Baltimore City Health Department
Unintentional Injury Mortality
Needs Assessment
STUDENT
KATHERINE OSTBYE
MPH 2009
PRECEPTOR
CAROLINE FICHTENBERG, PHD
Unintentional Injury Mortality Review
 Maryland Vital Statistics data for Baltimore City,
2000-2007
 Objectives
1.
2.
3.
4.
5.
Characterize Unintentional Injury Mortality for Baltimore
City
Compare to other deaths
Compare to similar, US
Identify Unintentional Injury of Need/Importance
Identify prevention and monitoring methods
What is Unintentional Injury Death?
 Classifications based on National Center for Vital
Statistics and the World Health Organization:



WHO ICD-10 codes identify specific underlying cause of death
Excludes ICD-10 codes for intentional mortality
(e.g. homicide and suicide)
Includes:
MV Accidents
 Falls, Fires, Poisoning, etc.


Intention must be definitively unintentional
(Excludes unknown intent)
 AKA “Accidents” – preventable deaths.
Unintentional Injury Mortality Review
 ICD-10 Code from death certificate/MD VS data
 Characterization based on demographics
 Age, Sex and Race
 Age-adjusted rates
 Looking for
 Differences among groups
 Time trends (2000-2007)
 Extension to Community Statistical Area analysis
2. Compare UI Mortality to Other Causes of
Death
 10 Leading Causes of Death for Baltimore City 2000-
2007

Determining Counts
113 Leading causes of death (adults)
 50 Leading causes of death (infants)
 Unknown ages (n=20)


Determining Population Denominators
CDC Wonder Population, vintage 2007
 (CSA, 2000 Census)

Baltimore City Leading Cause of Death
by Age Group
Rank
0
1‐4
5‐14
15‐24
25‐34
35‐44
45‐54
55‐64
65‐74
75‐84
85+
Total
1
Short gestation
(210)
Unintentional injuries
(37)
Unintentional injuries
(75)
Homicide
(831)
Homicide
(526)
HIV/AIDS
(986)
Heart disease
(1,508)
Malignant Neoplasms
(2,367)
Malignant Neoplasms
(3,136)
Heart disease
(4,260)
Heart disease
(4,192)
Heart disease
(15,721)
2
SIDS
(142)
Congenital anomalies
(18)
Homicide
(30)
Unintentional injuries
(131)
HIV/AIDS
(216)
Heart disease
(511)
Malignant Neoplasms
(1,408)
Heart disease
(2,145)
Heart disease
(2,924)
Malignant Neoplasms
(3,468)
Malignant Neoplasms
(1,558)
Malignant Neoplasms
(12,527)
3
Congenital anomalies
(92)
Homicide
(14)
Malignant Neoplasms
(20)
Suicide
(54)
Heart disease
(146)
Malignant neoplasm
(454)
HIV/AIDS
(911)
Cerebrovascular Disease
(366)
Diabetes mellitus
(519)
Cerebrovascular Disease
(999)
Cerebrovascular Disease
(938)
Cerebrovascular Disease
(3,219)
4
Maternal Complication
(57)
Malignant Neoplasms
(7)
Chronic lower respiratory disease
(12)
Malignant Neoplasm
(28)
Unintentional injuries
(139)
Homicide
(285)
Cerebrovascular Disease
(261)
Diabetes mellitus
(339)
Cerebrovascular Disease
(495)
Chronic lower respiratory disease
(717)
Chronic lower respiratory disease
(481)
HIV/AIDS
(2,525)
5
Bacterial sepsis
(43)
Cerebrovascular disease
(4)
Suicide
(11)
Heart disease
(27)
Suicide
(86)
Unintentional injuries
(193)
Chronic Liver Disease
(238)
HIV/AIDS
(319)
Chronic lower respiratory disease
(454)
Diabetes mellitus
(613)
Influenza and pneumonia
(444)
Chronic lower respiratory disease
(2,068)
6
Placenta, cord, membrane
(36)
Chronic lower respiratory disease
(4)
Benign neoplasm
(5)
Chronic lower respiratory disease
(13)
Malignant Neoplasms
(81)
Cerebrovascular Disease
(131)
Septicemia
(211)
Septicemia
(282)
Septicemia
(387)
Septicemia
(609)
Septicemia
(438)
Septicemia
(2,063)
7
Respiratory distress
(36)
Heart disease
(4)
Congenital anomalies
(5)
HIV/AIDS
(13)
Septicemia
(30)
Chronic Liver Disease
(103)
Unintentional injuries
(206)
Chronic lower respiratory disease
(213)
Nephritis, Nephrotic
(230)
Influenza and pneumonia
(392)
Alzheimer’s disease
(403)
Diabetes mellitus
(2,054)
8
Unintentional injuries
(18)
Influenza and pneumonia
(3)
Heart disease
(4)
Congenital anomalies
(10)
Diabetes mellitus
(19)
Suicide
(97)
Diabetes mellitus
(184)
Chronic Liver Disease
(180)
Influenza and pneumonia
(195)
Nephritis, Nephrotic
(306)
Diabetes mellitus
(316)
Homicide
(1,903)
9
Homicide
(17)
Medical complications
(2)
HIV/AIDS
(3)
Legal Intervention
(10)
Cerebrovascular Disease
(18)
Septicemia
(91)
Influenza and pneumonia
(136)
Unintentional injuries
(168)
Unintentional injuries
(160)
Unintentional injuries
(211)
Nephritis, nephritic
(229)
Unintentional injuries
(1,459)
10
Perinatal period
(17)
Suicide
(2)
Septicemia
(2)
Septicemia
(8)
Chronic lower respiratory disease
(17)
Influenza and pneumonia
(75)
Nephritis, nephritic
(123)
Nephritis, nephritic
(165)
Hypertension
(120)
Alzheimer’s disease
(203)
Hypertension
(193)
Influenza and pneumonia
(1,391)
Baltimore City Leading Cause of Death
by Sex
Men
Leading Causes of Death
Heart disease
Malignant neoplasm
Homicide
HIV/AIDS
Cerebrovascular disease
Unintentional injuries
Septicemia
Chronic lower respiratory disease
Diabetes mellitus
Influenza and Pneumonia
N
7,680
6,317
1,706
1,678
1,341
972
947
897
880
699
Women
Leading Causes of Death
Heart disease
Malignant neoplasm
Cerebrovascular disease
Diabetes mellitus
Chronic lower respiratory disease
Septicemia
HIV/AIDS
Influenza and Pneumonia
Nephritis
Unintentional injuries
N
8,048
6,210
1,878
1,174
1,171
1,117
847
693
595
489
Baltimore City Leading Cause of Death
by Race
African Americans
Leading Causes of Death
Heart disease
Malignant neoplasm
HIV/AIDS
Cerebrovascular disease
Homicide
Diabetes mellitus
Septicemia
Unintentional injuries
Chronic lower respiratory disease
Nephritis
N
9,162
7,726
2,347
1,986
1,783
1,440
1,357
923
905
840
Whites
Leading Causes of Death
Heart disease
Malignant neoplasm
Cerebrovascular disease
Chronic lower respiratory disease
Septicemia
Influenza and Pneumonia
Diabetes mellitus
Unintentional injuries
Alzheimer's disease
Chronic liver disease
N
6,479
4,734
1,215
1,157
697
619
601
518
353
293
3. Comparison to Other Cities, US
 DC, NYC, Pittsburgh, Detroit
 Data collected from respective HD websites
 Age-adjusted rates used when available
 Created crude rates with CDC Wonder populations if only N’s were
provided
 Overall, Baltimore has a lower rate of Unintentional
Injury mortality than comparable cities (except for
NYC)
 Baltimore and the state of Maryland have lower rates of
Unintentional Injury mortality than the United States
Unintentional Injury Mortality Rates
Location
Rate per
100,000 per
year
Baltimore City
2000-2007
28.24
New York City
2006
15.0
Philadelphia
2004-2006
47.9
Pittsburgh
2000
42.74*
Wayne County
(Detroit)
2006
38.6*
D.C.
2000-2005
36.61
Maryland
2000-2005
25.31
New York
2000-2005
23.45
U.S.
2000-2005
36.94
* Crude rate
4. Identify Unintentional Injury of
Need/Importance
 Utilized the CDC NCHS ICE “ICD-10 Matrix” for
Injury Mortality
 Characterize UI Subgroups


Age-adjusted rates
Counts by age group
 Characterize Falls
5 Leading Unintentional Injury Mortalities by Age Group, Baltimore City,
2000-2007
Rank
0
1‐4
5‐14
15‐24
25‐34
35‐44
45‐54
55‐64
65‐74
75‐84
85+
Total
1
Suffocation
14
Fire
16
All Transport
32
All Transport
97
All Transport
92
All Transport
85
All Transport
71
Fall
49
Fall
52
Fall
106
Fall
65
All Transport
514
2
Fire
3
All Transport
9
Fire
24
Fire
10
Fire
15
Fall
28
Fall
43
All Transport
46
All Transport
37
All Transport
31
Suffocation
27
Fall
355
3
Natural/
Environmental
1
Drowning
5
Drowning
11
Drowning
8
Poisoning
7
Poisoning
26
Fire
20
Fire
20
Fire
18
Suffocation
27
All Transport
31
Fire
158
4
Suffocation
4
Poisoning
3
Poisoning
5
Fall
5
Fire
15
Poisoning
18
Natural/
Environmental
15
Suffocation
12
Unspecified
13
Unspecified
13
Suffocation
99
5
Fall
3
Unspecified
2
Fall
3
Drowning
4
Drowning
11
Natural/
Environmental
16
Unspecified
9
Natural/
Environmental
9
Natural/
Environmental
11
Fire
9
Poisoning
83
Leading Unintentional Injury Deaths by Injury Type
Baltimore City, 2000-2007
Fall Mortality Rates
Age-adjusted
Fall Mortality Rate
Per 100,000/yr
Baltimore City
2000-2007
6.8
New York City
2006
5.7
D.C.
2000-2006
7.08
Maryland
2000-2006
5.39
New York
2000-2006
4.81
U.S.
2000-2005
5.84
CSA Map
 Rates per 100,000
population,
shaded by
quintiles.
 Potential to
identify high risk
areas.
 Healthy Homes
 CARE
Prevention & Monitoring
 Why are falls increasing, and what can be done to
prevent them?



“Why” is difficult to answer because the rates are increasing across
nearly all of the population demographics, despite noticeable gaps
between population subgroups.
High incidence + High susceptibility to injury
Prevention will have to focus on all races, both sexes, and all ages
>55 years.
 Prevention
 Identification of Organizations in contact with this age group
Healthy Homes
 CARE


Identification of intervention techniques
Prevention & Monitoring
 Psychosocial Support & Healthy Aging1:
 Beneficial effects on health behaviors
 Preventing poor diet, medication misuse, physical inactivity,
and social isolation
 “Research shows that detection and amelioration of
risk factors can significantly reduce the rate of future
falls.
Other evidence-based fall reduction methods include
systematic exercise programs and environmental
inspection and improvement programs.”2
1
Peel et al. Ann. N.Y. Acad. Sci. 1114: 162–169 (2007).
Rubenstein LZ. Age and Ageing 2006; 35-S2: ii37–ii41
2
Thank You
Alisa Ames, MHS
Baltimore City Health Department
PHASE & JHSPH