Combating unintentional injury in the United States: lessons learned from the ICD-10 classification period

Unintentional injury remains the leading cause of death among individuals <45-year-old in several developed countries, including the United States, despite the availability of evidence-based preventive policies and practices. This study aims to estimate the preventable fraction of unintentional injury mortality in the United States and critically examine variability components and time trends among four different US regions.

ICD-10 coded unintentional injury mortality data were electronically obtained for all available years (1999-2004) from the National Center for Injury Prevention and Control database; inter-region variability and time trends were calculated to assess age-specific and injury type-specific components. A theoretical model was applied to estimate the preventable fraction of unintentional injuries, assuming that all US regions could achieve the region-specific lowest mortality rate.

Children enjoy the lowest injury mortality rates, whereas adults present 4-fold and elderly 10-fold higher rates. Of all injury deaths approximately 25%, nearly 25,000 deaths, could have been averted (approximately 2,300 among children; approximately 17,200 among adults [15-64 years] and approximately 5,500 among elderly) provided that preventive strategies of the best performing region were implemented across the United States. During the studied period, a statistically significant annual increase of 1.6% was observed, caused by an alarming rising trend in poisoning (+11.5%) mainly among adults, and falls (+5.5%) among elderly. Contrary, a noticeable (-2.4%) and statistically significant decrease of all types of injuries except suffocation was noted among children.

A substantial number of lives might be saved if established injury preventive programs in low-mortality regions were also implemented in the less-privileged ones. Given the stable trends reported for motor vehicle and occupational injury mortality rates, poisoning and fall injuries occurring at home or during leisure time among the workforce population should be considered as main public health priority areas pending further elucidation of underlying mechanisms, such as the role of alcohol, drugs, and comorbidity in their causation.