The age-adjusted injury death rate due to poisonings remained stable from 1985 to 1991 around 5 deaths per 100,000, followed by an 18 percent increase in the poisoning death rate from 1991 to 1995. Most of this increase can be attributed to the 44 percent increase in the rate among males 25–44 years. Poisoning rates in children declined during both periods. Rates for suffocation were stable from 1985 to 1995. During this same interval, drowning death rates declined 27 percent, and fire and burn death rates declined by 33 percent (Fingerhut and Warner, 1997). Mortality from falls declined by 11 percent during this period, although among the elderly, where rates are highest, the rate increased slightly. In 1995, falls accounted for 23 percent of the deaths due to injury among persons over age 65 and 34 percent of injury deaths for those 85 and older.

Occupational injuries resulted in 77,675 fatalities for civilian workers from 1980 to 1992. This represents an annual average of 5.5 per 100,000 workers. In 1994 and 1995 the rates fell to 5 deaths per 100,000 workers. It has been estimated that, in 1995, occupational injuries cost $119 billion in lost wages and productivity, administrative expenses, health care, and other costs (NSC, 1997).

Recent data indicate that, in 1996, 147,126 individuals died as a result of injury, which was a 2.5 percent decline in the injury death rate to 50.2 per 100,000 population. The motor vehicle traffic injury death rate remained unchanged at 15.8 per 100,000 and the firearm death rate declined 7 percent to 12.9 per 100,000 population. Most of the decline is attributed to the 11 percent decline in the firearm homicide rate (with a more modest decline of 3 percent in the firearm suicide rate). The death rate for poisoning, the third leading cause of injury death, increased slightly, just under 2 percent, in 1996. By manner of injury death, the age-adjusted death rates for all unintentional injury and for all suicide remained unchanged and the homicide rate declined about 11 percent (Peters et al., 1998). Preliminary data for 1997 indicate a 6 percent decline in overall injury mortality. Preliminary data, however, are subject to change once the final figures are all accounted for. Known biases in preliminary data are attributed, in part, to medical examiner and coroner cases for which amended certificates are filed later (Ventura et al., 1998).

OVERALL BURDEN OF INJURY: MORBIDITY

Whereas current surveillance and other data collection efforts provide information about the numbers and types of fatal injuries, much less is known about the incidence and patterns of nonfatal injuries (see Chapter 3). Almost one in four people in the United States sustains an injury during a single year. In 1995, injuries accounted for an estimated 8 percent of all short-stay hospital discharges and 37 percent of all emergency department visits. Injury as a first-listed diagnosis was identified in 2.6 million hospital discharges. In addition, there were 3.4 million more discharges with injury listed as a secondary diagnosis (Gillum et al., 1998). Falls are the leading cause of nonfatal injury visits to



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