Injury Prevention
Violent injuries among adolescents: Declining morbidity and mortality in an urban population*,**,

Presented in abstract form at the Fourth World Injury Conference, Amsterdam, The Netherlands, May 1998, and in part at the Society for Adolescent Medicine annual meeting, Crystal City, VA, March 2000.
https://doi.org/10.1067/mem.2001.111763Get rights and content

Abstract

Study Objective: Adolescent homicide rates are decreasing nationally for unclear reasons. We explore changes in intentional injury morbidity and mortality within the context of other injuries and specific causes. Methods: We performed surveillance of hospital, medical examiner, and vital records for nonfatal injury among adolescents age 10 to 19 years living in the District of Columbia from June 15, 1996, to June 15, 1998, and fatal injury from 1989 to 1998. Results: Over the 2-year study period, 15,190 adolescents were seen for injury, resulting in an event-based rate of 148 injuries per 1,000 adolescents per year; 7% required hospitalization, and 0.8% died. Interpersonal intentional injuries accounted for 25% of all injuries, 45% of hospitalizations, and 85% of injury deaths. Assault morbidity decreased with no change noted for unintentional and self-inflicted injury. Firearm injuries, stabs, and assaults with other objects showed the largest decrease, with no decrease in unarmed assaults. Injury mortality peaked in 1993 and has declined since. Firearms caused 72% to 90% of all injury deaths from 1989 to 1998, most the result of homicide. Conclusion: There has been a decline in intentional injury rates over the study periods related to decreased weapon injury; data suggest a change in the lethality of fighting methods but no change in unarmed fighting behavior. [Cheng TL, Wright JL, Fields CB, Brenner RA, O'Donnell R, Schwarz D, Scheidt PC, the DC Child and Adolescent Injury Research Network. Violent injuries among adolescents: declining morbidity and mortality in an urban population. Ann Emerg Med. March 2001;37:292-300.]

Introduction

Adolescence is considered a critical developmental period of exploration, experimentation, and establishment of habits that may extend into adulthood. High rates of injury are associated with behavior patterns and risk factors common to adolescent development and include male sex, previous injuries, alcohol-drug use, conflict with parents, pattern of parent supervision, weapon carrying, delinquency, and pubertal development.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13 Covarying risk factors for violent behavior are similar: male sex, poor mental health, drug use, lack of parental affection and support, weapon carrying, school dropout, exposure to violence, victimization, and delinquency.14, 15, 16, 17 The resulting morbidity and mortality during this developmental period of high violence, victimization, and initiation of serious violent behavior are of great national concern.18

In the United States, homicide is the third leading cause of death for adolescents 10 to 14 years old and the second cause of death for those 15 to 24 years old.19 For blacks, homicide is the leading cause of death for males and females 15 to 34 years old.20 Although the number of youth dying from violent injuries is alarming, it represents only a fraction of the injuries that occur in this age group. Nonfatal injury rates caused by violence, risky behavior, and failure to take safety precautions are higher for teenagers than for any other age group.21 Study of nonfatal or disabling injuries may provide guidance for development of prevention strategies.

In recent years, the adolescent homicide rate has decreased in urban and nonurban areas.22 The reasons behind the decline in mortality are unclear and have been postulated to include such factors as changing demographics, improved policing, more jailed offenders, maturing drug markets, greater safety consciousness, and a stronger economy.23, 24 Little information, however, is available on nonfatal injuries, which may offer clues to reasons behind the mortality decline. Has morbidity declined along with mortality? Are there specific causes of injury that have accounted for this decline? Has there been a decrease in injuries presenting for medical care related to unarmed and armed assault?

This surveillance study with 7 emergency departments in the District of Columbia, the Department of Health, and the Office of the Chief Medical Examiner explores the epidemiology of injuries in the 51,236 adolescents in the city in 1997.25 This study provides insight regarding the patterns of injuries among urban youth and trends over the recent past.

Section snippets

Materials and methods

An injury case was defined as an event of trauma, poisoning, or other injury caused by external factors occurring to a city resident 10 to 19 years of age that led to an ED visit, hospitalization, or death between June 15, 1996, and June 15, 1998. Residents who were imprisoned in neighboring facilities outside the city and college students in the city were included. Injury events were classified by using the International Classification of Diseases, ninth revision, Clinical Modification

Results

During the 2-year study, there were 15,190 injury events leading to ED visits or deaths among the adolescent population aged 10 to 19 years. US Census Bureau data indicates that the targeted population of 51,236 adolescents in the city in 1997 was 67% black,25 with an estimated 1995 median household income of $33,682.30 The event-based injury rate was 149 per 1,000 per year. For the 10- to 14-year-old group, the rate was 120 per 1,000 per year and rose to 177 per 1,000 per year for the 15- to

Discussion

A substantial number of adolescents experienced injury events requiring medical attention during the study time period, which is consistent with other studies that have estimated that one fifth to one fourth of children and adolescents in the United States experience an injury requiring medical attention each year.1, 32, 33, 34 Although unintentional injury accounts for most injury, the proportion of interpersonal intentional injuries in this population is similar to findings in other studies

Acknowledgements

We thank the members of the DC Child and Adolescent Injury Research Network for their support of this project. In addition, we gratefully acknowledge the significant contribution (trend analysis) of Kantilal M. Patel, PhD, Senior Statistician, Children's National Medical Center, Washington, DC.

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    *

    Participants in the DC Child and Adolescent Injury Research Network include: Millicent Collins, MD, DC General Hospital; Melissa Clark, MD, Howard University Hospital; Peter Rhee, MD, Mark Smith, MD, Kristin Brandenburg, RNC, EMT, and Duncan Harviel, MD, Washington Hospital Center; Yolanda Haywood, MD, and B. Tilman Jolly, MD, George Washington University Medical Center; James Vafier, MD, Diane Sauter, MD, and Ira Mehlman, MD, Greater Southeast Community Hospital; Harinder Dhinsa, MD, Renee Reed, MD, and David P. Milzmann, MD, Georgetown University Hospital; Joseph Pestaner, MD, and Jacqueline Lee, MD, Chief Medical Examiner's Office; and Fern Johnson-Clarke, PhD, Department of Health, State Center for Health Statistics.

    **

    Supported by the Centers for Disease Control and Prevention (R49/CCR311657-01) and the Robert Wood Johnson Foundation Generalist Faculty Scholars Program (Dr. Cheng).

    Address for reprints: Tina L. Cheng, MD, MPH, Department of General Pediatrics, Children's National Medical Center, 111 Michigan Avenue, NW, Washington, DC 20010;,202-884-5094, fax 202-884-3386; E-mail [email protected].

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