Acknowledgments. Citation: The Burden of Injury in Iowa, Iowa Department of Public Health Comprehensive Injury Report, December 2008.

Transcription

1 The Burden f Injury in Iwa December 2008 Data frm

2 Acknwledgments This reprt wuld nt have been pssible withut the supprt f Binnie LeHew, Crinne Peek-Asa PhD., and James C. Trner PhD. The wrkgrup extends its appreciatin fr their invaluable guidance, supprt and leadership. Data wrkgrup members: The key members f the data wrkgrup, respnsible fr the data analysis and drafting f this reprt, include (in alphabetic rder): Suning Ca (IDPH), Ousmane Diall (IDPH), Kathy Leinenkugel (IDPH), James Trner PhD. (IPRC), Lnda Vanderwal (IPRC), and Tracey Yung (IPRC). Prgram advisry grup members: The fllwing individuals assisted with the planning and review f the reprt. They represent varius unintentinal and intentinal injury prgrams in public health. They are, in alphabetical rder: Katrina Altenhfen (IDPH Bureau f Emergency Medical Services), Sally Clausen (IDPH Bureau f Family Health), Debbi Cper (IDPH Bureau f Envirnmental Health Services), Sctt Falb (Iwa Dept. f Transprtatin), Jhn Fiedler (IDPH Bureau f Emergency Medical Services), Jhn Hedgecth (IDPH Divisin f Acute Disease Preventin & Emergency Respnse), Cindy Heick (IDPH Bureau f Emergency Medical Services), Carl Hintn (IDPH Bureau f Family Health), Dnna Jhnsn (IDPH Bureau f Health Statistics), Craig Keugh (lcal public health), Binnie LeHew (IDPH Bureau f Disability & Vilence Preventin), Kathy Leinenkugel (IDPH Occupatinal Safety and Health Surveillance Prgram), Luise Lex PhD. (IDPH Bureau f Cmmunicatin and Planning), Jhn Lundell (University f Iwa, Injury Preventin Research Center), Crrie Peek-Asa PhD. (University f Iwa, Injury Preventin Research Center), and Lisa Rth (Blank Children s Hspital - SAFE Kids). Citatin: The Burden f Injury in Iwa, Iwa Department f Public Health Cmprehensive Injury Reprt, December 2008.

3 Table f Cntents Acknwledgments... 1 Acrnyms used in this reprt... 4 Authrs f this reprt... 4 Executive Summary... 6 Intrductin... 9 Purpse f this reprt... 9 What yu will find in this reprt Hw t use this reprt Overview f burden f injury in Iwa Injury is a majr cause f death in Iwa Mtr vehicle crashes are the leading cause f injury death in Iwa Injury-related death, hspitalizatin and emergency department visit rate trends, Iwa, Injury affects genders, races, and age grups in Iwa differently: average rates f injury (per 100,000 Iwans) by gender Injury rates (per 100,000 Iwans) by race, Injury rates (per 100,000 Iwans) by age grup, Injury death, hspitalizatin and emergency department visit rates differ by cunty size, Injuries are a large percentage f all deaths, hspitalizatins, and emergency department visits, and varies by age grup in Iwa, Mst injuries in Iwa are unintentinal ( ) Years f ptential life lst by causes and intent Specific injury indicatrs Cmparisn f all indicatrs in Iwa Indicatrs fr all injuries, Iwa, Indicatrs fr drwning, Iwa, Indicatrs fr unintentinal falls, Iwa,

4 Indicatrs fr unintentinal fire-related injuries, Iwa, Indicatrs fr firearm-related injuries, Iwa, Indicatrs fr hmicide/assault, Iwa, Indicatrs fr mtr vehicle trauma, Iwa, Indicatrs fr pisning, Iwa, Indicatrs fr suicide/suicide attempts, Iwa Indicatrs fr traumatic brain injury (TBI), Iwa, Hspital charges per indicatr, Iwa, Iwa Crash Outcme Data Evaluatin System Crash data linked t death certificates ( ) Linked MV fatalities by vehicle type r rle... Errr! Bkmark nt defined. Demgraphic characteristics, safety device use and alchl use fr MVT-related deaths in Iwa Percentage f fatally injured drivers f passenger vehicles with bld alchl cncentratin (BAC) f 0.08 percent r greater, by driver age Linkage between crash data and hspitalizatins Demgraphic characteristics, safety device use and alchl use fr mtr vehicle-related hspitalizatins in Iwa, TBI severity level by mtrcycle helmet use - hspitalizatins Linkage between crash data and emergency department (ED) data ( ) Demgraphic characteristics, safety device use and alchl use fr mtr vehicle-related ED visits in Iwa, Discussin and Recmmendatins Cmparisns Healthy Iwans 2010 indicatrs Limitatins f the data Recmmendatins ANNEXES Annex 1. Data analysis methds

5 Annex 2. Definitin f terms Annex 3. References Annex 4. Data tables prduced in this reprt List f Tables Table 1: Five leading causes f ALL deaths in Iwa by age grups and ttal # f deaths, Table 2: Five leading causes f INJURY deaths in Iwa by age grups and ttal # f deaths, Table 3: All injury indicatrs - Ttal # and rates, Table 4: Demgraphic characteristics, safety device use and alchl use fr MVT-related deaths in Iwa Table 5: Fatal injuries and BAC by driver's age Table 6: Demgraphic characteristics, device use and alchl use fr MVT-related hspitalizatins in Iwa, Table 7: TBI severity level by mtrcycle use - hspitalizatins Table 8: Demgraphic characteristics, safety use and alchl use fr MVT-related ED visits, Fr further infrmatin r a cpy f this reprt, please cntact the Iwa Department f Public Health, Bureau f Disability and Vilence Preventin at (515) r the Injury Preventin Research Center at the University f Iwa at (319) Electrnic cpies f the reprt are available at 3

6 Acrnyms used in this reprt CDC Centers fr Disease Cntrl and Preventin CODES Crash Outcme Data Evaluatin System ED visits Emergency department visits (utpatient) EMS Emergency medical services IDOT Iwa Department f Transprtatin IDPH Iwa Department f Public Health IPRC University f Iwa Injury Preventin Research Center MVT Mtr Vehicle Traffic NCIPC Natinal Center fr Injury Preventin and Cntrl NIOSH Natinal Institute fr Occupatinal Safety & Health STIPDA State and Territrial Injury Preventin Directrs Assciatin TBI Traumatic brain injury TSAC Trauma System Advisry Cuncil WISQARS Web-based Injury Statistics Query and Reprting System YPLL Years f ptential life lst Authrs f this reprt This reprt was develped thrugh the State f Iwa Injury Preventin and Surveillance Partnership (a sub-cmmittee f TSAC), whse missin is t facilitate statewide injury preventin imprvement by leading a systematic prcess t gather, review, analyze and disseminate infrmatin abut injuries and injury preventin in Iwa. The fllwing rganizatins were the key members f the wrking grup that develped this reprt: Iwa Department f Public Health (IDPH) Bureau f Disability and Vilence Preventin This bureau wrks with cmmunities t reduce the incidence and severity f unintentinal and intentinal injuries resulting frm disability and vilence. Thrugh data cllectin and analysis, strategic planning and the implementatin f evidence-based prgrams, bureau staff wrks t reduce the burden f these injuries in Iwa. The bureau is rganized int tw ffices. Within the Office f Disability and Health are the Advisry Cuncil n Brain Injuries, Disability Preventin/Reducing Secndary Cnditins Prgram, and the Traumatic Brain Injury Prgram. Within the Office f Vilence Preventin are the Abuse Educatin Review Panel, Dmestic Abuse Death Review Team, Health Care Respnse t Vilence Against Wmen, Sexual Vilence Preventin and Yuth Suicide Preventin Prgram. Bureau f Health Statistics The Bureau staff maintains a cmprehensive data and surveillance system capable f mnitring prgress n health bjectives, identifying emerging health issues, and supprting plicy develpment. The bureau regularly analyzes health data residing in the department, cnducts research n health issues, prvides access t health infrmatin fr the state and public, and supprts ther health data activities as apprpriate. Divisin f Envirnmental Health (Occupatinal Health Prgram and Cnsumer Prduct Safety) The IDPH Occupatinal Safety and Health Surveillance Prgram (OSHSP) is part f the Envirnmental Health Divisin and funded thrugh NIOSH t prvide fundamental and enhanced surveillance and public health activities specific t wrk-related illness and injury. Netwrking with state and lcal prgrams, data is cllected, analyzed, and reprted regarding specific OSH indicatrs, including ccupatinal fatalities, pesticide pisnings, and adult lead expsures. OSHSP is als invlved in utbreak investigatins regarding infectius disease r envirnmental expsures that are linked t wrk situatins. 4

7 Bureau f Emergency Medical Services (EMS) Iwa has an all-inclusive trauma care system that has been peratinal since January 1, The IDPH Bureau f EMS is designated the lead agency fr the state trauma system. Frm cnceptin, key trauma/ems stakehlders have cnvened regularly t advise the department n strategies t achieve ptimal trauma care delivery, implement a statewide trauma system, assess, and evaluate system effectiveness. The Trauma System Advisry Cuncil (TSAC), as established by Iwa Cde 147A, has been meeting since Octber f Representatin is multidisciplinary and includes 21 members. The TSAC has subcmmittees that include: 1) hspital categrizatin and verificatin, 2) triage and transfer prtcls, Adult and Pediatric, 3) injury registry, 4) injury preventin/health prmtin, 5) educatin and training, and 6) rehabilitatin. TSAC meets semiannually. The System Evaluatin Quality Imprvement Cmmittee (SEQIC), als established by cde and meeting since Octber 1996, has established and implemented a statewide system evaluatin prcess. Representatin is multidisciplinary and includes 20 members wh meet three times per year fr nging system evaluatin. Researchers at The University f Iwa s Injury Preventin Research Center review the Iwa Trauma Patient Data. This grup presents its data analysis during SEQIC meetings. The bureau als huses the unintentinal injury preventin and the EMS pediatric prgrams. These prgrams prmte bicycle, pedestrian and mtr vehicle safety, as well as imprved respnses t children served thrugh Iwa s EMS system. Bureau f Family Health The bureau is cmprised f many prgrams related t maternal and child health. The prgrams that aim t reduce injury t children and adlescents are the Child Death Review Team, the Healthy Child Care Iwa prgram, and the Schl/Adlescent Health prgram. University f Iwa Injury Preventin Research Center (IPRC) Funded in 1990, the IPRC is ne f 12 injury "Centers f Excellence" funded by the Natinal Center fr Injury Preventin and Cntrl, Centers fr Disease Cntrl and Preventin. The theme f the Iwa Center is preventin and cntrl f rural injuries, but the Center wrks with injuries in all f Iwa. The IPRC aims t prevent and cntrl injuries in high-risk ppulatins, including children, the elderly, farmers, and farm families by supprting research and training and by disseminating research results t plicy makers. The IPRC has a number f cre grups, including administratin, evaluatin, simulatin, training, and research supprt. The training cre prepares graduate students t meet the need fr new academic faculty in the field f ccupatinal injury preventin, and the research supprt cre serves as the backbne fr the IPRC research prgram which prvides resurces t IPRC investigatrs, university injury cntrl researchers, and injury cntrl cllabratrs in the cmmunity. The IPRC is funded by CDC grant CCR The Iwa Department f Transprtatin (DOT) The Iwa DOT, Mtr Vehicle Divisin Office f Driver Services, cllects and maintains data n all mtr vehiclerelated accidents in Iwa. This ffice, alng with the Office f Traffic and Safety, prvides crash data analysis t infrm driver and highway safety prgramming. The data are used t develp the Iwa Cmprehensive Highway Safety Plan, guiding effrts t achieve a standard f safer travel acrss the state. These tw ffices partner with the Iwa Department f Public Safety s Gvernr s Traffic Safety Bureau, t implement mtr vehicle safety prgrams fr the public. 5

8 Executive Summary Injuries are majr public health cncerns that affect the lives f all Iwans, regardless f age, race, gender, r size f cunty. Unintentinal injuries are the leading cause f death fr Iwans between the ages f 1 and 34, while suicides and/r hmicides als rank amng the tp 5 leading causes f death fr Iwans between the ages f 1 and 54. Unintentinal injury is the 5 th leading cause f death fr all Iwans, with ver 1,500 injury deaths ccurring n average each year (frm ) in Iwa. Injuries als lead t mre than 17,000 hspitalizatins in Iwa each year and mre than 250,000 emergency department (ED) visits. Further, untld numbers f Iwans d nt seek medical care fr many f the injuries they may incur. Because injuries are preventable, they lead t unnecessary medical csts, ecnmic lsses, reduced prductivity, and immense physical and emtinal strain. Purpse f this reprt This reprt, the first cmprehensive ne t examine injury in Iwa, is intended t: - present a clear picture f the burden f injuries in Iwa (frm the years 2002 t 2006) in terms f mrtality, mrbidity, and causes; - prvide infrmatin t state and lcal plicymakers, cunty health departments, health practitiners, hspitals, and civic grups t imprve injury care and stimulate and strengthen injury preventin effrts; - dcument Iwa s success in meeting the Healthy Iwans 2010 gals related t injury; and - prvide infrmatin n the injury indicatrs specified by the Centers fr Disease Cntrl and Preventin s Natinal Center fr Injury Preventin and Cntrl (CDC/NCIPC). T further these ends, a detailed reprt f injuries in each cunty f Iwa has als been develped and is referenced in this reprt. Surces f infrmatin The data presented in this reprt are based n death certificates frm the Iwa Department f Public Health, the Iwa Hspital Assciatin hspital inpatient (referred t as hspitalizatins)/utpatient (referred t as ED visits) discharge data, and the Iwa trauma registry, including agricultural injuries. Key findings ( ) - Over 1,500 injury-related deaths ccurred n average each year (frm ) in Iwa 6% f all deaths in Iwa. In additin, injuries led t mre than 17,000 hspitalizatins and mre than 250,000 ED visits each year in Iwa. - Unintentinal injuries were the leading cause f death fr Iwans between the ages f 1 and 34 and the 5th leading cause f death fr all Iwans. 6

9 - While mtr vehicle traffic deaths were the leading cause f injury death fr Iwans aged 1-34 and 55-64, suicide was the leading cause f injury death amng Iwans aged 35-54, and falls were the leading cause f injury death fr peple ver 64 years f age. - Suicides are the third leading cause f injury death after mtr vehicle traffic and falls in Iwa; the rate f suicide (11.1/100,000) in Iwa is higher than the natinal average f 10.9/100, percent f injury deaths in Iwa ( ) are classified as unintentinal, with 21 percent as suicide and fur percent as hmicide. - Firearms (50%), suffcatin (27%) and pisnings (20%) are the leading causes f suicide death in Iwa; hwever, the exact percentage f these different causes varies greatly by cunty size and age f victim. - Firearms (52%), cut/pierce (15%) and suffcatin (7%) are the leading causes f hmicide death in Iwa. Firearms (average f 28 cases per year) are three times as likely t be the cause f hmicide in Iwa as cut/pierce (average f 8 cases per year). - Hmicide rates in Iwa (1.9/100,000) are lwer than the natinal average (5.9/100,000), but are still the secnd leading cause f injury death fr children under age 5 and in the tp fur causes f injury death in teens and yung adults aged Injury death rates increase with age, with rates by far the highest in senirs (85+). - Fr every female wh dies due t injuries in Iwa, tw males will die due t injuries, regardless f age grup. - Injuries have the greatest impact in the smallest cunties in Iwa (<10,000 ppulatin), which had the highest injury death rate (67/100,000 peple) vs. the injury death rate (45/100,000) in cunties with ver 50,000 ppulatin. - On average frm 2002 t 2006, Iwans whse deaths were related t injuries lst 22 years f ptential life. - On average, injury hspitalizatins represent five percent f all hspitalizatins. Injury hspitalizatin rates increase with age and rates are by far the highest in senirs (85+), particularly wmen. - Blacks in Iwa are three times mre likely t be hspitalized fr injury than whites and tw times mre likely t g t the ED fr an injury than whites. - Overall injury charges frm hspitals, fr inpatient and utpatient services, amunted t a 5-year average f $300 millin per year, which still underestimates the real cst f injury t the State f Iwa. - Firearm-related injuries have the highest medical charges f any mnitred indicatr fllwed by mtr vehicle traffic. Charges fr each are, respectively, $16,000/visit (hspitalizatins) and $1,850/visit (ED), and $13,000/visit (hspitalizatins) and $775/visit (ED). - Rates fr ED visits due t injuries are greatest amng the yuth and the elderly. Overall, ne in five ED visits in Iwa is due t injury. - Injuries frm falls have the highest rate f hspitalizatins and ED visits f the mnitred indicatrs. 7

10 Key cnclusins - Cntinued and strengthened cllectin f data is vital t mnitr trends in injuries in Iwa and t assess the effectiveness and impact f injury preventin strategies. Health care prviders must be encuraged t cmpletely and accurately cde and reprt all injuries s that a clearer picture f the burden f injury in Iwa is available, which in turn enables imprved preventin effrts. The IDPH needs t create and supprt bth an internal wrk grup and an external advisry cmmittee t supprt the establishment f an injury and vilence preventin prgram and raise the visibility and imprtance f injury and vilence preventin within state gvernment. The creatin f a subcmmittee cnnected t TSAC is a gd step in that directin. In the summer f 2004, the IDPH directr recgnized the fragmentatin and the sils mdus perandi f the public health system. He cmmissined a wrk grup t make recmmendatins fr redesigning public health in the state t limit incnsistent service delivery. As a first step, the wrkgrup develped standards fr lcal and state fficials, including injury preventin as a separate fcus area. - Injury preventin effrts can be targeted t thse grups with the greatest risk by using the data presented in this reprt. - Iwa has exceeded many f the gals established fr injuries by the Healthy Iwans 2010 initiative; hwever, much wrk is still needed t cntinue t reduce the burden f injury in Iwa. These effrts include: The use f public educatin, legislative/plicy, and technlgical strategies t reduce the number f injuries and injury deaths in Iwa. Prmting preventin prgrams that use a cmbinatin f strategies, such as an eclgical mdel targeting individual, relatinship, rganizatinal, and cmmunity levels f interventin. These are prven t be mre effective. 8

11 Intrductin Injuries are majr public health cncerns that affect the lives f all Iwans, regardless f age, race, gender, r size f cunty. Unintentinal injuries are the leading cause f death fr Iwans between the ages f 1 and 34, while suicides and/r hmicides als rank amng the tp five leading causes f death fr Iwans between the ages f 1 and 54. Unintentinal injuries (ften called accidents) are the 5th leading cause f death in the United States (2004) 1, as well as in Iwa, with ver 1,500 injury deaths ccurring n average each year (frm ) in Iwa. Further, injuries are the third leading cause f premature death in Iwa, measured in years f ptential life lst. Hwever, deaths are nly a prtin f the impact f injury n Iwa as indicated in Figure 1 belw 2. Injuries lead t mre than 17,000 hspitalizatins each year in Iwa with an average cst f care f ver $9,000 per visit and mre than 250,000 emergency department (ED) visits (average cst per visit f nearly $1,000). In additin, sme Iwa residents seek medical care utside f the state, leading t an estimated 1,200 additinal Iwans wh are hspitalized due t injuries utside the state each year. As nted in Figure 1, untld numbers f Iwans d nt seek medical care fr many f the injuries they may incur. Injury survivrs may have their regular activities f daily living disrupted temprarily r may be permanently disabled. Because injuries are preventable, they lead t unnecessary medical csts, ecnmic lsses, reduced prductivity, and immense physical and emtinal strain. Purpse f this reprt Figure 1. Iwa Injury Pyramid Since injuries are preventable, strategies and plicies can be develped t reduce this burden. Hwever, t develp effective strategies, cmmunities and plicymakers must understand the extent and nature f injuries incurred in the state. This reprt, the first f its kind in Iwa, intends t present a clear picture f the burden f injuries in Iwa (frm the year 2002 t 2006), in terms f mrtality, mrbidity, causes, and an indicatin f the csts f medical care fr varius injuries. 1 Surce: Natinal Vital Statistics Reprt, Vl. 55, N 19, Aug Surces f data fr pyramid: Iwa Department f Public Health vital recrds, State Trauma Registry, Iwa Hspital Assciatin hspital inpatient/ utpatient discharge data. Pyramid includes nly Iwa residents seeking medical care within the state. 9

12 Because f the detrimental impact f injuries n the state, Iwa has adpted a number f injury-related gals as part f the Healthy Iwans 2010 initiative. This reprt dcuments Iwa s success in reducing injuries, particularly in relatin t these gals, and pints t further effrts that can be made t cntinue this reductin. Further, this reprt is intended t prvide infrmatin t state and lcal plicymakers, cunty health departments, health practitiners, hspitals, and civic grups n the injuries t Iwans treated within the state. These data are categrized by cause, type, intent, and ther indicatrs, which can imprve injury care and stimulate and strengthen injury preventin effrts. This reprt als addresses the recmmendatins f the 2007 visit f the State and Territrial Injury Preventin Directrs Assciatin (STIPDA) fficials t Iwa, including the task f preparing a reprt t address the ten injury indicatrs specified by the Centers fr Disease Cntrl and Preventin (CDC) Natinal Center fr Injury Preventin and Cntrl (NCIPC). What yu will find in this reprt This reprt cmbines data frm Iwa Department f Public Health (IDPH) death certificates, Iwa Hspital Assciatin hspital inpatient/utpatient discharge data, Iwa Crash Outcmes Data Evaluatin System (CODES) and the Iwa trauma registry, including agricultural injuries. The main leading causes f injury deaths, hspitalizatins, and ED visits by age, gender, race (whenever available) and csts are described. Mre infrmatin n the authrs f the reprt, the surces f data, and the methds f data analysis used in the reprt are available in the technical ntes sectin at the end f this dcument. The reprt begins with an verview f the burden f injury in Iwa, including a cmparisn f injury t ther public health cncerns, yearly injury trends, demgraphics f thse injured, intent f injuries, and the years f ptential life lst due t injury. Infrmatin n injury-related deaths, hspitalizatins, and ED visits are presented. Key data are presented in graphical frm, with key pints and cmparisns als nted. Data n each f the CDC-specific injury indicatrs, by gender and age grup, are then presented in a similar frmat t that f the verview sectin. Data fr deaths, hspitalizatins, and ED visits are presented fr all indicatrs. Data n injuries incurred in mtr vehicle crashes frm the Iwa Crash Outcmes Data Evaluatin System (CODES) are then presented in detail. Further cmparisns f the data, including t the Healthy Iwans 2010 indicatrs, are then presented, alng with cnclusins and recmmendatins frm the data. Detailed infrmatin n the methds used t calculate the data, including the surces f data, analysis methds, and variables used fr the data are presented in Annex 1 f this reprt. This reprt als cntains a link t reprts frm every cunty f Iwa, detailing the injury death and hspitalizatin rates fr that cunty by gender, age grup, and cause f injury. These reprts shuld be especially helpful t cunty and lcal public health fficials t develp plicies and prgrams and increase advcacy fr injury preventin effrts at a lcal level. Lcal agencies interested in injury preventin effrts can als use these data t better infrm their effrts at the lcal level. These reprts are available frm the fllwing: The University f Iwa IPRC Website at: and 10

13 IDPH Website at: The data tables supprting the data presented in the reprt are available as a PDF file frm the IDPH Website at Hw t use this reprt This reprt is intended t prvide infrmatin n the burden f injury in Iwa t assist cmmunities, health practitiners and state and lcal plicymakers t develp strategies and plicies t reduce injuries in the state. T accmplish this gal, ptential uses f this reprt may include the fllwing: - Prviding infrmatin t the media t raise awareness amng them and the general public abut the burden f injuries in Iwa. Media utlets may be particularly receptive t such infrmatin after a traumatic injury has ccurred that has attracted a great deal f media attentin. - Prmting the need fr injury preventin effrts amng legislatrs, cmmunity grups, and thers thrugh targeted presentatins and campaigns. Infrmed legislatrs (at lcal, state, and natinal levels) can help advcate fr injury preventin effrts. Diverse grups wrking tgether can identify pririties and maximize preventin strategies and resurces t prevent injuries. State and lcal public health fficials can gain Ideas frm current and prpsed injury preventin effrts indicated in reprt. - Encuraging health care practitiners (hspitals, clinics, etc) t strengthen their injury preventin effrts. - Guiding the allcatin f resurces t injury preventin and priritizing/planning injury preventin effrts. - Prviding backgrund infrmatin fr injury preventin activities and grant applicatins. 11

14 Overview f the burden f injury in Iwa The fllwing pages present an verview f the burden f injury n all Iwans frm , unless therwise nted. The data in the first table shw that injury is an imprtant public health cncern fr all age grups in Iwa. The leading causes f injury in Iwa in each age grup are then presented t prvide insight n preventin effrts that are needed in varius prtins f the life span f Iwans. Next, the trends f injury ver the five-year perid are presented t prvide infrmatin n any majr changes in the data ver time, which can infrm decisins n ptential interventins, legislative r reprting methd changes, and ther similar effrts. Data are then presented n the differing impact that injuries have n males and females, peple f different races, age grups, and rural cmpared t urban residents. This infrmatin can assist with the design f injury preventin and care effrts t target specific segments f the ppulatin. Data shw the prprtin f all deaths, hspitalizatins and ED visits that are due t injuries, which underlines the large burden f injuries n health care systems and n all sciety. Data are then presented n the intent f injuries, which emphasizes the need fr cntinued and specific effrts t prevent bth unintentinal injuries (ften called accidents), as well as hmicides and suicides (intentinal injuries). This sectin cncludes with data n the years f ptential life lst due t injuries and demnstrates the disprprtinate impact f injuries n the yung peple f Iwa wh are the future f the state. When cnsidering the data in the verview sectin, please nte the fllwing: The data fr deaths and hspitalizatins are the yearly averages frm , and the data fr ED visits is the yearly average frm , unless therwise nted. Data fr hspitalizatins and ED visits include all hspitalizatins and ED visits, rather than nly reprting the first hspitalizatin r ED visit fr each injury. Nte that the ED visit data are frm as the ED visit data frm 2002 were recrded in a different manner than Als, the data frm CDC WISQARS in the first tw tables are frm as the CDC data frm 2006 were nt available at the time this reprt was drafted. Rates are reprted as average yearly rates per 100,000 ppulatin unless nted therwise. These rates were determined by calculating the rate fr each year per 100,000 peple in the state r cunties (as apprpriate), adding the rates, and dividing by the ttal number f years f data (5 fr deaths and hspitalizatins and 4 fr ED visits), fr a yearly average. All rates reprted in this sectin are age-adjusted t the 2000 US ppulatin, unless nted therwise. Mre infrmatin n details f the age adjustment and rate calculatin is available in Annex 1 f this reprt. It is knwn that the number f hspitalizatins and ED visits fr varius injury causes is underreprted, as 22% f hspitalizatins and 16% f ED visit recrds are NOT cded with an electrnic cause cde. Reprted values fr frequencies f varius events may nt exactly match the values in ther sectins f the reprt due t missing data fr the variable analyzed in that particular sectin. All age grupings are presented using CDC life span ages, which is similar t the Natinal Institute fr Occupatinal Safety and Health (NIOSH) ccupatinal age grupings. Mre detailed technical ntes and methdlgy are included in Annex 1 f this reprt. 12

15 Injury is a majr cause f death in Iwa Injuries are a majr public health cncern in Iwa due t the large number f Iwans affected by them. Like the entire U.S., unintentinal injuries are the fifth leading cause f all death fr Iwans f all ages and are als the leading cause f death fr Iwans frm 1 t 34 years f age. Table 1: Five leading causes f ALL deaths in Iwa by age grups and ttal # f deaths, Rank <1 1 t 4 5 t t t t t t t t All Ages 1 Cngenital Anmalies- 210 Unintentin al Injury- 55 Unintentin al Injury- 133 Unintentin al Injury- 545 Unintentin al Injury- 353 Malignant Neplasms- 518 Malignant Neplasms- 1,913 Malignant Neplasms- 3,837 Malignant Neplasms- 6,297 Heart Disease- 8,931 Heart Disease- 13,474 Heart Disease- 30,757 2 Shrt Gestatin- 100 Cngenital Anmalies- 15 Malignant Neplasms- 47 Suicide- 219 Suicide- 214 Heart Disease- 475 Heart Disease- 1,348 Heart Disease- 2,331 Heart Disease- 4,044 Malignant Neplasms- 8,168 Malignant Neplasms- 4,728 Malignant Neplasms- 25,735 3 SIDS- 99 Hmicide- 13 Cngenital Anmalies- 16 Malignant Neplasms- 66 Malignant Neplasms- 143 Unintentinal Injury- 439 Unintentinal Injury- 532 Chrnic Lw. Respiratry Disease- 529 Chrnic Lw. Respiratry Disease- 1,418 Chrnic Lw. Respiratry Disease- 2,584 Cerebrvas cular- 4,191 Cerebrvascul ar- 8,169 4 Maternal Pregnancy Cmp.- 65 Malignant Neplasms- 12 Heart Disease- 15 Hmicide- 46 Heart Disease- 89 Suicide- 269 Suicide- 295 Unintentin al Injury- 353 Cerebrvas cular- 836 Cerebrvas cular- 2,562 Alzheimer's Disease- 2,511 Chrnic Lw. Respiratry Disease- 6,504 5 Placenta Crd Membrane s- 41 Heart Disease- 5 Suicide- 9 Heart Disease- 36 Hmicide- 39 Liver Disease- 70 Liver Disease- 195 Diabetes Mellitus- 320 Diabetes Mellitus- 519 Alzheimer's Disease- 1,122 Influenza & Pneumnia- 2,291 Unintentinal Injury- 4,567 Surce: CDC Web-based Injury Statistics Query and Reprting System (WISQARS- - Unintentinal injuries are the 3 rd leading cause f death fr 35- t 54-year lds in Iwa, after cancer and heart disease. - Suicide is the 10 th leading cause f all deaths in Iwa (2005), while it ranked 11 th in all the US (2005). - Suicide is the 2 nd leading cause f all deaths fr 15- t 34-year lds in Iwa, the 4 th leading cause fr Iwans aged 35 t 54, and the 5 th leading cause fr Iwans aged 5 t 14. Suicide deaths rank slightly higher in Iwa than in the rest f the U.S. in mst age categries. - Hmicide ranks lwer amng causes f death in Iwans, particularly amng 5- t 34-year lds, than the US average 3. - Despite the large number f deaths due t injuries, mst injuries are nt fatal. Hwever, they are still devastating as described later in this reprt. 3 All cmparisns t natinal data n this page are frm CDC WISQARS ( ) 13

16 Mtr vehicle crashes are the leading cause f injury death in Iwa Mtr vehicle traffic deaths are the leading cause f injury-related deaths fr all ages f Iwans, fllwed by falls. These and ther leading causes f injury death vary by age grup. Table 2: Five leading causes f INJURY deaths in Iwa by age grups and ttal # f deaths, Rank <1 1 t 4 5 t t t t t t t t 84 >85 All Ages 1 Suffcatin - 12 MV Traffic - 20 MV Traffic - 73 MV Traffic MV Traffic Suicide Suicide MV Traffic Falls Falls Falls MV Traffic - 1,688 2 Hmicide - 7 Hmicide - 12 Fire/burn - 10 Suicide Suicide MV Traffic MV Traffic Suicide -132 MV Traffic MV Traffic Unspecified Falls - 1,255 3 Drwning - 5 Drwning - 10 Drwning - 9 Hmicide - 41 Unintentinal Pisning - 53 Unintentinal Pisning - 53 Unintentinal Pisning - 83 Falls - 63 Suicide - 64 Unspecified - 69 MV Traffic - 85 Suicide - 1,252 4 MV Traffic - 4 Fire/burn - 8 Suicide - 9 Unintentinal Pisning - 36 Hmicide - 24 Hmicide - 25 Falls - 54 Unintentinal Pisning - 21 Suffcatin - 30 Suffcatin - 66 Suffcatin - 67 Unintentinal Pisning Unspecified - 2 Pedestrian, Nn-MVT- 4 Pedestrian, Nn-MVT - 7 Drwning - 31 Falls - 14 Falls - 25 Suffcatin - 25 Suffcatin - 18 Adverse Effects - 26 Suicide - 61 Adverse Effects - 32 Suffcatin Surce: CDC Web-based Injury Statistics Query and Reprting System (WISQARS- - Mtr vehicle traffic trauma is the leading cause f injury death fr Iwans frm the age f 1-34 and 55-64, while falls are the leading cause fr injury death fr Iwans ages 65 and ver, the same as in the entire U.S Suicide is the leading cause f injury death amng 35- t 54-year lds, which accunts fr 41% f the ttal suicides in Iwa. - Hmicides are in the tp five causes f injury death in Iwa nly in children under 5 and in yung adults (15-44 years), while hmicides are in the tp five causes f injury deaths in the entire U.S. fr all age grups under the age f 45. Nte that the numbers listed in this table were calculated slightly differently than thse in the previus table, s sme small differences may exist. 4 All cmparisns t natinal data n this page are frm CDC WISQARS ( ). 14

17 Injury-related death, hspitalizatin and emergency department visit rate trends, Iwa, Over the five-year perid ( ) f this reprt, age-adjusted injury death rates (# f events/ 100,000 ppulatin) were basically cnstant with a slight upward trend, ranging frm 46.1 t 49.7 deaths/ 100,000 Iwans. In additin: - Injury death rates in Iwa are lwer than the natinal average injury death rate, which increased slightly frm 55.7 t 57.6/ 100,000 US ppulatin frm 2002 t The age-adjusted injury hspitalizatin rate was als basically cnstant, with a slight decrease ver time (frm 533 t 518 injury hspitalizatins/ 100,000 Iwans). This is lwer than the 2004 natinal 6 median rate fr all injury hspitalizatins acrss the NCIPC reprting states (555/100,000 US ppulatin ). - The injury ED visit age-adjusted rates have increased ver their fur-year reprting perid ( ), althugh declining frm 2005 t The data shw that after adjusting fr age, fr every 100 Iwans, there are, n average, eight injury-related ED visits. 5 CDC WISQARS ( ) 6 CDC NCIPC State Indicatrs Reprt, 3 rd Editin, 2004 data 15

18 Injury affects genders, races, and age grups in Iwa differently: average rates f injury (per 100,000 Iwans) by gender The rate f males dying in Iwa due t injury (69) is nearly duble that f females (37). The differences between genders vary greatly, depending n the specific indicatr and age f the victim. Iwa females have a greater injury hspitalizatin rate, but a lwer ED visit rate than males. Cautin is needed when interpreting these differences since the rates are nt ageadjusted. 16

19 Injury rates (per 100,000 Iwans) by race, The crude injury death rate fr blacks in Iwa (54) is cmparable t that f whites (54). Blacks (1,528) in Iwa are 3 times mre likely t be hspitalized fr an injury than whites (467). Blacks are mre than 2 times mre likely t g t the ED fr an injury than whites. Other racial grups cmbined tgether (Hispanic, Asians, Natives, etc.) have lwer crude rates fr injury deaths, hspitalizatins and ED visits than whites and blacks. A large amunt f data n race (22% and 21%) is missing fr hspitalizatins and ED visits, respectively. Cautin shuld be used when interpreting these results since the rates were nt age-adjusted. 17

20 Injury rates (per 100,000 Iwans) by age grup, Injury death and hspitalizatin rates in Iwa increased with age. Rates f injury deaths (369) and hspitalizatins (5,026) are by far the highest in thse aged 85 and ver. Hspitalizatin rates fr senirs (85+) in ther NCIPC reprting states (in 2004) range frm 2,600 t 6,800/ 100,000 ppulatin; thus, Iwa is als within this range. Injury- related ED visit rates were greatest amng yuth and the elderly. Iwa adults between the ages f 45 and 74 had a lw rate f 5 ED visits per 100 peple, cntrasted with yuth aged 15 t 24 that had duble the rate, f apprximately 12 ED visits per 100 peple. ED visit rates due t injuries were highest amng 15- t 24-year lds, fllwed by thse aged

21 Injury death, hspitalizatin and emergency department visit rates differ by cunty size, The 5-year average crude injury death rate was greatest in less ppulated cunties (rate f 67/100,000). Cmpared t cunties with ver 50,000 peple (rate f 45), cunties with <10,000, 10-20,000 and 20-50,000 reprt a 48%, 37% and 21% increase in injury death rates, respectively. Injury hspitalizatin rates are lwest in cunties with less than 50,000 peple (535), with the highest rates in cunties with <10,000 ppulatin (659). ED visit rates did nt demnstrate any trend by cunty size. The rate f injury ED visits was highest in cunties with 20-50,000 peple (6,728/100,000 peple) and lwest in cunties with 10-20,000 peple (6,083). Cautin shuld be used when interpreting these results since the rates were nt age-adjusted. Mre detailed infrmatin n the burden f injury in each cunty in Iwa is available as an annex t this reprt. 19

22 Injuries are a large percentage f all deaths, hspitalizatins, and emergency department visits, and varies by age grup in Iwa, Injuries accunted fr 6% f all deaths in Iwa. Hwever, this percentage varies by age grup. Yuths aged are the age grup with by far the greatest prprtin f deaths frm injury (74%) cmpared t all deaths. Yung adults (aged 25-34) have the secnd highest prprtin (56%) f deaths due t injury. Therefre, injury preventin is a very imprtant public health issue fr all entities wrking with children and yuth. On average, injury hspitalizatins represented 5% f all hspitalizatins. Amng children between 5-14 years ld, injury hspitalizatins crrespnded t 13% f all hspitalizatins, the highest prprtin f all age grups. The percent f injury ED visits as a prprtin f all ED visits is highest amng thse age 5 t 14 (43%). Overall, ne in fur (27%) ED visits is due t injury. 20

23 Mst injuries in Iwa are unintentinal, % f injury deaths in Iwa ( ) were classified as unintentinal, with 21% as suicide and 4% as hmicide. Iwa s unintentinal injury (Iwa: 35 vs. US: 39) and hmicide death rates (Iwa:2 vs. US:6) are lwer than the natinal average, while the suicide rate is higher than the natinal average (Iwa:12 vs. US:11). Fr every ne death due t unintentinal injury (rate= 35), there are nearly 10 hspitalizatins (rate=339). 22% f injury-related hspital visits did nt have an intent cded. Fr every 100 Iwans, there were, n average, 6 t 7 ED visits due t unintentinal injuries (frm ). The age-adjusted rate f hmicide/assault-related ED visits (319) was greater than the suicide-related ED visit rates (50). The suicide rate is larger than the hmicide rate fr deaths and hspitalizatins. Mechanisms f intentinal injuries (vilence) in Iwa Firearms (50%), suffcatin (27%), and pisnings (20%) are the leading mechanisms f suicide deaths in Iwa. Firearms (52%), cut/pierce (15%), and suffcatin (7%) are the leading mechanisms f hmicide deaths in Iwa. Althugh pisnings are nly the 3 rd leading mechanism f death by suicide, they are by far the leading mechanism f suicide attempt-related hspitalizatins, with an average f 1,400 cases per year. Struck by/against Years (4.6/100,000), f ptential fllwed by cut/pierce life lst (1.9/100,000) by causes are the leading and mechanisms intent f assaultrelated injury hspitalizatins. 21

24 Years f ptential life lst by causes and intent Cardivasc Cancers Injury Respirat CNS Endcrine Cngenital Digestive Mental Infectin Unclassified Urinary Cnnective Bld Other ENT Ophtalmic , , , , , ,

25 In Iwa, (frm ), cardivascular diseases are the leading cause f ttal YPLL fllwed by cancers and injury. Injuries cntributed t ver 34,000 YPLL. Lking at the average years f ptential life lst, cngenital diseases are the greatest cntributrs (64 YPLL), with all injuries (22 YPLL) being the third largest cntributr. Unintentinal injuries, particularly MVT by far, have the greatest impact n the ttal YPLL. On average, Iwans wh died in by unintentinal drwning lst 37 years f ptential life. Unintentinal firearm (34 years) and hmicide by firearm (31 years) were the 2 nd and 3 rd YPLL mechanisms. Nte: In the third and furth graphs, the intent/cause cmbinatins with an average f < 5 cases per year are nt shwn. Nte: The N listed fr each cause is the yearly average number f cases fr the intents listed fr that cause. 23

26 Specific injury indicatrs The Center fr Injury Preventin and Cntrl, Centers fr Disease Cntrl and Preventin (CDC), in cllabratin with the State and Territrial Injury Preventin Directrs Assciatin (STIPDA), have identified 10 areas f primary cncern related t tracking the burden f injury in a particular state. Injury indicatrs assciated with each f these areas describes a health utcme f an injury, such as hspitalizatin r death, r a factr knwn t be assciated with an injury 7. This sectin prvides infrmatin n each f these indicatrs and their relatinships t ther indicatrs. It must be nted that the indicatrs are NOT mutually exclusive as sme f the indicatrs are causes (fires), thers intents (suicide r hmicide) and types (traumatic brain injury) f injury. Therefre, the numbers f incidents, rates, and the charges fr ne injury case may als be included in the number, rates and charges f multiple indicatrs. Please als nte that the values reprted in the chart fr hspital charges per indicatr include nly the charges submitted by the hspital t the payer. They are included nly as a general means f cmparing a prtin f the csts f injuries related t each f the varius indicatrs. Nte als that hspitalizatin r ED data cannt be cmpared directly t death data, as the ppulatins they are drawn frm are different. This data table is presented nly t make general cmparisns between and amng the different indicatrs. Please als nte that unless therwise stated, all rates are reprted as incidents per 100,000 Iwans and adjusted t the 2000 US ppulatin. Reprted values fr frequencies f varius events may nt exactly match the values in ther sectins f the reprt due t missing data fr the variable analyzed in that particular sectin. Mre infrmatin n the calculatin methds and injury cding scheme is available in the methds sectin in Annex 1. Cmparisn f all indicatrs in Iwa Table 3: All injury indicatrs Ttal # and rates, Deaths ( ) Hspitalizatins ( ) Emergency department visits ( ) Average Indicatr area Average N^ Rate* Average N^ Rate* N^ Rate* All injuries 1, , ,073 8,953.8 Drwning Falls u , ,891 1,984.0 Fire-related u , Firearm-related Hmicide/Assault , Mtr vehicle traffic (MVT) u , , Pisning , , Suicide , , Traumatic brain injury (TBI) , , ^The Average N is calculated by adding the ttal number f incidents ver the 4 r 5 year perid and dividing by the apprpriate number f years, fr a yearly average. *All rates are reprted per 100,000 ppulatin and are age-adjusted t the 2000 US ppulatin. + The drwning indicatr includes nt nly unintentinal deaths, but all hspitalizatins and ED visits. u Data fr these indicatrs include nly unintentinal injuries. 7 Frm CDC NCIPC, available at: 24

27 Indicatrs fr all injuries, Iwa, The first f these 10 indicatr areas utlines the burden f all injuries in Iwa by age grup and gender, including deaths, hspitalizatins, and ED visits. Mre infrmatin n the demgraphic distributin f the verall injury burden in Iwa is available in the previus sectin f this reprt, the Overview f Injuries in Iwa. The subsequent specific indicatrs address specific causes, intents r type f injury, as apprpriate. Fr each indicatr, the rates per 100,000 ppulatin are charted, fllwed by a discussin f the issues reflected in the data. 25

28 In Iwa, ver the five-year perid f this reprt there were, n average, 1,558 injury deaths; 17,267 injury hspitalizatins; and 234,542 ED visits per year. Injury death rates vary greatly by age; hwever, acrss all ages, crude injury death rates were twice as high in Iwa males (69/100,000) as in Iwa females (36/100,000). The rate f injury deaths is by far the highest in Iwans ver 84 years ld (males: 468/100,000; females: 327/100,000). The rate f injury deaths was nearly three times higher in infants (males: 30/100,000; females: 16/100,000) than in children aged 1-4 (males: 10/100,000; females: 7/100,000). As shwn by the data in the previus pint, the injury death rate f male infants is duble that f female infants. Hwever, gender differences in injury death rates are small fr children between the ages f 1 and 14. Gender differences in death rates were greater after 14 years f age, with the death rate three times higher fr males (70/100,000) than females (23/100,000) in the 15-t 24-year-ld age grup. Iwa males wh are years ld are mre than 2.5 times as likely t die frm injuries as females in that age grup. Female death rates (368/100,000) increased substantially in thse ver 84 years ld, but still did nt reach the male death rate (468/100,000). The age and gender distributin fr injury hspitalizatins is similar t that f injury deaths, except that lder females are hspitalized fr injuries mre ften than lder males. Acrss all age grups, females had a 26 percent greater injury hspitalizatin rate than males, with a yearly average hspitalizatin rate f 643/100,000 vs. 509/100,000, respectively. Hwever, each age grup has different characteristics. Amng Iwans under the age f 65, males had higher injury hspitalizatin rates than females. Amng Iwans less than ne year f age, males are twice as likely as females t be hspitalized due t injuries. The female injury hspitalizatin rate steadily increased with age t surpass that f males. In Iwans aged 55-64, males and females had nearly the same hspitalizatin rates f 464/100,000 and 448/100,000, respectively. After the age grups, the trend reversed. Hspitalizatin rates fr females increased significantly, exceeding that f males (900/100,000 vs. 706/100,000, respectively), and cntinued t increase in the lder age grups. The rate f injury ED visits is greatest in the age grups, with anther peak in senirs (85+). Even thugh males f all ages had a higher rate f injury ED visits than females (8,813 vs. 6,881 per 100,000 Iwans, respectively), female ED visit rates were n average 13 percent higher after the age f 65. Iwa males aged 15 t 24 are mre likely than females (13,759 vs. 9,180/100,000 Iwans, respectively) t g t the ED fr an injury. This gender difference becmes less prnunced after age

29 Indicatrs fr drwning, Iwa, Althugh drwning death rates are lw in Iwa (1.0/100,000), lwer than the natinal NCIPC states 2004 average (1.3/100,000), it is still the 3 rd leading cause f injury death fr Iwans under the age f 14. This underlines the imprtance f preventin fr unintentinal drwning, particularly in infants and children. 0 27

30 Over the five-year perid f this reprt, drwning in Iwa resulted in an average f 29 deaths, 15 hspitalizatins, and 63 ED visits per year. Drwning is the 3 rd leading cause f injury death fr Iwans under the age f 14, and the 5 th leading cause f injury death in thse aged 15 t 24. While there were few drwning-related hspitalizatins in Iwa n average (15 cases/year), there was a larger number f deaths (29 cases/year), which demnstrates the severity f any drwning incidents. Althugh the annual average death rate fr drwning in Iwa fr is lw (1.0/100,000), lwer than the 2004 natinal average f NCIPC states (1.3/100,000), it is an imprtant cause f injury amng certain age grups. Because there are lw numbers f drwning deaths in certain age grups (less than 5 in sme grups), nly general patterns frm the resultant rates shuld be cnsidered. Under the age f 15, drwning death rates are similar between males and females. In Iwans 15 years and lder, males were mre than twice as likely as females t die frm drwning. The highest yearly average number f drwning deaths ccurred amng 15- t 24-year-ld males (6 cases/year), resulting in a rate f 2.7 per 100,000; while nly ne drwning death was reprted amng the same age females, with a subsequent rate f 0.5 per 100,000. Iwa s drwning hspitalizatin rate (0.5/100,000) is slightly lwer than the NCIPC states average f 0.7 per 100,000, and varies by age and gender. On average, frm , there were nine males f all ages hspitalized fr drwning per year and six females. Under the age f five, drwning-related hspitalizatin rates are higher in girls (<1: 4.3/100,000, 1-4 years: 2.8/100,000) than bys (<1: 1.0/100,000, 1-4 years: 1.9/100,000). In ages five and abve, mre males than females were hspitalized. In many age/gender grups, there was less than ne drwning-related hspitalizatin n average per year, while there were n drwning-related hspitalizatins frm in wmen aged and Males had twice as many drwning-related ED visits as females (yearly average f 42 vs. 21 ED visits). Fr every age grup, except infants less than ne year f age (males: 3.8/100,000, females: 4.0/100,000), males were anywhere frm tw t fur times mre likely than females t visit the ED fr drwning-related injuries. The majrity f ED visits ccurred amng children and yung adults, with the greatest number (average f 10 ED visits per year) in 15- t 24-year-ld males. The highest rate f ED visits ccurred in 1- t 4-year-ld males (7.5/100,000). 28

31 Indicatrs fr unintentinal falls, Iwa, The rate f fall-related deaths in Iwa (8.5/100,000) is abve the natinal average (6.2/100,000 8 ), partially due t the large prprtin f senirs (85+) in Iwa, the age grup with by far the highest rate f deaths frm falls (males: 244/100,000 and females: 204/100,000). Falls are als the leading cause f injury hspitalizatins and ED visits in Iwa.. 8 CDC WISQARS ( ) 29

32 Nte: Hspitalizatin data are fr falls in Iwa, ; emergency department visits are fr falls in Iwa,

33 - Althugh falls are the 2 nd leading cause f injury deaths in Iwa (yearly average f 314), falls are the leading cause f injury hspitalizatins and ED visits, with respective yearly averages f mre than 7,100 and 57,000. Falls accunt fr 20 percent f all injury deaths, 41 percent f injury hspitalizatins, and 23 percent f all injury ED visits in Iwa. The verall fall-related death rate was abut the same fr males (10/100,000) and females (11/100,000). Hwever, death rates and gender differences varied with each age grup. Fall-related deaths mainly ccur in peple ver 74 years ld, with by far the highest rate in thse ver the age f 84 (males: 244/100,000; females: 204/100,000). The average death rate increased as age increased, after the age f 14. Fall-related death rates were higher in males in every age grup. In the 15-t 24-year lds, the average death rate fr males was 0.9/100,000 vs. 0.5/100,000 fr females. By 55 years f age, the rate increased t 8/100,000 (males) vs. 3/100,000 (females). The greatest difference between fall death rates in males and females f the same age ccurred in the age grup where males (1.7/100,000) were five times mre likely than females (0.3/100,000) t die frm a fall. Amng thse aged 55 t 64, injury death rates in males (8/100,000) were mre than duble that f females (3/100,000). The demgraphic pattern f fall-related hspitalizatins is very similar t that f deaths frm falls, except that many mre elderly females than elderly males are hspitalized due t falls. Females f all ages (317/100,000) had twice the hspitalizatin rate f all males (156/100,000). In the 35- t 44-year-ld age grup, males (82/100,000) had an 80 percent increased rate f fallrelated hspitalizatins ver females (45/100,000). Hwever, in the 55- t 64-year-ld age grup, female rates (211/100,000) were 30 percent greater than in males (161/100,000) and cntinued t increase with age. Rates in wmen age 85 and ver (3,834/100,000) were nearly duble that f men age 85+ (2,242/100,000). Fall-related ED visit rates were greater in all females (2,079/100,000) than in all males (1,748/100,000) and differed greatly with age. Fall-related ED visit rates peaked in thse 85+ (males: 6,114/100,000, females: 7,901/100,000), with a smaller peak in ages 1-4 (males: 4,205/100,000, females: 3,189/100,000). Males had higher rates f fall-related ED visits in all age grups until the age f 25, after which female rates steadily increased cmpared t males. After the age f fur, ED visit rates steadily declined fr bth genders until ages (females) and (males), where the rates began t steadily increase fr bth genders. 31

34 Indicatrs fr unintentinal fire-related injuries, Iwa, Althugh the rate f fire-related deaths in Iwa (0.9/100,000) is slightly lwer than the natinal NCIPC states 2004 average (1.1/100,000), fire injuries are still a majr cncern in Iwa, particularly in certain age grups. Fires can be particularly deadly fr the elderly in Iwa, with males ver the age f 74 having by far the highest death rates (75-84: 6.9/100,000; 85+: 7.6/100,000).. 32

35 Each year in Iwa, n average, there are 29 fire-related deaths, 119 hspitalizatins and 922 ED visits. Fire-related deaths are twice as likely t ccur in men (1.3/100,000) as in wmen (0.6/100,000), but these ratis vary with age. Males ver age 74 are the mst likely grup t die frm fire-related injuries (ages 75-84, rate f 6.9/100,000; ages 85+, rate f 7.6/100,000). Amng females, the 85+ age grup is the mst likely t die frm fire-related injuries (3.2/100,000). There were, hwever, less than five deaths in every age/gender grup, which makes interpretatin f any rate calculatin difficult. Fires are particularly deadly fr the elderly, as their ability t escape frm a fire is ften limited by mbility. In fact, the fire-related death rates fr bth men and wmen, in bth the and 85+ age categries is nearly equal t fire-related hspitalizatin rate fr that same gender/age categry. The difference between death and hspitalizatin rates is the highest fr males in the 25- t 34- year-ld categry (17 hspitalizatins fr every death) and fr females, in the 35- t 44-year-ld categry (7.5 hspitalizatins fr every death). Fire-related hspitalizatins are, n average, fur times greater in males (6.5/100,000) than in females (1.5/100,000) and vary with age. The difference between genders is greatest in the (males: 10.4/100,000, females: 1.1/100,000) and the age grups (males: 9.5/100,000, females: 1.7/100,000). Males aged have the highest fire-related hspitalizatin rate verall, and thse have the secnd highest rate. Rates f fire-related ED visits were three times higher in all males (47/100,000) than in all females (15/100,000). Rates f fire-related ED visits peaked in men aged (78.6/100,000) and gradually decreased with age. Girls aged 1-4 had the highest rate f fire-related ED visits (25.4/100,000), with females aged having the secnd highest rate (21.4/100,000), fllwed by a gradual decline in subsequent age grups. The gender difference in rates f fire-related ED visits is largest in the 55- t 64-year-ld age grup where males (32/100,000) are fur times mre likely than females (8/100,000) t have a fire-related ED visit. 33

36 Indicatrs fr firearm-related injuries, Iwa, The rate f firearm-related deaths in Iwa (6.5/100,000) is much lwer than the natinal NCIPC states 2004 average (10/100,000). Firearm-related death rates are the highest amng males ver the age f 74 (ages 75-84: 22/100,000 and ages 85+: 23/100,000), mainly due t suicides. Hwever, firearm-related hspitalizatin (10/100,000) and ED visit rates (24/ 100,000) are highest in 15- t 24-year-ld males and gradually decrease with age.. 34

37 On average, there were 197 firearm-related deaths per year in Iwa, mre than the average yearly number f firearm-related hspitalizatins (69) r ED visits (163). 95 percent f all firearm-related deaths in Iwa are intentinal (81% suicides and 14% hmicides). Five percent f firearm-related deaths in Iwa are unintentinal. As age increases, an increasingly larger prtin f the firearm-related deaths in Iwa is due t suicide cmpared with hmicide. This is partially due t the lw numbers f hmicides due t firearms in many age grups. The age grup with the largest average number f hmicides due t firearms is the 15- t 24-year lds, with nine fatalities each year. On average, each f the age grups under the age f 14 and ver the age f 55 have < 1 hmicide due t firearms each year. The age grup with the largest average number f suicides due t firearms is the 45- t 54-year lds, with 31 fatalities each year. Only the age grups f thse less than 14 years ld have an average f < 1 suicide due t firearms each year. Firearm-related death rates were relatively cnstant acrss all age grups frm 15 t 74 and increased significantly in males ver the age f 75 (ages 75-84: rate f 22/100,000 and ages 85+: rate f 23/100,000). Overall, Iwa males (11.7/100,000) were seven times mre likely t suffer frm firearm- related deaths than females (1.6/100,000). Between the ages f 15 t 74 years, death rates ranged frm 13-14/100,000 fr males and 2/ 100,000 fr females. Over the age f 74, female death rates decreased significantly t 0.8/100,000, while male rates increased t 22/100,000. Since the numbers f firearm-related deaths, hspitalizatins, and ED visits were less than five in nearly every age grup f females, resultant rates shuld be interpreted with cautin. Firearm-related hspitalizatin (10/100,000) and ED visit rates (24/100,000) were greatest in 15- t 24- year-ld males and gradually decreased with age. Abut 50 percent f firearm-related hspitalizatins were due t suicide attempts (31%) and hmicide/assaults (19%), with the remaining cases due t unintentinal injury (40%), undetermined and ther (10%). Fr Iwa females, firearm-related hspitalizatin rates remained cnstant, with a high f 0.8/ 100,000 in 15- t 44-year lds. Firearm-related ED visits fllwed the same pattern as hspitalizatins. Overall, ED visit rates were eight times higher in males (9.8/100,000) than in females (1.2/100,000). Amng bth males and females, firearm-related ED visit rates were highest in the 15- t 24-year-ld age grup (males: 24/100,000, females: 3/100,000). 35

38 Indicatrs fr hmicide/assault, Iwa, While the hmicide death rate (1.9/100,000) in Iwa is cnsiderably lwer than the 2004 natinal average f the NCIPC states (5.9/100,000), the rate f assault-related hspitalizatins and particularly ED visits is substantially higher, particularly amng yuth and yung adult males (aged 15-34). Infants als have a high rate f assault-related hspitalizatins.. 36

39 In Iwa, n average frm , there were 55 hmicide deaths, 276 assault-related hspitalizatins, and 6,473 assault-related ED visits. This translates int an average f mre than ne hmicide per week, nearly ne assault-related hspitalizatin, and nearly 18 assault-related ED visits per day in Iwa. Overall, the hmicide death rate in Iwa is higher in males (2.3/100,000) than in females (1.4/100,000). The resulting rate rati shws that, verall, hmicide rates in males were 60 percent higher than in females. Males aged had the highest average number f hmicides (9), fllwed by thse aged and (each with 7 cases). Over the age f 45, the average number f hmicides per year was five r less fr bth males and females. There was n age grup f females in Iwa with an average number f hmicides greater than five. On average, there was ne hmicide per year amng bth female and male infants (< 1 year-ld). Because f the relatively small number f infants (as well as hmicides in any age grup) in Iwa, the resultant hmicide death rates fr infants are the highest f any age grup fr bth males and females. Over 90 percent f assault-related hspitalizatins in Iwa ccurred in 15- t 54-year lds. Yung males between the ages f had the greatest number f hspitalizatins (74) fllwed by the age grup (63), which had the highest hspitalizatin rate at 34/100,000. Amng females, the age grup had the highest hspitalizatin rate f 6.3/100,000, which crrespnded t a yearly average f nly 11 assault cases. Overall, males (15.5/100,000) were five times mre likely t be hspitalized fr assaults than females (3.1/100,000). With increasing age, gender differences in assault-related hspitalizatins decreased. The rate f assault-related ED visits was twice as high in males (278/100,000) as females (157/100,000). Males aged had the highest ED visit rate f any age/gender grup, with a rate f 838/100,000. The rate fr females in the same age grup (as well as amng all ages) was abut half that f males (441/100,000). The rate f assault-related ED visits in children under the age f 5 was nearly the same in males as females. 37

40 Indicatrs fr mtr vehicle trauma, Iwa, The death rate fr mtr vehicle traffic-related trauma (MVT) in Iwa (13.2/100,000) is lwer than the natinal NCIPC states 2004 average (14.7/100,000), but was still the leading cause f injury death in Iwa (420 cases/year), the 3 rd leading cause f injury hspitalizatins (1,648 cases/year), and the 2 nd leading cause f injury ED visits (17,120 cases/ year).. 38

41 In Iwa, frm , there were, n average, 420 deaths, 1,648 hspitalizatins, and 17,120 ED visits per year due t mtr vehicle traffic-related (MVT) crashes. MVT-related trauma was the leading cause f injury death in Iwa. Apprximately 1.15 MVT-related deaths ccur each day in Iwa. Amng Iwans aged 1-34 and 55-64, MVT-related injuries were the leading cause f injury death, and were the 2 nd leading cause f injury death fr Iwans aged and In Iwa, MVT-related injury death rates were the highest fr males aged 85 and lder (52/ 100,000), fllwed by 75- t 84-year lds (39/100,000) and 15- t 24-year lds (31/100,000). The rate f MVT-related deaths is tw times higher in males (19/100,000) than in females (10/100,000). MVT-related injuries were the third leading cause f injury hspitalizatins in Iwa (after falls and pisnings), with an average f 1,648 hspitalizatins per year in This is nearly 5 MVTrelated hspitalizatins per day thrughut Iwa. In all age grups, males had higher hspitalizatin rates than females, except children aged 1-4. Overall, MVT-related hspitalizatin rates were 1.6 times higher in males (68/100,000) than in females (42/100,000). Hspitalizatin rates were highest fr males aged (118/100,000), aged (88/100,000), and 85 r lder (85/100,000); fr females, the highest rates were in persns aged (75/100,000) and (74/100,000). MVT was the 2 nd leading cause f injury ED visits after falls, with an average f 17,120 ED visits per year in Iwa frm Overall, the ED visit rate fr females (600/100,000) was higher than fr males (543/100,000). Amng bth males and females, ED visit rates were the highest in the 15- t 24-year-ld grup (1,220/100,000 fr males and 1,525/100,000 fr females). Mre detailed infrmatin n the utcmes and ther characteristics f mtr vehicle crashes in Iwa is available in a subsequent sectin f this reprt n the Crash Outcme Data Evaluatin System. 39

42 Indicatrs fr pisning, Iwa, While Iwa s death rate due t pisning (5.6/100,000) was lwer than the 2004 natinal average f the NCIPC states (10.3/100,000), pisning injuries are a particular cncern in specific age grups. Fifty-three percent f pisning deaths in Iwa are unintentinal, 39 percent are due t suicide, and 8 percent are f undetermined intent. Pisning rates and intents als vary greatly by cunty size and gender.. 40

43 On average, there were 166 deaths, 2,008 hspitalizatins and 3,235 ED visits related t pisning each year in Iwa frm The majrity f pisning deaths 84 percent fr males and 77 percent fr females ccurred in Iwans aged The death rates fr bth males (15/100,000) and females (10/100,000) were highest in the 25- t 34-year-ld age grups and were fllwed by the 35- t 44-year lds fr bth males (13/100,000) and females (10/100,000). Between the ages f 5 and 44, the pisning death rate fr males was 50 percent higher than fr females. After the age f 45, the pisning death rates were very similar fr bth genders. Fifty-three percent f all pisning deaths in Iwa frm were unintentinal, 39 percent were due t suicide, and 8 percent were f undetermined intent. Like the age distributin fr pisning deaths, the rates f pisning hspitalizatins were highest amng the 15- t 44-year-ld age grups. In cntrast t the death rates, females ver the age f five had higher pisning-related hspitalizatin rates than males. The highest hspitalizatin rate was in 15- t 24-year-ld females (154/100,000), cmpared t males f the same age (77/100,000). Hspitalizatin rates cnsistently decreased until the age f 65, where it stayed relatively cnstant. Pisning-related ED visit rates were by far the highest amng children aged 1 t 4 (males: 396/100,000 and females: 356/100,000), and secnd highest amng 15- t 24-year lds. They steadily declined in subsequent lder age grups. Overall, pisning ED visit rates were nearly 1.2 times higher amng females (116/100,000) than males (100/100,000). Other than children under the age f five and senirs ver the age f 74, females had a higher rate f pisning-related ED visits than males. The greatest difference between females and males was in the 15- t 24-year-ld age grup, as females had a 70 percent higher ED visit rate. 41

44 Indicatrs fr suicide/suicide attempts, Iwa Iwa s suicide rate (11.1/100,000) is higher than the 2004 natinal average f the NCIPC states (10.9/100,000). Iwa s suicide attempt hspitalizatin rate (51.7/100,000) is als higher than the 2004 NCIPC natinal average (47.7/100,000). Males in Iwa are much mre likely t actually die frm suicide, but Iwa females are mre likely t be hspitalized r visit the ED fllwing a suicide attempt.. 42

45 In Iwa n average, there were 332 deaths, 1,483 hspitalizatins and 1,474 ED visits that ccurred yearly frm due t suicides r suicide attempts. Suicide rates are higher amng males, but wmen have higher hspitalizatin and ED visit rates due t suicide attempts. Suicide was the leading cause f injury death in Iwa fr individuals aged 35-54, and the secnd leading cause f injury death fr yuths aged and adults aged Suicide was the third leading cause f injury deaths acrss all ages in Iwa. Suicide rates (11/100,000) were almst six times higher than hmicide rates (2/100,000) in Iwa. Frm 2002 t 2006, the verall average suicide rate was fur times higher in males (18/100,000) than in females (4.2/100,000). Suicide rates were greatest amng elderly males. In the 75- t 84-year-ld age grup, males had a suicide rate f 27/100,000 and males ver the age f 85 had a suicide rate f 32/100,000. Beginning with 15- t 24-year-ld males, the suicide rate slightly increased frm 21/100,000 until it peaked at 26/100,000 fr the 35- t 44-year-ld age grup. After a slight decrease amng 65- t 74-year lds, anther upward trend ccurred, leveling ff at 32/100,000 fr men ver the age f 85. The suicide rate fr males between the ages f 5-24 was five times higher than females f the same age. In the age grups, the male rate (27/100,000) was 13 times that f females (2.1/100,000). The verall rate f hspitalizatins fr suicide attempts was 65 percent higher in females (62/100,000) cmpared t males (37/100,000). The rate f hspitalizatins fr suicide attempts was greatest amng 15- t 24-year-ld females (135/100,000) cmpared t males (59/100,000) f the same age grup. Amng the 5- t 14-year-ld age grup, the female hspitalizatin rate fr suicide attempts was five times that f males, while amng Iwans aged years, the female hspitalizatin rate fr suicide attempts was twice that f males. The ttal rate f ED visits fr suicide attempts was 40 percent higher amng females. Except fr thse ver the age f 74, the female ED visit rates fr suicide attempts were greater than males f all ages. ED visit rates were highest amng thse in the age grup f 15- t 24-year lds, reaching 177 (females) and 114 (males) per 100,000. ED visit rates fr suicide attempts decreased substantially after age 24. ED visit rates fr suicide attempts amng senirs (85+) were fur times greater in males (14/100,000) than in females (3.4/100,000). 43

46 Indicatrs fr traumatic brain injury (TBI), Iwa, Althugh it is nt a cause r intent f injury, traumatic brain injury (TBI) is included as a specific indicatr due t its deadly and debilitating nature. Althugh the death and hspitalizatin rates f TBI injuries in Iwa (17.3/100,000 and 56.8/100,000, respectively) is lwer than the natinal NCIPC states 2004 average (17.9/100,000 and 74.2/100,000, respectively), the TBI death rate is still the highest amng all the specific indicatrs fr death in Iwa. On average, there are 1.5 TBI-related deaths/day, 5 hspitalizatins, and nearly 40 TBI-related ED visits per day in all f Iwa. 44

47 Frm 2002 t 2006, there were n average 554 traumatic brain injury (TBI)-related deaths, 1,821 hspitalizatins and 14,271 ED visits per year. This translates t 1.5 TBI-related deaths per day, five hspitalizatins, and ver 40 TBI-related ED visits per day in all f Iwa. TBI death rates increased with age. Frm ages 15-64, the rates f TBI deaths were relatively stable acrss the age grups, ranging frm 21.5 t 28.7 per 100,000 fr males and frm 6.2 t 11.5 per 100,000 fr females. The gender difference cnsistently increased frm males having a death rate duble that f females amng 15- t 24-year lds, t males having three times the death rate f females after 24 years f age. The largest gender difference ccurred amng the age grups, where male death rates (27.7/100,000) were nearly 4 times greater than females (7.3/100,000). In bth males and females, the highest TBI death rates ccurred amng the elderly. In the age grups, the TBI death rate fr males (81/100,000) was 2.5 times greater than fr females (32/100,000). In Iwans ver the age f 84, the TBI death rate fr males (164/100,000) was mre than tw times greater than fr females (69/100,000). The TBI-related death rates dubled frm the and 85+ age grups fr bth males and females. Males had higher TBI hspitalizatin rates than females. On average, males (75/100,000) had a 60 percent increased rate cmpared t females (47/100,000). Hspitalizatin rates increased with age. Fr bth males and females, TBI hspitalizatin rates were highest amng the and 85+ age grups. The TBI hspitalizatin rates dubled frm the t the 85+ age grups. Overall, males (556/100,000) had a higher rate f TBI-related ED visits than females (400/100,000). ED visit rates were highest amng children and the elderly. The highest TBI-related ED visit rates ccurred amng children, particularly thse aged 1-4, wh had a rate f 1,260/100,000 fr males and 975/100,000 fr females. Yung males had higher TBIrelated ED visit rates than females, whereas amng the elderly, females had an increased rate (1058/100,000 vs. 983/100,000 fr males). 45

48 Hspital charges per indicatr, Iwa, Cst is anther significant aspect t cnsider when assessing the burden f a particular type f injury. The graphs belw present nly the median charges that hspitals submit t their payers. As such, the data include nly a fractin f the csts, but they prvide infrmatin n the general trends f the charges fr each f the varius indicatrs. $2,500 $2,000 Emergency Department Visits $1,500 $1,000 $500 $- Males Females All injuries Drwning Falls Fire-Related Firearms Hmicide/ Assault Mtr Vehicle Pisning Suicide Traumatic Brain Injury 46

49 The values presented are the average f the median charges ver the five-year perid ( ). On average, all Iwa hspitals charged $158 millin per year fr all injury hspitalizatins. Even thugh falls have a mderate, average median cst f hspitalizatin care ($10,000 charge/visit), the large average number f hspitalizatins in Iwa due t falls (8,900) causes the ttal charges t be $92 millin per year, the largest f any indicatr. Males ($9,900 charged) tend t have mre cstly injury-related hspital stays than wmen ($8,500 charged). Firearm-related hspital stays tend t be the mst expensive f any indicatr ($16,000 charge/visit), fllwed by MVT ($13,000 charge/visit) and fire-related injuries ($13,000 charge/visit). On average, the hspital charge fr all injury ED visits was $124 millin/year in Iwa. Even thugh falls have a lw average median cst f ED visit care ($576 charge/ visit), the large average number f ED visits in Iwa each year due t falls (61,000) causes the ttal charges fr ED visits due t falls t be $35 millin charged per year, the largest f any ED visit indicatr. Males and females had nearly identical average hspital charges fr an ED visit (average f $494/visit). ED visits due t firearm-related injuries tend t be the mst expensive f any indicatr ($1,850/visit), fllwed by TBI ($1,330/visit) and suicide ($1,290/visit). See table in appendix fr numbers f ccurrences and charges fr each indicatr and infrmatin n the calculatin f these figures. In additin t medical csts, lss f wrk prductivity, decreased ability t perfrm husehld tasks, reduced quality f life, and many ther factrs add t the ttal burden f injury in Iwa. 47

50 Iwa crash utcme data evaluatin system Mtr vehicle traffic-related trauma (MVT) is the leading cause f injury death, the third leading cause f injury hspitalizatins, and the secnd leading cause f injury ED visits amng Iwans f all ages. Because f the large impact that MVT has n Iwa and the availability f additinal sets f data n MVT in Iwa, this sectin f the reprt prvides infrmatin frm the Iwa Crash Outcme Data Evaluatin System (CODES) t supplement the infrmatin already presented in the MVT specific indicatr sectin. This infrmatin can be used t better target injury preventin and treatment effrts related t MVT. Surce f data CODES data links mtr vehicle crash recrds (frm the Iwa Department f Transprtatin) with injury utcme recrds cllected at the scene and en rute t medical care. These data sets include hspitalizatins, ED visit data, death certificates, and Iwa Emergency Medical System (EMS) data. These linked crash utcme data are unique resurces that relate mtr vehicle crash and vehicle characteristics t specific characteristics f the ccupants, injured r uninjured. This linked utcmes data is available fr the years , while the crash data are available fr Fr this particular reprt, Iwa s mtr vehicle crash data are linked t death certificates, inpatient, and utpatient (ED visits) data at the Center fr Health Statistics in the Iwa Department f Public Health. EMS data were nt included in this analysis, as the EMS database is nt cnsidered a cmplete database in Iwa. N rates are reprted because f uncertainty regarding the cmpleteness f the data fr the number f the varius injuries and nt all data are cmpletely matched between the datasets. Crash data linked t death certificates ( ) Linked MV fatalities by vehicle type r rle 48