Injury mortality in the European Union 1984-1993: An overview

Background: Approximately 190,000 European Union (EU) citizensdie annually as a result of an injury. In response, the EuropeanCommission identified accidents and injuries as a priority areafor action in the field of public health in 1993. In 1984, theWorld Health Organization (WHO) Health for All targets wereset in Europe to reduce unintentional injuries by 25% and reversethe rising trends in suicide by the year 2000. The aim of thisstudy was to examine the trends in mortality due to externallycaused physical injuries between 1984 and 1993 in the 15 countrieswhich are currently members of the EU. Methods: Injury mortalitydata for all countries were obtained from the WHO and nationalgovernment agencies. Age-standardized mortality rates were calculatedfor both unintentional and intentional injuries and examinedover time. Results: Downward trends in age-standardized injurymortality due to unintentional injuries were identified in mostcountries. Marked variations were observed between countries,with low rates in the UK, The Netherlands and Sweden and highrates in Finland, Portugal and France. Age-standardized suiciderates decreased In most countries over the study period, withmarked variations between countries. In general, countries innorthern Europe experienced higher suicide rates than countriesin southern Europe. Mortality rates due to homicide and otherviolent causes were low and relatively stable over the studyperiod. Conclusions: Most countries appear to be on track tomeet the WHO targets for unintentional injury mortality andsuicide mortality. However, disparities between countries remain,for reasons that are unclear. While mortality data were valuablein describing the epidemiology of fatal injury in Europe, agreementon standardized practices of data collection, coding and analysiswould improve the comparability of data between countries.     

Unintentional injury mortality in India, 2005: Nationally representative mortality survey of 1.1 million homes

ABSTRACT: BACKGROUND: Unintentional injuries are an important cause of death in India. However, no reliable nationally representative estimates of unintentional injury deaths are available. Thus, we examined unintentional injury deaths in a nationally representative mortality survey. METHODS: Trained field staff interviewed a living relative of those who had died during 2001-03. The verbal autopsy reports were sent to two of the130 trained physicians, who independently assigned an ICD-10 code to each death. Discrepancies were resolved through reconciliation and adjudication. Proportionate cause specific mortality was used to produce national unintentional injury mortality estimates based on United Nations population and death estimates. RESULTS: In 2005, unintentional injury caused 648 000 deaths (7% of all deaths; 58/100 000 population). Unintentional injury mortality rates were higher among males than females, and in rural versus urban areas. Road traffic injuries (185 000 deaths; 29% of all unintentional injury deaths), falls (160 000 deaths, 25%) and drowning (73 000 deaths, 11%) were the three leading causes of unintentional injury mortality, with fire-related injury causing 5% of these deaths. The highest unintentional mortality rates were in those aged 70 years or older (410/100 000). CONCLUSIONS: These direct estimates of unintentional injury deaths in India (0.6 million) are lower than WHO indirect estimates (0.8 million), but double the estimates which rely on police reports (0.3 million). Importantly, they revise upward the mortality due to falls, particularly in the elderly, and revise downward mortality due to fires. Ongoing monitoring of injury mortality will enable development of evidence based injury prevention programs.     

2014年广西壮族自治区居民伤害死亡谱及疾病负担分析

目的 了解2014年广西壮族自治区疾病监测点居民伤害死亡谱及疾病负担,为制定伤害预防控制措施提供科学依据。方法 利用死亡率、标化死亡率、潜在寿命损失年（years of potential life lost,YPLL）指标, 分析广西居民伤害死亡谱及所致的疾病负担。结果 2014年广西疾病监测点居民伤害死亡率为45.58/10 万、标化死亡率46.45/10 万,男性伤害死亡率为女性的2.36 倍。居民伤害死因前5 位依次为道路交通事故、意外跌落、其他意外伤害、溺水、自杀及后遗症。伤害首位死因0～14岁组为溺水、15～64岁为道路交通事故、≥65岁年龄组为意外跌落。伤害死亡前5位YPLL为道路交通事故、溺水、其他意外伤害、意外跌落和意外中毒。因伤害“早死”导致的YPLL为269 651.9人年、28.59年/人。结论 伤害给广西居民带来沉重的负担,不同性别及城乡之间伤害谱不尽相同,应根据实际情况制定有效的伤害预防控制策略和措施。     

Adolescent injury mortality in New Zealand and opportunities for prevention

Injury is recognised internationally as the major threat to adolescent health. The purpose of this study was to describe the epidemiology of adolescent fatal injury in New Zealand, and to examine opportunities for prevention. National mortality data were searched to identify all 15-19 year-olds, who died from injuries in the period 1986-1995. Leading causes of injury were reviewed in light of known risk factors, injury mortality rates in other industrialised countries, and available prevention strategies. The results showed that injury accounted for 2,095 deaths (72.8 per 100,000 person years). Males comprised 77% of victims (110.6 per 100,000 person years), and there was a three-fold increase in mortality from age 15 (35.3 per 100,000 person years) to 19 years (106.4 per 100,000 person years). The leading causes of death were road traffic crashes (42.6 per 100,000 person years), suicide (16.4 per 100,000 person years), and unintentional drowning (3.6 per 100,000 person years). The Graduated Driver Licensing System addresses a range of risk factors for adolescent road traffic crashes. Despite inadequate enforcement, early indications are that it has yielded modest reductions in injury. Hazardous drinking is implicated in the high rates of road traffic crashes and drownings, and given recent liberalization of supply-side policies, proactive identification of hazardous drinkers followed by brief intervention holds promise as a prevention measure. Suicide accounts for an increasing rate of adolescent deaths in New Zealand. The effect of national policies to address a range of suicide risk factors remains to be fully evaluated.     

Unintentional injury in Ireland: a comparison of mortality and morbidity data

BACKGROUND: The aim of this study was to examine the relationship between mortality and hospital admission data for the leading causes of unintentional injury in Ireland. METHODS: Mortality data were obtained from the Central Statistics Office for the years 1980-1996. Information on hospital admissions was obtained from the Hospital In-Patient Enquiry system for the years 1993-1997. RESULTS: Motor vehicle traffic accidents were the leading cause of unintentional injury death. Falls were the most common cause of unintentional injury hospital admission. Drowning and suffocation had high ratios of deaths to admissions, 2:1 and 1:3, respectively. The ratio of deaths to admissions was 1:39 for all unintentional injuries. CONCLUSION: Neither mortality data nor admissions data alone give an adequate guide to the impact of injuries, but together the two provide a reasonable basis on which to establish policy.     

Unintentional injury mortality in the European Union: how many more lives could be saved?

AIMS: The wide variation of unintentional (accidental) injury mortality rates in the European Union (EU) member states suggests that there is high potential for prevention. This paper attempts to quantify the potential for saving lives in this part of the world if all 25 member states were to learn from the experience of countries with advanced injury prevention records. METHODS: Unintentional injury mortality data (latest three available years), including denominator population estimates, were obtained from the World Health Organization (WHO) mortality database for all 22 EU countries with a population of more than one million. Annual average age-adjusted injury mortality rates were used to derive the potential for saving of lives under two scenarios: (a) if all EU member states matched the country with the lowest unintentional rate for all causes of injury combined; (b) if the benchmark was alternatively the country with the lowest unintentional injury cause-specific rate. Separate calculations were performed for children (0-14), adults (15-64), and the elderly (65 and over). RESULTS: Under the first scenario, over 73,000 lives could have been saved in the EU 25 in a single year, notably nearly half (47.4%) fewer unintentional injury deaths could be observed in children, over half in adult (54%), and two-fifths (38%) in the elderly. Under the second, more optimistic, scenario 59% of childhood and adult and 75% of unintentional injury deaths among the elderly would have been avoided. CONCLUSIONS: A substantial proportion of lives lost due to unintentional injury might be saved if all countries were to achieve the lowest unintentional injury mortality rates in the EU. The above calculations are based on a simple theoretical model but there is increasing evidence on the array of existing effective preventive interventions and improved trauma care calls for public health action in each member state that could in practice halt, to the extent possible, the unintentional injury epidemic.     

Preventing child unintentional injury deaths: prioritising the response to the New Zealand Child and Adolescent Injury Report Card

Objective: To develop recommendations for child unintentional injury prevention by comparing New Zealand's child unintentional injury mortality and injury prevention policies with those of European countries. Methods: Unintentional child injury death rates based on external cause of injury were calculated and ranked. NZ's score for each of the 12 domains (based on external causes of injury) from the New Zealand Child and Adolescent Report Card was compared to European scoring. Policy priorities are identified by domains where mortality makes up a high proportion of overall child unintentional injury mortality (high burden of injury) and where report card score for that domain is low in comparison to other countries (under‐utilisation of effective interventions). Results: Death as a motor vehicle occupant accounts for 49% of all child unintentional injury deaths, followed by pedestrian (10%) and drowning deaths (8%). The overall score for the 12 policy domains of the NZ Report Card ranks NZ as 15^th among the 25 European countries. There are important policy and legislative actions which NZ has not implemented. Conclusions: A number of evidence‐based injury prevention policy and legislative actions are available that could target areas of greatest childhood injury mortality in NZ. Implications: A set of injury prevention policy and legislation priorities are presented which, if implemented, would result in a significant reduction in the injury mortality and morbidity rates of NZ children.     

At risk in two worlds: Injury mortality among Indigenous people in the US and Australia, 1990–92

This paper outlines the commonalties and unique differences in injury experience among the Indigenous people in the United States and Australia. Injury mortality rates among Indigenous people in the United States and Australia are approximately 2–3 times greater than rates for the non-Indigenous population in each country. Motor vehicle-related injuries accounted for one-third of the injury deaths for Native Americans and Australian Aboriginals. Suicide accounted for more deaths in Native Americans (15.5 per 100,000) than it did for Australian Aboriginals (11.1 per 100,000), whereas the injury death rate in Australian Aboriginals due to poisoning was almost twice that of Native Americans. Culturally appropriate interventions tailored to specific local settings and problems will be necessary to reduce injury mortality among Indigenous people.     

Suicide mortality in the European Union

BACKGROUND: There are an estimated one million completed suicides per year worldwide. As a response to increasing concern about suicide within Europe, the EUROSAVE (European Review of Suicide and Violence Epidemiology) study was undertaken to examine recent trends in the epidemiology of suicide and self-inflicted injury mortality in the European Union (EU). METHODS: Suicide and self-inflicted injury mortality data for the 15 EU countries for the years 1984-1998 were obtained from the World Health Organisation (WHO), the European Statistical Office of the European Commission (EUROSTAT) and national statistical agencies. Data were also obtained for a second group of deaths classified as 'undetermined' or 'other violence'. Age-standardized mortality rates were calculated and examined for trends over time. RESULTS: Finland had the highest suicide rate, while Greece had the lowest for the latest available year (1997). Age-standardized suicide rates tended to be lowest in the Mediterranean countries. Significant downward linear time trends in suicide mortality were observed in most countries, although rates varied markedly between countries. Both Ireland and Spain displayed significant upward linear trends in suicide mortality. Portugal had the highest rate of undetermined deaths both in 1984 and 1998 while Greece had the lowest in both 1984 and 1997. Five countries (including Ireland and Spain) showed significant downward trends in deaths due to undetermined causes whereas Belgium and Germany showed borderline significant upward linear trends in deaths due to undetermined causes. CONCLUSIONS: Although suicide rates in most countries seem to be decreasing, the validity of the data is uncertain. Misclassification may contribute to the geographical and temporal variation in suicide rates in some EU countries but it does not explain the phenomenon. More detailed research comparing suicide-recording procedures and practices across the EU is required. In the absence of adequate EU wide data on suicide epidemiology, effective prevention of this distressing phenomenon is likely to remain elusive.     

Fatal Injuries in the Slums of Nairobi and their Risk Factors: Results from a Matched Case-Control Study

Injuries contribute significantly to the rising morbidity and mortality attributable to non-communicable diseases in the developing world. Unfortunately, active injury surveillance is lacking in many developing countries, including Kenya. This study aims to describe and identify causes of and risk factors for fatal injuries in two slums in Nairobi city using a demographic surveillance system framework. The causes of death are determined using verbal autopsies. We used a nested case-control study design with all deaths from injuries between 2003 and 2005 as cases. Two controls were randomly selected from the non-injury deaths over the same period and individually matched to each case on age and sex. We used conditional logistic regression modeling to identity individual- and community-level factors associated with fatal injuries. Intentional injuries accounted for about 51% and unintentional injuries accounted for 49% of all injuries. Homicides accounted for 91% of intentional injuries and 47% of all injury-related deaths. Firearms (23%) and road traffic crashes (22%) were the leading single causes of deaths due to injuries. About 15% of injuries were due to substance intoxication, particularly alcohol, which in this community comes from illicit brews and is at times contaminated with methanol. Results suggest that in the pervasively unsafe and insecure environment that characterizes the urban slums, ethnicity, residence, and area level factors contribute significantly to the risk of injury-related mortality.     

金山区居民伤害死亡原因及控制策略

[目的 ]　了解伤害死亡对各年龄组人群的危害程度及变化趋势 ,探讨伤害预防控制的对策。[方法 ]　按国际疾病分类第九版 (ICD -9)进行死因分类 ,统计分析伤害死亡率、潜在减寿年数 (YPLL)、标化YPLL、YPLL标化率。[结果 ]　金山区居民伤害死亡率仅次于呼吸系统病、循环系统病和肿瘤 ,居第 4位 ,占全区居民死亡人数的 7.0 3 %～ 8.77% ,前 4位伤害死因依次为交通事故 ( 3 4 .2 1% )、自杀 ( 2 0 .10 % )、意外跌落 ( 14 .18% )和溺水 ( 13 .75 % )。全人群非故意伤害和故意伤害标化死亡率分别为 40 .71/10万、9.95 /10万。经YPLL分析 ,伤害死亡死因位次由原来的第 4位升至首位 ,1～ 14岁儿童潜在寿命损失为 64 .61年 /千人 ,居各年龄组之首。 [结论 ]　伤害死亡对居民的危害和潜在寿命损失不容忽视 ,应当建立伤害报告信息管理系统 ,采取以社区为基础的干预对策控制伤害发生。     

Intentional and unintentional injury in the State of Nevada: 1989–1992

Introduction: Data from a large population-based trauma registry were used to assess risk factors and outcomes associated with injuries that were either caused unintentionally, were self-inflicted, or resulted from an assault.Design: A retrospective analysis was conducted of all cases of serious trauma (N = 19,505) occurring in the State of Nevada during the 4-year period from January 1, 1989, through December 31, 1992. The outcome measures of interest were Injury Severity Score, hospitalization, and mortality.Results: Of all patients with unintentional injuries, 9.9% died compared with 44.8% of those whose injuries were intentionally caused. Nearly half (49.0%) of all deaths occurred in persons who were intentionally injured. Of the intentional injuries, 70% were from assaults. Self-inflicted injuries accounted for 5.2% of all injuries but 28.2% of the deaths in the registry. Firearms were most often used in both assaults (38.8%) and self-inflicted injuries (87.4%). Logistic regressions showed that, compared with unintentional injuries, assaults were more likely to occur in urban counties, among males, African Americans, and young adults. Also, compared with unintentional injuries, self-inflicted injuries were more likely to occur in urban counties, among Caucasian, and the 65+ age group.Conclusion: Although the overwhelming number of injuries in the registry were unintentionally caused, deaths from intentionally caused injuries accounted for almost half of all deaths. The data from Nevada's registry provided the ability to identify who is at risk for trauma-related injury and death. Prevention programs should be designed to target these populations. As prevention programs are implemented, trauma registries such as Nevada's will provide a sound source of data for assessing long-term trends in injury patterns.     

Injury mortality rates in Native and non-Native children: a population-based study

OBJECTIVES: To examine injury mortality rates in Native and non-Native children in the province of Alberta, Canada, over a 10-year period, temporal trends in injury mortality rates (Native vs. non-Native), as well as relative risks of injury mortality (Native vs. non-Native) by injury mechanism and intent, were calculated. METHODS: An observational, population-based study design was used. Mortality data were obtained from provincial vital statistics, with injury deaths identified using external injury codes (E-codes). The relative risk (RR) of injury mortality (Native vs. non-Native) along with 95% confidence intervals (CIs) were calculated. Stratified analyses and Poisson regression modeling were used to calculate adjusted relative risk. RESULTS: Injury mortality rates declined over the study period, with no difference in the rate of decline between Native and non-Native children. The adjusted relative risk for all-cause injury death (Native vs. non-Native) was 4.6 (95% CI 4.1 to 5.2). The adjusted relative risks (Native vs. non-Native) by injury intent categories were: unintentional injuries, 4.0 (95% CI 3.5 to 4.6); suicide, 6.6 (95% CI 5.2 to 8.5); and homicide, 5.1 (95% CI 3.0 to 8.5). Injury mortality rates were consistently higher for Native children across all injury mechanism categories. The largest relative risks (Native vs. non-Native) were pedestrian injury (RR = 17.0), accidental poisoning (RR = 15.4), homicide by piercing objects (RR = 15.4), and suicide by hanging (RR = 13.5). CONCLUSION: The burden of injury mortality is significantly greater in Native children compared with non-Native children. Therefore, injury prevention strategies that target both intentional and unintentional injuries are needed.     

2010—2012年河南省洛阳市新安县居民伤害死亡状况分析

目的分析2010—2012年河南省新安县居民伤害死亡状况,为制定伤害防控策略和措施提供科学依据。方法选择2010—2012年河南省新安县全人群死因监测数据中常住居民的伤害死亡个案为研究对象,使用国家推荐的死因监测数据清洗与分析工具和Excel 2003进行统计分析。结果新安县居民伤害死亡居全死因的第4位,死亡率62.53/10万,标化死亡率59.30/10万,占全死因的9.54%。伤害前5位死因依次为机动车辆交通事故、意外跌落、自杀、意外中毒、淹死,占伤害死亡的84.02%。婴儿主要死因为机械性窒息;幼儿主要死因为淹死;青少年第1位为机动车辆交通事故,占40.00%,第2位为淹死,占30.00%;青年人第1位为机动车辆交通事故,占52.94%,第2位为自杀,占9.66%;中年人第1位为机动车辆交通事故,占53.21%,第2位为意外跌落,占14.44%;老年人第1位为机动车辆交通事故,占46.67%,第2位为自杀,占16.92%,第3位为意外跌落,占14.87%。结论伤害严重威胁新安县居民的生命健康,特别是机动车辆交通事故,应根据不同人群的特点,采取有效防控措施,降低伤害的发生和死亡,提高居民的生活质量。     

湖北省麻城市1974-2008年伤害死亡的长期趋势分析

目的 分析湖北省麻城市1974-2008年伤害死亡长期变化趋势、分布特点和疾病负担.方法 利用麻城市自1974年起建立的四级报告网络系统,对历年伤害死亡资料进行审核和整理,描述35年来伤害的死亡水平和主要死亡原因,并计算伤害导致的去死因期望寿命和潜在寿命损失年,以及伤害死亡和寿命损失占总死亡的比例.结果 麻城市35年伤害死亡率为62.64/10万至154.97/10万,其中男性为69.16/10万～163.86/10万,女性为55.34/10万～157.35/10万,男性高于女性.婴儿组的年平均伤害死亡率最高,达770.13/10万.伤害死亡率的地形分布以丘陵地区最高(37.03/10万),山区次之(33.66/10万),平原地区较低(31.43/10万).伤害死亡的前五位死因为自杀、淹溺、意外窒息、交通事故、意外跌落,共占伤害总死亡的84.26%,其中以自杀为最高,占伤害总死亡48.14%.伤害是儿童和青年的主要死因,在15～29岁年龄段伤害死亡占全死因比例最高,男性和女性分别为59.38%和62.26%.去伤害死亡期望寿命逐年提高,因伤害导致的潜在寿命损失年逐年下降.结论 麻城市伤害死亡率近10年虽有明显下降趋势,但仍处于较高水平;伤害主要死亡原因变化不大,各年段、年龄、性别、地形分布均以自杀为主,近年来交通事故的死亡率明显上升.     

Mortality from injuries and other causes in a cohort of 21,800 Brazilian steel workers.

OBJECTIVES: Injury is the leading cause of death in the male working population of Brazil. An important fraction of these deaths are work related. Very few cohort studies of steel workers, and none from developing countries, have reported on mortality from injuries. This paper analyses mortality from work and non-work related injuries among Brazilian steel workers. METHODS: Deaths during employment from 1 January 1977 to 30 November 1992 were analysed in a cohort of 21,816 male steel workers. Mortality rates specific for age and calendar year among the workers were compared with those of the male population of the state where the plant is located. Work related injuries were analysed by comparing the mortality rates for different subgroups of the cohort. RESULTS: The number of deaths (391) was less than half that expected based on death rates of the general population. Over 60% (242) of deaths were due to injuries. Mortality from most causes was substantially below that in the general population, but that from unintentional injury, was 50% above that of the general population. Standardised mortality ratios (SMRs) were highest for the youngest and the oldest employees and for labourers and clerical workers. Mortality from motor vehicle injury was twice that expected from population rates (SMR = 209, 95% confidence interval (95% CI) 176-244). There was a 67% fall in the age adjusted mortality from occupational injuries in the study period. CONCLUSION: The healthy worker effect in this cohort was greater than that commonly found in studies of occupational groups in developed countries, probably because of a greater socioeconomic gap between employed and unemployed populations in Brazil, and unequal distribution of health care resources. Mortality was especially high for motor vehicle injuries. The fall in mortality from occupational injuries during the study period was probably due to improvement in safety standards, increased automation, and better medical care. There is a need to investigate risk factors for unintentional injuries among steel workers, especially those due to motor vehicle injuries. Prevention of occupational and nonoccupational injuries should be a main priority in Brazil.     

Population-based study of emergency department admissions and deaths from injuries in Barcelona,Spain: Incidence,causes and severity

The aim of this study was to estimate the incidence of morbidity and mortality due to injuries in the population over the age of 14 years in Barcelona, Spain. Injury distribution according to sex, age, external cause, place of occurrence of the injury and severity was also obtained. A one-year survey was conducted in the emergency departments of the six main hospitals in Barcelona, based on a multistage sampling. Information was collected prospectively in emergency services by specially trained non-staff interviewers. Mortality data were drawn from death certificates. The incidence rate was 74.7 injury cases per 1,000 person-years over 14 years of age, higher in males than in females. Injury rates were highest in the youngest age-group and progressively lower until people over 75 years of age. Main external causes of injury were falls, being struck or caught by objects, and traffic-related injuries. The leading specific causes of injury mortality were traffic injuries, suicides and poisonings. While the overall admission incidence was 3.34 cases per 1,000 inhabitants, the proportion of hospitalized cases was 45.0 per 1,000 injury cases admitted to emergency rooms, higher for females, for traffic injuries and in the elderly population. Ninety-six percent of injury cases had an ISS value of 8 or less, mean ISS being highest for traffic injuries and falls. Injury morbidity and mortality amongst residents of Barcelona follow sex, age and cause of injury patterns which are, overall, comparable to those observed in other industrialized countries, suggesting that similar etiologic factors might be operating in those areas. The results should enable the orientation of injury prevention policies in the urban environment targeted on the young and the elderly population.     

1976-2006年大丰市居民伤害死亡趋势分析

目的了解大丰市1976—2006年居民因伤害引起的死亡现状,分析居民伤害死亡的趋势和特征,为制定伤害预防控制策略和措施提供科学依据。方法收集大丰市1976—2006年死因登记资料,用Joinpoint回归分析主要伤害死亡趋势,用Poisson回归分析性别、年龄和时间的伤害死亡率比。结果1976—2006年大丰市居民累计因伤害死亡13905人,年均死亡率为61.40/10万,其中男性死亡率为70.18/10万,女性为51.85/10万,男性高于女性（P〈0.05）。年均死亡率1976—1980年为67.96/10万,标化率为82.58/10万;2006年下降到42.37/10万,标化率为38.99/10万。引起伤害死亡的原因中位居前3位的分别是自杀、溺水和交通事故。0～14岁儿童青少年伤害死亡中溺水死亡率最高,为41.76/10万;15岁以上人群中伤害死亡以自杀和交通事故为主。31a间总的伤害死亡有下降趋势,其中自杀死亡波动较大,但仍有下降趋势;溺水死亡下降显著,死亡率从1976—1980年的27.74/10万下降到2006年的7.95/10万;交通事故死亡上升迅速,死亡率从1976—1980年的1.68/10万上升到2006年的19.34/10万。结论31a来大丰市居民伤害死亡率虽有下降趋势,但低年龄组人群伤害死亡所占构成比上升,交通事故死亡上升迅速,伤害仍然是危害居民生命健康的主要原因之一。     

Injury mortality among non-US residents in the United States 1979-1984

More than 20 million non-US residents visit the United States each year. Data on deaths in this country among these non-US residents were obtained from US vital records. These data showed that from 1979 through 1984, 17,988 deaths occurred. Cardiovascular disease (International Classification of Diseases [ICD-9] 390-459) was the leading cause of death among non-residents. Injuries (ICD-9 E800-E999) ranked second as a cause of death and accounted for 23% of the deaths (4078). More than half of these injury deaths occurred among people aged 15-34 years and 79% of the people who died from injuries were males. The most frequent causes of injury deaths were motor vehicle traffic crashes (37%), drownings (15%), and homicides (11%). Although general patterns of injury mortality among non-US residents and US residents were similar, there were differences in the proportion of deaths due to homicides, drownings, and falls. Prevention efforts targeted to the major causes of injury mortality in the US will affect both US and non-US residents.     

Unintentional injuries in the home in the United States Part I: mortality

BACKGROUND: Unintentional injuries are a leading cause of death in the United States. It is unclear, however, what proportion of these injuries occur in the home. The purpose of this paper is to quantify and describe fatal unintentional injuries that take place in the home environment. METHODS: Data from the National Vital Statistics System (NVSS) were used to calculate average annual rates for unintentional home injury deaths, with 95% confidence intervals from 1992 to 1999 for the United States overall, and by mechanism of injury, gender, and age group. RESULTS: From 1992 to 1999, an average of 18,048 unintentional home injury deaths occurred annually in the United States (6.83 deaths per 100,000). Home injury deaths varied by age and gender, with males having higher rates of home injury death than females (8.78 vs 4.97 per 100,000), and older adults (>/=70 years) having higher rates than all other age groups. Falls (2.25 per 100,000), poisoning (1.83 per 100,000), and fire/burn injuries (1.29 per 100,000) were the leading causes of home injury death. Rates of fall death were highest for older adults, poisoning deaths were highest among middle-aged adults, and fire/burn death rates were highest among children. Inhalation/suffocation and drowning deaths were important injury issues for young children. CONCLUSIONS: Unintentional injury in the home is a significant problem. Specific home injury issues include falls among older adults, poisonings among middle-aged adults, fire/burn injuries among older adults and children, and inhalation/suffocation and drowning among young children. In addition, recommendations are presented for improvements to the NVSS.