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Distinctive injury deaths: the role of environment, policy and measurement across states
  1. Sara E Heins,
  2. Cassandra K Crifasi
  1. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to Sara Heins, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Room 508, Baltimore, MD 21205,USA; sheins2{at}


Background Maps identifying the most distinctive feature of each state have become popular on social media, but may also have important public health applications. A map identifying the most distinctive injury death in each state could be a useful tool for policymakers, enabling them to identify potential gaps in prevention efforts.

Objective To identify the most distinctive cause of injury death in each state and explore potential reasons for the geographical variation.

Methods The Centers for Disease Control Web-based Injury Statistics Query and Reporting System was used to identify the injury death for each state with a rate which was the largest multiple of the national rate. Analyses were conducted with and without inclusion of ‘indefinite’ codes, which include injury causes of death of undetermined intent, unspecified person killed in a motor vehicle crash (MVC; vehicle occupant, cyclist, pedestrian, etc) or unspecified injury.

Results Noteworthy patterns included seven states in Appalachia and the Southeast with high relative rates of unintentional firearm deaths (2.14–4.06 times the national average) and five states on the West Coast with high relative rates of legal intervention deaths (1.76–3.49 times the national average). Sensitivity analyses indicated that use of ‘undetermined intent’ classifications and the level of detail in coding MVCs vary substantially by state.

Conclusions These analyses highlight potential areas for prevention, such as promotion of safe storage laws in states with relatively high rates of unintentional firearm deaths and areas where standardisation of cause of death codes could be improved.

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