revised survey methods to estimate poisoning and drug overdose incidence.

EPIDEMIOLOGY OF POISONING

Estimating the incidence of poisoning is a complex and difficult exercise. First, in order to gain a general understanding of the magnitude of the poisoning problem, the Committee commissioned a paper on the epidemiology of poisoning. Cisternas (2003) provides annual estimates of poisoning incidence through an analysis of data from multiple sources available for public use through NCHS. These data were used to generate annual estimates of overall incidence as well as annual incidence stratified by age, gender, race, and geographic region. In addition, level of medical care received and outcome status (where available) were used as an indirect severity measure. Second, summary data for total incidence from two additional data sources were also included to supplement a final tabulation of morbidity and mortality. These supplemental summary totals were derived from the American Association of Poison Control Centers’ (AAPCC’s) annual Toxic Exposure Surveillance System (TESS) data report and the Centers for Disease Control and Prevention (CDC)-Consumer Product Safety Commission (CPSC) National Electronic Injury Surveillance System (NEISS). Finally, in order to characterize poisoning and drug overdose deaths, a separate analysis of U.S. mortality data was carried out by Lois Fingerhut of CDC’s NCHS (Personal communication, L. Fingerhut, December 2003). These data were analyzed by demographic and geographic strata, as well as type and intent of poisoning.

Data Sources

Four core data sources were used in the first part of the analysis. Wherever possible, multiple years of data were combined in order to increase the stability of the estimates (see Table 3-1 for a summary of the number of poison observations extracted from each data source). Appendix 3-A contains a detailed description of each of these four data sources. The sources are:

  • National Health Interview Survey (NHIS): This annual population-based survey collects health status and demographic information from a sample of households and their family members selected from and meant to estimate for the entire civilian, noninstitutionalized U.S. population (approximately 275 million persons over the period analyzed).

  • National Ambulatory Medical Care Survey (NAMCS): NAMCS is a



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