Introduction

Injuries are the leading cause of death for persons under 44 years of age in the U.S. Injuries kill more Americans aged 1-34 than all diseases combined, and result in the loss of more working years of life than all forms of cancer and heart disease combined. Injury was labeled in one prominent report "the principal public health problem in America today." Yet injuries receive scant attention and a fraction of health research expenditures compared to other diseases or health hazards. Injury prevention strategies, in increasing order of effectiveness, include: persuading persons at risk of injury to alter their behavior for increased self-protection (e.g., encouraging seat belt use), requiring behavior change by law (e.g., requiring smoke detectors in new buildings), and providing automatic protection by product design (e.g., built-in sprinkler systems). Injuries are predictable and preventable. The enormous loss of life and function due to injuries can be reduced.

Prevalence

Injury, Morbidity and Mortality

In 1983, 144,091 people died from injuries resulting from all causes including motor vehicle crashes and pedestrian injuries (44,452 deaths), all other unintentional injuries (48,036), suicides (28,295), homicides (20,191) and deaths from unknown causes (3,117).

Injury is the leading cause of death in the U.S. up to the age of 44, or for over half the human lifespan.

Injuries kill more Americans aged 1-34 than all diseases combined. 4 out of 5 deaths to persons aged 15-24 are a result of injury.

Injury is the 4th leading cause of death among all Americans accounting for 61 deaths per 100,000 population in 1983 compared to 328 for heart disease, 188 for cancer and 67 for stroke.

A 1982 National Health Interview Survey of the civilian noninstitutionalized population showed that 59,968,000 episodes of nonfatal injury occurred, for a nonfatal injury rate of 26.4 injuries per 100 persons.

The 1982 NHIS revealed that the nonfatal injury rate for males (29.6 per 100 persons) was higher than the rate for females (23.4), and that the injury rate for whites (27.8) was higher than that for Blacks (19.4).

The age group with the highest nonfatal injury rate in 1982 was 18-24 year olds with a rate of 35.0, over 1.7 times the rate for 45-64 year olds, whose rate of 20.1 injuries per 100 persons was the lowest of all age groups.

The 1982 NHIS also showed that persons in the lowest income bracket had a higher nonfatal injury rate (30.2) than those in the highest bracket (injury rate 27.0).

The home is the most common site of injury 39% of all injuries in 1980-81 occurred in or around the home, whereas 10% occurred in an industrial place, 11% on streets or highways, 9% at schools, 9% at places of recreation, 1% on farms and 18% in other or unknown places.

In 1982, injuries caused an average of 239.3 days of restricted activity per 100 persons. For persons in the lowest income bracket, the rate of restricted activity days was 404.0, nearly 3 times the rate of 137.2 for those in the highest income bracket.

Injury results in the loss of more economically productive years of life than cardiovascular disease and cancer combined.

Each year, more than 75,000 Americans sustain brain injuries that result in long-term disabilities, including 2,000 who remain in persistent vegetative states.

Children 6-16 years of age missed 14 million days of school per year due to injuries and injury-related impairments in 1980-81.

In 1983, 956 infants under 1 year died as a result of injury. The death rate from this cause for Black infants (45.6) was 2 times the rate for white infants (23.0).

Persons 15-24 years old are 8.7 times more likely to die as a result of injury than from any other cause.

The National Safety Council estimates that the cost of all injuries in 1984 totaled $96.9 million, including wages lost, medical expenses incurred, insurance administration costs, property damage, loss from fire, and indirect costs (time lost to production slowdowns, filling out injury reports, etc.).

Motor Vehicle Accidents

In 1984, 44,241 persons lost their lives as a result of motor vehicle crashes including pedestrian injuries. There were 2.58 fatalities per 100 million vehicle miles traveled and 18.7 motor vehicle fatalities per 100,000 population.

41% of traffic related deaths in 1984 involved single vehicles and 20% involved non-occupants of vehicles.

In 1984, 59.7% of the vehicles involved in traffic fatalities were passenger cars, 19.5% were light or medium trucks, 8% were motorcycles, 7.6% were heavy trucks, 2.6% were special vehicles, 1.9% were unknown and 0.6% were buses.

77.7% of the drivers involved in traffic fatalities were males and 20.7% females (in 1.6% of cases the sex was not reported).

In 1984, 59.5% of the 57,498 drivers in traffic fatalities were under 35 years of age, including 17.8% who were under 21 years old.

The National Highway Traffic Safety Administration estimates that between 50% and 55% of all fatal accidents involve a drinking driver.

In 1984, alcohol was involved in 52.0% of traffic fatalities of passenger cars, 58.7% of traffic fatalities of motorcycles, 55.4% of light truck traffic fatalities, 24.3% of medium truck traffic fatalities and 29.6% of heavy truck traffic fatalities.

47.2% of pedestrians killed in traffic fatalities in 1984 had been drinking, including over 60% of those aged 21 to 45 years old. 24.9% of pedal-cyclists killed in traffic fatalities in 1984 had been drinking.

In 1984, 2.2% of drinking drivers were wearing seatbelts when involved in traffic fatalities compared to 72% of sober drivers.

In 1984, 552 children aged 0-4 years died in traffic accidents, representing a 11% decrease from the 1983 figure of 618 deaths and a 20% decrease from the 1980 figure of 689.

Falls

In 1983, 12,024 deaths occurred as a result of falls in the U.S., making falls the 2nd leading cause of injury death in the U.S. behind motor vehicle crashes, including pedestrian injury.

Falls are the leading cause of injury death in the home, where an estimated 6,100 fatal falls occurred in 1984. Falls are also the leading cause of injury death in public places, where 4,000 fall-related deaths occurred in 1984.

72% of the 12,024 deaths from falls in 1983 were suffered by persons 65 years of age or older and were the leading cause of injury death for this age group. Of those 75 and over, falls kill twice as many people as traffic-related injuries.

Fires

Injuries caused by fires claimed 5,028 lives in 1983 in the U.S. 15% of those deaths occurred to children under 5 years of age, while 29% of the deaths from fire occurred to persons 65 or older.

The death rate per 100,000 population for fires was 2.1 for all persons in the U.S.; however, the rate for Blacks (5.5) was 3.2 times the rate for whites (1.7). The death rate by fire for Black infants under 1 year of age was 9.4 per 100,000, which is 4.7 times the rate of 2.1 for white infants.

According to National Safety Council statistics, death from fires was the 2nd leading cause of death in the home behind falls. 81% of all deaths from fire occur from fires in the home.

Poisonings

In 1983, 3,382 deaths occurred as a result of accidental poisoning by drugs, medicaments, biologics and other solid and liquid substances. An additional 1,251 deaths occurred as a result of unintentional poisoning by gases and vapors.

The death rate from the total 4,633 deaths from all poisonings for all persons in 1983 was 2.0 deaths per 100,000 population. The death rate from unintentional poisonings for children 1-4 years old was 0.5 while the rate for those 30-34 was 3.6. The highest rate was 4.8 for persons 85 years of age or older.

About 4 out of 5 deaths from poisoning by solids and liquids and more than 3 out of 5 deaths from poisonings by gases and vapors occurred in the home.

Drowning

In 1983, 5,254 persons died from drowning and submersion. More than half (54%) of the persons drowned were under 25 years of age. Children 1-4 years of age have the highest rate of deaths from drowning of any age group: 4.7 deaths per 100,000 population. The rate of deaths from drowning among Blacks (3.7) is higher than the rate for whites (2.0).

In 1983, 82.4% of those who drowned were males. The rate of death from drowning among males (3.8 per 100,000 in 1983) was nearly 5 times the rate for females (0.8). For males under 45, drowning is the 2nd leading cause of accidental death behind motor vehicle related injury.

Suffocation

3,387 deaths from suffocation or inhalation and ingestion of food or other objects causing obstruction of the respiratory tract occurred in 1983, for a rate of 1.4 deaths per 100,000 population. Infants under 1 year of age had a rate of death from suffocation or airway obstruction of 5.2. The rate of deaths from suffocation or airway obstruction for persons 70 years or older was 3 times the rate for all ages.

Firearms

In 1983, use of handguns caused 209 unintentional deaths and use of firearms caused 1,486 unintentional deaths, for a total of 1,695 deaths from all firearms. 86.4% of those killed were male, and 46.4% were under age 25.

In a study of emergency-room patients, 30% of patients injured on the road had alcohol detected in their blood, as did 22% of those injured at home, 16% of those injured on the job and 56% of those injured in fights or assaults.

Public Awareness

76% of the U.S. public supported the 55mph speed limit in 1982, a slight decline from the 81% who supported it in 1980.

The number of States in which more than 50% of drivers exceed the 55mph speed limit increased from 30 in 1982 to 37 in 1983.

According to the National Survey of Personal Health Practices, 30% of Americans claim to wear seat belts all of the time while driving or riding in a car, 34% claim to wear seat belts once in a while or some of the time and 36% claim they never wear seat belts.

A 1985 study by the Department of Transportation showed that 65.9% of infants 0-1 year-old were in restraints and 55.1% of toddlers age 1-4 years were in restraints while riding in cars. The same study found 23.3% of adults using automobile seat belts.

In 1984, 4.5% of drivers and passengers killed in traffic accidents were known to be wearing restraints.

Provisional data from a national survey revealed that 58% of persons have working smoke detectors in their homes.

91% of persons in families with children under 10 years of age have heard about Poison Control Centers; 61% of those persons have the telephone number of their local Poison Control Center in their area.

Service Delivery

Injury was the leading reason for physician contacts in 1980, when there were 99 million physician visits for injuries, compared to 72 million visits for heart disease and 64 million visits for respiratory disease, the 2nd and 3rd leading reasons for physician visits.

According to a 1980 National Health Interview Survey, 25% of all hospital emergency-room visits were for the treatment of injuries.

The cost of all injuries in 1980 was estimated to be $75-$100 billion (in 1980 dollars), according to a study by the National Academy of Sciences.

The total Federal expenditures for nonmilitary research on injury were approximately $112 million in fiscal 1983.

Injury research in 1983 accounted for less than 2% of the total National Institutes of Health research budget. The Federal expenditures for research in injury control is approximately one-tenth of that for cancer and less than one-fifth of that for heart disease and stroke.

The 55mph speed limit became effective in all States by March 1974. Highway fatalities declined an unprecedented 16.4% that year, from 55,511 in 1973 to 46,402 in 1974. The Transortation Research Board estimates that the 55mph speed limit resulted in 2,000-4,000 lives saved in 1983; 2,500-4,500 fewer serious, severe and critical injuries; and 34,000-61,000 fewer minor and moderate injuries. Other factors, such as higher gasoline prices resulting in fewer miles driven and improved vehicle and highway design, are also posed as possible explanations for declining fatalities on the Nation's highways.

An estimated $65 million per year was saved in benefit payments from Medicare, Medicaid and Old Age Survivors and Disability Insurance as a result of the 55mph speed limit.

Special Issues

Research Needed

2 in 3 Americans are injured yearly. More persons up to age 44 die from injury than any other cause of death. Injury results in the loss of more working years of life than all forms of cancer and heart disease combined and costs $75?100 billion a year in the U.S. Research on injury, however, receives less than $.02 out of every Federal dollar for research on health problems.