 New Mexico 167 9.8 North Carolina 647 7.9 North Dakota 11 —ll Ohio 463 4.1 Oklahoma 224 6.6 Oregon 107 3.3 South Carolina 312 7.8 Texas 1,313 6.6 Utah 51 2.3 Vermont 17 —ll Washington 189 3.1 Wisconsin 213 4.0 0 3 6 9 § 12 * Incompleteness can lead to bias. § Rate=[(male rate*pop) + (female rate*pop)] / (male+female pop). † Subjective assessment by health department staff that a substantial proportion of state residents injured in-state who require hospitalization are hospitalized in a neighboring state. ll Rates are suppressed if fewer than 20 cases were reported. ‡ No data available. ¶ Case counts are suppressed if fewer than 5 cases were reported. FIGURE 8b. Homicide Indicator: Homicide by Sex, 1999 Males Number of Cases Age Adjusted Rate per 100,000 Males Females Females Arizona ‡ California 9.3 1,622 413 Colorado 6.1 139 59 —‡ Age Adjusted Rate per 100,000 —‡ ¶,ll Arizona ‡ California 2.5 Colorado 2.7 Delaware 5.2 20 — Delaware ll Rates Florida 9.7 714 260 Florida 3.5 Georgia 11.6 156 Georgia 3.8 461 Hawaii 4.5 27 11 Hawaii ll Rates Kansas 7.4 98 40 Kansas 2.9 Kentucky 7.5 145 67 Kentucky 3.3 ll Louisiana 16.9 365 104 Louisiana 4.6 Massachusetts 2.8 91 37 Massachusetts 1.2 Michigan 11.8 581 168 Michigan 3.3 Minnesota 3.9 93 43 Minnesota 1.8 Nebraska 4.6 38 23 Nebraska 2.7 New Mexico 16.1 137 30 New Mexico 3.3 North Carolina 12.0 489 158 North Dakota ll Rates Ohio 5.8 319 Oklahoma 9.9 Oregon 4.4 South Carolina 11.8 Texas Utah Vermont ll Rates Washington 4.5 135 Wisconsin 6.0 159 0 North Carolina 3.9 North Dakota ll Rates 144 Ohio 2.5 165 59 Oklahoma 3.4 72 35 Oregon 2.2 230 82 South Carolina 4.1 10.0 988 325 3.3 36 15 2 7ll 9ll 4 6 8 10 12 14 16 — ¶,ll Texas 3.2 ll Utah ll Rates 8ll Vermont ll Rates 54 Washington 1.8 54 Wisconsin 2.1 18 ‡ No data available. ll Rates are suppressed if fewer than 20 cases were reported. ¶ Case counts are suppressed if fewer than 5 cases were reported. 0 1 2 3 4 5 FIGURE 8C. Homicide Indicator: Homicide by Age**, 1999 State <1 AZ CA CO DE FL GA HI KS KY LA MA MI MN NE NM NC ND OH OK OR SC TX UT VT WA WI ‡ — 30 ¶ — ¶ — 19 11 ¶ — ¶ — 5 8 ¶ — 18 ¶ — ¶ — 7 10 ¶ — 11 7 ¶ — ¶ — 28 ¶ — ¶ — ¶ — 8 5-14 1-4 Rate N †† N ‡ — 44 7 ¶ — 24 14 ¶ — 5 ¶ — 6 ¶ — 15 7 ¶ — ¶ — 10 ¶ — 12 6 ¶ — 8 38 ¶ — ¶ — 7 7 — 6.0 — ll — ll — ll — ll — ll — ll — ll — ll — ll — ll — ll — ll — ll — ll — ll — ll — ll — ll — ll 8.4 — ll — ll — ll — ll Rate ‡ ‡ — 2.2 —ll —ll 3.2 —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll 2.9 —ll —ll —ll —ll 15-24 Rate N ‡ — 57 9 ¶ — 25 17 ¶ — 5 ¶ — 11 5 12 7 ¶ — 7 9 ¶ — 9 ¶ — ¶ — 10 49 ¶ — ¶ — 10 7 —‡ 1.1 —ll —ll 1.3 —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll 1.6 —ll —ll —ll —ll 25-34 Rate N ‡ — 712 57 5 230 165 ¶ — 39 50 140 40 212 36 21 48 178 ¶ — 124 64 26 80 350 12 ¶ — 57 85 ‡ — 15.2 9.5 —ll 12.4 14.9 —ll 9.8 8.7 20.1 4.5 15.8 5.3 8.3 18.2 16.0 —ll 7.9 12.7 5.7 14.4 11.5 —ll —ll 7.1 11.2 ‡ — 475 52 11 235 181 7 35 56 128 34 217 26 10 36 161 ¶ — 111 46 33 80 310 18 5 37 46 ‡ No data available. ll Rates are suppressed if fewer than 20 cases were reported. ¶ Case counts are suppressed if fewer than 5 cases were reported. 45-54 35-44 Rate N Rate N ‡ — 9.3 7.9 —ll 11.9 15.0 —ll 10.3 10.3 22.4 3.4 15.1 4.1 —ll 17.1 13.2 —ll 7.3 11.0 7.8 14.3 11.2 —ll —ll 4.4 6.7 ‡ — 338 39 ¶ — 212 116 31 23 35 89 24 131 29 13 32 146 ¶ — 95 33 20 66 265 6 —¶ 39 35 ‡ — 6.0 5.4 —ll 9.1 8.7 15.6 5.4 5.5 13.2 2.4 8.2 3.6 —ll 11.5 11.5 —ll 5.2 6.5 3.8 10.5 8.1 —ll —ll 4.0 4.0 55-64 Rate N ‡ — 207 18 ¶ — 102 64 22 9 23 52 11 74 11 5 22 72 ¶ — 46 22 13 36 149 6 —¶ 20 15 ‡ — 5.0 —ll —ll 5.1 6.3 13.3 —ll 4.2 9.2 —ll 5.6 —ll —ll 9.6 6.8 —ll 3.1 5.0 —ll 6.9 5.8 —ll —ll 2.5 —ll ‡ — 74 9 ¶ — 56 29 10 10 18 15 7 29 5 ¶ — ¶ — 28 ¶ — 23 23 ¶ — 16 59 —¶ —¶ 6 5 ** Age in years. †† 65-74 Rate N Rate per 100,000 population. ‡ — 3.0 — ll — ll 3.7 4.6 — ll — ll — ll — ll — ll 3.5 — ll — ll — ll 4.0 — ll 2.3 7.2 — ll — ll 3.6 — ll — ll — ll — ll 75-84 Rate N ‡ — 55 ¶ — ¶ — 31 11 ¶ — ¶ — 10 12 ¶ — 21 7 ¶ — ¶ — 25 ¶ — 14 8 ¶ — 8 38 —¶ —¶ 7 —¶ ‡ — 2.8 —ll —ll 2.1 —ll —ll —ll —ll —ll —ll 3.3 —ll —ll —ll 4.7 —ll —ll —ll —ll —ll 3.4 —ll —ll —ll —ll 85+ Rate N ‡ — 32 ¶ — ¶ — 30 7 11 5 7 8 ¶ — 11 ¶ — ¶ — ¶ — 7 ¶ — 14 9 ¶ — —¶ 16 —¶ —¶ —¶ —¶ Rate N ‡ — 0.6 —ll —ll 2.8 —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll ‡ — 11 ¶ — ¶ — 6 ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — 9 ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — —¶ 11 —¶ —¶ —¶ —¶ ‡ — —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll 9. Suicide Indicators Suicide is a major public health problem in the United States, claiming the lives of approximately 30,000 people each year.1 In 1999 and 2000, suicide was the 11th leading cause of death overall in the United States, the second leading cause of death among adults ages 25 to 34 years, and the third leading cause of death for adolescents and young adults ages 15 to 24 years.2 Although suicide rates are highest among persons age 65 and older,1 the rate of suicide among adolescents and young adults nearly tripled between 1952 and 1994.1 Overall, males are four times more likely than females to die from suicide.1 In addition to the human toll, the economic costs of suicide are enormous. One study estimated the total economic burden of suicide in the United States to be $111.3 billion in 1995.3 Completed suicides are not the only public health concern. Suicidal ideation, planning, and attempts also have a major public health impact. In 1999, there were an estimated 671,000 hospital emergency department visits for suicide attempts in the United States.4 Because one of the strongest risk factors for suicide is a previous attempt, surveillance of such attempts can help identify high risk groups and target prevention strategies.5 The comparative epidemiology of suicidal ideation and behavior shows some important differences. For example, the suicide rate for males is higher than for females, but studies of suicidal thoughts and suicide attempts routinely show females with higher rates.5 two-fold difference between the lowest and highest rates. Hospitalization was 1.8 to 5.0 times more common than death. Males show a higher rate of suicide, while females have a higher rate of hospitalization for suicide attempts. Suicide attempts resulting in hospitalization, that did not have an injury coded in the principal diagnostic field, are not counted in the case definition for hospitalization for a suicide attempt. Therefore, not all hospitalizations related to suicide attempts are represented in these figures. Figures 9g and 9h present Youth Risk Behavior Survey data on self-reported suicide attempts among high school students in 14 states. Female high school students report a higher rate of suicide attempts than males. References 1. Moscicki E. Identification of suicide risk factors using epidemiologic studies. The Psychiatric Clinics of North America; 1997;20:499–517. 2. Centers for Disease Control and Prevention. Webbased Injury Statistics Query and Reporting System (WISQARS) [online]. 2002. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (producer). [accessed 2003 Jul 31]. Available from URL: www.cdc.gov/ncipc/wisqars. Figures 9a, 9b, and 9c display suicide attempt injury hospitalization data in 21 states. Figures 9d, 9e, and 9f show suicide data from 25 states in 1999, illustrating a more than Suicide Indicators – 91 3. Miller T, Covington K, Jensen A. Costs of injury by major cause, United States, 1995: cobbling together estimates in measuring the burden of injuries. In: Mulder S, van Beeck EF, editors. Proceedings of a conference in Noordwijkerhout; 1998 May 13–15. Amsterdam: European Consumer Safety Association; p. 23–40. 4. McCaig LG. National hospital ambulatory medical care survey: 1998 emergency department summary. Advance data from vital and health statistics; no.: 313. Hyattsville (MD): National Center for Health Statistics; 2000. 5. United States Public Health Service. National strategy for suicide prevention: goals and objectives for action. Washington (DC): 2001. Suicide Indicators – 92 Suicide Indicators Figures 9a. Suicide Attempt Hospitalizations (Overall), 1999 9b. Suicide Attempt Hospitalizations by Sex, 1999 9c. Suicide Attempt Hospitalizations by Age, 1999 9d. Suicide (Overall), 1999 9e. Suicide by Sex, 1999 9f. Suicide by Age, 1999 9g. Percentage of High School Students Reporting Suicide Attempt During Past 12 Months, 1999, Youth Risk Behavior Survey 9h. Percentage of High School Students Reporting Suicide Attempt During Past 12 Months by Sex, 1999, Youth Risk Behavior Survey Suicide Indicators – 93 FIGURE 9a. Suicide Indicator: Suicide Attempt Hospitalizations (Overall), 1999 Factors Affecting Representativeness of State Hospital Discharge Data Sets for Injury Surveillance Age Adjusted Rate per 100,000 Number Rate State Percentage of HDD Injury Records with External Cause Coding* Inclusion of Readmission and Transfers? Cross-Border † Hospitalization Incomplete Hospital Participation Arizona 1,902 41.3 AZ 84.0% Yes No No California 13,405 40.3 CA 100.0% Yes No No Colorado 1,832 CO 98.8% Yes No No Delaware — DE 76.0% Yes No No Florida 6,787 46.5 FL 74.0% Yes No No Georgia 2,114 26.1 GA 91.8% Yes Unknown No Hawaii 403 34.5 HI 52.9% Yes No No Kansas 909 34.6 KS 58.0% Yes Unknown No Kentucky 897 22.7 KY 68.0% Yes Yes Yes Louisiana — — LA ‡ ‡ ‡ ‡ Massachusetts 2,201 34.2 MA 95.3% Yes No No Michigan 3,495 35.4 MI 82.3% Yes No No Minnesota 1,596 33.3 MN 78.4% Yes No Yes Nebraska 389 24.0 NE 100.0% No Yes No NM 48.3% Yes Unknown No NC 89.1% Yes No No ‡ ‡ ‡ ‡ 41.8 ‡ — ‡ ‡ New Mexico — — North Carolina 2,609 32.4 North Dakota — ‡ ‡ ‡ ‡ ‡ — ‡ ND ‡ Ohio — — OH ‡ ‡ ‡ ‡ Oklahoma 1,280 38.8 OK 65.9% Yes No No Oregon Yes No No 1,671 51.3 OR 67.5% South Carolina 982 25.0 SC 94.1% ‡ Yes No Texas 4,336 21.5 TX 62.7% Yes Yes Yes Utah UT 89.2% Yes No No 713 32.8 Vermont 245 40.7 VT 85.0% Yes Yes No Washington 1,678 28.5 WA 98.9% Yes No No Wisconsin 2,319 44.2 WI 97.3% Yes No No 0 10 20 30 40 50 60 * Incompleteness can lead to bias. § Rate=[(male rate*pop) + (female rate*pop)] / (male+female pop). † Subjective assessment by health department staff that a substantial proportion of state residents injured in-state who require hospitalization are hospitalized in a neighboring state. ll Rates are suppressed if fewer than 20 cases were reported. ‡ No data available. ¶ Case counts are suppressed if fewer than 5 cases were reported. FIGURE 9b. Suicide Indicator: Suicide Attempt Hospitalizations by Sex, 1999 Males Number of Cases Age Adjusted Rate per 100,000 Females Females Males Age Adjusted Rate per 100,000 Arizona 33.9 782 1,120 Arizona California 30.8 5,156 8,249 California 49.9 Colorado 33.3 746 1,086 Colorado 50.5 Delaware ‡ — Delaware ‡ Florida 38.4 2,818 3,965 Florida 54.2 Georgia 21.6 851 1,254 Georgia 30.5 Hawaii 25.7 152 251 Hawaii 43.3 Kansas 25.1 332 577 Kansas 43.8 Kentucky 19.8 387 510 Kentucky 25.5 Louisiana ‡ — Louisiana ‡ Massachusetts 28.0 887 1,314 Massachusetts 40.0 Michigan 30.4 1,463 2,032 Michigan 40.2 Minnesota 24.0 576 1,020 Minnesota 42.4 Nebraska 16.7 135 254 Nebraska 30.9 New Mexico ‡ — New Mexico ‡ North Carolina 24.8 1,002 North Dakota ‡ — ‡ Ohio ‡ — ‡ Oklahoma 30.4 496 777 Oklahoma 46.9 Oregon 38.9 630 1,041 Oregon 63.5 South Carolina 20.4 395 590 South Carolina 29.2 Texas 14.1 1,390 2,924 Texas 28.8 Utah 28.8 308 405 Utah 36.8 Vermont 33.9 100 145 Vermont 47.2 Washington 21.5 635 1,042 Washington 35.4 Wisconsin 34.6 908 1,411 Wisconsin 53.5 0 10 20 30 ‡ ‡ ‡ — — — ‡ ‡ ‡ 48.5 North Carolina 39.7 — ‡ North Dakota ‡ — ‡ Ohio ‡ 1,607 40 ‡ No data available. ll Rates are suppressed if fewer than 20 cases were reported. ¶ Case counts are suppressed if fewer than 5 cases were reported. 0 10 20 30 40 50 60 70 FIGURE 9C. Suicide Indicator: Suicide Attempt Hospitalizations by Age**, 1999 State <1 AZ CA CO DE FL GA HI KS KY LA MA MI MN NE NM NC ND OH OK OR SC TX UT VT WA WI ¶ — ¶ — ¶ — ‡ — ¶ — ¶ — ¶ — ¶ — ¶ — ‡ — ¶ — ¶ — ¶ — ¶ — ‡ — ¶ — —‡ —‡ ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — —¶ 5-14 1-4 Rate N —ll —ll —ll ‡ — —ll —ll —ll —ll —ll ‡ — —ll —ll —ll —ll —‡ —ll —‡ —‡ —ll —ll —ll —ll —ll —ll —ll —ll †† N ¶ — ¶ — ¶ — ‡ — ¶ — ¶ — ¶ — ¶ — 22 ‡ — ¶ — ¶ — ¶ — ¶ — —‡ ¶ — —‡ —‡ ¶ — ¶ — —¶ —¶ —¶ —¶ —¶ —¶ Rate N — ll — ll — ll ‡ — — ll — ll — ll — ll 10.7 ‡ — — ll — ll — ll — ll —‡ — ll —‡ —‡ — ll — ll — ll — ll — ll — ll — ll — ll 66 2,803 59 ‡ — 219 81 15 51 25 ‡ — 42 133 81 20 ‡ — 79 —‡ —‡ 31 46 26 182 24 8 52 82 Rate 8.9 55.4 9.7 —‡ 11.1 7.1 — ll 13.2 4.7 —‡ 5.2 9.2 11.2 8.1 —‡ 7.2 —‡ —‡ 6.3 10.0 4.8 5.8 6.3 — ll 6.0 10.7 15-24 N 438 2,828 449 ‡ — 1,326 469 117 247 216 ‡ — 490 789 505 91 ‡ — 546 —‡ —‡ 345 379 161 1,322 223 50 345 593 Rate 65.5 60.4 74.7 ‡ — 71.8 42.2 70.3 62.0 37.4 ‡ — 55.4 59.0 73.9 36.1 ‡ — 49.2 —‡ —‡ 68.4 82.7 28.9 43.4 54.0 59.8 43.0 78.2 25-34 N 441 3,644 422 ‡ — 1,442 560 83 215 205 ‡ — 523 804 340 95 —‡ 661 —‡ —‡ 297 393 245 986 139 61 391 525 ‡ No data available. ll Rates are suppressed if fewer than 20 cases were reported. ¶ Case counts are suppressed if fewer than 5 cases were reported. Rate 70.1 71.2 63.9 ‡ — 73.0 46.5 56.5 63.1 37.8 ‡ — 52.0 56.0 54.0 46.0 —‡ 54.3 —‡ —‡ 71.2 92.5 43.7 35.6 42.1 80.1 46.3 76.3 45-54 35-44 N 499 2,221 476 ‡ — 1,913 563 76 240 255 ‡ — 607 965 365 103 —‡ 758 —‡ —‡ 359 464 322 968 177 67 487 647 Rate 67.8 39.7 65.9 ‡ — 82.3 42.1 38.3 56.2 39.8 ‡ — 59.5 60.2 44.9 39.4 —‡ 59.8 —‡ —‡ 70.6 88.0 51.2 29.7 56.7 66.4 50.0 74.5 N 301 401 290 ‡ — 1,067 286 66 106 106 ‡ — 338 523 206 48 —‡ 384 —‡ —‡ 153 259 159 514 98 41 255 325 Rate 51.2 9.8 49.2 ‡ — 53.1 27.9 39.8 30.9 19.6 ‡ — 41.3 39.6 32.8 22.3 —‡ 36.5 —‡ —‡ 34.8 53.0 30.3 20.1 42.6 45.2 31.6 46.7 55-64 N 75 738 69 ‡ — 348 88 25 29 45 ‡ — 92 150 52 15 —‡ 100 —‡ —‡ 54 71 45 172 30 6 62 86 ** Age in years. †† Rate per 100,000 population. 65-74 75-84 Rate N Rate N 18.6 30.2 20.8 ‡ — 23.3 14.0 24.1 13.2 12.1 ‡ — 18.6 18.0 13.2 — ll —‡ 14.2 —‡ —‡ 16.9 23.5 12.9 10.6 22.0 — ll 12.9 19.1 42 384 32 ‡ — 210 39 9 8 13 ‡ — 51 66 21 8 —‡ 48 —‡ —‡ 21 30 17 114 8 7 37 34 12.3 19.9 14.3 ‡ — 14.5 9.3 — ll — ll — ll ‡ — 11.5 10.2 7.2 — ll —‡ 9.1 —‡ —‡ 8.8 13.7 — ll 10.3 — ll — ll 10.8 9.7 30 288 23 ‡ — 189 17 11 11 7 ‡ — 47 50 21 9 —‡ 25 —‡ —‡ 14 14 7 50 9 —¶ 32 15 Rate 13.5 22.3 16.6 ‡ — 17.9 — ll — ll — ll — ll ‡ — 15.7 11.5 10.0 — ll —‡ 7.8 —‡ —‡ — ll — ll — ll 7.4 — ll — ll 13.7 — ll 85+ N Rate 10 95 12 ‡ — 72 ¶ — ¶ — ¶ — ¶ — ‡ — 11 15 ¶ — ¶ — —‡ 8 —‡ —‡ 6 15 ¶ — 28 —¶ —¶ 16 12 — ll 22.4 — ll ‡ — 22.4 — ll — ll — ll — ll ‡ — — ll — ll — ll — ll —‡ — ll —‡ —‡ — ll — ll — ll 12.0 — ll — ll — ll — ll FIGURE 9d. Suicide Indicator: Suicide (Overall), 1999 Age Adjusted Rate per 100,000 Number Arizona —‡ Rate —‡ California 3,044 9.8 Colorado 567 13.9 Delaware 86 11.2§ Florida 2,075 13.0 Georgia 860 11.7 Hawaii 133 11.3 Kansas 298 11.5 Kentucky 473 12.8 Louisiana 511 12.3 Massachusetts 430 6.9 Michigan 969 10.0 Minnesota 439 9.4 Nebraska 177 10.9 New Mexico 318 19.5 North Carolina 880 11.3 North Dakota 73 Ohio 1,144 10.4 Oklahoma 454 14.0 Oregon 493 14.9 South Carolina 419 10.9 Texas 1,981 9.9 Utah 282 14.3 Vermont 63 10.3 Washington 820 14.5 Wisconsin 616 11.9 0 4 8 12 16 11.6§ § 20 * Incompleteness can lead to bias. § Rate=[(male rate*pop) + (female rate*pop)] / (male+female pop). † Subjective assessment by health department staff that a substantial proportion of state residents injured in-state who require hospitalization are hospitalized in a neighboring state. ll Rates are suppressed if fewer than 20 cases were reported. ‡ No data available. ¶ Case counts are suppressed if fewer than 5 cases were reported. FIGURE 9e. Suicide Indicator: Suicide by Sex, 1999 Males Number of Cases Age Adjusted Rate per 100,000 Males Females Arizona ‡ California 15.7 2,398 646 Colorado 22.0 446 121 —‡ Females Age Adjusted Rate per 100,000 —‡ ll Arizona — California 3.9 Colorado 5.8 Delaware 19.8 73 13 Delaware — Florida 20.8 1,605 470 Florida 5.7 Georgia 19.6 690 170 Georgia 4.3 Hawaii 17.9 105 28 Hawaii 4.7 Kansas 19.5 250 48 Kansas 3.7 Kentucky 21.6 389 84 Kentucky 4.4 Louisiana 20.9 412 99 Louisiana 4.4 Massachusetts 10.9 329 101 Massachusetts 3.1 Michigan 16.8 784 183 Michigan 3.6 Minnesota 15.9 367 72 Minnesota 3.0 Nebraska 19.3 154 23 Nebraska 2.8 New Mexico 32.2 262 56 New Mexico 6.5 North Carolina 18.5 701 179 North Carolina 4.4 North Dakota 17.9 56 Ohio 17.8 939 Oklahoma 23.3 369 Oregon 25.2 410 South Carolina 18.2 Texas Utah Vermont 17.3 49 14 Washington 23.3 649 Wisconsin 19.3 490 0 North Dakota — 205 Ohio 3.5 85 Oklahoma 5.2 83 Oregon 4.8 335 84 South Carolina 4.1 16.0 1,582 399 Texas 3.9 24.3 241 41 Utah 4.3 Vermont — 171 Washington 5.8 126 Wisconsin 4.7 5 10 15 20 25 30 17 ll ll 35 ‡ No data available. ll Rates are suppressed if fewer than 20 cases were reported. ¶ Case counts are suppressed if fewer than 5 cases were reported. 0 1 2 3 4 5 6 7 FIGURE 9f. Suicide Indicator: Suicide by Age**, 1999 State <1 AZ CA CO DE FL GA HI KS KY LA MA MI MN NE NM NC ND OH OK OR SC TX UT VT WA WI ‡ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — —¶ 5-14 1-4 Rate N ‡ — —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll †† Rate N ‡ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — ¶ — —¶ ‡ — —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll 15-24 Rate N ‡ — 26 ¶ — ¶ — 7 8 ¶ — 5 ¶ — 6 10 13 ¶ — ¶ — ¶ — 9 ¶ — 11 ¶ — ¶ — 8 23 ¶ — ¶ — ¶ — 8 ‡ — 0.5 —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll —ll 0.7 —ll —ll —ll —ll 25-34 Rate N ‡ — 311 86 10 166 118 14 55 54 80 45 137 78 34 62 127 18 157 73 55 64 286 62 8 125 105 ‡ — 6.6 14.3 —ll 9.0 10.6 —ll 13.8 9.4 11.5 5.1 10.2 11.4 13.5 23.5 11.4 —ll 10.0 14.5 12.0 11.5 9.4 15.3 —ll 15.6 13.8 ‡ — 512 101 17 299 184 38 55 90 99 84 188 68 38 54 161 13 193 98 67 61 360 55 8 135 98 ‡ No data available. ll Rates are suppressed if fewer than 20 cases were reported. ¶ Case counts are suppressed if fewer than 5 cases were reported. 45-54 35-44 Rate N ‡ — 10.0 15.3 —ll 15.1 15.3 25.9 16.2 16.6 17.3 8.4 13.1 10.8 18.4 25.6 13.2 —ll 12.6 23.5 15.8 10.9 13.0 16.7 —ll 16.0 14.2 Rate N ‡ — 641 135 27 457 173 13 62 118 96 105 217 113 40 69 189 10 252 103 107 96 447 68 17 173 128 ‡ — 11.5 18.7 20.7 19.7 12.9 —ll 14.5 18.4 14.2 10.3 13.5 13.9 15.3 24.8 14.9 —ll 13.8 20.3 20.3 15.3 13.7 21.8 —ll 17.7 14.7 55-64 Rate N ‡ — 593 105 14 389 132 9 52 80 90 74 173 75 26 54 169 8 173 66 105 65 347 44 8 149 113 ‡ — 14.4 17.8 —ll 19.4 12.9 —ll 15.2 14.8 15.8 9.0 13.1 12.0 12.1 23.5 16.0 —ll 11.6 15.0 21.5 12.4 13.6 19.1 —ll 18.5 16.2 ‡ — 316 50 7 202 87 ¶ — 27 42 50 55 94 37 17 29 92 9 107 38 45 60 178 19 6 77 62 ** Age in years. †† 65-74 Rate N Rate per 100,000 population. ‡ — 12.9 15.1 —ll 13.5 13.8 —ll 12.3 11.3 13.0 11.1 11.3 9.4 —ll 19.4 13.0 —ll 10.8 11.9 14.9 17.2 11.0 —ll —ll 16.0 13.8 75-84 Rate N ‡ — 282 40 ¶ — 244 78 5 19 39 38 20 67 22 12 20 69 5 122 30 49 34 170 20 6 68 46 ‡ — 14.6 17.9 —ll 16.9 18.6 —ll —ll 14.6 13.7 4.5 10.4 7.6 —ll 18.0 13.1 —ll 15.5 12.6 22.4 12.7 15.3 20.2 —ll 19.8 13.2 85+ Rate N ‡ — 255 36 ¶ — 219 70 ¶ — 18 33 37 24 56 38 9 22 50 5 98 35 46 24 135 8 7 66 35 Rate N ‡ — 19.7 26.1 —ll 20.7 27.3 —ll —ll 19.6 22.0 8.0 12.9 18.1 —ll 32.8 15.5 —ll 18.3 22.8 28.7 15.1 20.0 —ll —ll 28.2 14.1 ‡ — 108 11 ¶ — 89 10 ¶ — 5 15 15 13 24 ¶ — ¶ — 6 14 ¶ — 31 7 17 7 35 5 ¶ — 24 21 ‡ — 25.5 —ll —ll 27.7 —ll —ll —ll —ll —ll —ll 16.7 —ll —ll —ll —ll —ll 17.6 —ll —ll —ll 15.0 —ll —ll 29.4 22.2 FIGURE 9g. Suicide Indicator: Percentage of High School Students Reporting Suicide Attempt During Past 12 Months, 1999, Youth Risk Behavior Survey Percent Arizona ‡ California ‡ Colorado ‡ Delaware 7.5 Florida 17.4 Georgia ‡ Hawaii 10.1 Kansas ‡ Kentucky 6.7 Louisiana ‡ Massachusetts 8.3 Michigan 7.9 Minnesota ‡ Nebraska 5.5 New Mexico 7.7 North Carolina ‡ North Dakota 6.4 Ohio 7.8 Oklahoma ‡ Oregon ‡ South Carolina 7.9 Texas ‡ Utah 6.9 Vermont 6.4 Washington ‡ Wisconsin 8.2 0 4 8 12 16 20 Note: No data available for Arizona, California, Colorado, Georgia, Kansas, Louisiana, Minnesota, North Carolina, Oklahoma, Oregon, Texas, and Washington. FIGURE 9h. Suicide Indicator: Percentage of High School Students Reporting Suicide Attempt During Past 12 Months by Sex, 1999, Youth Risk Behavior Survey Males Females Percent Percent Arizona ‡ Arizona ‡ California ‡ California ‡ Colorado ‡ Colorado ‡ Delaware 4.4 Delaware 10.5 Florida 21.0 Florida 13.7 Georgia ‡ Georgia ‡ Hawaii 5.2 Hawaii 14.3 Kansas ‡ Kansas ‡ Kentucky 4.7 Kentucky 8.3 Louisiana ‡ Louisiana ‡ Massachusetts 6.3 Massachusetts 10.7 Michigan 5.5 Michigan 10.0 Minnesota ‡ Minnesota ‡ Nebraska 3.3 Nebraska 7.5 New Mexico 4.8 New Mexico 10.1 North Carolina ‡ North Carolina ‡ North Dakota 4.2 North Dakota 8.5 Ohio 5.0 Ohio 10.6 Oklahoma ‡ Oklahoma ‡ Oregon ‡ Oregon ‡ South Carolina 5.4 South Carolina 10.2 Texas ‡ Texas ‡ Utah 4.8 Utah 8.6 Vermont 4.8 Vermont 8.0 Washington ‡ Washington ‡ Wisconsin 5.1 Wisconsin 11.2 0 3 6 9 12 15 18 21 0 3 Note: No data available for Arizona, California, Colorado, Georgia, Kansas, Louisiana, Minnesota, North Carolina, Oklahoma, Oregon, Texas, and Washington. 6 9 12 15 Appendix – Instructions for Calculating National Public Health Surveillance System Indicators Using 1999 Data Instructions referenced in this report were circulated to the states to help them prepare 1999 data. While the format for those instructions has been modified for presentation here, the content is the same. Note: In the future, CDC will modify instructions based upon feedback received. Instructions for calculating the National Public Health Surveillance System (NPHSS) indicators will be modified as appropriate in subsequent data collection cycles. Data Source: Death Certificates Mortality indicators should be age-adjusted to the 2000 standard using CDC’s National Center for Health Statistics (NCHS) population distribution (Table 1). Calculate age-adjusted rates for both the male and female populations. ➤ Computation of Rates ➤ ➤ ➤ Compute rates per 100,000 population. Use the estimated population for the year of the data. Obtain that estimate from your state’s demographic center or from: www.census.gov/population/ http://eire.census.gov/popest/estimates.php ➤ ➤ With the exception of the fatal TBI indicator, all fatal indicators should be calculated by searching the underlying cause of death field only. For the fatal TBI indicator, search all fields in a multiple cause of death file. Count deaths of state residents only. For each indicator, report the age-adjusted rates stratified by sex (female and male), and report the overall age-adjusted rate for the state as the weighted average of the age-adjusted male and female rates as follows: Round rates to one decimal place. Overall Rate Appendix – 103 = AgeAdjusted Male X Male Population Rate + AgeAdjusted Female X Female Population Rate Male Population + Female Popluation Report age-specific rates for each indicator in the following age categories: Under 1 Suicide: X60–X84, Y87.0 45–54 1–4 55–64 5–14 65–74 15–24 75–84 25–34 85+ Fatal Motor Vehicle Traffic injuries: V30–V39 (.4–.9), V40–V49 (.4–.9), V50–V59 (.4–.9), V60–V69 (.4–.9), V70–V79(.4–.9), V81.1, V82.1, V83–V86 (.0–.3), V20–V28 (.3–.9), V29 (.4–.9), V12–V14 (.3–.9), V19 (.4–.6), V02–V04 (.1, .9), V09.2, V80 (.3–.5), V87 (.0–.8), V89.2 35–44 Poisoning: X40–X49, X60–X69, X85–X90, Y10–Y19, Y35.2 Indicators Fatal TBI: S01.0–S01.9, S02.0, S02.1, S02.3, S02.7–S02.9, S06.0–S06.9, S07.0, S07.1, S07.8, S07.9, S09.7–S09.9, T01.0, T02.0, T04.0, T06.0, T90.1, T90.2, T90.4, T90.5, T90.8, T90.9 Data Source: Hospital Discharge Data (HDD) ➤ ➤ Drowning: (1) Unintentional: W65–W74 (2) Water transport: V90, V92 ➤ Fatal Fire-Related Injuries: X00-X09 ➤ Fatal Firearm Injuries: W32–W34, X72–X74, X93–X95, Y22–Y24, Y35.0 ➤ Homicide: X85–Y09, Y87.1 Appendix – 104 Hospitalizations should be age-adjusted to the 2000 standard using NCHS population distribution (Table 1). Include only non-federal, acute care, or inpatient facilities in your HDD data set. This excludes VA and other federal hospitals, rehabilitation centers, and psychiatric hospitals. Include readmissions, transfers, and deaths occuring in the hospital. Count hospitalizations of state residents only. In order to calculate Injury Hospitalization Indicators, first you need to create a subset of hospital discharge records based on the principal diagnosis field. The subset you create will be injury hospitalizations, defined as follows. ➤ Injury hospitalization: Records in which the principal reason for admission, after study, to a non-federal, acute care, inpatient facility was an injury, including late effects, but excluding adverse effects of therapeutic use of drugs and adverse effects of medical/surgical care and the late effects of those adverse effects. Instructions for Creating the Injury Hospitalizations Subset of a State Hospital Discharge Data Set Search only the principal diagnostic code field for the included N-codes. Exclude all other records from the injury hospitalization subset. Include Once the injury hospitalization subset has been created, calculate the injury indicators defined below by searching for E-codes in the following manner: Search all diagnosis fields. If there is a designated E-code field in your data set, start with the designated E-code field. Count the first-listed valid E-code, unless it is E849, E967, E869.4, E870–879, or E930–949, in which case, search any additional E-code fields and all diagnostic fields and use the next listed valid E-code. For each indicator, report the age-adjusted rates stratified by sex (female and male), and report the overall ageadjusted rate for the state as the weighted average of the age-adjusted male and female rates as follows: Exclude 305 < 305 518 (only if there is also a corresponding E-code of E830, E832, E910, E854, E864, or E884) 306–800 (with the exception of 518 as noted under “include”) 800–909.2 909.3 909.4 909.5 909.9–994.9 995.0–995.4 995.5–995.59 995.6–995.7 995.80–995.85 995.86, 995.89 Overall Rate = AgeAdjusted Male X Male Population Rate + AgeAdjusted Female X Female Population Rate Male Population + Female Popluation Report age-specific rates for each indicator in the following age categories: Under 1 996–999 1–4 55–64 5–14 65–74 15–24 75–84 25–34 85+ 35–44 Appendix – 105 45–54 Indicators Hospitalizations for Motor Vehicle Injuries: E-codes E810–E825 E-codes E810–E819 Hospitalizations for Injury: N-codes 800–909.2, 909.4, 909.9–994.9, 995.5–995.59, 995.80–995.85. Search for N-code only in the principal diagnostic field. Hospitalizations for Poisoning: E-codes E850–E869, E950–E952, E962, E972, and E980–E982 The case count for hospitalizations for injury should be equivalent to the number of records in your injury hospitalization subset. Percentage of HDD Injury Hospitalizations with External Cause Coding: Hospitalizations for TBI: N-codes 800.0–801.9, 803.0–804.9, 850.0–854.1, 959.01. Search all diagnosis fields of the injury hospitalization subset. Hospitalizations for Near Drowning: N-code 994.1 and/or E-codes E830, E832, E910, E954, E964, or E984 Search all diagnosis fields for N-code. Search for E-codes as described above. Percentage of HDD Injury Hospitalizations = with External Cause Coding Hospitalizations for Fire-Related injuries: E-codes E890–E899 Hospitalizations for Firearm Injuries: E-codes E922.0–E922.3, E922.9, E955.0–E955.4, E965.0–E965.4, E985.0–E985.4, or E970 Hospitalizations for Suicide Attempts: E-codes E950–E959 Number of records with principal diagnosis of ICD-9 CM 800–994, 995.5 and 995.80–995.85, excluding ICD-9 CM 909.3 and 909.5 that have a valid E-code other than E849, E967, E869.4, E870–879, or E930–949 All Hospital Discharge Records with Injury Principal Diagnosis and Associated E-code x All Hospital Discharge Records with an Injury Principal Diagnosis 100 Number of records with principal diagnosis of ICD-9 CM 800–994, 995.5 and 995.80–995.85, excluding ICD-9 CM 909.3 and 909.5 Note: Please submit rates for fatal and hospitalization indicators in the accompanying Excel spreadsheets to facilitate CDC’s Injury Center compilation of the results. Appendix – 106 Data Source: Fatality Analysis Reporting System (FARS) Indicators based on BRFSS, YRBS, and FARS will be calculated at CDC and sent to participating state health departments for their review. Alcohol-involved Motor Vehicle Crash (MVC) Deaths: An alcohol-related crash death is defined as a death in a motor vehicle traffic crash where either the driver or nonoccupant (e.g., pedestrian) had a blood alcohol concentration (BAC) > 0.01 g/dL in a police-reported traffic crash. Data Source: Behavioral Risk Factor Surveillance System (BRFSS) ➤ Not all BRFSS questions are asked every year. In 1999, the only injury questions asked pertained to the indicators listed below. ➤ BRFSS indicators are at: www.cdc.gov/nccdphp ➤ Report percentage of respondents. ➤ State-specific counts are published by National Highway Traffic Safety Administration (NHTSA) in the annual publication Traffic Safety Facts. To calculate the crude alcohol-involved MVC death rate, look up the count in Table 114 “Persons Killed, by State and Highest Blood Alcohol Concentration in the Crash.” The numerator for calculating this rate is in the column “Total Killed in Alcohol-Related Crashes.” Use the estimated state population for the year as the denominator. Using this method, it will not be possible to calculate age-adjusted rates, as agespecific counts are not provided in the tables. Percentage of Adults Reporting Driving after Perhaps Having Too Much to Drink, in the Past Month: How often have you driven after having perhaps too much to drink during the last 30 days? Report percentage answering one or more times. Data Source: Youth Risk Behavior Survey (YRBS) ➤ ➤ ➤ ➤ ➤ YRBS is a biennial survey. YRBS indicators should be reported as percentage of respondents. Do not age adjust. Percentage of High School Students Reporting Suicide Attempt During Past 12 Months: Report percentage of respondents answering one or more attempts. Percentage of High School Students Reporting Always Using Safety Belts: How often do you wear a seatbelt when riding in a car driven by someone else? Report percentage of respondents answering “Always”. Appendix – 107 Table 1. Age Adjustment Table All Ages — Eleven Age Groups Age U.S. 2000 Standard Population (1,000’s) Adjustment Weights All ages 274,634 1.000000 Under 1 3,795 0.013818 1–4 15,192 0.055317 5–14 39,977 0.145565 15–24 38,077 0.138646 25–34 37,233 0.135573 35–44 44,659 0.162613 45–54 37,030 0.134834 55–64 23,961 0.087247 65–74 18,136 0.066037 75–84 12,315 0.044842 4,259 0.015508 85+ Appendix – 108
