Abstract
Introduction: Recent changes in unspecified unintentional injury mortality for the elderly by U.S. state remain unreported. This study aims to examine U.S. state variations in mortality from unspecified unintentional injury among Americans aged 65+, 1999–2013; Methods: Using mortality rates from the U.S. CDC’s Web-based Injury Statistics Query and Reporting System (WISQARS™), we examined unspecified unintentional injury mortality for older adults aged 65+ from 1999 to 2013 by state. Specifically, the proportion of unintentional injury deaths with unspecified external cause in the data was considered. Linear regression examined the statistical significance of changes in proportion of unspecified unintentional injury from 1999 to 2013; Results: Of the 36 U.S. states with stable mortality rates, over 8-fold differences were observed for both the mortality rates and the proportions of unspecified unintentional injury for Americans aged 65+ during 1999–2013. Twenty-nine of the 36 states showed reductions in the proportion of unspecified unintentional injury cause, with Oklahoma (−89%), Massachusetts (−86%) and Oregon (−81%) displaying the largest changes. As unspecified unintentional injury mortality decreased, mortality from falls in 28 states and poisoning in 3 states increased significantly. Mortality from suffocation in 15 states, motor vehicle traffic crashes in 12 states, and fire/burn in 8 states also decreased; Conclusions: The proportion of unintentional injuries among older adults with unspecified cause decreased significantly for many states in the United States from 1999 to 2013. The reduced proportion of unspecified injury has implications for research and practice. It should be considered in state-level trend analysis during 1999–2013. It also suggests comparisons between states for specific injury mortality should be conducted with caution, as large differences in unspecified injury mortality across states and over time could create bias for specified injury mortality comparisons.
Highlights
Recent changes in unspecified unintentional injury mortality for the elderly by U.S state remain unreported
We found that (a) 81% of U.S states with stable mortality rates witnessed reductions in the proportion of unspecified unintentional injury mortality among Americans aged 65+ from 1999 to 2013; (b) changes in the proportion of unspecified unintentional injury mortality between 1999 and 2013 varied greatly across states—Oklahoma, Massachusetts, and Oregon decreased by over 80% but another seven states did not change significantly; and (c) the decreases in rates of unintentional injury mortality with unspecified cause were accompanied with increased mortality from falls in 28 states and from poisoning in 3 states, but decreases in mortality from suffocation in 15 states, motor vehicle traffic crashes in 12 states, and fire/burn in 8 states
Our findings provide evidence that, consistent with CDC goals [4], the specificity of older adult unintentional injury mortality cause data has improved in 81% of the U.S states with stable mortality rates (i.e., 29 out of 36 states) [5,15,16]
Summary
Recent changes in unspecified unintentional injury mortality for the elderly by U.S state remain unreported. The proportion of unintentional injury deaths with unspecified external cause in the data was considered. The reduced proportion of unspecified injury has implications for research and practice It should be considered in state-level trend analysis during 1999–2013. The proportion of injuries reported with an unspecified cause of injury can substantially affect the reported morbidity and mortality rates of cause-specific injury data. Researchers can approximate this proportion using the proportion of injury deaths with unspecified external cause codes [1,2,3], Int. J. Public Health 2016, 13, 763; doi:10.3390/ijerph13080763 www.mdpi.com/journal/ijerph
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