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Injury Data from NCHS

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics. Injury Data from NCHS. Lois A. Fingerhut, MA Special Assistant for Injury Epidemiology. Where are we?. National Center for Health Statistics Mission.

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Injury Data from NCHS

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  1. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics Injury Data from NCHS Lois A. Fingerhut, MA Special Assistant for Injury Epidemiology

  2. Where are we?

  3. National Center for Health StatisticsMission • Principal health statistics agency • The Secretary, acting through the Center, shall conduct and support statistical and epidemiological activities for the purpose of improving the effectiveness, efficiency, and quality of health services in the United States.

  4. Key NCHS Activities • Research and methodology • Analysis and epidemiology • Classification and public health data standards • International activities • Dissemination and outreach

  5. New NCHS Injury web pages www.cdc.gov/nchs/injury.htm • NCHS Injury Data and Resources The purpose of this Web site is to provide an overview of the sources of national level injury data available from the National Center for Health Statistics (NCHS) and to provide details on the injury morbidity and mortality data collection systems, surveys and coding schemes used to collect and categorize the data. Links to other injury data Web sites are provided.

  6. ICE on Injury Statistics The International Collaborative Effort (ICE) on Injury Statistics is one of several international activities sponsored by CDC’s NCHS. The goal is to provide a forum for international exchange and collaboration among injury researchers who develop and promote international standards in injury data collection and analysis. A secondary goal is to produce products of the highest quality to facilitate the comparability and improved quality of injury data.

  7. International Classification of Diseases (ICD) • Recent Versions for Mortality • ICD-9 (1979-1998) • ICD-10 (1999…) • For Morbidity • ICD 9-CM (Clinical modification) • ICD-10-CM is not yet in effect (although draft is on the NCHS website) www.cdc.gov/nchs/about/otheract/icd9/icd10cm.htm

  8. International Classification of Diseases (ICD) • ICD Codes for injury • Nature of injury codes (diagnoses, i.e., fractures, head injuries, sprains, burns) • External cause codes (mechanism/ cause and intent) of injury (unintentional fall, firearm suicide)

  9. ICD-10 • E-codes are not for external causes • V, W, X and Y codes are for external causes • “N” codes are not for diagnoses • S and T codes are for diagnoses • ICD-10 codes for transportation related injuries are very different than they were in ICD-9 Some of the differences between ICD-9 and ICD-10

  10. Differences (con’t) • ICD-10 has more extensive place and activity codes (although activity codes are rarely being used) • ICD-10-CM ‘T’ codes for poisoning morbidity will be different • Injuries included in the WHO official leading cause list have changed

  11. ICE on Injury Statisticsbegan in May 1994….. • Australia, Austria, Canada, Denmark, England, France, Greece, Israel, The Netherlands, New Zealand, Norway, South Africa, Spain, Sweden, Switzerland, Thailand, Trinidad and the US • World Health Organization • Pan American Health Organization

  12. Active Projects as of 2003 • Indicators group • Barell matrix- conversion to ICD-10 • Multiple injury profiles • Main injury from multiple cause of death • Household surveys • Occupational injury • Strategic Planning • ICECI and WHO

  13. Newer projects.. • Injury severity and administrative datasets • Poisoning definition

  14. AdvICE list…

  15. Mortality • National Vital Statistics System • Death Certificates • Underlying cause • Multiple Cause Morbidity • National Health Care Surveys • National Hospital Discharge Survey • National Hospital Ambulatory Medical Care Survey • National Health Interview Survey • National Health and Nutrition Examination Survey NCHS data sources with injury information

  16. NCHS Data Strengths • National coverage (census or sample) • State and county for vital statistics • Fully accessible, free of charge • Well-documented • ICD coded Limitations • Lack of timeliness • Lack of detail- ICD Coded • Hard to get state/county level data for surveys

  17. Deaths: 161 thousand Hospital Discharges: 1.8 million ED Visits: 33.0 million Other Outpatient visits: 82.3 million All other??? 1 11 205 511 ??? Burden of Injury, 2002

  18. Source of Mortality Data • Annual data come from death certificates that are completed for each death occurring in the US • Death certificates have two very different purposes • A legal document regarding the facts and circumstances of the death • A statistical resource providing information on the characteristics of the decedent

  19. Special instructions for deaths from injury and poisoning • Death certificates are generally revised every 10 years to coincide with changes in the ICD revision • Next revision is due to be implemented on a staggered basis beginning with data year 2003 [PA has not yet set a date] • Moving toward an electronic certificate Death certificates

  20. Precise wording on the certificate determines the cause of death. • Concise description of how injury occurred improves ability to code cause of death. • Lack of specificity translates into unspecific codes that hamper understanding and prevention of injury. Quality of certification

  21. Issues to consider with injury mortality data Know what you want to analyze • Underlying cause of death [external cause of death codes– motor vehicle crashes, firearm deaths] or • Multiple causes of death [injury diagnosis codes—internal organ injuries, penetrating wounds, poisoning substances or agents]

  22. More issues to consider… • Timeliness of the data • What are the most recent data years available? • Final mortality data are often not available until 18 months after the data year ends. • Preliminary data, available sooner, are accurate but are pre-tabulated.

  23. Limitation of death certificates • Little or no information on … • Details on the circumstances, • Other persons involved, • Drug and alcohol involvement, • Weapon type (if applicable)

  24. Data dissemination • Annual published reports • Deaths: Injuries (2001 was 1st year) • Deaths: Final data for (year) • Deaths: Leading causes for (year) • Health US & Chartbooks • Tabulated data • Interactive data sources • WISQARS, WONDER • Public Use data

  25. What can you get from routine published injury mortality statistics? • Underlying cause of death • Age, sex, race and/or ethnicity • Time trends • Some geographic detail- State • Pre-classified external cause of injury categories

  26. Tabulated data • Mortality tables by NCHS, Division of Vital Statistics available on the web • Detailed tables include data on age, race, sex, cause-of death. • Includes some state-level data • Size of tables not constrained www.cdc.gov/nchs/datawh/statab/unpubd/mortabs.htm

  27. Underlying and multiple cause of death • 1 cause vs. up to 19 contributing causes (but for injury usually only 1 or 2 cc) • For injury the underlying cause is the external cause while the contributing causes are generallyinjury diagnoses • Detailed demographic & geographic variables • Cause of death either by each cause code or by NCHS defined recodes What can you get from annual public use data files?

  28. Public use data • Available on CD-ROM from NCHS at no charge. • ASCII text file • Need to have software to interface with the data

  29. Frameworks for Presentation • External Cause of Injury Matrix • Collaboration between Injury ICE and APHA Injury Section-began in late ’90’s. • Classifies external causes by cause and intent • For morbidity and mortality • ICD-9, 9-CM and ICD-10

  30. Recommended External Cause of Injury Matrix • Exclusion criteria • place of occurrence • second-hand tobacco smoke • misadventures to patients during surgical and medical care • drugs, medicinal, and biological substances causing adverse effects in therapeutic use

  31. External Cause of Injury Matrix (in part)

  32. Injury deaths according to matrix: US, 2002 Source: National Vital Statistics System

  33. Injury death rates, <20, 2001-02 Source: National Vital Statistics System

  34. Injury death rates, ages 15-19 yrs, PA and US: 1999-2002

  35. Injury death rates by intent, <20, 2002 Source: National Vital Statistics System

  36. Mortality sex ratios by intent, < 20, 2002 Homicide line is ‘broken’ due to unstable numbers (<20) Source: National Vital Statistics System

  37. Injury death rates by mechanism of injury, < 20 years: 2002 Log scale Source: National Vital Statistics System Lines are broken when rate would have been based on fewer than 20 deaths.

  38. The Barell Matrix • Classifies body region by nature of injury • Developed for morbidity (ICD-9-CM) • “Reinvented” for mortality (ICD-10)

  39. ICD-9-CM codes The Barell Matrix (in part)

  40. Barell Matrix – ICD-10 Mortality • Similar structure to morbidity matrix • Was difficult to revise because of changes made in ICD-10 dx codes • Mortality issues: • Any mention vs total mention of an injury

  41. Total and any mentions of injuries on death certificate by site, < 20 yrs: 2002 Total number of injury deaths=17,589 Source: National Vital Statistics System

  42. Total and any mentions of injuries on death certificate by nature of injury, <20 yrs: 2002 Source: National Vital Statistics System

  43. Leading site by nature of injury groups, (total mentions) < 20 yrs: 2002 Unspecified site Thorax Source: National Vital Statistics System

  44. But..... deaths are only the “tip” of the injury problem

  45. Morbidity data from NCHS

  46. NCHS data sources with injury information Morbidity • National Health Care Surveys • National Hospital Discharge Survey • National Hospital Ambulatory Medical Care Surveys • National Health Interview Survey • [National Health and Nutrition Exam Survey-Interview Component]

  47. National Hospital Discharge Survey (NHDS) • Provides data on hospitalizations, not persons • Collected annually 1965-present • National probability sample of short stay non-Federal hospitals

  48. NHDS - Variables • Patient demographic characteristics • ICD-9-CM diagnoses (up to 7) • Inpatient procedures (up to 4) • Days of care • Month of admission/discharge • Discharge disposition • Weight to account for national sample

  49. NHDS - Publications • Series Reports • National Hospital Discharge Survey: 2001 Annual Summary with Detailed Diagnosis and Procedure Data (Series 13, No. 156) • Advance Data • 2002 National Hospital Discharge Survey (No.342) • Hospitalizations for injury: United States, 1996 (No. 318) • All of these can be downloaded via web

  50. NHDS - Public use data • Website • CD-Rom • Multiple year data file (1979-2002) • Single year

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