Unintentional Injuries

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In 2011, there were just over nine million unintentional injuries among children and youth younger than 20 that were serious enough to warrant a trip to the emergency room. In addition, there were 8,473 unintentional injuries in this age group that were fatal.

Importance

The toll of childhood injuries on society is staggering. Over 8,000 children—more than 20 a day—die annually in the U.S. because of such injuries. However, it is estimated that for every child death resulting from injuries, more than 1,000 children receive medical treatment or consultation for non-fatal injuries. (Appendix 1 and Appendix 2) In 2000, associated medical and other costs, including lost time at work by family members caring for injured children, totaled more than $87 billion.   Annual costs rise to more than $200 billion when reduced quality of life for injured children and their families is included.[1]

Unintended injuries are the leading cause of death and disability for children and adolescents in the U.S. Among people ages 1-19 years, they account for more than a third (36 percent) of all deaths; for newborns and infants under the age of one year, they are the fifth leading cause.[2] Although child injuries occur under diverse circumstances, motor vehicle crashes are the leading cause of fatal injuries, while falls account for the greatest proportion of non-fatal injuries. (Appendix 1)

Trends

Data on fatal and non-fatal injuries tend to follow different patterns, so we discuss them separately below.

Fatal injuries

122_fig1Between 1981 and 1992, the rate of deaths due to injuries among all children ages birth through 19 fell by nearly 36 percent. Over this period, rates of fatal injury among males decreased more than rates among females, although both declined (by 39 and 28 percent, respectively. (Figure 1)

Rates declined at a slower pace between 1992 and 2007, falling from 17 to 14 deaths per 100,000 population. However, between 2008 and 2011 there were greater declines—a drop of 16 percent over the three years. In 2011, there were 10 child and youth deaths per 100,000 population, caused by unintentional injuries. Approximately equal percentage-declines occurred for males and females between 2000 and 2011 (Figure 1)

Declines in death rates related to motor vehicles accounted for the single largest portion of the decline in fatal injuries. The steepest decline has been in the last decade: rates of motor-vehicle-related deaths fell 48 percent between 2001 and 2011, although this remains the leading cause of injury-related deaths among all persons younger than 20. Rates associated with most other causes of fatal injuries also declined significantly in the past decade, with the exception of suffocation and poisoning, each of which increased significantly (by 28 and 68 percent, respectively. (Appendix 1) Eighty-nine percent of child and adolescent deaths by poisoning in 2011 were due to drug overdoses or alcohol poisoning, and non-drug poisoning deaths increased less than 10 percent between 2001 and 2011.[3]

Non-Fatal injuries

122_fig2Rates of non-fatal injuries requiring a trip to the emergency department decreased by 13 percent between 2000 and 2009, from 12,202 to 10,556 injuries per 100,000 population. However, in 2010 the rate increased to 11,008, and remained virtually unchanged in 2012, at 10,955. (Figure 2) Accounting for the greatest proportions of the decade’s decline were motor-vehicle-related injuries (down by 35 percent between 2002 and 2012), bicycle accidents (down by 21 percent), and poisoning (down by 19 percent). (Appendix 2)

Differences by Age

Fatal injuries

122_fig3Unintentional fatal injuries are most common among infants. The 2011 rates per 100,000 population range from a high of 29 among children younger than one year, to a low of 3.7 among those ages five to nine. The second-highest rate was for adolescents ages 15 to 19 (20 deaths per 100,000). Fatal injuries have been trending downward for all age groups except infants. (Appendix 1)

The most common causes of fatal injuries differ among age groups. For instance, although suffocation is the most common type of fatal injury among infants (77 percent, in 2011), it accounts for only one percent of unintentional fatalities among adolescents ages 15 to 19. While only eight percent of fatal injuries among infants are due to motor vehicle crashes, they account for 67 percent among adolescents. While drowning is the most common cause of fatal injury among children ages one to four (32 percent), for adolescents it accounts for six percent of fatal injuries. Other notably common types of injury are poisoning among adolescents (accounting for 17 percent of fatal injuries), and fire and burn injuries among one- to four- and five- to nine-year-olds (nine and 11 percent of fatal injuries, respectively). (Figure 3)

Non-Fatal injuries

122_fig4Rates for non-fatal injuries are highest among children ages one to four (13,484 injuries per 100,000 population, in 2012), followed by adolescents ages 15 to 19 (12,074 per 100,000), children ages 10 to 14 (10,640 per 100,000), children ages five to nine (8,947 per 100,000), and infants less than a year old (6,686 per 100,000). (Appendix 4)

Marked age-related differences are also evident in the causes of non-fatal injuries. Falls are the most common cause between birth and age nine, and the second most common for 10- to 19-year-olds. However, the proportion of injuries that is associated with falls decreases with age. Among infants, 55 percent of serious non-fatal injuries were from falls in 2012, compared with 18 percent of non-fatal injuries among adolescents ages 15 to 19. Non-fatal injuries that result from being “struck by or against an object or person” comprised 23 percent of injuries among 15- to 19-year-olds (the single largest category), and 13 percent among infants. (Figure 4)

Differences by Gender

Males are more likely than females to sustain both fatal and non-fatal injuries. The 2011 rate of fatal injuries among males was 13 per 100,000 population–nearly double the rate among females (7 per 100,000). (Figure 1) For serious non-fatal injuries, the 2012 rate among males was 12,436 per 100,000, while the rate among females was 9,404 per 100,000. (Figure 2)

Differences by Race and Hispanic Origin[4]

Rates of fatal injury are highest among American Indian and Alaska Native children (14 per 100,000 population, in 2011), and lowest for Asian and Pacific Islander children (3.5 per 100,000). In between are rates for white and black children (11 and 12 per 100, 000, respectively), and Hispanic children (7 per 100,000). (Appendix 1) White and black children have nearly the same rates of injury-related death, except in the case of drowning, where the rate for black children is higher.[5]

While information is not available on rates of non-fatal injury for American Indians and Alaska Natives or for Asian and Pacific Islanders, in 2012 white children were more likely than either black or Hispanic children to go to an emergency department with a non-fatal injury (11,518 injuries per 100,000 population, versus 8,642 and 5,647 per 100,000, respectively). (Appendix 2)

State and Local Estimates

The Centers for Disease Control and Prevention has published state-level rates of deaths due to unintentional injury among persons ages birth through 19, for 2000-2009.

2007 state-level data on non-fatal injuries (ages birth to five) that required medical attention are available from the National Survey of Children's Health. These parent-reported data can be tabulated by race, family income, and other variables.

International Estimates

Estimates of injury-related death rates for selected developed countries are in UNICEF's League Table of Child Deaths by Injury in Rich Nations.

National Goals

The federal government, through the Healthy People 2020 initiative, has set a number of goals to reduce unintentional injuries. They include a goal to reduce suffocation deaths among infants up to a year old from 22.5 per 100,000 (in 2007) to 20.3 deaths per 100,000 by 2020. There are also goals, although not specifically for children, to reduce fatal and non-fatal injuries in general, prevent an increase in poisonings (fatal and non-fatal), and reduce injuries and deaths due to motor vehicle crashes, drowning, and fire.

More information is available here.

What Works to Make Progress on This Indicator

Owing to the diverse causes of injuries in children, it is not practical to give a comprehensive summary of effective prevention practices. However, consistent use of protective equipment (e.g., bicycle helmets, seat belts and car seats, stair gates, cabinet locks, and smoke detectors) can reduce the risk of serious injury. For example, mandatory helmet legislation is strongly association with reduced bicycle-related head injuries in children.[6]

The Trust for America's Health has identified 10 indicators of evidence-based strategies for injury prevention, including state policies related to intimate partner violence, sports-related concussions, and prescription drug monitoring.

Related Indicators

Definition

Deaths due to unintentional injuries are those in which the attending physician, medical examiner, or coroner ruled that the death was neither a homicide, suicide, nor due to legal intervention (i.e., self defense or police action). Non-fatal unintentional injuries are defined as “bodily harm resulting from severe exposure to an external force or substance (mechanical, thermal, electrical, chemical, or radiant) or a submersion"[7] which was not intended. More information is available here.

Data Sources

Fatal Injury Data: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. (2014). WISQARS online, fatal injury reports. Available at: http://www.cdc.gov/injury/wisqars/fatal.html

Non-Fatal Injury Data: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. (2014). WISQARS online, non-fatal injury reports. Available at: http://www.cdc.gov/injury/wisqars/nonfatal.html.

Raw Data Source

Fatal injury data: National Vital Statistics System

www.cdc.gov/nchs/deaths.htm

Non-Fatal injury data: National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP)

http://www.cdc.gov/ncipc/wisqars/nonfatal/datasources.htm#5.2

 

Appendix 1 - Unintentional Fatal Injuries: Rates per 100,000 Population, Ages Birth to 19, by Selected Characteristics: Selected Years, 1981-2011

1981 1985 1990 1995 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Total Fatal Injuries 19,442 16,087 14,604 13,122 12,441 12,172 12,442 12,035 12,184 11,778 11,674 11,560 10,184 9,143 8,684 8,473
Fatal Injuries (Rate per 100,000) 27.1 22.9 20.3 17.1 15.5 15.0 15.3 14.8 14.9 14.4 14.2 14.0 12.3 11.0 10.4 10.2
Gender
Male 37.7 30.9 27.2 22.0 19.9 19.6 19.9 19.1 19.0 18.4 18.2 17.9 15.9 14.1 13.5 13.1
Female 16.0 14.5 13.1 12.0 10.8 10.3 10.6 10.3 10.6 10.1 10.0 9.8 8.4 7.7 7.2 7.2
Race/Hispanic origin
Non-Hispanic White - - 19.3 17.3 16.3 15.8 16.1 15.8 16.3 15.3 15.0 15.3 13.6 11.7 11.6 11.3
Non-Hispanic Black - - 21.0 19.2 16.2 16.0 16.2 14.3 14.9 14.9 15.0 15.1 13.3 12.6 11.5 11.9
Hispanic1 - - 17.5 13.8 12.4 12.1 12.5 12.4 11.5 12.1 12.0 10.5 9.0 8.7 7.5 7.4
American Indian/Alaska Native - - 32.7 27.4 24.2 23.8 21.1 22.2 19.6 19.9 19.3 18.2 15.7 14.9 13.9 13.8
Asian/Pacific Islander - - 12.7 9.4 7.7 7.7 8.3 7.7 7.1 6.5 6.8 6.5 5.1 4.7 4.2 3.5
Mechanism of injury
Motor vehicle traffic 15.8 13.4 12.2 10.3 9.3 9.1 9.5 9.0 8.9 8.3 8.1 7.6 6.1 5.5 5.0 4.8
Suffocation 1.3 1.1 1.0 1.0 1.1 1.2 1.2 1.1 1.3 1.3 1.4 1.5 1.6 1.4 1.4 1.4
Drowning 3.3 2.7 2.3 2.0 1.6 1.5 1.4 1.3 1.3 1.4 1.3 1.3 1.2 1.2 1.2 1.2
Poisoning 0.6 0.4 0.4 0.3 0.6 0.6 0.7 0.8 0.9 0.9 1.0 1.2 1.1 1.0 1.0 1.0
Other transportation 0.6 0.5 0.4 0.3 0.9 0.8 0.7 0.9 0.8 0.8 0.8 0.7 0.7 0.6 0.6 0.5
Fire/burn 2.2 1.9 1.5 1.2 0.9 0.8 0.8 0.7 0.7 0.7 0.6 0.7 0.5 0.5 0.4 0.4
Falls 0.5 0.4 0.4 0.3 0.2 0.3 0.2 0.3 0.2 0.2 0.2 0.2 0.2 0.2 0.2 0.2
Other 2.9 2.5 2.1 1.7 0.9 0.9 0.9 0.8 0.8 0.9 0.8 0.8 0.7 0.6 0.7 0.7
Age group
0 to 4 24.2 20.7 14.1 13.9 13.3 13.6 13.6 13.8 13.8 14.3 13.7 13.1 12.4 12.6 14.1 13.9
less than 1 - - 23.2 24.3 23.9 23.8 26.2 27.1 28.4 31.0 31.8 29.5 28.1 29.3 23.2 24.3
1 to 4 - - 11.9 11.2 10.6 11.0 10.4 10.5 10.1 9.9 9.1 9.0 8.6 8.5 11.9 11.2
5 to 9 13.9 11.8 6.8 6.4 5.9 5.6 5.8 5.5 5.3 4.9 4.2 3.8 3.7 3.7 6.8 6.4
10 to 14 14.3 13.2 7.7 7.4 7.3 7.1 7.2 6.3 5.8 5.9 5.0 4.4 4.3 4.2 7.7 7.4
15 to 19 51.2 43.7 33.4 32.5 34.6 32.5 32.3 30.8 30.5 29.4 25.0 21.7 20.6 19.9 33.4 32.5
1Hispanics may be of any race.

Source: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. (2014). WISQARS online, fatal injury reports. Available at: http://www.cdc.gov/injury/wisqars/fatal.html

Appendix 2 - Unintentional Injuries Requiring Attention at a Hospital Emergency Department, Rates per 100,000 Population, Ages Birth to 19, by Selected Characteristics: 2000-2012

20001 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Total Non-Fatal Injuries  9,818,946  9,699,473  9,180,998  9,087,625  9,111,354  8,935,898  9,072,870  8,844,651  8,780,938  8,790,851  9,166,112  9,185,139  9,038,763
Non-Fatal Injuries (Rate per 100,000) 12,202 11,988 11,310 11,161 11,145 10,897 11,021 10,688 10,564 10,556 11,008 11,087 10,955
Gender
Male 14,475 14,075 13,150 12,884 12,943 12,634 12,855 12,448 12,314 12,213 12,698 12,753 12,436
Female 9,803 9,786 9,366 9,344 9,249 9,070 9,090 8,840 8,727 8,816 9,237 9,341 9,404
Race/Hispanic origin
Non-Hispanic White 10,622 10,327 9,633 10,165 9,887 9,439 9,293 9,189 10,146 10,873 10,743 10,855 11,518
Non-Hispanic Black 11,891 12,787 11,945 10,372 10,704 9,395 9,219 8,109 8,744 8,224 8,546 9,048 8,642
Hispanic2 7,204 6,139 5,015 3,434 3,985 4,067 4,604 3,576 4,566 4,697 5,450 5,700* 5,647*
Age group
less than 1 6,930 5,936 6,185 5,868 6,028 5,819 5,938 5,641 5,746 6,225 6,520 6,790 6,686
1 to 4 14,093 14,081 13,128 12,789 12,934 12,544 12,768 12,315 12,446 12,968 13,596 13,796 13,484
5 to 9 9,969 10,183 9,582 9,299 9,279 8,935 8,964 8,501 8,498 8,378 8,638 8,896 8,947
10 to 14 11,943 11,981 11,447 11,083 10,931 10,534 10,612 10,471 10,391 10,321 10,864 10,829 10,640
15 to 19 14,288 13,401 12,453 12,786 12,718 12,751 12,928 12,619 12,109 11,770 12,226 12,163 12,074
Mechanism of injury
Fall 3,467 3,639 3,386 3,431 3,443 3,306 3,279 3,184 3,285 3,384 3,457 3,473 3,409
Struck by/ against object or person 2,753 2,612 2,497 2,403 2,390 2,329 2,522 2,409 2,415 2,404 2,508 2,511 2,499
Overexertion 1,032 1,090 1,032 981 979 982 1,037 1,052 997 979 1,078 1,060 1,082
Occupant of a motor vehicle 995 903 870 842 839 776 737 684 637 618 623 576 569
Cut/Pierce 812 847 763 734 719 711 698 660 636 599 655 668 648
Bite/sting 750 654 630 650 690 649 666 610 599 625 672 738 721
Pedal Cyclist 555 420 417 417 396 371 339 355 332 354 341 349 329
Other transportation 390 400 398 408 414 423 398 404 401 357 362 339 328
Foreign Body 342 337 283 281 300 302 315 308 301 290 323 330 335
Fire/burn 230 218 199 191 182 185 166 157 158 143 154 165 165
Poisoning 180 199 188 167 149 147 155 143 132 140 154 157 152
Unknown/unspecified 463 443 422 388 338 409 355 366 375 356 325 314 324
All others 233 225 225 268 305 308 353 356 296 310 356 408 394
1non-fatal injury reports from 2000 are not comparable to later years because of seasonal effects (survey conducted in the summer).

2Hispanics may be of any race

Source: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. (2014). WISQARS online, non-fatal injury reports. Available at: http://www.cdc.gov/injury/wisqars/nonfatal.html.

 

Appendix 3 - Fatal Injuries: Rates and Percentages by Type of Injury, By Age Group: 2011

Age group less than 1 1 to 4 5 to 9 10 to 14 15 to 19
Rate per 100,000 percent1 Rate per 100,000 percent1 Rate per 100,000 percent1 Rate per 100,000 percent1 Rate per 100,000 percent1
Fatal Injuries
All fatal injuries 29.3 100 8.5 100 3.7 100 4.2 100 19.9 100
Motor vehicle traffic 2.3 8.0 2.0 23.9 1.9 51.9 2.4 55.7 13.2 66.6
Suffocation 22.6 77.0 0.9 10.4 0.2 4.5 0.2 5.0 0.2 1.2
Drowning 1.3 4.5 2.7 31.8 0.6 16.8 0.5 12.3 1.1 5.7
Poisoning - - 0.2 2.5 - - 0.2 4.0 3.4 17.2
Other transportation - - 0.7 8.1 0.1 3.7 0.2 5.7 0.4 2.1
Fire/burn 0.6 2.1 0.8 9.4 0.4 10.7 0.2 4.7 0.2 1.1
Fall - - 0.2 1.8 - - - - 0.4 1.8
Other 1.7 5.9 1.0 12.1 0.4 9.4 0.4 10.4 0.9 4.4
1may not add up to 100% due to rounding.

Source: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. (2014). WISQARS online, fatal injury reports. Available at: http://www.cdc.gov/injury/wisqars/fatal.html

Appendix 4 - Unintentional Injuries that Resulted in Emergency Department Visits: Rates and Percentage by Type of Injury, by Age Group: 2012

Age group less than 1 1 to 4 5 to 9 10 to 14 15 to 19
Rate per 100,000 percent1 Rate per 100,000 percent1 Rate per 100,000 percent1 Rate per 100,000 percent1 Rate per 100,000 percent1
All unintentional injuries 6,686 100 13,484 100 8,947 100 10,640 100 12,074 100
Fall 3,688 55.2 5,784 42.9 3,336 37.3 2,905 27.3 2,129 17.6
Struck by/ against object or person 839 12.5 2,399 17.8 2,089 23.3 2,965 27.9 2,825 23.4
Overexertion 163 2.4 554 4.1 457 5.1 1,541 14.5 1,804 14.9
Occupant of a motor vehicle 102 1.5 217 1.6 293 3.3 374 3.5 1,371 11.4
Cut/Pierce 151 2.3 566 4.2 582 6.5 614 5.8 897 7.4
Bite/sting 412 6.2 1,314 9.7 771 8.6 496 4.7 504 4.2
Pedal Cyclist - - 157 1.2 405 4.5 476 4.5 302 2.5
Other transportation - - 222 1.6 241 2.7 369 3.5 507 4.2
Foreign Body 285 4.3 904 6.7 316 3.5 123 1.2 139 1.1
Fire/burn 275 4.1 353 2.6 110 1.2 83 0.8 137 1.1
Poisoning 107 1.6 229 1.7 33 0.4 65 0.6 301 2.5
Unknown/unspecified 127 1.9 282 2.1 187 2.1 429 4.0 420 3.5
All else 537 8.0 502 3.7 127 1.4 199 1.9 739 6.1
1may not add up to 100% due to rounding.Source: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. (2014). WISQARS online, non-fatal injury reports. Available at: http://www.cdc.gov/injury/wisqars/nonfatal.html

Endnotes


[1]Centers for Disease Control and Prevention. (2012). National action plan for child injury prevention: A agenda to prevent injuries and promote the safety of children and adolescents in the United States. National Center for Injury Prevention and Control. Retrieved from http://www.cdc.gov/safechild/nap/

[2]Centers for Disease Control and Prevention. (2012). Vital Signs: Unintentional injury deaths among persons aged 0-19 years--United States, 2000-2009. MMWR, 61(15), 270-276.

[3]Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS) [Online]. (2014). National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Available at http://www.cdc.gov/injury/wisqars/index.html

[4]Hispanics may be any race. Estimates for whites and blacks in this report exclude Hispanics.

[5]In 2010, the crude drowning death rate for non-Hispanic black children ages 0-19 was 1.8 per 100,000 population; for non-Hispanic whites, it was 1.2. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Retrieved from http://www.cdc.gov/injury/wisqars/index.html

[6]MacPherson, A. K., To, T. M., Macarthur, C., Chipman, M. L., Wright, J. G., and Parkin, P. C. (2002). Impact of mandatory helmet legislation on bicycle-related head injuries in children: A population-based study. Pediatrics, 110(5), e60.

[7]Centers for Disease Control and Prevention. (2007). Definitions for WISQARS non-fatal. Available at: http://www.cdc.gov/ncipc/wisqars/nonfatal/definitions.htm

 

 

Suggested Citation:

Child Trends Databank. (2014). Unintentional injuries. Available at: http://www.childtrends.org/?indicators=unintentional-injuries

 

Last updated: August 2014