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KEY POINTS

KEY POINTS

  • Injuries are the leading cause of death for Americans age 1 to 44 years and the third leading cause of death overall.

  • Disease of injury has a bimodal age distribution of mortality, with peaks for those 16 to 40 years old and for those over 65 years old.

  • Injury deaths have risen in the United States over the past 2 decades, from 52 per 100,000 in 2000 to 72 per 100,000 in 2016.

  • The International Classification of Diseases, Tenth Revision, Clinical Modification external cause of injury code is known as an E-code and is used when a patient presents to a health care provider with an injury.

  • Deaths from drug overdose now account for 27.4% of injury-related deaths in the United States, more than from motor vehicle collisions.

  • Approximately 50% of all traffic fatalities (driver, occupant, bicyclist, or pedestrian) have been found to have a blood alcohol concentration of 0.08 g/dL or greater.

  • Firearm-related mortality is eight times higher in the United States than in other high-income countries in the world.

INTRODUCTION

Injury is not an “accident” but rather a disease, much like infectious diseases such as malaria or tuberculosis or health diagnoses such as cancer, diabetes mellitus, or heart disease. Injury, like other diseases, has variants such as blunt or penetrating. It has degrees of severity, rates of incidence, prevalence, and mortality that can differ by race and other sociodemographic factors. In addition, injuries have a predictable pattern of occurrence related to age, sex, alcohol, illicit or prescription drugs, and, again, sociodemographic factors, among others. Finally, they have a predictable prognosis, based on age, sociodemographic factors, and injury severity.

This characterization of injury as a disease is an important one and a matter of more than just semantics. When public health concepts are applied to injury, the first step after recognition is to characterize the disease such that control strategies can be applied. Epidemiology is the study of patterns of disease occurring in human populations and the factors that influence these patterns.1

Descriptive epidemiology refers to the distribution of disease over time and place as well as within or across specific subgroups of the population. It is important for understanding the impact of injury in a population and identifying opportunities for intervention. The burden of injury can be described as the most common, most fatal, most debilitating, or most costly within a specific population.

In contrast, analytic epidemiology refers to the more detailed study of the determinants of observed distributions of disease in terms of causal factors. The epidemiologic framework traditionally identifies these factors as related to the host (characteristics intrinsic to the person), the agent (physical, chemical, nutritive, or infectious), and the physical or sociocultural environment (characteristics extrinsic to the person that influence exposure or susceptibility to the agent). The importance of this epidemiologic approach is the direction it gives ...

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