Weekly

October 19, 2012 / 61(41);830-833

Unintentional injuries are the leading cause of deaths among persons aged 0–19 years in the United States. Quantifying years of potential life lost (YPLL) highlights childhood causes of mortality and provides a simple method to identify important causes of premature death and specific groups in need of intervention (1). Deaths attributed to unintentional injuries among persons aged 0–19 years number approximately 12,000 each year in the United States; another 9 million young persons are treated for nonfatal injuries in emergency departments (2). To estimate the burden of premature deaths attributed to unintentional injuries among persons aged 0–19 years, CDC calculated state-specific YPLL by sex, age, race, and injury mechanism based on data from the National Vital Statistics System multiple cause of death files for the period 2000–2009. This report summarizes the results of that analysis, which found that an average of 890 years of potential life were lost each year because of unintentional injuries for every 100,000 persons aged 0–19 years. The burden of unintentional injuries was higher among males compared with females, among persons aged <1 15="15" 5-year="5-year" adjacent="adjacent" age="age" aged="aged" alabama="alabama" american="american" among="among" and="and" any="any" arkansas="arkansas" at="at" be="be" can="can" central="central" clusters="clusters" compared="compared" dakota="dakota" estimates="estimates" ethnicity="ethnicity" groups="groups" in="in" indian="indian" injury="injury" laska="laska" louisiana="louisiana" mississippi="mississippi" montana="montana" most="most" mountain="mountain" native="native" of="of" other="other" p="p" persons="persons" prevention="prevention" race="race" region.="region." residing="residing" risk.="risk." south="south" states="states" strategies="strategies" target="target" the="the" these="these" those="those" to="to" two="two" used="used" with="with" wyoming="wyoming" year="year" years="years" young="young"> CDC analyzed data from the National Vital Statistics System multiple cause of death files for the period 2000–2009 (3), the most recent data available. Unintentional injury deaths were defined as those with the underlying cause of death classified by the International Classification of Diseases, 10th Revision (ICD-10) as drowning (W65–W74), falls (W00–W19), fires or burns (X00–X19), transport-related injuries (V01–V99), poisoning (X40–X49), and suffocation (W75–W84) (4), or falling in a category of other injury deaths comprising all other mechanisms of unintentional injuries: cut or pierced, unintentional firearm, machinery, natural and environmental, overexertion, struck by or against an object, and other specified and unspecified.
YPLL was calculated for each decedent by subtracting the age at death in years from 75. Annualized YPLL during 2000–2009 for each demographic group, injury mechanism, and geographic area was calculated by summing its associated YPLL for the 10 years and dividing by 10.
The annualized YPLL per 100,000 for each demographic group, injury mechanism, or geographic area was calculated by dividing its YPLL for 2000–2009 by the sum of the mid-year annual population estimates of the relevant population for 2000–2009. Population estimates used for YPLL rate calculations were bridged-race population figures (5). Annualized YPLL and YPLL rates were calculated at the national and state level; by sex, age, and race; and for the injury mechanisms of drowning, falls, fires or burns, motor vehicle traffic–related, other transportation, poisoning, suffocation, and "all other" mechanisms.
National Level YPLL
Unintentional childhood injuries accounted for 115,613 deaths during 2000–2009. Males contributed almost twice the number of YPLL as females, with an annual rate of 1,137 per 100,000, compared with 630 (Table 1). Persons aged 15–19 years contributed 51% of the total YPLL from unintentional injuries. The YPLL rate per 100,000 by 5-year age group ranged from 367 in persons aged 5–9 years to 1,768 in those aged 15–19 years, but the highest rate in any single-year age group was in persons aged <1 100="100" 1="1" 71="71" attributed="attributed" each="each" injuries.="injuries." of="of" p="p" per="per" suffocation="suffocation" to="to" were="were" which="which" with="with" year="year" ypll="ypll"> YPLL rates differed by race/ethnicity. The rate was highest among AI/AN males at 1,790 per 100,000, followed by black males at 1,194, and white males at 1,147 (Table 1). Among females, AI/AN females had a YPLL rate nearly twice that of both white and black females and three times that of Asian/Pacific Islander females, who lost an average of 320 years of potential life per 100,000 each year.
Injuries attributed to motor vehicle traffic crashes contributed the bulk (55%) of all YPLL during the period analyzed. The YPLL per 100,000 for motor vehicle traffic–related injuries was 491, five times higher than that for suffocation, the second leading YPLL contributor at 95. Drowning was third, with a YPLL rate of 91 per 100,000. Motor vehicle traffic–related pedestrian injuries contributed more to YPLL (52 per 100,000) than injuries from fire or burns (45), poisoning (52), and falls (14).
State Level YPLL
Thirty states had YPLL rates greater than or equal to the national YPLL rate of 890 per 100,000 persons aged 0–19 years. The YPLL per 100,000 varied among the states, from 416 in Massachusetts to 1,770 in Mississippi. States with the highest YPLL rates were Mississippi (1,770), Alaska (1,592), South Dakota (1,573), and Wyoming (1,543). States with the lowest YPLL rates were Massachusetts (416), New Jersey (470), New York (484), and Connecticut (521) (Table 2 and Figure).

Reported by

Nagesh N. Borse, PhD, Div of Global HIV and AIDS, Center for Global Health; Rose A. Rudd, MSPH, Ann M. Dellinger, David A. Sleet, PhD, Div of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC. Corresponding contributor: Nagesh N. Borse, nborse@cdc.gov, 404-639-8339.

Editorial Note

This report provides new information on YPLL attributed to unintentional injuries among persons aged 0–19 years, by state, which can be used to prioritize and identify subgroups of the population most at risk. Although recent declines have been observed in the unintentional injury–related crude mortality rate per 100,000 persons aged 0–19 years (from 15.46 in 2000 to 10.96 in 2009), unintentional injuries remain the number one killer among this population in the United States. The burden of unintentional injuries was highest among males, persons aged <1 15="15" aged="aged" ai="ai" and="and" contributed="contributed" drowning="drowning" injuries="injuries" most="most" motor="motor" p="p" related="related" s.="s." suffocation="suffocation" those="those" to="to" traffic="traffic" vehicle="vehicle" year="year" years="years" ypll.="ypll."> By taking into account the decedent's age at death, YPLL measures premature mortality. Unlike other mortality indicators, YPLL is a more relevant measure for children because it incorporates both the number of those who died and the number of years lost because of premature death. With different injury mechanisms disproportionally affecting persons of different ages (e.g., suffocation being the leading mechanism of death only in those aged <1 activities="activities" addition="addition" and="and" can="can" departments="departments" develop="develop" estimates="estimates" evaluate="evaluate" federal="federal" guide="guide" health="health" help="help" i="i" in="in" injury="injury" local="local" meeting="meeting" prevention="prevention" programs="programs" reduce="reduce" reflects="reflects" researchers="researchers" state="state" that="that" these="these" this="this" to="to" toward="toward" use="use" variation.="variation." year="year" ypll.="ypll." ypll="ypll">Healthy People 2020
objectives for children and adolescents and to help identify and target injury prevention strategies. The findings of this report are subject to at least one limitation. The analysis was based on death certificate data indicating that an unintentional injury was the underlying cause of death; previous studies have shown that some injury-related deaths are underestimated or misclassified by mechanism on death certificates (6).
Decreasing the burden of injuries is a central challenge for public health in the United States. Most injuries are preventable, and many effective strategies are available to reduce child injury and mortality (7,8). Measuring the burden of injuries with YPLL gives greater weight to the injuries that disproportionately affect younger persons and permits comparison of the premature injury death by sex, age group, race, and state. YPLL will help prioritize implementation of known and effective interventions, such as using safety belts, wearing bicycle and motorcycle helmets, reducing drinking and driving, strengthening graduated driver licensing laws, using safety equipment during sports participation, requiring four-sided residential pool fencing, and encouraging safe sleep practices for infants. Implementing these strategies widely can reduce the burden of injuries to all persons aged 0–19 years (2,7–9). In 2009, in an effort to raise parent's awareness about the leading causes of child injury in the United States and how they can be prevented, CDC published its childhood injury report on patterns of unintentional injuries among persons aged 0–19 years (2), launched a Protect the Ones You Love initiative, and made available a number of resources that can be accessed online at http://www.cdc.gov/safechild. In 2012, CDC launched the National Action Plan on Childhood Injury Prevention (available online at http://www.cdc.gov/safechild/nap) to mobilize action around a set of recommendations for research, communications, policy, health services, education and training, and data and surveillance that can save children's lives (10).

References

CDC. Premature mortality in the United States: public health issues in the use of years of potential life lost. MMWR 1986;35(2 Suppl):1S–11S.
Borse NN, Gilchrist J, Dellinger AM, et al. Unintentional childhood injuries in the United States: key findings from the CDC childhood injury report. J Safety Res 2009;40:71–4.
Xu JQ, Kochanek KD, Murphy SL, et al. Deaths: final data for 2007. Natl Vital Stat Rep 2010;58(19).
World Health Organization. Manual of the international statistical classification of disease, injuries, and causes of death, 10th revision. Geneva, Switzerland: World Health Organization; 1999.
CDC. Postcensal estimates of the resident population of the United States for July 1, 2000–July 1, 2006, by year, county, age, bridged race, Hispanic origin, and sex (Vintage 2006). Available at http://www.cdc.gov/nchs/nvss/bridged_race/data_documentation.htm#vintage2006. Accessed October 9, 2012.
Nagaraja J, Menkedick J, Phelan KJ, et al. Deaths from residential injuries in US children and adolescents, 1985–1997. Pediatrics 2005;116:454–61.
Peden M, Oyegbite K, Ozanne-Smith J, et al, eds. World report on child injury prevention. Geneva, Switzerland: World Health Organization; 2008. Available at http://www.who.int/violence_injury_prevention/child/injury/world_report/report/en/index.html . Accessed October 9, 2012.
Doll LS, Bonzo SE, Mercy JA, et al, eds. Handbook of injury and violence prevention. New York, NY: Springer Science Business Media, LLC; 2007.
Sleet DA, Ballesteros MF, Borse NN. A review of unintentional injuries in adolescents. Annu Rev Public Health 2010;31:195–212.
CDC. National action plan for child injury prevention. Atlanta, GA: US Department of Health and Human Services, CDC, National Center for Injury Prevention and Control; 2012. Available at http://www.cdc.gov/safechild/nap. Accessed October 9, 2012.