CDC Childhood Injury Report

CDC Childhood Injury Report:

Patterns of Unintentional Injuries among 0-19 Year Olds in the

United States, 2000-2006 US DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION

Keeping our children safe and helping them live to their full potential 1 CDC Childhood Injury Report:

Patterns of Unintentional Injuries among 0-19 Year Olds in the United States, 2000-2006

Nagesh N. Borse, Ph.D. M.S. Julie Gilchrist, MD Ann M. Dellinger, Ph.D. Rose A. Rudd, MSPH Michael F. Ballesteros, Ph.D. David A. Sleet, Ph.D.

U. S. Department of Health and Human Services Centers for Disease Control and Prevention National Center for Injury Prevention and Control Division of Unintentional Injury Prevention

Atlanta, GA December 2008

1 The CDC Childhood Injury Report: Patterns of Unintentional Injuries among 0-19 Year Olds in the United States, 2000-2006 is a publication of the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.

Centers for Disease Control and Prevention Julie L. Gerberding, MD, MPH, Director Coordinating Center for Environmental Health and Injury Prevention Henry Falk, MD, MPH, Director National Center for Injury Prevention and Control Ileana Arias, PhD, Director Division of Unintentional Injury Prevention Grant Baldwin, PhD, MPH, Director

Authors

Nagesh N. Borse, Ph.D. M.S. Julie Gilchrist, MD Ann M. Dellinger, Ph.D. Rose A. Rudd, MSPH Michael F. Ballesteros, Ph.D. David A. Sleet, Ph.D.

Acknowledgments

The authors would like to acknowledge the contributions of the following individuals: Grant Baldwin, Laurie Beck, Rebecca Boyd, Shelley Hammond, Michele Huitric, Scott Kegler, Shelly Prescod, Chet Pogostin, Caryll Rinehart, Robert Thomas, Karen Thomas, James Tobias, Kevin Webb, Bethany West, and Dionne Williams

Suggested Citation: Borse NN, Gilchrist J, Dellinger AM, Rudd RA, Ballesteros MF, Sleet DA. CDC Childhood Injury Report: Patterns of Unintentional Injuries among 0 -19 Year Olds in the United States, 2000-2006. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2008.

2 Summary

Unintentional injuries are the leading cause of morbidity and mortality among children in the United States. This report uses data from the National Vital Statistics System and the National Electronic Injury Surveillance System - All Injury Program to provide an overview of unintentional injuries related to drowning, falls, ﬁ res or burns, transportation-related injuries, poisoning, and suffocation, among others during the period 2000 - 2006. Results are presented by age group and sex, as well as the geographic distribution of injury death rates by state.

Some of the key ﬁ ndings from this report include the following:

Injury Deaths • On average, 12,175 children 0 to 19 years of age died each year in the U.S. from an unintentional injury. • Males had higher injury death rates than females. The death rate for males was almost two times the rate for females, and males had a higher injury death rate compared to females in all childhood age groups. • Injuries due to transportation were the leading cause of death for children. The highest death rates were among occupants of motor vehicles in traffi c. There were also a substantial number of pedestrian and pedal cyclist deaths among children. Combining all unintentional injury deaths among those between 0 and 19 years, motor vehicle traffi c-related deaths were the leading cause. • The leading causes of injury death differed by age group. For children less than 1 year of age, two-thirds of injury deaths were due to suffocation. Drowning was the leading cause of injury death for those 1 to 4 years of age. For children 5 to 19 years of age, the most injury deaths were due to being an occupant in a motor vehicle traffi c crash. • Risk for injury death varied by race. Injury death rates were highest for American Indian and Alaska Natives and were lowest for Asian or Pacifi c Islanders. Overall death rates for whites and African-Americans were approximately the same. • Injury death rates varied by state depending upon the cause of death. Overall, states with the lowest injury death rates were in the northeast. Fire and burn death rates were highest in some of the southern states. Death rates from transportation- related injuries were highest in some southern states and some states of the upper plains, while lowest rates occurred in states in the northeast region.

3 • For injury causes with an overall low burden, death rates greatly varied by age. The poisoning death rate for those older than 15 years of age was at least ﬁ ve times the rates of the younger age groups, and the suffocation death rate for those less than 1 year was over 16 times the rates for all older age groups.

Nonfatal Injuries • An estimated 9.2 million children annually had an initial emergency department visit for an unintentional injury. • Males generally had higher nonfatal injury rates than females. For children 1 to 19 years of age, nonfatal injury rates were higher among males than females, while the rates were approximately the same for those less than 1 year. • Injuries due to falls were the leading cause of nonfatal injury. Each year, approximately 2.8 million children had an initial emergency department visit for injuries from a fall. For children less than 1 year of age, falls accounted for over 50% of nonfatal injuries. • The majority of nonfatal injuries were from ﬁ ve causes. Falls was the leading cause of nonfatal injury for all age groups less than 15. For children ages 0 to 9, the next two leading causes were being struck by or against an object and animal bites or insect stings. For children 10 to 14 years of age, the next leading causes were being struck by or against an object and overexertion. For children 15 to 19 years of age, the three leading causes of nonfatal injuries were being struck by or against an object, falls, and motor vehicle occupant injuries. • Nonfatal injury rates varied by age group. Nonfatal suffocation rates were highest for those less than 1 year of age. Rates for injuries from ﬁ res or burns and drowning were highest for children 4 years and younger. Children 1 to 4 years of age had the highest rates of nonfatal falls and poisoning. Injury rates related to motor vehicles was highest in children 15 to 19 years of age.

4 Foreword

Injuries are among the most under-recognized public health problems facing the United States today. About 20 children die every day from a preventable injury – more than die from all diseases combined.(1) Injuries requiring medical attention or resulting in restricted activity affect approximately 20 million children and adolescents and cost $17 billion annually in medical costs.(2)

Today we recognize that these injuries, like the diseases that once killed children, are predictable, preventable and controllable. The U.S. Centers for Disease Control and Prevention works closely with other federal and state agencies, national, state and local organizations and research institutions to reduce deaths and nonfatal injuries, disabilities and costs of childhood injuries in the United States.

The release of this CDC Childhood Injury Report coincides with the launch of the World Report on Child Injury Prevention (2008) developed by the World Health Organization and UNICEF.(3) Our report complements the World Report and highlights the nature of the problem in the United States.

The CDC report can inform the work of practitioners, policy-makers, elected ofﬁ cials, and researchers to better understand the problem and take the necessary steps to reduce the devastating burden childhood injuries place on this nation.

Grant Baldwin, Ph.D., MPH Director Division of Unintentional Injury Prevention National Center for Injury Prevention and Control Centers for Disease Control and Prevention

5 Contents

1: About this Report ...... 14 2: Methods ...... 16 3: Comparison of External Cause of Injury Mortality Matrix and the Modiﬁ ed Matrix ...... 20 4: Unintentional Injury Deaths among Children 0 to 19 Years, United States, 2000 – 2005 ...... 24 4.1: Injury Deaths by Age Group ...... 24 4.2: Injury Deaths by Sex and Age Group ...... 26 4.3: Injury Deaths by Cause ...... 27 4.4: Injury Deaths by Cause and Sex ...... 29 4.5: Injury Deaths by Age Group and Cause ...... 33 4.6: Injury Deaths by Race and Sex ...... 34 4.7: Injury Deaths by State ...... 35 4.8: Analysis by Age group ...... 38 4.8.1: Injury Deaths among Children Less Than 1 Year ...... 38 4.8.2: Injury Deaths among Children 1 to 4 Years ...... 41 4.8.3: Injury Deaths among Children 5 to 9 Years ...... 44 4.8.4: Injury Deaths among Children 10 to 14 Years ...... 47 4.8.5: Injury Deaths among Children 15 to 19 Years ...... 50 4.9: Analysis by Cause ...... 53 4.9.1: Injury Deaths due to Drowning ...... 53 4.9.2: Injury Deaths due to Falls ...... 56 4.9.3: Injury Deaths due to Fires or Burns ...... 57 4.9.4: Injury Deaths due to Poisoning ...... 60 4.9.5: Injury Deaths due to Suffocation...... 63 4.9.6: Injury Deaths related to Transportation ...... 66 5: Nonfatal Unintentional Injury Estimates among Children 0 to 19 Years, United States, 2001 – 2006 ...... 77 5.1: Nonfatal Injuries by Age Group ...... 77 5.2: Nonfatal Injuries by Sex and Age Group ...... 79 5.3: Nonfatal Injuries by Cause ...... 81 5.4: Nonfatal Injuries by Sex and Cause ...... 82 5.5: Nonfatal Injuries by Age Group and Cause ...... 83

6 5.6: Analysis by Age Group ...... 84 5.6.1: Nonfatal Injuries among Children Less Than 1 Year ...... 86 5.6.2: Nonfatal Injuries among Children 1 to 4 Years ...... 87 5.6.3: Nonfatal Injuries among Children 5 to 9 Years ...... 88 5.6.4: Nonfatal Injuries among Children 10 to 14 Years ...... 89 5.6.5: Nonfatal Injuries among Children 15 to 19 Years ...... 90 5.7: Analysis by Cause ...... 91 5.7.1: Nonfatal Injuries due to Bites or Stings ...... 91 5.7.2: Nonfatal Drowning ...... 92 5.7.3: Nonfatal Injuries due to Falls ...... 93 5.7.4: Nonfatal Injuries due to Fire or Burns ...... 94 5.7.5: Nonfatal Poisoning ...... 95 5.7.6: Nonfatal Injuries due to being Struck by or Against an Object ...... 96 5.7.7: Nonfatal Suffocation ...... 97 5.7.8: Nonfatal Injuries related to Transportation ...... 98 References ...... 102 Appendices ...... 104 Appendix 1. Cause of Unintentional Injury Death Categories based on ICD-10 External Cause-of-Injury Codes ...... 105 Appendix 2: Categorization of Cause of Death: Numbers of Deaths from Unintentional Injuries among Children 0 to 19 Years, United, States, 2000 – 2005 ...... 106 Appendix 3: Number of Unintentional Injury Deaths among Children 0 to 19 Years, by State and Age Group, United States, 2000 – 2005 ...... 107 Appendix 4: Number of Unintentional Injury Deaths among Children 0 to 19 Years, by State and Cause, United States, 2000 – 2005 ...... 108 Appendix 5: Nonfatal Unintentional Injuries and Rates among Children 0 to 19 Years, by Sex and Cause, United States, 2001 – 2006 ...... 109

7 List of Tables

Table 1: Death Rates and Average Annual Number of Deaths Compared using the External Cause of Injury Mortality Matrix and the Modiﬁ ed Matrix ...... 20 Table 2. Leading Causes of Unintentional Injury Death among Children 0 to 19 Years using the External Cause of Injury Mortality Matrix, by Age Group, United States, 2000 – 2005 ...... 21 Table 3: Leading Causes of Unintentional Injury Death among Children 0 to 19 Years using the Modiﬁ ed Matrix, by Age Group, United States, 2000 – 2005 ...... 22 Table 4: Leading Causes of Unintentional Injury Deaths among Males 0 to 19 Years, by Age Group, United States, 2000 – 2005 ...... 31 Table 5: Leading Causes of Unintentional Injury Deaths among Females 0 to 19 Years, by Age Group, United States, 2000 – 2005 ...... 32 Table 6: Nonfatal Unintentional Injury Rates among Children 0 to 19 Years, by Age Group and Cause, United, States, 2001 – 2006 ...... 83 Table 7: Leading Causes of Nonfatal Unintentional Injuries among Children 0 to 19 Years, by Age Group, United States, 2001 – 2006 ...... 85

List of Figures

Figure 1: Cause of Death by Injury Status and Intent among Children 1 to 19 Years, United States, 2000 – 2005 ...... 15 Figure 2: Cause of Death by Injury Status and Intent among Children Less Than 1 year, United States, 2000 – 2005 ...... 16 Figure 3: Percent of Unintentional Injury Deaths among Children 0 to 19 Years, by Age Group, United States, 2000 – 2005 ...... 24 Figure 4: Unintentional Injury Death Rates among Children 0 to 19 Years, by Age Group, United States, 2000 – 2005 ...... 25 Figure 5: Unintentional Injury Death Rates among Children 0 to 19 Years, by Sex and Age Group, United States, 2000 – 2005 ...... 26 Figure 6: Unintentional Injury Death Rates among Children 0 to 19 Years, by Cause, United States, 2000 – 2005 ...... 27 Figure 7: Unintentional Injury Death Rates among Children 0 to 19 Years, by Cause, United States, 2000 – 2005 ...... 28

8 Figure 8: Unintentional Injury Death Rates among Children 0 to 19 Years, by Sex and Cause, United States, 2000 – 2005 ...... 29 Figure 9: Unintentional Injury Death Rates among Children 0 to 19 Years, by Age Group and Cause, United States, 2000 – 2005 ...... 33 Figure 10: Unintentional Injury Death Rates among Children 0 to 19 Years, by Age Group and Selected Causes, United States, 2000 – 2005 ...... 34 Figure 11: Unintentional Injury Death Rates among Children 0 to 19 Years, by Race and Sex, United States, 2000 – 2005 ...... 35 Figure 12: Unintentional Injury Death Rates among Children 0 to 19 Years, by State, United States, 2000 – 2005 ...... 36 Figure 13: Unintentional Injury Death Rates among Children Less Than 1 Year, by Cause, United States, 2000 – 2005 ...... 38 Figure 14: Unintentional Injury Death Rates among Children Less Than 1 Year, by State, United States, 2000 – 2005 ...... 39 Figure 15: Unintentional Injury Death Rates among Children 1 to 4 Years, by Cause, United States, 2000 – 2005 ...... 41 Figure 16: Unintentional Injury Death Rates among Children 1 to 4 Years, by State, United States, 2000 – 2005 ...... 42 Figure 17: Unintentional Injury Death Rates among Children 5 to 9 Years, by Cause, United States, 2000 – 2005 ...... 44 Figure 18: Unintentional Injury Death Rates among Children 5 to 9 Years, by State, United States, 2000 – 2005 ...... 45 Figure 19: Unintentional Injury Death Rates among Children 10 to 14 Years, by Cause, United States, 2000 – 2005 ...... 47 Figure 20: Unintentional Injury Death Rates among Children 10 to 14 Years, by State, United States, 2000 – 2005 ...... 48 Figure 21: Unintentional Injury Death Rates among Children 15 to 19 Years, by Cause, United States, 2000 – 2005 ...... 50 Figure 22: Unintentional Injury Death Rates among Children 15 to 19 Years, by State, United States, 2000 – 2005 ...... 51 Figure 23: Unintentional Injury Death Rates due to Drowning among Children 0 to 19 Years, by Age Group, United States, 2000 – 2005 ...... 53

9 Figure 24: Unintentional Injury Death Rates due to Drowning among Children 0 to 19 Years, by State, United States, 2000 – 2005 ...... 54 Figure 25: Unintentional Injury Death Rates due to Falls among Children 0 to 19 Years, by Age Group, United States, 2000 – 2005 ...... 56 Figure 26: Unintentional Injury Death Rates due to Fires or Burns among Children 0 to 19 Years, by Age Group, United States, 2000 – 2005 ...... 57 Figure 27: Unintentional Injury Death Rates due to Fires or Burns among Children 0 to 19 Years, by State, United States, 2000 – 2005 ...... 58 Figure 28: Unintentional Injury Death Rates due to Poisoning among Children 0 to 19 Years, by Age Group, United States, 2000 – 2005 ...... 60 Figure 29: Unintentional Injury Death Rates due to Poisoning among Children 0 to 19 Years, by State, United States, 2000 – 2005 ...... 61 Figure 30: Unintentional Injury Death Rates Due to Suffocation among Children 0 to 19 Years, by Age Group, United States, 2000 – 2005 ...... 63 Figure 31: Unintentional Injury Death Rates due to Suffocation among Children 0 to 19 Years, by State, United States, 2000 – 2005 ...... 64 Figure 32: Unintentional Injury Death Rates due to Transportation-related Injuries among Children 0 to 19 Years, by Age Group, United States, 2000 – 2005 ...... 66 Figure 33: Unintentional Injury Death Rates due to Transportation-related Injuries among Children 0 to 19 Years, by State, United States, 2000 – 2005 ...... 67 Figure 34: Unintentional Injury Death Rates due to Motor Vehicle Trafﬁ c-Occupant Injuries among Children 0 to 19 Years, by Age Group, United States, 2000 – 2005 ...... 69 Figure 35: Unintentional Injury Death Rates due to Motor Vehicle Trafﬁ c-Occupant Injuries among Children 0 to 19 Years, by State, United States, 2000 – 2005 ...... 70 Figure 36: Unintentional Injury Death Rates due to Pedal Cyclist Injuries among Children 0 to 19 Years, by Age Group, United States, 2000 – 2005 ...... 72 Figure 37: Unintentional Injury Death Rates due to Pedestrian Injuries among Children 0 to 19 Years, by Age Group, United States, 2000 – 2005 ...... 73 Figure 38: Unintentional Injury Death Rates due to Pedestrian Injuries among Children 0 to 19 Years, by State, United States, 2000 – 2005 ...... 74 Figure 39: Percent of Nonfatal Unintentional Injuries by Age Group, Children 0 to 19 Years, United States, 2001 – 2006 ...... 77

10 Figure 40: Nonfatal Unintentional Injury Rates among Children 0 to 19 Years, by Age Group, United States, 2001 – 2006 ...... 78 Figure 41: Nonfatal Unintentional Injury Rates among Children 0 to 19 Years, by Sex, United States, 2001 – 2006 ...... 79 Figure 42: Nonfatal Unintentional Injury Rates among Children 0 to 19 Years, by Age Group and Sex, United States, 2001 – 2006 ...... 80 Figure 43: Nonfatal Unintentional Injury Rates among Children 0 to 19 Years, by Cause, United States, 2001 – 2006 ...... 81 Figure 44: Nonfatal Unintentional Injury Rates among Children 0 to 19 Years, by Sex and Cause, United States, 2001 – 2006 ...... 82 Figure 45: Nonfatal Unintentional Injury Rates among Children Less Than 1 Year, by Cause, United States, 2001 – 2006 ...... 86 Figure 46: Nonfatal Unintentional Injury Rates among Children 1 to 4 Years, by Cause, United States, 2001 – 2006 ...... 87 Figure 47: Nonfatal Unintentional Injury Rates among Children 5 to 9 Years, by Cause, United States, 2001 – 2006 ...... 88 Figure 48: Nonfatal Unintentional Injury Rates among Children 10 to 14 Years, by Cause, United States, 2001 – 2006 ...... 89 Figure 49: Nonfatal Unintentional Injury Rates among Children 15 to 19 Years, by Cause, United States, 2001 – 2006 ...... 90 Figure 50: Nonfatal Unintentional Injury Rates due to Bites and Stings among Children 0 to 19 Years, by Age Group, United States, 2001 – 2006 ...... 91 Figure 51: Nonfatal Unintentional Injury Rates due to Drowning among Children 0 to 19 Years, by Age Group, United States, 2001 – 2006 ...... 92 Figure 52: Nonfatal Unintentional Injury Rates due to Falls among Children 0 to 19 Years, by Age Group, United States, 2001 – 2006 ...... 93 Figure 53: Nonfatal Unintentional Injury Rates due to Fires or Burns among Children 0 to 19 Years, by Age Group, United States, 2001 – 2006 ...... 94 Figure 54: Nonfatal Unintentional Injury Rates due to Poisoning among Children 0 to 19 Years, by Age Group, United States, 2001 – 2006 ...... 95 Figure 55: Nonfatal Unintentional Injury Rates due to being Struck by or Against an Object among Children 0 to 19 Years, by Age Group, United States, 2001 – 2006 ...... 96

11 Figure 56: Nonfatal Unintentional Injury Rates due to Suffocation among Children 0 to 19 Years, by Age Group, United States, 2001 – 2006 ...... 97 Figure 57: Nonfatal Unintentional Injury Rates due to Transportation-related Injuries among Children 0 to 19 Years, by Age Group, United States, 2001 – 2006 ...... 98 Figure 58: Nonfatal Unintentional Injury Rates due to Motor Vehicle - Occupant Injuries among Children 0 to 19 Years, by Age Group, United States, 2001 – 2006 ...... 99 Figure 59: Nonfatal Unintentional Injury Rates due to Pedal Cyclist Injuries among Children 0 to 19 Years, by Age Group, United States, 2001 – 2006 ...... 100 Figure 60: Nonfatal Unintentional Injury Rates due to Pedestrian Injuries among Children 0 to 19 Years, by Age Group, United States, 2001 – 2006 ...... 101

List of Maps

Map 1: Unintentional Injury Death Rates among Children 0 to 19 Years, by State, United States, 2000 – 2005 ...... 37 Map 2: Unintentional Injury Death Rates among Children Less Than 1 Year, by State, United States, 2000 – 2005 ...... 40 Map 3: Unintentional Injury Death Rates among Children 1 to 4 Years, by State, United States, 2000 – 2005 ...... 43 Map 4: Unintentional Injury Death Rates among Children 5 to 9 Years, by State, United States, 2000 – 2005 ...... 46 Map 5: Unintentional Injury Death Rates among Children 10 to 14 Years, by State, United States, 2000 – 2005 ...... 49 Map 6: Unintentional Injury Death Rates among Children 15 to 19 Years, by State, United States, 2000 – 2005 ...... 52 Map 7: Unintentional Injury Death Rates due to Drowning among Children 0 to 19 Years, by State, United States, 2000 – 2005 ...... 55 Map 8: Unintentional Injury Death Rates due to Fires or Burns among Children 0 to 19 Years, by State, United States, 2000 – 2005 ...... 59 Map 9: Unintentional Injury Death Rates due to Poisoning among Children 0 to 19 Years, by State, United States, 2000 – 2005 ...... 62 Map 10: Unintentional Injury Death Rates due to Suffocation among Children 0 to 19 Years, by State, United States, 2000 – 2005 ...... 65

12 Map 11: Unintentional Injury Death Rates due to Transportation-related Injuries among Children 0 to 19 Years, by State, United States, 2000 – 2005 ...... 68 Map 12: Unintentional Injury Death Rates due to Motor Vehicle Trafﬁ c – Occupant Injuries among Children 0 to 19 Years, by State, United States, 2000 – 2005 ...... 71 Map 13: Unintentional Injury Death Rates due to Pedestrian Injuries among Children 0 to 19 Years, by State, United States, 2000 – 2005 ...... 75

List of Appendices

Appendix 1. Cause of Unintentional Injury Death Categories based on ICD-10 External Cause-of-Injury Codes ...... 105 Appendix 2. Categorization of Cause of Death: Numbers of Deaths from Unintentional Injuries among Children 0 to 19 Years, United States, 2000–2005 ...... 106 Appendix 3: Number of Unintentional Injury Deaths among Children 0 to 19 Years, by State and Age Group, United States, 2000 – 2005 ...... 107 Appendix 4: Number of Unintentional Injury Deaths among Children 0 to 19 Years, by State and Cause, United States, 2000 – 2005 ...... 108 Appendix 5: Nonfatal Unintentional Injuries and Rates among Children 0 to 19 Years, by Sex and Cause, United States 2001 – 2006 ...... 109

13 1: About this Report

Unintentional injuries are a leading cause of morbidity and mortality among children and adolescents in the United States.(4) A thorough understanding of the demographics of the groups most at risk for common injury causes can help direct resources toward research and programs most likely to reduce the burden.

This report was produced in part to coincide with the release of a World Report on Child Injury Prevention (WHO, 2008).(3) This report provides an overview of patterns of childhood unintentional injury in the United States related to drowning, falls, ﬁ res or burns, transportation (e.g. motor vehicle crashes), poisoning, and suffocation, among others.

The burden of deaths and nonfatal injuries due to each cause is shown in this report by age group and sex, as well as the geographic distribution of injury death rates by state. Information on injury deaths is from the National Center for Health Statistics, National Vital Statistics System (i.e. death certiﬁ cate data), and nonfatal injury information is from the National Electronic Injury Surveillance System – All Injury Program, which represents nonfatal injuries treated in U.S. hospital emergency departments. While use of emergency department data does not capture the burden of all injuries (such as those treated at medical care sites other than emergency departments or those that did not seek care), this information combined with deaths can be helpful to state and local health ofﬁ cials and advocates in prioritizing programs targeting their at-risk populations, to researchers tracking trends or evaluating prevention activities, to policy- makers at all levels determining the best use of limited public health resources, as well as the to general public in identifying injury prevention strategies for themselves, their families and their communities.

14 The Importance of Childhood Injury Prevention

Worldwide, childhood injuries are a growing problem. Every year, approximately 875,000 children are killed and nonfatal injuries affect the lives of between 10 million and 30 million more globally.(5) Moreover, 95% of these deaths and injuries occur in low and middle income countries.(5) Childhood injuries are also a problem in high income countries such as the United States, where approximately 12,000 children die annually from unintentional injury-related causes.(4)

Figure 1: Cause of Death by Injury Status and Intent * among † Children 1 to 19 Years, United States, 2000 - 2005

Non-Injury (n = 57,373) 38% Unintentional Injury (n = 67,169) 44%

* Analysis Excluded Unknown Intent and Legal Intervention / Operations of War = 1,668 Deaths

Intentional Injury † Infants less than 1 year of age were not included in this analysis (n = 27,222) 18% Data Source: CDC/NCHS, National Vital Statistics System

In the United States, injuries continue to be the leading cause of death among children.(6,7) Among those 1 to 19 years of age, 44% of all deaths are due to unintentional (i.e., accidental) injuries. (Fig 1) (4) For infants, the proportion of deaths due to injury is much less, with only 4% of infant deaths due to unintentional injuries. (Fig 2) Approximately 9.2 million nonfatal injuries are treated in emergency departments each year among children 0 to 19 years of age, translating to an annual nonfatal injury rate of 11,272 per 100,000 population.(4) The estimated cost of unintentional childhood injuries approached $300 billion annually in the United States.(2)

15 Figure 2: Cause of Death by Injury Status and Intent * among Children Less than 1 Year, United States, 2000 - 2005

Unintentional Injury (n = 5,883) Intentional Injury 4% (n = 1,956) 1%

Non-Injury * Analysis Excluded Undetermined = 532 Deaths (n = 159,667) 95% Data Source: CDC/NCHS, National Vital Statistics System

2: Methods

Data used in this report were obtained from two sources. Death data from 2000 – 2005 came from the National Center for Health Statistics (NCHS), National Vital Statistics System, annual mortality ﬁ les (www.cdc.gov/nchs/about/major/dvs/Vitalstatsonline.htm).(8) Nonfatal data from 2001 – 2006 came from the National Electronic Injury Surveillance System - All injury Program (NEISS-AIP).(9) From both data sources, information was analyzed for infants, children and adolescents between the ages of 0 to 19 years. They are reported in ﬁ ve age groups: less than 1 year, 1 to 4 years, 5 to 9 years, 10 to 14 years, and 15 to 19 years, and are all referred to as ‘children’ throughout the report.

16 Death Data

Unintentional injury deaths included in this report are those for which the underlying cause of death recorded on death certifi cates by a physician or coroner was coded as one of the following International Classifi cation of Diseases, Tenth Revision (ICD-10) codes: drowning (W65-W74), falls (W00-W19), fi res or burns (X00-X19), transport-related injuries (V01 –V99), poisoning (X40-X49) and suffocation (W75-W84).(10) All other causes of injuries (i.e., cut or pierced, unintentional fi rearm, machinery, natural and environmental, overexertion, struck by or against an object, other specifi ed and unspecifi ed) were combined and reported as “other injury deaths”. The fi rst fi ve categories represent frequent causes of injury death worldwide and are addressed in the World Report on Child Injury Prevention (WHO, 2008) (http://www.who.int/violence_ injury_prevention/en/)(3); suffocation was also included in this report because it was the leading cause of injury death in the U.S. population for children less than 1 year of age. Causes of death are presented in the report, fi gures and tables in alphabetical order.

Causes of injury death were categorized fi rst using the External Cause of Injury Mortality Matrix (http:www.cdc.gov/nchs/about/otheract/Ice/matrix10.htm).(11, 12) Then for this report we used a “Modifi ed Matrix” where transportation-related injury deaths were reported as a combined category (“Transportation-related”) and in subgroups including Motor Vehicle Traffi c (MVT)- Occupant, Pedestrian, Pedal Cyclist, Transportation-other, and MVT-unspecifi ed. Deaths from pedestrian injuries and pedal cyclist injuries included both traffi c (on public roadways) and nontraffi c (off public roadways) motor vehicle incidents, as well as other types of transportation- related pedestrian and pedal cyclist injuries. Some of these transportation categories appearing here differ from the External Cause of Injury Mortality Matrix categories in order to combine and present all pedestrian and pedal cyclist injuries both on and off public roadways. Injury deaths categorized using both the Modifi ed Matrix approach and the External Cause of Injury Mortality Matrix were compared to understand how this change would affect death rates. A detailed listing of ICD-10 codes for all categories used in this report is presented in Appendix 1. The number of injury deaths categorized by both the External Cause of Injury Mortality Matrix and the Modifi ed Matrix is presented in Appendix 2.

It is important to note that death certifi cate data undercount deaths to MVT-Occupants. Death certifi cates include a large number of deaths categorized as “motor vehicle unspecifi ed,” which mainly include motor vehicle occupants.(13) The rates and numbers in this report have not been adjusted to account for this; therefore, MVT-Occupant deaths are underrepresented here.

Death data were analyzed by age group, sex, cause, race, and state. ArcGIS was used for geo- mapping of death rates by cause and age group for each state. Figures and text presenting death data by race should be interpreted with caution. Misclassiﬁ cation of race can occur in both death

17 certiﬁ cate data and in population estimates leading to inaccurate death rates by race. A discussion of the validity of race in death data has been presented elsewhere.(14)

Nonfatal Data

NEISS-AIP is operated by the U.S. Consumer Product Safety Commission, which collects case data about initial visits for all types and causes of injuries treated in U.S. hospital emergency departments (ED). Data are drawn from a nationally representative subsample of 66 hospitals out of 100 NEISS hospitals that were selected as a stratiﬁ ed probability sample of hospitals in the United States and its territories; the hospitals have a minimum of six beds and a 24-hour ED. Each case was assigned a sample weight on the basis of the inverse probability of selection; these weights were summed to provide national estimates.(9) Due to the data source, the nonfatal injury data in this report represent only those initial injuries treated in U.S. hospital EDs; injuries for which medical care was sought at other sites or not at all are not included. Therefore, these data are an underestimate of all nonfatal injuries in the United States.

Categories of nonfatal injuries examined included injuries from bites or stings, being cut or pierced, drowning, falls, fi res or burns, poisoning, being struck by or against an object, suffocation, transportation-related injuries (motor vehicle occupant, pedal cyclist, pedestrian, other), other injuries (i.e., foreign bodies, gunshot wounds, machinery, natural or environmental, overexertion, and other specifi ed), and unknown or unspecifi ed. Transportation-related injuries included both traffi c- and nontraffi c-related injuries. A defi nition of each of these categories is available at: http://www.cdc.gov/ncipc/wisqars/nonfatal/defi nitions.htm#nonfatalcause. Nonfatal data were examined by age group, sex, and cause. Because a large percentage of NEISS-AIP records lacked information on the race of the injured child, information by race is not presented using nonfatal data. Additionally, because NEISS-AIP is a nationally representative sample, no data are available for analysis at the state level.

Rate Calculations and Statistics

Population estimates for rate calculations are from Bridged-Race Postcensal Population Estimates of the United States for April 1, 2000, and July 1 for 2001 through 2006. These estimates were produced by the U.S. Census Bureau under a collaborative arrangement with NCHS (www.cdc.gov/nchs/about/major/dvs/popbridge/popbridge.htm).

Rates presented are annualized rates for the years of data used in the analysis (i.e., 2000-2005 for deaths, 2001-2006 for nonfatal injuries). In this report, death rates were rounded to and presented as a single decimal place, unless the rate was greater than 0.00 but less than 0.05 in which case two decimal places are presented.

18 If the terms “higher” or “lower” are used, a statistically signifi cant difference between the rates was determined. For nonfatal categories and fatal categories with 100 or more deaths, a nondirectional, 2-tailed z test was used with signifi cance set at the p<0.05 level. When there were fewer than 100 deaths, non-overlapping confi dence intervals based on the gamma distribution was used to indicate a signifi cant difference between rates.

Some rate estimates may be unreliable (i.e., unstable) due to a small number of events (i.e., deaths or initial emergency department visits) occurring in a category. For death rates, estimates were suppressed in tables and fi gures or fl agged in maps if they were based on fewer than 20 deaths. Appendices 3 and 4 list the number of deaths in each state by age group or cause. For nonfatal rates, estimates were fl agged as unreliable if either the estimated number (based on weighted data) of initial emergency department visits was less than 1,200 or the coeffi cient of variation of the estimate was greater than 30%. Appendix 5 presents the estimated number of nonfatal unintentional injuries and rates by age group and sex.

19 3: Comparison of External Cause of Injury Mortality Matrix and the Modiﬁ ed Matrix

Table 1 compares the injury death rates and number of deaths by causes for the External Cause of Injury Mortality Matrix and Modiﬁ ed Matrix.(11,12) Injury death rates for transportation causes differed only slightly when comparing the categorization in two matrices.

Table 1: Death Rates and Average Annual Number of Deaths Compared using the External Cause of Injury Mortality Matrix and the Modified Matrix

The External Cause of Injury Mortality Matrix* The Modified Matrix Rate† (average annual Rate† (average annual number of deaths) number of deaths) Drowning 1.4 (1,150) Drowning 1.4 (1,150) Falls 0.2 (187) Falls 0.2 (187) Fires/Burns 0.7 (592) Fires/Burns 0.7 (592) MV Traffic-related‡ 9.1 (7,317) Transportation-related§ 9.8 (7,979) MVT-Occupant 4.6 (3,724) MVT-Occupant 4.6 (3,724) MVT-Unspecified 3.1 (2,486) MVT-Unspecified 3.1 (2,486) MVT-Pedal Cyclist 0.2 (162) Pedal Cyclist 0.2 (196) MVT-Pedestrian 0.9 (724) Pedestrian 1.2 (953) MVT-Other 0.3 (221) Transportation-Other 0.8 (620)

Poisoning 0.7 (606) Poisoning 0.7 (606) Suffocation 1.2 (956) Suffocation 1.2 (956) Other Injuries║ 1.7 (1,368) Other Injuries¶ 0.9 (704) All Injuries 15.0 (12,175) All Injuries 15.0 (12,175) * Fingerhut L. ICD Framework: External Cause of Injury Mortality Matrix [Online]. Hyattsville, MD: National Center for Health Statistics. Available from: http://www.cdc.gov/nchs/about/otheract/Ice/matrix10.htm † Rate Per 100,000 Population ‡ MV Traffic-related includes MVT-Occupant; MVT-Unspecified; MVT-Pedal Cyclist; MVT-Pedestrian and MVT injuries (MVT- Motorcyclist; MVT-other) § Transportation-related includes MVT-Occupant; MVT-Unspecified; Pedal Cyclist (MVT and Other); Pedestrian (MVT & Other) and Other Transportation-related injuries (MVT-Motorcyclist; MVT-other; Other Land Transportation and Other Transport) ║ Other injuries Include Cut/Pierce; Other Pedal Cyclist; Other Pedestrian; Other Land Transportation; Other Transport; Firearms, Machinery; Natural/Environmental; Overexertion; Stuck By/Against; Other Specified, Classifiable; Other Specified, Not Elsewhere Classified and Unspecified ¶ Other injuries Include Cut/Pierce; Firearms; Machinery; Natural/Environmental; Overexertion; Stuck By/Against; Other Specified, Classifiable; Other Specified, Not Elsewhere Classified and Unspecified Data source: CDC/NCHS, National Vital Statistics System, 2000-2005

20 Table 2 shows the leading causes of unintentional injury deaths by age group using the External Cause of Injury Mortality Matrix. Suffocation was ranked fi rst for children less than 1 year of age, while MVT-related deaths were fi rst for all other age groups. In order to understand how some subcategories of Transportation-related death rates differ with other causes of unintentional injury, the Modifi ed Matrix is used in all subsequent data presented in this report.

Table 3 shows the leading causes of unintentional injury deaths by age group using the Modifi ed Matrix. Suffocations was still ranked fi rst for infants. However, drowning was the leading cause of death for children 1 to 4, and MVT-Occupant ranked fi rst for the older age groups.

Table 2: Leading Causes of Unintentional Injury Death among Children 0 to 19 Years using the External Cause of Injury Mortality Matrix, by Age Group, United States, 2000 – 2005

Age Group in Years Less Than 1 1 to 4 5 to 9 10 to 14 15 to 19 Rank (n = 5,883) (n = 10,203) (n = 7,144) (n = 9,088) (n = 40,734) Suffocation MVT-related MVT-related MVT-related MVT-related 1 66% 31% 53% 58% 76% MVT-related Drowning Other Injuries Other Injuries Other Injuries 2 14% 27% 15% 18% 9% Drowning Other Injuries Fires or Burns Drowning Poisoning 3 7% 15% 13% 10% 7% Other Injuries Fires or Burns Drowning Fires or Burns Drowning 4 6% 14% 13% 6% 5% Fires or Burns Suffocation Suffocation Suffocation Falls 5 4% 8% 4% 4% 1% Poisoning Falls Falls Poisoning Fires or Burns 6 2% 2% 1% 2% 1% Falls Poisoning Poisoning Falls Suffocation 7 2% 2% 1% 2% 1%

Modified Matrix, by Age Group, United States, 2000 – 2005 Table 3: Leading Unintentional Causes of Injury Death among Children using the 0 to 19 Years Rank Rank 10 11 9 8 7 5 6 4 3 1 2

MVT - Unspecified - Unspecified MVT MVT - Occupant Other Injuries Injuries Other V te MVT - Other MVT - Other ea yls PdlCcit Poisoning Pedal Cyclist Pedal Cyclist Less Than 1 Fires/Burns Fires/Burns Suffocation Pedestrian Poisoning Poisoning Pedestrian Drowning Poisoning Other Injuries MVT - Other - Other MVT Injuries Other Poisoning n583 n1,0)(=,4) (n=9,088) (n=7,144) (n=5,883) (n=10,203) .2 .% % 2% 1% 0.02% 0.3% .%2 1 2% 1% 0.5% 2% Falls 66% 1% 2% 6% 4% 2% 6% 2% 8% 5% 4% 5% 7% 8% MVT - Unspecified - Unspecified MVT MVT - Occupant Fires/Burns Fires/Burns Suffocation Other Injuries Other Injuries Injuries Other Injuries Other Suffocation Pedestrian Drowning 1 to 4 Falls 13% 14% 27% 15% %7 8% 8% 7% 9% Age Group in Years MVT - Unspecified MVT - Unspecified - Unspecified MVT - Unspecified MVT V cuat MVT - Occupant MVT - Occupant ea yls Pedal Cyclist Pedal Cyclist Fires/Burns Fires/Burns Suffocation Pedestrian Drowning MVT 5 to 9 Falls 13% 14% 13% 9% 22% 15% 4% Fires/Burns Fires/Burns Suffocation Pedestrian rwig Drowning Poisoning 10 to 14 Falls 10% 12% 26% 15% 4% 6% - Other MVT M Oth M P V Fi Suf P (n=40 e Dr P T - V 15 to 19 dal - U e r o er de e T F fo iso ow 28 41 s O 1 1 1 1 5 5 5 6 7 a / I - s n % C c % % % % % % % % B

lls % % n t ,734) ning ning a c Ot sp rian y u ju

c t clist rns upant ecif on i he ries

ied

22 Unintentional Injury Deaths, 2000 – 2005

23 4: Unintentional Injury Deaths among Children 0 to 19 Years, United States, 2000 – 2005

4.1: Injury Deaths by Age Group

The proportion of unintentional injury deaths represented by each age group varied. Of the 73,052 deaths among children 0 to 19 years of age during 2000-2005, 40,374 deaths (56%) occurred among those 15 to 19 years, followed by 10,203 (14%) among those 1 to 4 years of age. (Fig 3)

Figure 3: Percent of Unintentional Injury Deaths among Children 0 to 19 Years, by Age Group, United States, 2000 - 2005

Less Than 1 Year (n = 5,883) 8%

1 to 4 Years (n = 10,203) 14%

5 to 9 Years 15 to 19 Years (n = 7,144) (n = 40,734) 10% 56%

10 to 14 Years (n =9,088) 12% Data Source: CDC/NCHS, National Vital Statistics System

24 The death rate for unintentional injury was 15.0 per 100,000 children. The rate was highest among those 15 to 19 years (33.1 per 100,000) followed by those less than 1, 1 to 4, 10 to 14, respectively, and lowest among those 5 to 9 years. (Fig 4)

Figure 4: Unintentional Injury Death Rates among Children 0 to 19 Years, by Age Group, United States, 2000 - 2005

35 33.1

24.4 25

20 Overall Rate 15.0 per 100,000

15 10.8 10 7.2 6.0 Death Rate per 100,000 Population 5

0 Less Than 1 1 to 4 5 to 9 10 to 14 15 to 19 Age Group in Years Data Source: CDC/NCHS, National Vital Statistics System

25 4.2: Injury Deaths by Sex and Age Group

Males had higher death rates compared to females in all age groups. The overall death rate among males 0 to 19 years was 19.3 per 100,000 and among females 10.4 per 100,000. When examining rates by sex and age group, the death rate was highest among males 15 to 19 years (rate 45.1 per 100,000). (Fig 5)

Figure 5: Unintentional Injury Death Rates among Children 0 to 19 Years, by Sex and Age Group, United States, 2000 - 2005 50 45.1 45

30 26.9

25 21.8 20.3 20

15 12.9 8.7 9.2 10 7.0 4.9 5.2 Death Rate Per 100,000 Population Rate Death 5

- Less 1 to 4 5 to 9 10 to 14 15 to 19 Less 1 to 4 5 to 9 10 to 14 15 to 19 Than 1 Than 1

Female Male Age Group in Years Data Source: CDC/NCHS, National Vital Statistics System

26 4.3: Injury Deaths by Cause

Death rates differed by cause, with the highest rates related to injuries due to transportation (9.8 per 100,000) and the lowest rates related to falls (0.2 per 100,000). (Fig 6)

Figure 6: Unintentional Injury Death Rates among Children 0 to 19 Years, by Cause, United States, 2000 - 2005

9.8 10

0,000 Population 0,000 5

Death Rate Per 10 2 1.4 1.2 0.9 1 0.7 0.8 0.2 0 Drowning Falls Fires or Burns Other Injuries Poisoning Suffocation Transportation- Data Source: CDC/NCHS, National Vital Statistics System related

27 In the ﬁ gure that follows, transportation-related injuries are divided into several categories based on the road user type: MVT occupants, pedal cyclists, pedestrians, and others. For some deaths the road user type was unknown; these deaths were designated “MVT-unspeciﬁ ed.” A large proportion of these deaths are likely MVT occupant deaths.(13) When transportation-related injuries were examined by road user type, occupants of motor vehicles that were in crashes represented the highest death rate (death rate: 4.6 per 100,000). (Fig 7)

Figure 7: Unintentional Injury Death Rates among Children 0 to 19 Years, by Cause, United States, 2000 - 2005

5.0 4.6 4.5

4.0

3.5 3.1 3.0

2.5

2.0 1.4 1.5 1.2 1.2 0.9 1.0 0.7 0.8 0.8

Death Rate Per 100,000 Population 0.5 0.2 0.2 0.0

es Falls tion yclist * Drowning Poisoning res or Burns Pedestrian * Suffoca Fi Other Injuri Pedal c portation-Other * MVT - OccupantVT * - Unspecified * M Trans * Categories were combined and defined as 'Transportation-related Injuries' as per the Modified Matrix Data Source: CDC/NCHS, National Vital Statistics System

28 4.4: Injury Deaths by Cause and Sex

Males had higher death rates compared with females for each individual cause examined. The highest rate for both males and females was among those with MVT occupant injuries (5.6 and 3.6 per 100,000, respectively). Males had death rates that were three times higher for fall-related injuries and four times higher for pedal cyclists and other motor vehicle injuries than females. (Fig 8)

Figure 8: Unintentional Injury Death Rates among Children 0 to 19 Years, by Sex and Cause, United States, 2000 - 2005

6.0 5.6 5.5 Male 5.0 4.5 Female 4.0 3.7 3.6 3.5 3.0 2.4 2.5 2.0 2.0 1.3 1.5 1.4 1.5 1.1 1.2 0.8 0.9 1.0 0.8 0.8

Death Rate Per 100,000 Population 100,000 Per Rate Death 0.6 0.3 0.4 0.4 0.4 0.3 0.5 0.1 0.1 0.0

s list Fall wning njuries Dro dal cyc Poisoning tion-Other Pedestrian Suffocation - Unspecified Pe Fires or Burns Other I MVT - Occupant MVT Transporta Data Source: CDC/NCHS, National Vital Statistics System

29 The rankings of the leading causes of death also differed for males compared with females. While the leading cause was similar for males and females (suffocation: less than 1 year, drowning: 1 to 4 years, MVT occupants: 5 years and older), the rankings differed beginning at the second ranked cause. Notably among children 1 to 4 years of age, pedestrian injuries were ranked second for males and fourth for females. For children 5 to 9 years of age, drowning ranked second for males and ﬁ fth for females. (Tables 4 and 5)

30 Group, - 2005 United States, 2000 Table 4: Leading Causes Unintentional Inju of

Rank Rank 11 10 1 2 4 3 5 7 6 8 9

MVT - Unspecified - Unspecified MVT MVT - Occupant Other Injuries Injuries Other MVT - Other MVT - Other - Other MVT - Other MVT ea yls Pedal Cyclist Pedal Cyclist Less Than 1 Fires/Burns Other Other Fires/Burns Injuries Other Inju Suffocation Pedestrian (n = 3,316) Drowning Poisoning 0.03% 0.3% .%2 2% 0.4% 2% Falls Falls Pedal 67% 8% 5% 6% 5% 2% 8% 3% 8% 10% 2% 3% 5% 2% 3% 1% MVT - Unspecified MVT - Other Pedal Cyclist Pedal Cyclist - Other MVT - Unspecified MVT MVT - Occupant Fires/Burns Fires/Burns Suffocation Pedestrian (n = 6,206) Drowning Poisoning 1 to 4 29% 16% 10% 13% 8% 8% 6% 8% 2%

ry Deaths among Males 0 to 19 Years, by Age by Age 0 to 19 Years, ry Deaths among Males Age Group in Years MVT - Unspecified MVT - Other - Other MVT - Unspecified MVT V cuat MVT - Occupant MVT - Occupant Fires/Burns Fires/Burns Suffocation Pedestrian (n = 4,289) Drowning Poisoning Falls 5 to 9 Falls 19% 15% 13% 15% 13% 10% 1% 2% 4% Cyclist Cyclist ries Other ries Other Injuries MVT - Unspecified - Unspecified MVT Fires/Burns Fires/Burns Suffocation (n = 5,904) Pedestrian Drowning Poisoning 10 to 14 22% 13% 12% 12% 2% 5% 5% MVT M Oth M P V Fi (n = 28,555) Suf Pe e Dr P T - V da - Un 15 to 19 re o e d T F f isoning o 26% 38% s Oc l e o 7 6 1% 6 8% 1 1 2 5 wning a

/ In - st cation % % % Cy % % % % B

lls Ot sp rian u ju

c r upant ecified he list ri n s esr r

Group, - 2005 United States, 2000 Table 5: Leading Causes Unintentional Inju of Rank Rank 10 11 9 8 7 6 2 5 4 3 1

MVT - Unspecified - Unspecified MVT V cuat MVT - Occupant MVT - Occupant Other Injuries Injuries Other MVT - Other MVT - Other - Other MVT - Other MVT ea yls Pedal Cyclist Pedal Cyclist Less Than 1 Fires/Burns Fires/Burns Suffocation Pedestrian Falls Pedal (n = 2,567) Drowning Poisoning Other Injuries MVT - Other Other Injuries Injuries Other - Other MVT Injuries Other Poisoning .0 .% % 1% 1% 0.00% 0.3% Falls 64% 1% 1% 2% 2% 2% 2% 7% 5% 5% 4% 9% 5% 6% 7% MVT - Unspecified - Unspecified MVT Fires/Burns Fires/Burns Suffocation Other Injuries MVT - Other - Other MVT Injuries Other Suffocation Pedestrian (n = 3,997) Drowning Poisoning 1 to 4 16% 11% 14% 15% 24% 2% 7% 8% 6% ry 0 to 19 Years, by Age Females Deaths among Age Group in Years MVT - Unspecified - Unspecified MVT MVT - Occupant - Occupant MVT Fires/Burns Fires/Burns Suffocation Pedestrian (n = 2,855) Drowning Poisoning Pedal 5 to 9 Falls 18% 13% 14% 26% 2% 3% 9% Cyclist Cyclist MVT - Unspecified - Unspecified MVT MVT - Occupant Fires/Burns Fires/Burns Suffocation Pedestrian (n = 3,184) rwig Drowning Poisoning 10 to 14 Falls 20% 12% 33% 3% 2% 7% 8% Cyclist Cyclist MVT M Oth M Pe V Fi (n = 12,179) Su P D P T - V - Un d e 15 to 19 r o e r f des e al Cy 0.4% F foca r In isoning owning 32% 47% Oc s/ 1% 2% 1% 1% 1% 3% 5% 6% a - B lls trian OtT sp u ju

c t

r upant ecif on i he ries ns ns r clist ied ied

32 4.5: Injury Deaths by Age Group and Cause

The death rate for transportation-related injuries was highest among those 15 years and older while the death rate for suffocation was dramatically lower after the ﬁ rst year of life. Injury death rates from ﬁ res or burns and drowning both peaked among children 1 to 4 years of age. Unintentional poisoning death rates peaked among the 15 to 19 year olds. Transportation-related injuries among 15 to 19 were more than 5 times the rate of those 10 to 14. (Fig 9 and 10)

Figure 9: Unintentional Injury Death Rates among Children 0 to 19 Years, by Age Group and Cause, United States, 2000 - 2005

30 Fires or Burns Drowning 25 Falls Transportation-related Poisoning 20 Suffocation

5 Death Rate Per 100,000 Population

0 Less Than 1 1 to 4 5 to 9 10 to 14 15 to 19 Age Group in Years

Data Source: CDC/NCHS, National Vital Statistics System

33 In order to more easily see some of these changes by age group, Fig 10 shows the death rates for the four causes with rates less than 3.0 per 100,000: burns, drowning, falls and poisoning.

Figure 10: Unintentional Injury Death Rates among Children 0 to 19 Years, by Age Group and Selected Causes, United States, 2000 - 2005

Fires or Burns 3.5 Drowning 3.0 Falls Poisoning 2.5

2.0

1.5

1.0

0.5 Death Rate Per 100,000 Population Rate Death

0.0 Less Than 1 1 to 4 5 to 9 10 to 14 15 to 19 Age Group in Years

Data Source: CDC/NCHS, National Vital Statistics System

4.6: Injury Deaths by Race and Sex

Among all races, males had higher death rates than females. Among all racial groups, the death rate was highest for American Indian or Alaska Native males (29.8 per 100,000). Among females, only American Indian or Alaska Native females had higher death rates than the national average. The rate was lowest among Asian or Paciﬁ c Islander females (5.4 per 100,000). (Fig 11)

34 Figure 11: Unintentional Injury Death Rates among Children 0 to 19 Years, by Race and Sex, United States, 2000 - 2005

29.8 30

19.7 19.2 20 18.1 Overall Rate 15.0 per 100,000 15

10.6 10.4 9.9 10 5.4 5 Death Rate Per 100,000 Population 100,000 Population Death Rate Per 0 White Male White Black Male Black American American Asian or Asian or Female Female Indian or Indian or Pacific Pacific Alaska Alaska Islander Islander Native Male Native Male Female Female

Data Source: CDC/NCHS, National Vital Statistics System

4.7: Injury Deaths by State

The U.S. death rate was 15.0 per 100,000 population. State injury death rates varied from 7.2 per 100,000 to 28.8 per 100,000. (Fig 12 and Map 1) Appendix 3 presents the number of injury deaths by age group and state.

35 Figure 12: Unintentional Injury Death Rates among Children 0 to 19 Years, by State, United States, 2000 - 2005 Overall Rate 15.0 per 100,000 - 5 10 15 20 25 30

AK 26.7 AL 23.9 AR 26.4 AZ 18.2 CA 10.4 CO 14.6 CT 8.9 DC 9.2 DE 15.8 FL 18.7 GA 17.7 HI 11.0 IA 15.2 ID 19.3 IL 12.0 IN 17.1 KS 19.5 KY 23.1 LA 23.8 MA 7.2 MD 10.8 ME 15.1 MI 14.8 MN 13.6 MO 21.2 MS 28.8 MT 24.6 NC 18.2 ND 17.3 NE 16.7 NH 10.9 NJ 8.2 NM 20.5 NV 16.1 NY 8.0 OH 13.9 OK 21.8 OR 15.4 PA 13.6 RI 9.2 SC 22.0 SD 27.6 TN 21.6 TX 16.6 UT 13.7 VA 13.2 VT 14.7 W 12.9 WI 15.0 WV 21.4 WY 24.8

Data Source: CDC/NCHS, National Vital Statistics System

36 37 4.8: Analysis by Age Group

4.8.1: Injury Deaths among Children Less Than 1 Year

The U.S. death rate for children less than 1 year of age was 24.4 per 100,000. Males in this age group had a rate of 26.9 per 100,000 and females a rate of 21.8 per 100,000. (Fig 5) The death rate due to suffocation was 16.1 per 100,000. (Fig 13)

Figure 13: Unintentional Injury Death Rates among Children Less Than 1 Year, by Cause, United States, 2000 - 2005

18 16.1 16

3.7 4 Death Rate Per 100,000 Population Rate Death

2 1.6 0.9 1.3 0.4 0.5 0 Drowning Falls Fires or Burns Other Poisoning Suffocation Transportation- Injuries related Data Source: CDC/NCHS, National Vital Statistics System

In this age group, the state death rates varied from 6.1 per 100,000 to 92.6 per 100,000. (Fig 14 and Map 2)

38 Figure 14: Unintentional Injury Death Rates among Children Less Than 1 Year, by State, United States, 2000 - 2005 Overall Rate 24.4 per 100,000 - 102030405060708090100

AK 92.6 AL 34.2 AR 42.3 AZ 26.0 CA 10.9 CO 18.5 CT 11.1 DC * DE * FL 37.3 GA 29.5 HI 31.0 IA 16.3 ID 28.9 IL 29.9 IN 44.4 KS 27.9 KY 40.3 LA 41.5 MA 6.1 MD 12.3 ME * MI 49.2 MN 26.4 MO 44.4 MS 36.1 MT * NC 25.7 ND * NE * NH * NJ 10.8 NM 20.6 NV 38.3 NY 9.0 OH 32.3 OK 23.8 OR 23.1 PA 16.2 RI * SC 37.3 SD 40.5 TN 39.1 TX 22.9 UT 18.2 VA 18.9 VT * WA 23.5 WI 26.8 WV 17.0 WY 61.9 * The injury death rate is suppressed Data Source: CDC/NCHS, National Vital Statistics System if fewer than 20 deaths were reported

39 40 4.8.2: Injury Deaths among Children 1 to 4 Years

The U.S. death rate for children 1 to 4 years of age was 10.8 per 100,000. Males in this age group had a rate of 12.9 per 100,000 and females a rate of 8.7 per 100,000. (Fig 5) Transportation-related injuries resulted in the highest death rate (4.2 per 100,000). (Fig 15)

Figure 15: Unintentional Injury Death Rates among Children 1 to 4 Years, by Cause, United States, 2000 - 2005

4.5 4.2

4.0

3.5

3.0 3.0

2.5

2.0 1.5 1.5

Death Rate Per 100,000 Population Rate Death 1.0 0.8 0.9

0.5 0.3 0.2

0.0 Drowning Falls Fires or Burns Other Poisoning Suffocation Transportation- Injuries related Data Source: CDC/NCHS, National Vital Statistics System

In this age group, the state death rates varied from 4.4 per 100,000 to 24.4 per 100,000. (Fig 16 and Map 3)

41 Figure 16: Unintentional Injury Death Rates among Children 1 to 4 Years, by State, United States, 2000 - 2005

Overall Rate 10.8 per 100,000 - 5 10 15 20 25 30 AK 17.8 AL 18.4 AR 21.7 AZ 14.6 CA 8.8 CO 8.6 CT 5.4 DC * DE 9.4 FL 16.2 GA 14.0 HI 8.0 IA 9.5 ID 14.3 IL 8.0 IN 12.7 KS 14.2 KY 14.7 LA 20.7 MA 4.4 MD 6.8 ME 9.8 MI 9.3 MN 8.0 MO 12.5 MS 24.4 MT 12.4 NC 11.0 ND * NE 10.8 NH * NJ 5.0 NM 14.0 NV 11.0 NY 5.7 OH 9.1 OK 15.2 OR 11.5 PA 9.0 RI * SC 13.7 SD 22.6 TN 14.0 TX 13.1 UT 12.4 VA 8.7 VT * WA 9.7 WI 8.7 WV 11.8 WY 14.5 * The injury death rate is suppressed Data Source: CDC/NCHS, National Vital Statistics System if fewer than 20 deaths were reported

42 43 4.8.3: Injury Deaths among Children 5 to 9 Years

The U.S. death rate for children 5 to 9 years of age was 6.0 per 100,000. This age group had the lowest death rate among all age groups. Males 5 to 9 years of age had a death rate of 7.0 per 100,000 and females a rate of 4.9 per 100,000. (Fig 5) Transportation-related injuries resulted in the highest death rate (3.6 per 100,000). (Fig 17)

Figure 17: Unintentional Injury Death Rates among Children 5 to 9 Years, by Cause, United States, 2000 - 2005

4.0 3.6 3.5

3.0

2.5

2.0

1.5

1.0 0.8

Death Rate Per 100,000 Population 0.8

0.4 0.5 0.2 0.1 0.1 0.0 Drowning Falls Fires or Burns Other Poisoning Suffocation Transportation- Injuries related Data Source: CDC/NCHS, National Vital Statistics System

In this age group, the state death rates varied from 2.1 per 100,000 to 16.0 per 100,000. (Fig 18 and Map 4)

44 Figure 18: Unintentional Injury Death Rates among Children 5 to 9 Years, by State, United States, 2000 - 2005

Overall Rate 6.0 per 100,000 - 2 4 6 8 1012141618 AK 7.4 AL 9.2 AR 10.7 AZ 7.5 CA 4.4 CO 5.1 CT 2.8 DC * DE * FL 6.3 GA 7.3 HI * IA 8.1 ID 8.6 IL 4.3 IN 6.1 KS 7.6 KY 8.7 LA 10.9 MA 2.1 MD 5.1 ME 6.5 MI 6.2 MN 5.3 MO 7.3 MS 13.6 MT 9.7 NC 7.2 ND 11.2 NE 8.8 NH 4.4 NJ 3.3 NM 7.6 NV 4.7 NY 3.4 OH 5.5 OK 9.4 OR 5.9 PA 4.8 RI * SC 8.7 SD 16.0 TN 7.5 TX 7.2 UT 6.1 VA 5.3 VT * WA 4.9 WI 6.3 WV 9.3 WY * * The injury death rate is suppressed Data Source: CDC/NCHS, National Vital Statistics System if fewer than 20 deaths were reported

45 46 4.8.4: Injury Deaths among Children 10 to 14 Years

The U.S. death rate for children 10 to 14 years of age was 7.2 per 100,000. Males in this age group had a rate of 9.2 per 100,000 and females 5.2 per 100,000. (Fig 5) Transportation-related injuries resulted in the highest death rate (4.9 per 100,000). (Fig 19)

Figure 19: Unintentional Injury Death Rates among Children 10 to 14 Years, by Cause, United States, 2000 - 2005

4.9 5

2 Death Rate Per 100,000 Population 1 0.7 0.6 0.4 0.3 0.1 0.2 0 Drowning Falls Fires or Burns Other Poisoning Suffocation Transportation- Injuries related Data Source: CDC/NCHS, National Vital Statistics System

In this age group, the state death rates varied from 3.3 per 100,000 to 20.7 per 100,000. (Fig 20 and Map 5)

47 Figure 20: Unintentional Injury Death Rates among Children 10 to 14 Years, by State, United States, 2000 - 2005 Overall Rate 7.2 per 100,000 - 5 10 15 20 25 AK 20.7 AL 11.4 AR 12.6 AZ 9.3 CA 5.2 CO 7.4 CT 3.4 DC* * DE 6.4 FL 7.6 GA 9.2 HI* IA 7.3 ID 10.8 IL 5.6 IN 6.9 KS 10.1 KY 10.3 LA 12.2 MA 3.3 MD 5.3 ME 4.8 MI 7.6 MN 7.3 MO 9.7 MS 15.6 MT 12.0 NC 9.2 ND 9.0 NE 8.0 NH 6.4 NJ 3.9 NM 11.3 NV 9.5 NY 4.0 OH 6.7 OK 9.6 OR 8.1 PA 6.0 RI* SC 10.4 SD 19.2 TN 11.1 TX 8.1 UT 7.9 VA 5.3 VT 7.6 WA 5.7 WI 6.7 WV 10.3 WY 13.3 * The injury death rate is suppressed Data Source: CDC/NCHS, National Vital Statistics System if fewer than 20 deaths were reported

48 49 4.8.5: Injury Deaths among Children 15 to 19 Years

The U.S. death rate for children 15 to 19 years of age was 33.1 per 100,000. This age group had the highest death rate among all age groups. Males in this age group had a death rate of 45.1 per 100,000 and females 20.3 per 100,000. (Fig 5) Transportation-related injuries resulted in the highest death rate (26.4 per 100,000) (Fig 21)

Figure 21: Unintentional Injury Death Rates among Children 15 to 19 Years, by Cause, United States, 2000 - 2005

26.4

10 Death Rate Per 100,000 Population 5 2.5 1.6 1.5 0.4 0.4 0.3 0 Drowning Falls Fires or Burns Other Poisoning Suffocation Transportation- Injuries related Data Source: CDC/NCHS, National Vital Statistics System

In this age group, the state death rates varied from 16.4 per 100,000 to 57.7 per 100,000. (Fig 22 and Map 6)

50 Figure 22: Unintentional Injury Death Rates among Children 15 to 19 Years, by State, United States, 2000 - 2005 Overall Rate 33.0 per 100,000 - 10203040506070 AK 45.7 AL 52.7 AR 55.6 AZ 40.3 CA 23.3 CO 35.6 CT 23.0 DC 16.4 DE 39.1 FL 40.4 GA 37.9 HI 26.1 IA 32.6 ID 39.6 IL 25.9 IN 36.0 KS 41.9 KY 53.3 LA 45.9 MA 18.2 MD 25.0 ME 36.7 MI 28.4 MN 29.0 MO 47.8 MS 57.7 MT 56.8 NC 42.8 ND 35.9 NE 37.3 NH 25.2 NJ 20.0 NM 46.3 NV 36.3 NY 18.1 OH 29.6 OK 49.8 OR 33.4 PA 31.6 RI 20.2 SC 49.1 SD 46.8 TN 49.0 TX 36.3 UT 26.8 VA 31.2 VT 34.5 W 28.6 WI 33.2 WV 50.0 WY 48.0

Data Source: CDC/NCHS, National Vital Statistics System

51 52 4.9: Analysis by Cause

This section describes childhood injury deaths by selected causes in more detail (Fig 6 and 7).

4.9.1: Injury Deaths due to Drowning

Drowning represented 9% of unintentional injury deaths among children 0 to 19 years of age. The death rate for drowning-related injuries was 1.4 per 100,000. Males had death rates nearly three times higher than females (2.0 vs. 0.8 per 100,000). (Fig 8) The rate was highest among children 1 to 4 years of age (3.0 per 100,000), followed by children less than 1 year and those 15 to 19 years (1.6 per 100,000). (Fig 23)

Figure 23: Unintentional Injury Death Rates due to Drowning among Children 0 to 19 Years, by Age Group, United States, 2000 - 2005

3.5

3.0 3.0

2.5

2.0 Overall Rate 1.6 1.6 1.4 per 100,000 1.5

1.0 0.8 0.7

Death Rate Per 100,000 Population Rate Death 0.5

0.0 Less Than 1 1 to 4 5 to 9 10 to 14 15 to 19 Age Group in Years Data Source: CDC/NCHS, National Vital Statistics System

State death rates from drowning varied from 0.7 per 100,000 to 3.9 per 100,000. (Fig 24 and Map 7)

53 Figure 24: Unintentional Injury Death Rates due to Drowning among Children 0 to 19 Years, by State, United States, 2000 - 2005

Overall Rate 1.4 per 100,000 - 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 AK 3.9 AL 2.0 AR 2.4 AZ 2.2 CA 1.2 CO 1.0 CT 0.9 DC * DE * FL 2.7 GA 1.8 HI 1.6 IA 1.2 ID 1.6 IL 1.0 IN 1.4 KS 1.3 KY 1.7 LA 2.3 MA 0.7 MD 0.8 ME 1.0 MI 1.2 MN 1.1 MO 1.2 MS 2.9 MT 1.9 NC 1.4 ND * NE 1.3 NH 1.2 NJ 0.8 NM 1.1 NV 1.6 NY 0.7 OH 1.2 OK 2.2 OR 1.9 PA 0.9 RI * SC 1.9 SD * TN 1.8 TX 1.7 UT 1.3 VA 1.3 VT * WA 1.5 WI 1.2 WV 1.6 WY 2.4 * The injury death rate is suppressed Data Source: CDC/NCHS, National Vital Statistics System if fewer than 20 deaths were reported

54 55 4.9.2: Injury Deaths due to Falls

Injuries from falls represented 2% of unintentional injury deaths among children 0 to 19 years of age. The death rate for fall-related injuries was 0.2 per 100,000. Males had death rates nearly three times higher than females (0.3 vs. 0.1 per 100,000). (Fig 8) The rates were highest among children 15 to 19 years of age (0.4 per 100,000) and children less than 1 year (0.4 per 100,000). (Fig 25)

Figure 25: Unintentional Injury Death Rates due to Falls among Children 0 to 19 Years, by Age Group, United States, 2000 - 2005

0.5

0.4 0.4 0.4

0.3 0.3 Overall Rate 0.2 per 100,000

0.2

0.1 0.1 0.1 Death Rate Per 100,000 Population

0.0 Less Than 1 1 to 4 5 to 9 10 to 14 15 to 19 Age Group in Years Data Source: CDC/NCHS, National Vital Statistics System

Death rates by state are not presented in a map or ﬁ gure due to the high percentage of states with unreliable fall-related death rates. There was very little difference among states with reliable fall-related death rates. Appendix 4 presents a listing of the number of deaths per state by cause.

56 4.9.3: Injury Deaths due to Fires or Burns

Fire or burn-related injuries represented 5% of the unintentional injury deaths among children 0 to 19 years of age. The death rate for ﬁ re or burn-related injuries was 0.7 per 100,000. Males had a higher death rate than females (0.8 vs. 0.6 per 100,000). (Fig 8) The rate was highest among children 1 to 4 years (1.5 per 100,000) and lowest among those over age 10 (0.4 per 100,000). (Fig 26)

Figure 26: Unintentional Injury Death Rates due to Fires or Burns among Children 0 to 19 Years, by Age Group, United States, 2000 - 2005

1.6 1.5

1.4

1.2

1.0 0.9 Overall Rate 0.8 0.7 per 100,000 0.8

0.6 0.4 0.4 0.4 Death Rate Per 100,000 Population Rate Death 0.2

0.0 Less Than 1 1 to 4 5 to 9 10 to 14 15 to 19 Age Group in Years Data Source: CDC/NCHS, National Vital Statistics System

State death rates from ﬁ re or burn-related injuries varied from 0.2 per 100,000 to 2.4 per 100,000. (Fig 27 and Map 8)

57 Figure 27: Unintentional Injury Death Rates due to Fires or Burns among Children 0 to 19 Years, by State, United States, 2000 - 2005 Overall Rate 0.7 per 100,000 - 0.5 1.0 1.5 2.0 2.5

AK * AL 1.2 AR 2.1 AZ 0.5 CA 0.2 CO * CT * DC * DE * FL 0.4 GA 1.0 HI * IA 0.8 ID * IL 0.8 IN 1.0 KS 1.1 KY 1.4 LA 2.1 MA 0.3 MD 0.7 ME * MI 1.1 MN 0.5 MO 1.2 MS 2.1 MT * NC 0.8 ND * NE 0.7 NH * NJ 0.5 NM * NV * NY 0.6 OH 0.9 OK 1.0 OR 0.5 PA 0.8 RI * SC 1.1 SD 2.4 TN 1.3 TX 0.7 UT * VA 0.8 VT * WA 0.5 WI 0.5 WV 1.1 WY * * The injury death rate is suppressed Data Source: CDC/NCHS, National Vital Statistics System if fewer than 20 deaths were reported

58 59 4.9.4: Injury Deaths due to Poisoning

Poisoning represented 5% of the unintentional injury deaths among children 0 to 19 years of age. The death rate for poisoning was 0.8 per 100,000. Males had death rates twice as high as females (1.1 vs. 0.4 per 100,000). (Fig 8) The rate was highest among children 15 to 19 years of age (2.5 per 100,000) and lowest among those 5 to 9 years (0.1 per 100,000). (Fig 28)

Figure 28: Unintentional Injury Death Rates due to Poisoning among Children 0 to 19 Years, by Age Group, United States, 2000 - 2005

3.0

2.5 2.5

2.0

1.5

Overall Rate 0.8 per 100,000 1.0

0.5 0.5 Death Rate Per 100,000 Population Rate Death 0.2 0.2 0.1 0.0 Less Than 1 1 to 4 5 to 9 10 to 14 15 to 19 Age Group in Years Data Source: CDC/NCHS, National Vital Statistics System

State death rates from poisoning varied from 0.2 per 100,000 to 2.1 per 100,000. (Fig 29 and Map 9)

60 Figure 29: Unintentional Injury Death Rates due to Poisoning among Children 0 to 19 Years, by State, United States, 2000 - 2005

Overall Rate 0.8 per 100,000 - 0.5 1.0 1.5 2.0 2.5

AK 2.1 AL 0.8 AR 0.7 AZ 1.2 CA 0.4 CO 0.6 CT 1.1 DC * DE * FL 1.5 GA 0.7 HI * IA 0.5 ID * IL 0.8 IN 0.6 KS 0.4 KY 1.4 LA 1.4 MA 0.2 MD * ME 1.4 MI 0.5 MN 0.4 MO 0.8 MS 0.5 MT * NC 1.1 ND * NE * NH * NJ 0.9 NM 1.4 NV 1.1 NY 0.4 OH 0.7 OK 1.3 OR 0.7 PA 1.4 RI * SC 0.8 SD * TN 1.0 TX 0.9 UT * VA 0.6 VT * WA 0.7 WI 0.6 WV 0.8 WY * * The injury death rate is suppressed Data Source: CDC/NCHS, National Vital Statistics System if fewer than 20 deaths were reported

61 62 4.9.5: Injury Deaths due to Suffocation

Suffocation represented 8% of the unintentional injury deaths among children 0 to 19 years of age. The death rate for suffocation was 1.2 per 100,000. Males had higher death rates than females (1.4 vs. 0.9 per 100,000). (Fig 8) The rate was highest among children less than 1 year of age (16.1 per 100,000). Suffocation was the leading cause of injury death in children less than 1 year of age. (Fig 30)

Figure 30: Unintentional Injury Death Rates due to Suffocation among Children 0 to 19 Years, by Age Group, United States, 2000 - 2005

18 16.1 16

6 Overall Rate 4 1.2 per 100,000 Death Rate Per 100,000 Population Rate Death 0.9 2 0.2 0.3 0.3

0 Less Than 1 1 to 4 5 to 9 10 to 14 15 to 19 Age Group in Years Data Source: CDC/NCHS, National Vital Statistics System

State death rates from suffocation varied from 0.5 per 100,000 to 4.4 per 100,000. (Fig 31 and Map 10)

63 Figure 31: Unintentional Injury Death Rates due to Suffocation among Children 0 to 19 Years, by State, United States, 2000 - 2005

Overall Rate 1.2 per 100,000

- 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 AK AL 1.6 4.4 AR 1.7 AZ 1.2 CA 0.5 CO 0.9 CT 0.5 DC * DE * FL 1.7 GA 1.3 HI 1.6 IA 0.6 ID 1.4 IL 1.4 IN 2.3 KS 1.5 KY 2.0 LA 2.0 MA 0.5 MD 0.6 ME MI 2.2 MN 1.5 MO 2.1 MS 1.6 MT * NC 1.3 ND * NE 0.8 NH 1.0 NJ 0.5 NM 0.9 NV 1.7 NY 0.5 OH 1.6 OK 1.1 OR 1.2 PA 0.9 RI * SC 2.0 SD 1.8 TN 1.8 TX 1.1 UT 1.0 VA 0.9 VT * WA 1.1 WI 1.4 WV 0.8 WY 2.6 * The injury death rate is suppressed Data Source: CDC/NCHS, National Vital Statistics System if fewer than 20 deaths were reported

64 65 4.9.6: Injury Deaths related to Transportation

Transportation-related injuries represented 66% of the unintentional injury deaths among children 0 to 19 years of age. These deaths occur among all road user types (e.g., MVT occupants, pedestrians and pedal cyclists) and all vehicle types. The death rate for transportation-related injuries was 9.8 per 100,000. Males had death rates nearly twice as high than females (12.4 vs. 7.2 per 100,000). The rate was highest among those 15 to 19 years of age (26.4 per 100,000) and lowest among those 5 to 9 years and those less than 1 year (3.6 and 3.7 per 100,000, respectively). (Fig 32)

Figure 32: Unintentional Injury Death Rates due to Transportation-related Injuries* among Children 0 to 19 Years, by Age Group, United States, 2000 - 2005

30 26.4

15 Overall Rate 9.8 per 100,000 10

Death Rate Per 100,000 Population Rate Death 4.9 5 3.7 4.2 3.6

0 Less Than 1 1 to 4 5 to 9 10 to 14 15 to 19 * Includes all Motor Vehicle-related and Age Group in Years Other Transportation-related Injuries Data Source: CDC/NCHS, National Vital Statistics System

State death rates from transportation-related injuries varied from 4.7 per 100,000 to 19.5 per 100,000. (Fig 33 and Map 11)

66 Figure 33: Unintentional Injury Death Rates due to Transportation-related Injuries* among Children 0 to 19 Years, by State, United States, 2000 - 2005 Overall Rate 9.8 per 100,000 - 2.5 5.0 7.5 10.0 12.5 15.0 17.5 20.0 22.5 AK 13.0 AL 15.9 AR 17.7 AZ 11.9 CA 7.3 CO 10.9 CT 5.5 DC 5.1 DE 10.8 FL 11.4 GA 11.5 HI 6.6 IA 10.9 ID 13.1 IL 7.1 IN 10.5 KS 13.9 KY 14.7 LA 14.0 MA 5.0 MD 7.8 ME 10.3 MI 9.0 MN 9.3 MO 14.4 MS 19.5 MT 17.8 NC 12.8 ND 13.2 NE 12.4 NH 6.9 NJ 4.7 NM 15.0 NV 10.2 NY 5.1 OH 8.4 OK 14.2 OR 10.0 PA 8.6 RI 6.0 SC 14.8 SD 18.6 TN 14.0 TX 11.3 UT 9.3 VA 8.6 VT 9.6 W 8.1 WI 10.3 WV 15.4 WY 15.8 * Includes all Motor Vehicle-related and Other Transportation-related Injuries Data Source: CDC/NCHS, National Vital Statistics System

67 68 Deaths due to MVT Occupant Injuries

MVT occupant injuries represented 31% of the unintentional injury deaths among children 0 to 19 years of age. The death rate for MVT occupant injuries was 4.6 per 100,000. Males had death rates nearly twice as high as females (5.6 vs. 3.6 per 100,000). (Fig 8) The rate was highest among children 15 to 19 years of age (13.5 per 100,000) and lowest among those 5 to 9 years and those 1 to 4 years of age (1.3 and 1.4 per 100,000, respectively). (Fig 34)

Figure 34: Unintentional Injury Death Rates due to Motor Vehicle Traffic-Occupant Injuries among Children 0 to 19 Years, by Age Group, United States, 2000 - 2005

14 13.5

8 Overall Rate 6 4.6 per 100,000

4 2.1 Death Rate Per 100,000 Population Rate Death 1.9 2 1.4 1.3

0 Less Than 1 1 to 4 5 to 9 10 to 14 15 to 19 Age Group in Years Data Source: CDC/NCHS, National Vital Statistics System

State death rates from MVT occupant injuries varied from 0.7 per 100,000 to 15.1 per 100,000. (Fig 35 and Map 12)

69 Figure 35: Unintentional Injury Death Rates due to Motor Vehicle Traffic - Occupant Injuries among Children 0 to 19 Years, by State, United States, 2000 - 2005

Overall Rate 4.6 per 100,000 -246810121416

AK * AL 4.1 AR 8.2 AZ 1.7 CA 2.9 CO 3.5 CT 0.7 DC * DE 4.3 FL 7.4 GA 3.1 HI 2.3 IA 8.4 ID 10.1 IL 3.4 IN 4.6 KS 10.3 KY 4.9 LA 2.7 MA 0.9 MD 2.9 ME 7.6 MI 3.6 MN 5.8 MO 8.0 MS 15.1 MT 13.8 NC 8.8 ND 8.5 NE 9.7 NH 2.3 NJ 1.5 NM 10.9 NV 3.6 NY 1.9 OH 2.4 OK 2.9 OR 5.7 PA 2.0 RI 4.5 SC 5.2 SD 13.5 TN 10.0 TX 6.9 UT 3.0 VA 3.2 VT 4.0 WA 5.9 WI 7.7 WV 4.4 WY 10.4 * The injury death rate is suppressed Data Source: CDC/NCHS, National Vital Statistics System if fewer than 20 deaths were reported

70 71 Deaths due to Pedal Cyclist Injuries

Pedal cyclist injuries represented 2% of the unintentional injury deaths among children 0 to 19 years of age. The death rate for pedal cyclist injuries was 0.2 per 100,000. Males had death rates nearly four times higher than females (0.4 vs. 0.1 per 100,000). (Fig 8) The rate was highest among children 10 to 14 years of age (0.4 per 100,000). (Fig 36)

Figure 36: Unintentional Injury Death Rates due to Pedal Cyclist Injuries among Children 0 to 19 Years, by Age Group, United States, 2000 - 2005

0.45 0.4 0.40

0.35 0.3 0.30

0.2 0.25 Overall Rate 0.2 per 100,000 0.20

0.15

0.10 Death Rate Per 100,000 Population Rate Death 0.05 0.03 0 0.00 Less Than 1 1 to 4 5 to 9 10 to 14 15 to 19 Age Group in Years Data Source: CDC/NCHS, National Vital Statistics System

Death rates by state are not presented in a map or ﬁ gure due to the high percentage of states with unreliable pedal cyclist death rates. There was very little difference among states with reliable death rates. Appendix 4 presents a listing of the number of deaths per state by cause.

72 Deaths due to Pedestrian Injuries

Pedestrian injuries represented 8% of the unintentional injury deaths among children 0 to 19 years of age. The death rate for pedestrian injury was 1.2 per 100,000. Males had death rates nearly twice as high as females (1.5 vs. 0.8 per 100,000). (Fig 8) The rates were highest among children 1 to 4 years of age (1.7 per 100,000) and those 15 to 19 years of age (1.6 per 100,000). (Fig 37)

Figure 37: Unintentional Injury Death Rates due to Pedestrian Injuries among Children 0 to 19 Years, by Age Group, United States, 2000 - 2005

1.8 1.7 1.6 1.6

1.4 Overall Rate 1.2 per 100,000 1.2

1.0 0.9 0.9

0.8

0.6

0.4

Death Rate Per 100,000 Population Rate Death 0.2 0.2

0.0 Less Than 1 1 to 4 5 to 9 10 to 14 15 to 19 Age Group in Years Data Source: CDC/NCHS, National Vital Statistics System

State death rates from pedestrian injuries varied from 0.5 per 100,000 to 2.0 per 100,000. (Fig 38 & Map 13)

73 Figure 38: Unintentional Injury Death Rates due to Pedestrian Injuries among Children 0 to 19 Years, by State, United States, 2000 - 2005 Overall Rate 1.2 per 100,000 - 0.5 1.0 1.5 2.0 2.5

AK 2.0 AL 1.2 AR 1.5 AZ 1.6 CA 1.2 CO 1.0 CT 0.6 DC * DE * FL 1.5 GA 1.3 HI * IA 0.8 ID 1.0 IL 1.0 IN 1.0 KS 1.0 KY 1.1 LA 1.9 MA 0.5 MD 1.2 ME * MI 1.3 MN 0.9 MO 1.2 MS 1.5 MT * NC 1.5 ND * NE 0.9 NH * NJ 0.8 NM 1.4 NV 1.5 NY 1.0 OH 1.0 OK 1.3 OR 1.3 PA 1.0 RI * SC 1.4 SD 1.8 TN 1.1 TX 1.5 UT 1.3 VA 0.8 VT * WA 1.0 WI 0.8 WV 1.5 WY * * The injury death rate is suppressed Data Source: CDC/NCHS, National Vital Statistics System if fewer than 20 deaths were reported

74 75 Nonfatal Unintentional Injury, 2001 – 2006

76 5: Nonfatal Unintentional Injury Estimates among Children 0 to 19 Years, United States, 2001 – 2006

5.1: Nonfatal Injuries by Age Group

During the entire study period, there were an estimated 55 million nonfatal injuries among children 0 to 19 years of age, or an average of 9.2 million per year. From 2001-2006, an estimated 16.2 million or 29% occurred among those 15 to 19 years of age, for a nonfatal unintentional injury rate of 13,036 per 100,000 population. (Fig 39) The lowest rate (5,870 per 100,000) was found among children less than 1. (Fig 40)

Figure 39: Percent of Nonfatal Unintentional Injuries among Children 0 to 19 Years, by Age Group, United States, 2001 - 2006 Less Than 1 Year (n = 1,430,365) 3% 1 to 4 Years 15 to 19 Years (n = 12,243,897) (n = 16,206,251 ) 22% 29%

5 to 9 Years (n = 11,070,041) 20% 10 to 14 Years (n = 14,124,306) 26% Data Source: NEISS-AIP

77 Figure 40: Nonfatal Unintentional Injury Rates among Children 0 to 19 years, by Age Group, United States, 2001 - 2006

14,000 12,873 13,036 Overall Rate 11,272 per 100,000 12,000 11,220

10,000 9,311

8,000

5,870 6,000

4,000 Rate per 100,000 Population Rate

2,000

0 Less Than 1 1 to 4 5 to 9 10 to 14 15 to 19 Age Group in Years Data Source: NEISS-AIP

78 5.2: Nonfatal Injuries by Sex and Age Group

Combining all ages, males had higher nonfatal injury rates than females. The nonfatal injury rate among males 0 to 19 years was 13,122 per 100,000 compared with 9,331 per 100,000 among females. (Fig 41) To further examine nonfatal injury rates by sex and cause for each age group, see Appendix 5.

Figure 41: Nonfatal Unintentional Injury Rate among Children 0 to 19 years, by Sex, United States, 2001 - 2006

14,000 13,122

Overall Rate 12,000 11,272 per 100,000

10,000 9,331

8,000 ,000 Population 6,000

4,000 Rate per 100

2,000

0 Female Male

Data Source: NEISS -AIP

79 The nonfatal injury rates were higher among males in each age group, except among those less than 1 year where the rates were similar. The rate was 15,510 per 100,000 among males 15 to 19 years of age, about 1.5 times greater than the rate among females in the same age group. The lowest nonfatal injury rates were observed among both males and females less than 1 year of age. (Fig 42)

Figure 42: Nonfatal Unintentional Injury Rates among Children 0 to 19 years, by Age Group and Sex, United States, 2001 - 2006

18,000 15,510 16,000 14,444 Overall Rate 14,000 13,443 11,272 per 100,000 12,000 11,228 10,423 10,615

10,000 7,944 8,887 8,000 6,296 6,000 5,423

Rate per 100,000 Children Rate 4,000

2,000

0 Less 1 to 4 5 to 9 10 to 14 15 to 19 Less 1 to 4 5 to 9 10 to 14 15 to 19 Than 1 Than 1

Female Male Age Group in Years Data Source: NEISS-AIP

80 5.3: Nonfatal Injuries by Cause

Nonfatal injury rates differed by cause, with the highest rates related to falls (3,420 per 100,000), followed by injuries due to being struck by or against an object. The lowest rate was reported for nonfatal drowning (5 per 100,000). In the graph below, transportation-related injuries are divided into categories based on the road user type: MV-occupants, pedal cyclists, pedestrians, and all others. (Fig 43)

Figure 43: Nonfatal Unintentional Injury Rates among Children 0 to 19 years, by Cause, United States, 2001 - 2006

3,420 3,500

3,000 2,463 2,500

2,000

1,500 1,019 1,000 829 658 746 394 336 393

Rate per 100,000 Population 100,000 per Rate 500 304 190 253 168 5 72 22 0

s ng ries Fall cified soni s/Burns gn Body Cyclist Cut/PierceDrowning re PedestrianPoi Bites/Stings Fi Suffocation Forei MV-OccupantOther Inju OverexertionPedal

Struck By/Against Transportation-OtherUnknown/Unspe

Data Source: NEISS-AIP

81 5.4: Nonfatal Injuries by Sex and Cause

Nonfatal injury rates for most causes were highest among males (i.e., cut or pierced, falls, transportation-other, pedal cyclist, struck by or against). The nonfatal injury rate among both sexes was highest due to fall-related injuries, followed by being struck by or against an object. (Fig 44)

Figure 44: Nonfatal Unintentional Injury Rates among Children 0 to 19 years, by Sex and Cause, United States, 2001 - 2006

4,000 3,871 Male Female 3,500 3,163 2,946 3,000

2,500

2,000 1,728

1,500 1,102 944 931 922

1,000 741 706 606 559 539 529 401 313 303 294 268 250

500 221 206 202 174 172 163 Rate per 100,000 Population Rate 83 61 23 21 4 6 0

s Falls ified /Burns Cut/PierceDrowning PedestrianPoisoning Bites/Stings Fires Suffocation Foreign BodyMV-OccupantOther InjurieOverexertionPedal Cyclist

Struck By/Against Transportation-OtherUnknown/Unspec Data Source: NEISS-AIP

82 5.5: Nonfatal Injuries by Age Group and Cause

The leading causes of nonfatal injury also differed by age group. Fall-related injuries were highest among those less than 1, 1 to 4, 5 to 9 and 10 to 14. For those 15 to 19 years, struck by or against an object was the leading cause of nonfatal injuries, followed by falls, MV occupant, & overexertion, respectively. The nonfatal rate for suffocation was highest among children less than 1 year (150 per 100,000). (Table 6)

Table 6: Nonfatal Unintentional Injury Rates among Children 0 to 19 Years, by Age Group and Cause, United States, 2001 – 2006*

Age Group in Years Less Than 1 1 to 4 5 to 9 10 to 14 15 to 19 Bites/Stings 338 1116 723 495 471 Cut/Pierce 168 558 639 759 1094 Drowning 12 14 3 2 1 Falls 3049 5531 3406 3136 2178 Fire/Burns 282 379 111 96 200 Foreign Body 230 726 287 126 191 Overexertion 156 468 385 1347 1883 Other Injuries 142 254 92 168 516 Poisoning 168 373 45 62 236 Struck By/Against 795 2411 2152 2854 2732 Suffocation 150 48 11 6 4 Transportation MV - Occupant 182 279 366 489 2164 MV - Other 43 202 268 401 498 Pedal cyclist 7 175 532 639 258 Pedestrian 5 41 68 88 97 Unknown/Unspecified 142 301 224 552 514

* Data Source: NEISS-AIP Rates per 100,000 population

83 5.6: Analysis by Age Group

This section describes nonfatal injury for each age group in more detail. Table 7 displays the leading causes of nonfatal injury among children by age group and rank. For each age group, the total number of nonfatal injuries over the period 2001-2006 is reported, along with the proportion of all nonfatal injuries among each age group that each cause represented.

Among children less than 1 year of age, the majority of nonfatal injuries were due to falls (52%) followed by being struck by or against an object (14%). In those 1 to 4 years of age, the leading cause of nonfatal injury was falls (43%), followed by being struck by or against an object (19%). In those 5 to 9 years of age, the leading cause of nonfatal injury was falls (37%) followed by being struck by or against an object (23%). In those 10 to 14 years of age, the leading causes of nonfatal injury were falls (28%) and being struck by or against an object (25%). In those 15 to 19 years of age, the leading cause of nonfatal injury was being struck by or against an object (21%), followed by falls (17%).

84 Table 7: Leading Causes Nonfatal Unin of Rank Rank 16 12 14 11 10 15 13 9 8 7 5 4 6 3 2 1

Unknown/ Unspecified Unspecified Unknown/ Nonfatal Drowning Drowning Nonfatal MV - Occupant MV - Occupant (n = 1,430,364) Other Injuries Injuries Other Foreign Body Struck By/Ag By/Ag Struck Overexertion Pedal cyclist Less Than 1 Fires/Burns MV - Other Bites/Stings Suffocation Pedestrian Cut/Pierce Poisoning 0.08% 0.12% 0.2% Falls 14% 14% 52% 2% 3% 3% 1% 2% 3% 3% 3% 4% 5% 3% 3% 6% 2% 1% 2% 2% 3% 3% 3% 4% 6% 0.4% 0.11% 0.31% Fires/Burns Fires/Burns Foreign Unknown/ Unspecified Nonfatal Nonfatal Drowning (n= 12,243,896) MV - Occupant Other Injuries Injuries Other Struck By/Ag Overexertion Overexertion Pedal cyclist MV - Other MV - Other Bites/Stings Suffocation Suffocation Cut/Pierce Pedestrian Poisoning tentional Injuries among Children 0 to 19 Years, by Age Group, United States, 2001 – 2006 1 to 4 Falls 19% 19% 43% 2% 4% 4% 9% Body 1% 1% 1% 2% 3% 3% 3% 6% 7% 0.5% 0.5% 0.03% 0.12% Unknown/ Unspecified Age Group in Years Nonfatal Nonfatal Drowni (n= 11,070,041) MV - Occupant MV - Occupant Other Injuries Injuries Other Foreign Struck By/Ag By/Ag Struck Overexertion Overexertion Pedal cyclist MV - Other Fires/Burns Fires/Burns Bites/Stings Suffocation Pedestrian Cut/Pierce Po 5 to 9 Falls 23% 23% 37% isoning 4% 4% 4% 8% Body 1% 1% 1% 1% 4% 4% 6% 7% 7% 5% 0.02% 0.05% ng Unknown/ Unspecified Unspecified Unknown/ Nonfatal Nonfatal Drowning (n= 14,124,306) MV - Occupant Other Injuries Struck By/Ag By/Ag Struck Foreign Body Body Foreign Overexertion Overexertion Pedal cyclist MV - Other Fires/Burns Fires/Burns Bites/Stings Unknown/ U Suffocation Pedestrian Cut/Pierce Poisoning 10 to 14 Falls 12% 12% 25% 25% 28% 1% 1% 4% 4% 2% 1% 2% 2% 4% 4% 8% 4% 0.01 0.03 Nonfatal Nonfatal D (n= 16,206,250) MV - Occupant MV - Occupant Other I Other Struck By/Ag Foreign Overexertion Overexertion Pedal c Fires/B MV - O Bites/S Suffoc Pedes Cut/Pierce Poiso 15 to 19 Falls 17% 17% 14% 14% 17% 17% 21% 1% 4% njuries njuries trian ning ning ation % % yclist yclist Body tings rowning rowning nspecified urns urns ther

85 5.6.1: Nonfatal Injuries among Children Less Than 1 Year

The U.S. nonfatal injury rate among children less than 1 year of age was 5,870 per 100,000. Males in this age group had a nonfatal injury rate of 6,296 per 100,000 and females a rate of 5,423 per 100,000. (Fig 42) Falls resulted in the highest rate of injury (3,049 per 100,000), followed by being struck by or against an object (795 per 100,000). The nonfatal injury rate due to suffocation, which was the leading cause of injury death in this age group, was only 150 per 100,000 children. (Fig 45)

Figure 45: Nonfatal Unintentional Injury Rates among Children Less Than 1 Year, by Cause, United States, 2001 - 2006

3,500 3,049 3,000

2,500

2,000

1,500

1,000 795

338 Rate per 100,000 Population 100,000 per Rate 500 282 168 230 182 142 156 167 150 142 12 7 5* 43 0

g s in Falls ther own s/Burns isoning r Injurie ffocation Cut/PierceDr Po Bites/Stings Fire Pedestrian * Su tion - O Foreign Body Othe OverexertionPedal Cyclist MV - Occupant Struck By/Against

TransportaUnknown/Unspecified

* Rate is unreliable because of small sample size and should be interpreted with caution Data Source: NEISS-AIP

86 5.6.2: Nonfatal Injuries among Children 1 to 4 Years

The U.S. nonfatal injury rate among children 1 to 4 years of age was 12,873 per 100,000. Males in this age group had a nonfatal injury rate of 14,444 per 100,000 and females a rate of 11,228 per 100,000. (Fig 42) Falls resulted in the highest rate of injury (5,531 per 100,000), followed by being struck by or against an object (2,411 per 100,000). (Fig 46)

Figure 46: Nonfatal Unintentional Injury Rates among Children 1 to 4 Years, by Cause, United States, 2001 - 2006

6,000 5,531

5,000

4,000

3,000 2,411

2,000 1,116 1,000 726

Rate per 100,000 Population 100,000 per Rate 558 379 468 372 279 254 175 202 301 14 40 48 0

ng st ngs Falls cli ning Sti

Cut/PierceDrowni er Injuries PedestrianPoiso Bites/ Fires/Burns Suffocation Foreign Body Oth OverexertionPedal Cy MV - Occupant Struck By/Against

TransportationUnknown/Unspecified - Other

Data Source: NEISS-AIP

87 5.6.3: Nonfatal Injuries among Children 5 to 9 Years

The U.S. nonfatal injury rate among children 5 to 9 years of age was 9,311 per 100,000. Males 5 to 9 years of age had a nonfatal injury rate of 10,615 per 100,000 and females a rate of 7,944 per 100,000. (Fig 42) Falls resulted in the highest rate of injury (3,406 per 100,000) followed by being struck by or against an object (2,152 per 100,000). (Fig 47)

Figure 47: Nonfatal Unintentional Injury Rates among Children 5 to 9 Years, by Cause, United States, 2001 - 2006

4,000 3,406 3,500

3,000

2,500 2,152 2,000

1,500

1,000 723 639 532 366 385 Rate per 100,000 Population 100,000 Rate per 500 287 267 224 3 111 92 68 45 11 0

Falls estrian rowning D Cut/Pierce Ped Poisoning Bites/Stings Fires/Burnsoreign Body Suffocation F Other InjuriesOverexertionPedal Cyclist MV - Occupant Struck By/Against

TransportationUnknown/Unspecified - Other Data Source: NEISS-AIP

88 5.6.4: Nonfatal Injuries among Children 10 to 14 Years

The U.S. nonfatal injury rate among children 10 to 14 years was 11,220 per 100,000. Males in this age group had a nonfatal injury rate of 13,443 per 100,000 and females a rate of 8,887 per 100,000. (Fig 42) Falls and being struck by or against an object resulted in the highest rates of injury (3,136 and 2,854 per 100,000, respectively). (Fig 48)

Figure 48: Nonfatal Unintentional Injury Rates among Children 10 to 14 Years, by Cause, United States, 2001 - 2006

3,500 3,136 3,000 2,854

2,500

2,000

1,500 1,347

1,000 759 639 495 552 489 401

Rate per 100,000 Population 100,000 per Rate 500 96 126 168 2 88 62 6 0

clist Falls y rowning Cut/PierceD PedestrianPoisoning Bites/Stings Fires/Burns Suffocation Foreign Body OverexertionPedal C MV - OccupantOther Injuries Struck By/Against

TransportationUnknown/Unspecified - Other

Data Source: NEISS-AIP

89 5.6.5: Nonfatal Injuries among Children 15 to 19 Years

The U.S. nonfatal injury rate among those 15 to 19 years of age was 13,036 per 100,000. Males 15 to 19 years of age had a rate of 15,510 per 100,000 and females a rate of 10,423 per 100,000. (Fig 42) Injuries due to being struck by or against an object had the highest rate (2,732 per 100,000), followed by falls, motor vehicle occupant injuries and overexertion (2,178, 2,164 and 1,883 per 100,000, respectively). (Fig 49) The nonfatal drowning rate may be unreliable due to variation in number of drowning injuries seen in emergency departments.

Figure 49: Nonfatal Unintentional Injury Rates among Children 15 to 19 Years, by Cause, United States, 2001 - 2006

3,000 2,732

2,500 2,178 2,164

2,000 1,883

1,500 1,094 1,000

471 516 498 513 500 Rate per 100,000 Population 100,000 per Rate 200 191 257 236 97 1 4 0

nt a Falls uries ffocation Cut/PierceDrowning PedestrianPoisoning Bites/Stings Fires/Burnsoreign Body Su F OverexertionPedal Cyclist MV - OccupOther Inj Struck By/Against

TransportationUnknown/Unspecified - Other

Data Source: NEISS-AIP

90 5.7: Analysis by Cause

This section describes nonfatal injuries from selected causes in more detail.

5.7.1: Nonfatal Injuries due to Bites or Stings

Dog bites, insect stings and other animal bites accounted for 6% of the nonfatal injuries among children 0 to 19 years of age. The nonfatal injury rate for bites and stings was 658 per 100,000. The rate among males was 706 per 100,000 and among females was 606 per 100,000. (Fig 44) The rate was highest among children 1 to 4 years of age (1116 per 100,000), followed by those 5 to 9 years (723 per 100,000). (Fig 50)

Figure 50: Nonfatal Unintentional Injury Rates due to Bites and Stings* among Children 0 to 19 Years, by Age Group, United States, 2001 - 2006

1,200 1,116

1,000

800 Overall Rate 723 658 per 100,000

600 495 471

400 338 Rate per 100,000 Population Rate

200

0 Less Than 1 1 to 4 5 to 9 10 to 14 15 to 19 Age Group in Years * Includes Dog Bites, Animal Bites, Stings and Other Bites Data Source: NEISS-AIP

91 5.7.2: Nonfatal Drowning

Nonfatal drowning accounted for less than 1% of the nonfatal injuries among children 0 to 19 years of age. The nonfatal drowning rate was 5 per 100,000. The rate for males was 6 per 100,000 and the rate for females was 4 per 100,000. (Fig 44) The highest rates were among children 1 to 4 years of age (14 per 100,000) and among children less than 1 year of age (12 per 100,000). (Fig 51) The nonfatal drowning rate may be unreliable due to variation in the number of drowning injuries seen in emergency departments.

Figure 51: Nonfatal Unintentional Injury Rates due to Drowning among Children 0 to 19 Years, by Age Group, United States, 2001 - 2006

14 14 12 12

8 Overall Rate 5 per 100,000 6

Rate per 100,000 Population 4 3 2 2 1

0 Less Than 1 1 to 4 5 to 9 10 to 14 15 to 19 * Age Group in Years

* Rate is unreliable and should be interpreted with caution Data Source: NEISS-AIP

92 5.7.3: Nonfatal Injuries due to Falls

Falls accounted for 31% of the nonfatal injuries among children 0 to 19 years of age. Fall- related injuries were the most common reason for injury-related initial ED visits among all age groups except 15 to 19 year olds. (Table 7) The nonfatal injury rate for falls was 3,420 per 100,000. Males had a higher rate than females (3,871 vs. 2,946 per 100,000). (Fig 44) The fall rate was highest among children 1 to 4 years (5,531 per 100,000). (Fig 52)

Figure 52: Nonfatal Unintentional Injury Rates due to Falls among Children 0 to 19 Years, by Age Group, United States, 2001 - 2006

6,000 5,531

5,000

Overall Rate 4,000 3,420 per 100,000 3,406 3,136 3,049 3,000

2,178 2,000 Rate per 100,000 Population

1,000

0 Less Than 1 1 to 4 5 to 9 10 to 14 15 to 19 Age Group in Years Data Source: NEISS-AIP

93 5.7.4: Nonfatal Injuries due to Fire or Burns

Injuries from fi re or burns accounted for almost 2% of the nonfatal injuries among children 0 to 19 years of age. These injuries were the fourth leading cause of ED visits among children less than 1 year of age. (Table 7) The overall nonfatal injury rate due to fi re or burns was 190 per 100,000. The rate for males was 206 per 100,000 and the rate for females was 174 per 100,000. (Fig 44) The rate of nonfatal fi re or burn injuries was highest among children 1 to 4 years of age (379 per 100,000) followed by those less than 1 year (282 per 100,000). (Fig 53)

Figure 53: Nonfatal Unintentional Injury Rates due to Fires or Burns among Children 0 to 19 Years, by Age Group, United States, 2001 - 2006

400 379

350

300 282

250 Overall Rate 190 per 100,000 200 200

150 111 Rate per 100,000 Population 96 100

0 Less Than 1 1 to 4 5 to 9 10 to 14 15 to 19 Age Group in Years Data Source: NEISS-AIP

94 5.7.5: Nonfatal Poisoning

Poisoning accounted for almost 2% of the nonfatal injuries among children 0 to 19 years of age. The nonfatal injury rate for poisoning was 168 per 100,000. The rate among males was 172 per 100,000 and among females was 163 per 100,000. (Fig 44) The rate of poisoning was highest among children 1 to 4 years of age (372 per 100,000), followed by those 15 to 19 years of age (236 per 100,000). (Fig 54)

Figure 54: Nonfatal Unintentional Injury Rates due to Poisoning among Children 0 to 19 Years, by Age Group, United States, 2001 - 2006

400 372

350

300

250 236

Overall Rate 200 167 168 per 100,000

150 Rate per 100,000 Population Rate 100 62 45 50

0 Less Than 1 1 to 4 5 to 9 10 to 14 15 to 19 Age Group in Years Data Source: NEISS-AIP

95 5.7.6: Nonfatal Injuries due to being Struck by or Against an Object

Being struck by or against an object accounted for 22% of the nonfatal injuries among children 0 to 19 years of age. The nonfatal injury rate due to being struck by or against an object was 2,463 per 100,000. The rate among males was nearly twice that of females (3,163 vs. 1,728 per 100,000). (Fig 44) Rates were similar among all age groups older than 1 year of age. (Fig 55)

Figure 55: Nonfatal Unintentional Injury Rates due to Struck By or Against an Object among Children 0 to 19 Years, by Age Group, United States, 2001 - 2006

3,000 2,854 2,732 Overall Rate 2,463 per 100,000 2,500 2,411 2,152

2,000

1,500

1,000

Rate per 100,000 Population Rate 795

500

0 Less Than 1 1 to 4 5 to 9 10 to 14 15 to 19 Age Group in Years Data Source: NEISS-AIP

96 5.7.7: Nonfatal Suffocation

Suffocation accounted for less than 1% of the nonfatal injuries among children 0 to 19 years of age. The nonfatal injury rate for suffocation was 22 per 100,000. The rate was 23 per 100,000 among males and 21 per 100,000 among females. (Fig 44) The rate of nonfatal suffocation was highest among children less than 1 year of age (150 per 100,000) and decreased with age. (Fig 56)

Figure 56: Nonfatal Unintentional Injury Rates due to Suffocations among Children 0 to 19 Years, by Age Group, United States, 2001 - 2006

160 150

140

120

100

60 48 Rate per 100,000 Population Rate 40 Overall Rate 22 per 100,000 20 11 6 4 0 Less Than 1 1 to 4 5 to 9 10 to 14 15 to 19 Age Group in Years Data Source: NEISS-AIP

97 5.7.8: Nonfatal Injuries related to Transportation

Transportation-related injuries accounted for 15% of the nonfatal injuries among children 0 to 19 years of age. The nonfatal injury rate for this cause was 1,631 per 100,000. Males had a higher rate than females (1,784 vs. 1,472 per 100,000). (Fig 44) The nonfatal injury rate for motor vehicle-related injuries increased with age. The rate was highest among those 15 to 19 years of age (3,016 per 100,000) followed by those 10 to 14 years of age (1,617 per 100,000). (Fig 57)

Figure 57: Nonfatal Unintentional Injury Rates due to Transportation-related Injuries* among Children 0 to 19 Years, by Age Group, United States, 2001 - 2006

3,500

3,016 3,000

2,500 Overall Rate 2,000 1,631 per 100,000 1,617 1,500 1,233 Rate per 100,000 Population 100,000 per Rate 1,000 696

500 237

0 Less Than 1 1 to 4 5 to 9 10 to 14 15 to 19

* Includes All Motor Vehicle-related and Age Group in Years Other Transportation-related Injuries Data Source: NEISS-AIP

98 Nonfatal Injuries among Motor Vehicle Occupants

Motor vehicle occupant injuries accounted for almost 8% of the nonfatal injuries among children 0 to 19 years of age. The nonfatal injury rate for motor vehicle occupants was 829 per 100,000. Males had a rate of 741 per 100,000; females had a rate of 922 per 100,000. (Fig 44) The rate was highest among those 15 to 19 years of age (2,164 per 100,000). (Fig 58)

Figure 58: Nonfatal Unintentional Injury Rates due to Motor Vehicle - Occupant Injuries among Children 0 to 19 Years, by Age Group, United States, 2001 - 2006

2,500

2,164

2,000

1,500

Overall Rate 1,000 829 per 100,000 Rate per 100,000 Population Rate

489 500 366 279 182

0 Less Than 1 1 to 4 5 to 9 10 to 14 15 to 19 Age Group in Years Data Source: NEISS-AIP

99 Nonfatal Injuries among Pedal Cyclists

Pedal cyclist injuries accounted for 4% of the nonfatal injuries among children 0 to 19 years of age. The nonfatal injury rate for pedal cyclists was 394 per 100,000. The rate among males was twice that of females (559 vs. 221 per 100,000). (Fig 44) The rate increased with age up to 14 years. The rate was highest among children 10 to 14 years of age (639 per 100,000) and among those 5 to 9 years of age (532 per 100,000). (Fig 59)

Figure 59: Nonfatal Unintentional Injury Rates due to Pedal Cyclist Injuries among Children 0 to 19 Years, by Age Group, United States, 2001 - 2006

700 639

600 532

500 Overall Rate 394 per 100,000 400

300 257

Rate per 100,000 Population 200 175

100

7 0 Less Than 1 1 to 4 5 to 9 10 to 14 15 to 19 Age Group in Years Data Source: NEISS-AIP

100 Nonfatal Injuries among Pedestrians

Pedestrian injuries accounted for less than 1% of the nonfatal injuries among children 0 to 19 years of age. The nonfatal injury rate for pedestrians was 72 per 100,000. Males had a rate of 83 per 100,000; females had a rate of 61 per 100,000. (Fig 44) The rate increased with age. The rate was highest among those 15 to 19 years of age and those 10 to 14 years of age (97 and 88 per 100,000, respectively). (Fig 60) The nonfatal injury rate for pedestrians among children less than 1 year of age was based on a small number of events and may be unreliable.

Figure 60: Nonfatal Unintentional Injury Rates due to Pedestrian Injuries among Children 0 to 19 Years, by Age Group, United States, 2001 - 2006

120

97 100 88

80 Overall Rate 72 per 100,000 68 ` 60

40 40 Rate per 100,000 Population

20 5 0 Less Than 1 * 1 to 4 5 to 9 10 to 14 15 to 19 Age Group in Years

* Rate is unreliable and should be interpreted with caution Data Source: NEISS-AIP

101 References

1. Sleet, DA, RA Schieber, A Dellinger. Childhood injuries. The Enclyclopedia of Public Health, Vol I (Ed., L Breslow). New York: Macmillan Reference, USA 2002, pp 184-187.

2. Danesco ER, Miller TR, Spicer RS. Incidence and costs of 1987-1994 childhood injuries: demographic breakdowns. Pediatrics 2000;105(2):E27.

3. WHO. World report on child injury prevention WHO, Geneva 2008

4. Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System [online]. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. www.cdc.gov/ncipc/wisqars. [Accessed Aug 2008].

5. Child and adolescent injury prevention: a global call to action. Geneva, World Health Organization and UNICEF, 2005. http://whqlibdoc.who.int/publications/2005/9241593415_ eng.pdf. [Accessed: September 17, 2008].

6. Bernard SJ, Paulozzi LJ, Wallace DL. Fatal injuries among children by race and ethnicity-- United States, 1999-2002. MMWR Surveill Summ 2007; 18;56(5):1-16.

7. Schnitzer PG. Prevention of unintentional childhood injuries. Am Fam Physician 2006; 74(11):1864-9.

8. Centers for Disease Control and Prevention. National Center for Health Statistics. VitalStats. http://www.cdc.gov/nchs/vitalstats.htm. [Accessed: Aug 10, 2008].

9. US Consumer Product Safety Commission. The NEISS sample: design and implementation. In: Kessler E, Schroeder T, eds. Washington, DC: US Consumer Product Safety Commission, 2000.

10. World Health Organization. Manual of the international statistical classiﬁ cation of disease, injuries, and causes of death, 10th revision. Geneva, Switzerland: World Health Organization; 1999.

11. Fingerhut L. ICD Framework: External cause of injury mortality matrix [online]. Hyattsville, MD: National Center for Health Statistics. Available from: http://www.cdc.gov/ nchs/about/otheract/ice/matrix10.htm.

12. CDC. Recommended framework for presenting injury mortality data. In: Reports and Recommendations, August 29, 1997. MMWR 1997:46(No. RR-14):1-30.

102 13. Vyrostek SB, Annest JL, Ryan GW. Surveillance for Fatal and Nonfatal Injuries --- United States, 2001. In: Surveillance Summaries, September 3, 2004. MMWR 2004;53(No. SS- 7):1-57.

14. Arias E, Schauman WS, Eschbach K, Sorlie PD, Backlund E. The validity of race and Hispanic origin reporting on death certiﬁ cates in the United States. National Center for Health Statistics. Vital Health Stat 2(148). 2008.

103 Appendices

Appendix 1: Cause of Unintentional Injury Death Categories based on ICD-10 External Cause-of-Injury Codes ...... 105

Appendix 2: Categorization of Cause of Death: Numbers of Deaths from Unintentional Injuries among Children 0 to 19 Years, United, States, 2000 – 2005 ...... 106

Appendix 3: Number of Unintentional Injury Deaths among Children 0 to 19 Years, by State and Age Group, United States, 2000 – 2005 ...... 107

Appendix 4: Number of Unintentional Injury Deaths among Children 0 to 19 Years, by State and Cause, United States, 2000 – 2005 ...... 108

Appendix 5: Nonfatal Unintentional Injuries and Rates among Children 0 to 19 Years, by Sex and Cause, United States, 2001 – 2006 ...... 109 Appendix 5A: Nonfatal Unintentional Injury Rates among Children 0 to 19 Years, by Sex and Cause, United States, 2001 – 2006 ...... 109 Appendix 5B: Nonfatal Unintentional Injuries and Rates among Children Less Than 1 Year, by Sex and Cause, United States, 2001 – 2006 ...... 110 Appendix 5C: Nonfatal Unintentional Injuries and Rates among Children 1 to 4 Years, by Sex and Cause, United States, 2001 – 2006 ...... 111 Appendix 5D: Nonfatal Unintentional Injuries and Rates among Children 5 to 9 Years, by Sex and Cause, United States, 2001 – 2006 ...... 112 Appendix 5E: Nonfatal Unintentional Injuries and Rates among Children 10 to 14 Years, by Sex and Cause, United States, 2001 – 2006 ...... 113 Appendix 5F: Nonfatal Unintentional Injuries and Rates among Children 15 to 19 Years, by Sex and Cause, United States, 2001 – 2006 ...... 114

104 Appendix 1. Cause of Unintentional Injury Death Categories based on ICD-10 External Cause-of-Injury Codes*

Cause of Unintentional Injury Death ICD-10 Codes Drowning W65-W74 Falls W00-W19 Fire/Burns X00-X19 Poisoning X40-X49 Suffocation W75-W84 Transportation-related MV traffic – Occupant V30-V79 (.4-.9), V83-V86 (.0-.3) MV traffic – Unspecified V87 (.0-.8), V89.2 Pedal cyclist V10-V18, V19(.0-.6,.8,.9) Pedestrian V01, V02-V04 (.0,.1,.9), V05, V06, V09 (.0,.1,.2,.3,.9) Transportation – Other V20-V29, V30-V79 (.0-.3), V80, V81-V82 (.0,.1,.2-.9), V83-V86 (.4- .9), V87.9, V88 (.0-.9), V89 (.0,.1 .3,.9), V90-V99 Other injuries W20-W45, W49-W64, W85-W99, X20-X39, X50-X59, Y85, Y86

*ICD-10 is the International Classification of Diseases, Tenth Revision.

105 Appendix 2: Categorization of Cause of Death: Numbers of Deaths from Unintentional Injuries among Children 0 to 19 Years, United, States, 2000 – 2005*

Mechanism of Injury sCause Defined using the Modified Matrix from the External Cause of Injury Fires or MV Traffic Pedal Transportation MV Traffic Other † Mortality Matrix Drowning Falls Burns Occupant Pedestrian Cyclist Other Unspecified Poisoning Suffocation Injuries Cut/Pierce ------49 Drowning 6,900 ------Falls - 1,123 ------Fires/Flame - - 3,507 ------Hot Object/Substance - - 47 ------Firearm ------1,009 Machinery ------239 MV Traffic Occupant - - - 22,345 ------MV Traffic Motorcyclist ------1,308 - - - - MV Traffic Other ------17 - - - - MV Traffic Unspecified ------14,916 - - - MV Traffic Pedal Cyclist - - - - - 969 - - - - - Pedal Cyclists, Other - - - - - 208 - - - - - 106 MV Traffic Pedestrian - - - - 4341 ------Other Land Transport ------1,684 - - - - Pedestrians, Other - - - - 1, 379 ------Other Transport ------710 - - - - Natural/Environmental ------667 Overexertion ------2 Poisoning ------3,638 - - Struck by or Against ------560 Suffocation ------5,734 - Other Specified, ------607 Classifiable Other Specified, NEC‡ ------230 Unspecified ------863 Total 6,900 1,123 3,554 22,345 5,720 1,177 3,719 14,916 3,638 5,734 4,226 Death Rate per 100,000§ 1.4 0.2 0.7 4.6 1.2 0.2 0.8 3.1 0.8 1.2 0.9

* CDC/NCHS National Vital Statist cs Si ystem † Fingerhut L. ICD Framework Ex: ternal cause of injury mortality matrix [online]. Hyattsville, MD: National Center for Health Statistics. Available from: http://www.cdc.gov/nchs/about/otheract/ice/matrix1 t0.h m ‡ Not Elsewhere Classified § NCH PopuS lation 2000 – 2005 used for calculation of Rates (n = 487,055,735) Appendix 3: Number of Unintentional Injury Deaths among Children 0 to 19 Years, by State and Age Group, United States, 2000 – 2005*

Age Group in Years

Less Than 1 1 to 4 5 to 9 10 to 14 15 to 19 Total AK 55 41 22 69 141 328 AL 122 262 168 220 1010 1782 AR 95 191 118 146 646 1196 AZ 137 292 181 227 932 1769 CA 345 1075 699 849 3571 6539 CO 74 130 94 142 662 1102 CT 28 57 40 50 322 497 DC 5 9 17 7 37 75 DE 12 24 18 22 135 211 FL 468 787 388 506 2587 4736 GA 236 431 272 356 1401 2696 HI 32 31 10 17 127 217 IA 37 86 94 91 431 739 ID 37 70 52 69 258 486 IL 322 338 230 311 1401 2602 IN 229 260 158 187 960 1794 KS 65 130 87 122 518 922 KY 132 189 142 175 892 1530 LA 161 316 209 249 969 1904 MA 29 83 52 87 470 721 MD 54 118 114 127 571 984 ME 9 33 30 26 199 297 MI 386 295 260 345 1236 2522 MN 108 128 110 162 651 1159 MO 202 224 167 240 1173 2006 MS 91 241 170 205 774 1481 MT 17 33 34 48 236 368 NC 181 301 242 321 1437 2482 ND 7 12 27 24 111 181 NE 19 62 63 61 297 502 NH 12 18 22 36 136 224 NJ 73 136 117 141 668 1135 NM 34 90 62 99 406 691 NV 76 84 45 90 299 594 NY 135 335 259 323 1451 2503 OH 289 327 258 331 1432 2637 OK 71 176 135 145 766 1293 OR 63 125 82 118 484 872 PA 140 313 223 307 1648 2631 RI 17 18 10 16 95 156 SC 124 179 143 185 881 1512 SD 26 56 50 66 169 367 TN 183 257 173 269 1145 2027 TX 505 1088 724 819 3617 6753 UT 53 133 73 92 330 681 VA 113 201 153 161 943 1571 VT 5 10 11 20 96 142 WA 113 185 122 150 735 1305 WI 111 143 136 159 804 1353 WV 21 58 59 71 360 569 WY 24 22 19 29 114 208 Total 5780 10136 7059 9028 40734 73052

* Any rate calculation based on fewer than 20 deaths may be unreliable

107 Cause, United States, 2000 – 2005* Appendix 4: Number of Unintentional Injury Deaths among Children 0 to 19 Years, by State and ‡ Other Injury includes Cut or pierced, Unintentional Firearm, Machinery, Natural environmental, Overexertion, Struck by † Transportation includes MVT Occupants, Pedestrians, Pedal Cyclist, Other, Unspecified and other transportation relate * Any rate calculation based on fewer than 20 deaths may be unreliable Total 6900 WA WV WY MO MA MD MN NM ME MT OK OH MS KY AK CO OR NH GA VA ND 10 CA NC AR NV DC 2 NY UT TX VT TN LA WI NE AL AL AZ CT DE MI PA KS SD 18 SC FL NJ HI IN IA ID RI 10 RI IL Dr

owning owning 146 28 113 22 674 75 214 69 182 151 32 156 28 169 26 112 21 128 130 780 107 211 26 147 205 26 110 26 184 20 109 150 117 21 106 235 41 281 29 682 42 180 40 230 80 62 65 27 71 23 57 39 71 32 42 38 74 26 48 95 25 20 38 20 2 29 48 59 4 F 1123 10 16 17 13 9 14 14 12 10 10 19 17 11 9 18 16 12 lsB alls 3 3 5 6 3 2 5 8 2 7 3 15 8 6 16 7 10 8 4 9 19

3554 284 120 106 171 170 1119 193 174 107 113 150 163 197 106 1005 147 102 urns 12 30 408 13 97 50 657 46 47 32 247 26 92 37 530 78 1016 13 68 71 62 843 70 22 373 44 39 27 567 13 16 93 800 93 1187 9 9 Tran relat s 39431 4591 1310 1106 1015 4561 1154 1538 1582 1736 1540 1367 1672 1591 1752 2893 po 330 253 130 46 459 151 160 133 87 818 971 305 41 823 260 138 89 929 500 203 149 141 47 102 77 144 57 505 367 266 207 647 792 375 131 93 39 42 r e 1 265 ta d tion- †

Occ 22345 MV 2814 1804 1869 1193 479 485 728 408 218 325 939 116 383 169 477 596 179 302 694 456 609 371 173 354 205 290 779 761 379 589 494 321 91 16 13 11 u pa T

Pe des 5720 109 596 106 151 200 225 770 153 214 113 116 199 194 379 198 311 116 Pe t 66 10 3 55 46 73 18 8 41 97 11 3 14 9 78 25 25 41 87 96 24 76 17 3 36 66 78 97 75 74 46 26 13 2 71 56 6 0 9 1 6 3 rian against an object, Other specified and classifiable, specifiable-not Unspecified. a yls P dal Cyclist 1177 d injuries 143 107 95 28 17 10 17 17 11 20 12 33 22 34 13 23 21 10 33 24 12 35 19 39 19 66 57 24 10 10 49 16 17 18 24 23 6 7 14 6 9 9 6 8 9 1

o 3638 is 347 115 168 226 136 378 112 154 1 262 116 120 62 10 11 20 70 97 166 95 73 109 20 48 24 29 21 22 71 13 15 26 54 58 56 27 77 65 47 30 28 80 84 60 28 42 69 30 79 63 122 73 37 69 40 61 33 nn Su oning 3 4 1 04 195 7 4 f 5734 oain Othe focation 430 240 162 133 310 308 171 134 114 324 169 153 124 199 373 442 121 129 51 50 24 31 31 22 34 47 16 20 13 23 26 12 13 73 58 44 11 3 6 5 r I 4226 106 139 352 104 132 391 139 101 161 188 197 110 104 101 145 136 116 152 104 11 53 33 18 11 46 93 25 3 23 73 86 77 39 62 42 89 14 28 55 46 49 31 8 9 8 8 njuries ‡ TO 73 17 19 26 15 65 67 26 47 17 20 26 15 11 24 11 17 13 15 25 14 25 11 13 26 12 20 11 2 9 4 7 3 1 7 32 6 2 1 2 5 2 9 6 2 4 5 1 5 8 7 TAL 17 22 86 39 67 81 21 052 81 08 42 24 02 97 84 91 68 11 97 69 56 94 72 94 04 02 30 39 53 96 36 69 27 37 71 35 82 96 82 05 12 03 81 22 02 53 31 93 06 5 59 8

108 Appendix 5: Nonfatal Unintentional Injuries and Rates among Children 0 to 19 Years, by Sex and Cause, United States, 2001 – 2006

Appendix 5A: Nonfatal Unintentional Injury Rates among Children 0 to 19 Years, by Sex and Cause, United States, 2001 – 2006

Overall Males Females Rate per Rate per Rate per Weighted 100,000 100,000 100,000 Cause Estimate population* population* population* Fall 16,708,081 3,420 3,871 2,946 Struck By/Against 12,034,546 2,463 3,163 1,728 Overexertion 4,976,839 1,019 1,102 931 MV-Occupant 4,050,659 829 741 922 Cut/Pierce 3,646,945 746 944 539 Other Bite/Sting 2,288,653 468 495 441 Pedal Cyclist 1,924,756 394 559 221 Unknown/Unspecified 1,920,436 393 530 250 Foreign Body 1,483,355 304 313 294 Other Transport 1,285,877 263 277 249 Fire/Burn 942,978 191 206 174 Other Specified 930,531 193 206 179 Dog Bite 924,203 189 212 166 Poisoning 819,725 168 173 163 Motorcyclist 358,069 73 124 20 Pedestrian 351,764 72 83 61 Suffocation 143,709 22 23 21 Machinery 108,729 29 46 12 BB/Pellet Gunshot 77,491 16 27 4 Natural/Environment 50,265 10 15 5 Nonfatal Drowning 23,826 5 6 4 Firearm Gunshot 23,421 5 8 1 Total 55,074,860 11,272 13,122 9,331 * Population 2001-2006: Overall 488,582,677; Males 250,264,225; Females 238,318,452

109 Appendix 5B: Nonfatal Unintentional Injuries and Rates among Children Less Than 1 Year, by Sex and Cause, United States, 2001 – 2006

Overall Male Female Rate per Rate per Rate per Weighted 100,000 100,000 100,000 Cause Estimate population* population* population* Fall 742,930 3,049 3,320 2,765 Struck By/Against 193,789 795 879 707 Other Bite/Sting 72,471 297 331 262 Fire/Burn 68,790 282 319 244 Foreign Body 56,110 230 236 224 MV-Occupant 44,446 182 191 174 Cut/Pierce 41,021 168 166 171 Poisoning 40,816 168 175 160 Overexertion 37,991 156 124 189 Suffocation 36,557 150 141 159 Unknown/Unspecified 34,534 142 151 132 Other Specified 33,511 138 143 132 Other Transport 10,468 43 44 42 Dog Bite 9,859 41 45 36 Nonfatal Drowning 2,953 12 13 11† Pedal Cyclist 1,701 7 8† 6† Pedestrian 1,167† 5† 4† 5† Natural/Environment 780† 3† 5† 1† Machinery 338† 1† 2† 1† Motorcyclist 85† 0.3† 0.0† 1† Firearm Gunshot 23† 0.1† 0.0† 0.2† Bb/Pellet Gunshot 23† 0.1† 0.2† 0.0† Total 1,430,365 5,870 6,296 5,423 * Population 2001-2006: Overall 24,368,733; Male 12,462,355; Female 11,906,378 † Estimate or rate is unreliable because of small sample size and should be interpreted with caution.

110 Appendix 5C: Nonfatal Unintentional Injuries and Rates among Children 1 to 4 Years, by Sex and Cause, United States, 2001 – 2006

Overall Male Female Rate per Rate per Rate per Weighted 100,000 100,000 100,000 Cause Estimate population* population* population* Fall 5,260,470 5,531 6,337 4,687 Struck By/Against 2,293,035 2,411 2,885 1,915 Other Bite/Sting 826,789 869 933 803 Foreign Body 690,437 726 717 736 Cut/Pierce 530,492 558 656 455 Overexertion 445,093 468 396 543 Fire/Burn 360,033 379 429 326 Poisoning 354,272 373 393 351 Unknown/Unspecified 286,165 301 323 278 MV-Occupant 265,538 279 281 277 Dog Bite 234,777 247 261 232 Other Specified 230,104 242 256 227 Other Transport 188,240 198 217 178 Pedal Cyclist 166,431 175 229 118 Suffocation 45,594 48 50 45 Pedestrian 38,499 41 45 36 Nonfatal Drowning 13,136 14 17 11 Machinery 6,354 7 10 4 Motorcyclist 3,613 4 5 2† Bb/Pellet Gunshot 2,369 3 3 2† Natural/Environment 2,160 2 2† 2† Firearm Gunshot 294† 0.3† 0.3† 0.3† Total 12,243,896 12,873 14,444 11,228 * Population 2001-2006: Overall 95,114,828; Male 48,637,811; Female 46,477,017 † Estimate or rate is unreliable because of small sample size and should be interpreted with caution.

111 Appendix 5D: Nonfatal Unintentional Injuries and Rates among Children 5 to 9 Years, by Sex and Cause, United States, 2001 – 2006

Overall Male Female Rate per Rate per Rate per Weighted 100,000 100,000 100,000 Cause Estimate population* population* population* Fall 4,050,141 3,406 3,765 3,031 Struck By/Against 2,558,947 2,152 2,679 1,600 Cut/Pierce 759,484 639 750 523 Pedal Cyclist 632,730 532 663 523 Other Bite/Sting 558,954 470 513 425 Overexertion 457,365 385 370 400 MV-Occupant 434,798 366 349 383 Foreign Body 341,098 287 324 248 Dog Bite 300,514 253 286 218 Other Transport 282,819 238 235 241 Unknown/Unspecified 266,292 224 269 177 Fire/Burn 131,481 111 113 108 Other Specified 89,093 75 80 69 Pedestrian 80,792 68 85 50 Poisoning 53,368 45 49 41 Motorcyclist 35,217 30 47 11 Suffocation 13,423 11 12 10 Bb/Pellet Gunshot 10,524 9 14 3 Machinery 6,346 5 8 3 Nonfatal Drowning 3,087 3 3 2† Natural/Environment 2,922 3 2 3 Firearm Gunshot 646† 0.5† 1† 0.4† Total 11,070,041 9,311 10,615 7,644 * Population 2001-2006: Overall 118,897,067; Male 60,835,200; Female 58,061,867 † Estimate or rate is unreliable because of small sample size and should be interpreted with caution.

112 Appendix 5E: Nonfatal Unintentional Injuries and Rates among Children 10 to 14 Years, by Sex and Cause, United States, 2001 – 2006

Overall Male Female Rate per Rate per Rate per Weighted 100,000 100,000 100,000 Cause Estimate population* population* population* Fall 3,947,358 3,136 3,612 2,636 Struck By/Against 3,592,332 2,854 3,720 1,944 Overexertion 1,695,386 1,347 1,383 1,309 Cut/Pierce 955,592 759 952 557 Pedal Cyclist 803,828 639 950 557 Unknown/Unspecified 695,092 552 768 325 Other Bite/Sting 616,105 489 327 282 MV-Occupant 383,993 305 437 545 Other Transport 377,430 300 299 300 Dog Bite 239,484 190 229 150 Foreign Body 158,813 126 131 121 Other Specified 148,809 118 120 116 Motorcyclist 127,388 101 171 28 Fire/Burn 121,287 96 96 97 Pedestrian 110,233 88 102 72 Poisoning 78,433 62 59 65 Bb/Pellet Gunshot 35,652 28 48 8 Machinery 11,838 9 15 4 Natural/Environment 10,400 8 9 7 Suffocation 7,683 6 7 5 Firearm Gunshot 4,303 3 6 1† Nonfatal Drowning 2,867 2 3 2† Total 14,124,306 11,220 13,443 8,887 *Population 2001-2006: Overall 125,880,215; Male 64,475,429; Female 61,404,786 † Rate is unreliable because of small sample size and should be interpreted with caution.

113 Appendix 5F: Nonfatal Unintentional Injuries and Rates among Children 15 to 19 Years, by Sex and Cause, United States, 2001 – 2006

Overall Male Female Rate per Rate per Rate per Weighted 100,000 100,000 100,000 Cause Estimate population* population* population* Struck By/Against 3,396,442 2,732 3,719 1,690 Fall 2,707,182 2,178 2,464 1,875 MV-Occupant 2,689,772 2,164 1,879 2,646 Overexertion 2,341,004 1,883 2,244 1,502 Cut/Pierce 1,360,356 1,094 1,491 675 Unknown/Unspecified 638,354 514 768 244 Other Bite/Sting 446,446 359 345 374 Other Specified 441,460 355 387 322 Other Transport 426,921 343 387 298 Pedal Cyclist 320,066 257 424 81 Poisoning 292,835 236 236 235 Fire/Burn 248,940 200 214 1856 Foreign Body 236,897 191 192 188 Motorcyclist 191,766 154 265 37 Dog Bite 139,568 112 119 105 Pedestrian 121,072 97 104 90 Machinery 118,833 96 152 36 Natural/Environment 34,004 27 45 9 Bb/Pellet Gunshot 28,923 23 41 5 Firearm Gunshot 18,155 15 26 3 Suffocation 5,471 4 6 3 Nonfatal Drowning 1,783† 1† 2† 1† Total 16,206,250 13,036 15,510 10,423 *Population 2001-2006: Overall 124,321,834; Male 63,853,430; Female 60,468,404 † Estimate or rate is unreliable because of small sample size and should be interpreted with caution.

114 115