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Karch D.L.,National Center for Injury Prevention and Control
Morbidity and mortality weekly report. Surveillance summaries (Washington, D.C. : 2002) | Year: 2012

An estimated 50,000 persons die annually in the United States as a result of violence-related injuries. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) regarding violent deaths from 16 U.S. states for 2009. Results are reported by sex, age group, race/ethnicity, marital status, location of injury, method of injury, circumstances of injury, and other selected characteristics. 2009. NVDRS collects data regarding violent deaths obtained from death certificates, coroner/medical examiner reports, and law enforcement reports. NVDRS data collection began in 2003 with seven states (Alaska, Maryland, Massachusetts, New Jersey, Oregon, South Carolina, and Virginia) participating; six states (Colorado, Georgia, North Carolina, Oklahoma, Rhode Island, and Wisconsin) joined in 2004, four (California, Kentucky, New Mexico, and Utah) in 2005, and two (Ohio and Michigan) in 2010, for a total of 19 states. This report includes data from 16 states that collected statewide data in 2009. California is excluded because data were collected in only four counties. Ohio and Michigan are excluded because data collection did not begin until 2010. For 2009, a total of 15,981 fatal incidents involving 16,418 deaths were captured by NVDRS in the 16 states included in this report. The majority (60.6%) of deaths were suicides, followed by homicides and deaths involving legal intervention (i.e., deaths caused by police and other persons with legal authority to use deadly force, excluding legal executions) (24.7%), deaths of undetermined intent (14.2%), and unintentional firearm deaths (0.5%). Suicides occurred at higher rates among males, non-Hispanic whites, American Indians/Alaska Natives, and persons aged 45-54 years. Suicides occurred most often in a house or apartment and involved the use of firearms. Suicides were preceded primarily by mental health, intimate partner, or physical health problems or by a crisis during the previous 2 weeks. Homicides occurred at higher rates among males and persons aged 20-24 years; rates were highest among non-Hispanic black males. The majority of homicides involved the use of a firearm and occurred in a house or apartment or on a street/highway. Homicides were preceded primarily by arguments and interpersonal conflicts or in conjunction with another crime. Characteristics associated with other manners of death, circumstances preceding death, and special populations also are highlighted in this report. This report provides a detailed summary of data from NVDRS for 2009. The results indicate that violent deaths resulting from self-inflicted or interpersonal violence disproportionately affected adults aged <55 years, males, and certain racial/ethnic minority populations. For homicides and suicides, relationship problems, interpersonal conflicts, mental health problems, and recent crises were among the primary factors that might have precipitated the fatal injuries. Because additional information might be reported subsequently as participating states update their findings, the data provided in this report are preliminary. For the occurrence of violent deaths in the United States to be better understood and ultimately prevented, accurate, timely, and comprehensive surveillance data are necessary. NVDRS data can be used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in the development, implementation, and evaluation of programs and policies to reduce and prevent violent deaths at the national, state, and local levels. The continued development and expansion of NVDRS is essential to CDC's efforts to reduce the personal, familial, and societal costs of violence. Additional efforts are needed to increase the number of states participating in NVDRS, with an ultimate goal of full national representation.


Paulozzi L.J.,National Center for Injury Prevention and Control | Mack K.A.,Research and Practice Integration | Hockenberry J.M.,Emory University
Morbidity and Mortality Weekly Report | Year: 2014

Background: Overprescribing of opioid pain relievers (OPR) can result in multiple adverse health outcomes, including fatal overdoses. Interstate variation in rates of prescribing OPR and other prescription drugs prone to abuse, such as benzodiazepines, might indicate areas where prescribing patterns need further evaluation.Methods: CDC analyzed a commercial database (IMS Health) to assess the potential for improved prescribing of OPR and other drugs. CDC calculated state rates and measures of variation for OPR, long-acting/extended-release (LA/ER) OPR, high-dose OPR, and benzodiazepines.Results: In 2012, prescribers wrote 82.5 OPR and 37.6 benzodiazepine prescriptions per 100 persons in the United States. State rates varied 2.7-fold for OPR and 3.7-fold for benzodiazepines. For both OPR and benzodiazepines, rates were higher in the South census region, and three Southern states were two or more standard deviations above the mean. Rates for LA/ER and high-dose OPR were highest in the Northeast. Rates varied 22-fold for one type of OPR, oxymorphone.Conclusions: Factors accounting for the regional variation are unknown. Such wide variations are unlikely to be attributable to underlying differences in the health status of the population. High rates indicate the need to identify prescribing practices that might not appropriately balance pain relief and patient safety.Implications for Public Health: State policy makers might reduce the harms associated with abuse of prescription drugs by implementing changes that will make the prescribing of these drugs more cautious and more consistent with clinical recommendations. © 2014, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. All rights reserved.


Gilchrist J.,National Center for Injury Prevention and Control | Ballesteros M.F.,National Center for Injury Prevention and Control | Parker E.M.,CDC
Morbidity and Mortality Weekly Report | Year: 2012

Background: Unintentional injuries are the leading cause of death in the United States for persons aged 1-19 years and the fifth leading cause of death for newborns and infants aged <1 year. This report describes 10-year trends in unintentional injury deaths among persons aged 0-19 years. Methods: CDC analyzed 2000-2009 mortality data from the National Vital Statistics System by age group, sex, race/ethnicity, injury mechanism, and state. Results: From 2000 to 2009, the overall annual unintentional injury death rate decreased 29%, from 15.5 to 11.0 per 100,000 population, accounting for 9,143 deaths in 2009. The rate decreased among all age groups except newborns and infants aged <1 year; in this age group, rates increased from 23.1 to 27.7 per 100,000 primarily as a result of an increase in reported suffocations. The poisoning death rate among teens aged 15-19 years nearly doubled, from 1.7 to 3.3 per 100,000, in part because of an increase in prescription drug overdoses (e.g., opioid pain relievers). Childhood motor vehicle traffic-related death rates declined 41%; however, these deaths remain the leading cause of unintentional injury death. Among states, unintentional injury death rates varied widely, from 4.0 to 25.1 per 100,000 in 2009. Conclusions and Implications for Public Health Practice: Although the annual rate is declining, unintentional injury remains the leading cause of death among children and adolescents in the United States, led by motor vehicle traffic-related deaths. Death rates from infant suffocation and teen poisoning are increasing. The 2012 National Action Plan for Child Injury Prevention provides actions in surveillance, research, communication, education, health care, and public policy to guide efforts in saving lives by reducing injuries.


Shults R.A.,National Center for Injury Prevention and Control
Morbidity and Mortality Weekly Report | Year: 2012

Background: Although every state prohibits persons aged <21 years from driving with any measurable amount of blood alcohol, many young persons still drink and drive. Additionally, fatal crash data indicate that most teen drivers with positive (>0.00%) blood alcohol concentrations (BACs) who are involved in fatal crashes have BACs ≥0.08%, the level designated as illegal for adult drivers. Methods: CDC analyzed data from the 1991-2011 national Youth Risk Behavior Surveys (YRBS) to describe the trend in prevalence of drinking and driving (defined as driving one or more times when they had been drinking alcohol during the 30 days before the survey) among U.S. high school students aged ≥16 years. The 2011 national YRBS data were used to describe selected subgroup differences in drinking and driving, and 2011 state YRBSs data were used to describe drinking and driving prevalence in 41 states. Results: During 1991-2011, the national prevalence of self-reported drinking and driving among high school students aged ≥16 years declined by 54%, from 22.3% to 10.3%. In 2011, 84.6% of students who drove after drinking also binge drank. Drinking and driving prevalence varied threefold across 41 states, from 4.6% in Utah to 14.5% in North Dakota; higher prevalences were clustered among states in the upper Midwest and along the Gulf Coast. Conclusions: Although substantial progress has been made during the past 2 decades to reduce drinking and driving among teens, in 2011, one in 10 students aged ≥16 years reported driving after drinking during the past 30 days. Most students who drove after drinking alcohol also binge drank. Implications for Public Health Practice: Effective interventions to reduce drinking and driving among teens include enforcement of minimum legal drinking age laws, zero tolerance laws (i.e., no alcohol consumption allowed before driving for persons aged <21 years), and graduated driver licensing systems.


Dowell D.,National Center for Injury Prevention and Control | Haegerich T.M.,National Center for Injury Prevention and Control | Chou R.,National Center for Injury Prevention and Control
MMWR Recommendations and Reports | Year: 2016

This guideline provides recommendations for primary care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. The guideline addresses 1) when to initiate or continue opioids for chronic pain; 2) opioid selection, dosage, duration, follow-up, and discontinuation; and 3) assessing risk and addressing harms of opioid use. CDC developed the guideline using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework, and recommendations are made on the basis of a systematic review of the scientific evidence while considering benefits and harms, values and preferences, and resource allocation. CDC obtained input from experts, stakeholders, the public, peer reviewers, and a federally chartered advisory committee. It is important that patients receive appropriate pain treatment with careful consideration of the benefits and risks of treatment options. This guideline is intended to improve communication between clinicians and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including opioid use disorder, overdose, and death. CDC has provided a checklist for prescribing opioids for chronic pain (http://stacks.cdc.gov/view/cdc/38025) as well as a website (http://www.cdc.gov/drugoverdose/prescribingresources.html) with additional tools to guide clinicians in implementing the recommendations. © 2016.

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