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Unintentional injuries in the home in the United States: Part II: Morbidity

https://doi.org/10.1016/j.amepre.2004.09.017Get rights and content

Background

Homes are an important setting for nonfatal unintentional injuries. The purpose of this study was to quantify and describe nonfatal, unintentional injuries in the United States, in which the injury took place at home.

Methods

Data derived from the National Health Interview Survey, National Ambulatory Medical Care Survey, and National Hospital Ambulatory Medical Care Surveys for Outpatient and Emergency Departments. The nonfatal unintentional home injury rate and 95% confidence interval were computed for the United States overall (1998–1999), as well as by type of injury, gender, and age group. Weights were applied for each data set as designated by the National Center for Health Statistics.

Results

In 1998, there were more than 12 million unintentional home injuries requiring some form of medical attention. Falls were the most common injury among all age groups, followed by cutting/piercing injuries, and injuries associated with being struck by or against an object or person. Injury rates were highest among the oldest and youngest age groups. There was inconsistency across data sets with regard to the presence of location information and definitions of the home environment, inclusion criteria, and the presence of external cause of injury and poisoning codes (E-codes). Depending on the data set, information was missing for 8% and 41% of cases on the location of injury, making it impossible to determine whether the injuries occurred in the home environment.

Conclusions

Falls are a significant problem, particularly among older adults. Additionally, data collection systems need to be improved so that location of injury data are routinely collected using consistent definitions so as to allow comparisons across data sets and over time.

Introduction

Despite the significant morbidity in the United States associated with unintentional injury,1, 2, 3, 4, 5, 6 fatalities often receive more attention, probably in part because of the greater accessibility and uniformity of mortality data. However, deaths represent only a small proportion of overall injury incidence.7 In a recent study comparing fatal and nonfatal injuries to young people, there were nearly 1000 injuries that required care in an emergency department for each fatality.6 Also, the causes of fatal and nonfatal injuries are distinct.7 The leading causes of nonfatal unintentional injuries—falls, injuries associated with being struck by or against an object, overexertion, and cut/pierce injuries—are seldom lethal in the otherwise healthy individuals.6, 7 Furthermore, the debilitating long-term effects of nonfatal injuries for individuals and families contribute to significant social costs in the forms of lost days of work or school, and healthcare expenditures.8

The home environment is an important setting for unintentional injuries.9, 10, 11, 12 About one fifth of all fatal unintentional injuries take place in a home.12 However, the incidence of nonfatal unintentional home injuries has not yet been fully established or described. In this study, the magnitude and nature of the problem of nonfatal unintentional home injury in the United States were documented using available data from several sources. The utility of available data was examined to describe the problem, to understand patterns by age and sex, and to identify opportunities for intervention. Finally, the data set characteristics were documented that could result in incomplete analyses or an inability to make comparisons across data sets, or across years, as part of an overall surveillance strategy for unintentional home injury. Specifically, differences were noted between data sets with respect to the definition of the home environment, the definition of populations used for rates, and the presence of systematically missing data.

Section snippets

Data set selection

We compiled a list of injury data sources by searching data systems available from federal agencies and in consultation with an advisory panel selected by the Home Safety Council, the foundation sponsoring the research. We developed a set of criteria for inclusion of data sets into this study, with the main requirement being that any data set be part of an ongoing surveillance system that includes information about nonfatal unintentional injuries occurring at home (Table 1). An additional

Nonfatal unintentional home injuries

The NHAMCS data indicate that nearly 9.8 million emergency department and 1.4 million outpatient hospital visits were made in 1999 for nonfatal, unintentional injuries that took place in a home environment (Table 3). Likewise, self-report data obtained in the NHIS include 12,922,220 nonfatal unintentional home injuries, excluding poisonings, requiring some form of medical advice in the United States in 1998. NHIS data also show that >2.15 million persons aged ≥14 years experienced an injury

Discussion

These analyses confirm that unintentional injury at home is a significant source of morbidity requiring treatment by healthcare providers and resulting in lost workdays and schooldays, especially among young people and older adults. The results also show the critical importance of falls as a major source of morbidity. Our finding that females have similar rates of nonfatal injury rates to males is curious, given that the male:female rate ratio of unintentional home injury deaths is 1.70:1,12

Conclusions

As helpful as these findings are in beginning to understand the problem of unintentional injury at home, the available data contain significant gaps. More careful consideration needs to be given concerning surveillance of home injury given that this is where people spend a substantial amount of time and are, therefore, exposed for long periods of time to the hazards present in the home. The collection of morbidity data, including development of consistent definitions for “home injury” and

References (27)

  • A.L. Dannenberg et al.

    Intentional and unintentional injuries in womenan overview

    Ann Epidemiol

    (1994)
  • C.W. Runyan et al.

    Unintentional injuries in the home in the United States. Part I: mortality

    Am J Prev Med

    (2005)
  • S.J. Hambidge et al.

    Epidemiology of pediatric injury–related primary care office visits in the United States

    Pediatrics

    (2002)
  • National estimates of nonfatal injuries treated in hospital emergency departments—United States, 2000

    MMWR Morb Mortal Wkly Rep

    (2001)
  • L.F. McCaig

    National Hospital Ambulatory Medical Care Survey1998 emergency department summary

    Adv Data

    (2000)
  • P.C. Scheidt et al.

    The epidemiology of nonfatal injuries among U.S. children and youth

    Am J Public Health

    (1995)
  • M.F. Ballesteros et al.

    Differential ranking of causes of fatal versus non-fatal injuries among U.S. children

    Inj Prev

    (2003)
  • T. Christoffel et al.

    Injury surveillancea 10-step plan

  • Magnitude and costs

  • D.A. Pollock et al.

    Deaths due to injury in the home among persons under 15 years of age, 1970–1984

    MMWR Morb Mortal Wkly Rep

    (1988)
  • Residential injuries

  • Injury facts, 2001 edition

    (2001)
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