Injury Surveillance Activities of the National Center for Injury Prevention and Control Data Issues

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Injury Surveillance Activities of the National
Center for Injury Prevention and ControlData
Issues

• Lee Annest, Ph.D.
• Director, Office of Statistics and Programming
• National Center for Injury Prevention and Control
• Coordinating Center for Environmental Health
• and Injury Prevention
• Centers for Disease Control and Prevention
• September 7, 2006

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National Violent Death Reporting System(NVDRS)

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

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NVDRS States as of August, 2006
FY 02 (6 states)
FY 03 (7 states)
FY 04 (4 states)
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National Violent Death Reporting System(NVDRS)
Data Issues

• How do we provide timely access to data? WISQARS
  NVDRS in the works
• How do we streamline the data collection and
  still provide valuable details?
• How do we expand to all states?

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Child MaltreatmentImproving National/State
Surveillance Systems

• Lessons Learned from 5 state cooperative
  agreements (Minnesota, Rhode Island, Missouri,
  California, Michigan) completed
• Uniform Definitions Recommended Data Elements
  scheduled for release in Fall 2006
• Model State-based Child Maltreatment Surveillance
  System being developed
• CDCs cooperative agreements (NY state,
  Pennsylvania) shaken baby syndrome/abusive head
  trauma

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Definition of Child Maltreatment

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

Number of Injuries among Children lt 18 Years, US,
2004
Deaths 1,490 (est. from NCANDS) Victimizations
872,000 (est. from NCANDS)
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Child MaltreatmentMortality and Incidence Data
Sources

• National Child Abuse and Neglect Data System
  (NCANDS) current best national/state data
  source
• Child abuse/neglect reported by child protective
  services (CPS) in all 50 states, DC, and US
  territories and armed services
• State CPS offices voluntarily submit aggregate
  data to the Administration of Children and
  Families (ACF)
• Use data to estimate CM deaths, investigation
  rates, victimization rates
• Likely an undercount because only based on
  children investigated for alleged maltreatment
  (neglect, physical abuse, sexual abuse, medical
  neglect, and emotional or psychological
  maltreatment)

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Child MaltreatmentMortality and Incidence Data
Sources

• CDCs National Violent Death Reporting System
  (NVDRS) Child Fatality Review Module current
  state data limited
• NCHS National Vital Statistics System (NVSS)
  undercount CM deaths
• Using ICD-10 external-cause-of-injury codes Y06
  (neglect and abandonment) and Y07 (other
  maltreatment syndrome such as sexual abuse,
  mental cruelty, torture), there were 200 deaths
  for children lt 18 years or 13 of the 1,500
  deaths per year estimated using NCANDS data.

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Child MaltreatmentData Issues

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

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Drug-induced Mortality SurveillanceSharply on
the Rise

• Recent increase mostly likely due to overuse of
  opioid analgesics as pain killers
• Use of ICD-10 T codes to investigate increase
• Reference Paulozzi L, Budnitz D, Xi L.
  Increasing deaths from Opioid analgesics in the
  United States. Pharmacoepidemiology and Drug
  Safety (online) at www.interscience.wiley.com

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Source NVSS mortality files, NCHS
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Source NVSS mortality files, NCHS
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Deaths from narcotics and psychodysleptics
(X42) and other and unspecified drugs, (X44)
US, 1999-2002
Drug Type Involved 1999 2002 Increase
Opioid analgesics 2,891 5,528 91.2
Cocaine 3,182 3,909 22.8
Heroin 1,723 1,937 12.4
Other specified 1,666 1,790 7.4
Unspecified 2,255 3,635 61.2
Source NVSS mortality files, NCHS
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Deaths by type of opioid analgesic, US, 2002
Type Number Percent of total drugs listed
Other opioid (hydrocodone, oxycodone) 3,967 54.3
Methadone 2,361 32.3
Other synthetic narcotic (fentanyl) 982 13.4
Source NVSS mortality files, NCHS
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Drug-induced Mortality SurveillanceData Issues

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

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Disaster-Related Injury SurveillanceCDC
Emergency Preparedness

• Directors Emergency Operations Center (DEOC)
  Assessment and Surveillance Unit for Natural
  Disasters
• CDC Emergency Preparedness and Response Web site

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Where is Injury Surveillance??
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Disaster-Related Injury SurveillanceData Issues

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

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

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