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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Bruce A. Lawrence, PhD, Pacific Institute for Research and Evaluation, 11710 Beltsville Drive, Suite 300, Calverton, MD 20705-3102, 301/755-2731, lawrence@pire.org, Ted R. Miller, PhD, Public Services Research Institute, Pacific Institute for Research and Evaluation, Calverton Office Park, 11710 Beltsville Drive, Suite 300, Calverton, MD 20705-3102, and Harold B. Weiss, MPH, PhD, Center for Injury Research and Control, University of Pittsburgh, 200 Lothrop St., Suite B400, Pittsburgh, PA 15213.
When working with NCHS's Multiple Cause of Death Data (MCOD) and related datasets, most researchers rely exclusively on the Underlying Cause of Death field to identify and classify injuries. But death often results from a chain of causes involving both injuries and illnesses. It is common, for example, for a fracture to cause a blood clot that can lead to death from a circulatory event. Such a death might be coded incorrectly in the MCOD with an underlying cause of circulatory disease, even though it was triggered by the fracture. The authors scrutinized the MCOD, bringing to bear techniques they developed for identifying injuries in state hospital discharge data. Their alternative method of injury selection employed the ICD-9 diagnoses and E-codes from the entity axis (i.e., the codes as they appeared on the death certificate) as well as the Underlying Cause of Death. This comprehensive injury definition detected 19,655 probable injury-related deaths that were not detected by the Underlying Cause definition, while dropping 1,253 deaths with a listed Underlying Cause of injury. The increased injury count was concentrated in fractures of the neck of the femur, an injury disproportionately affecting older white women. The dropped cases were mostly choking deaths of victims under medical care for illness. Among the more egregious problems were 234 suicides and 215 homicides whose Underlying Causes were listed as illness, e.g., depression. When working with the MCOD, researchers should not rely uncritically on the Underlying Cause of Death for identifying and classifying injuries.
Learning Objectives:
Keywords: Data/Surveillance, Injury
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.