Joseph L Annest’s research while affiliated with Centers for Disease Control and Prevention and other places

Introduction With the aging of the United States population, unintentional injuries among older adults, and especially falls-related injuries, are an increasing public health concern. Methods We analyzed emergency department (ED) data from the Nationwide Emergency Department Sample, 2006–2011. We examined unintentional injury trends by 5-year age groups, sex, mechanism, body region, discharge disposition, and primary payer. For 2011, we estimated the medical costs of unintentional injury and the distribution of primary payers, plus rates by injury mechanisms and body regions injured by 5-year age groups. Results From 2006 to 2011, the age-adjusted annual rate of unintentional injury-related ED visits among persons aged ≥ 65 years increased significantly from 7987 to 8163, per 100,000 population. In 2011, 65% of injuries were due to falls. Rates for fall-related injury ED visits increased with age and the highest rate was among those aged ≥ 100. Each year, about 85% of unintentional injury-related ED visits in this population were expected to be paid by Medicare. In 2011, the estimated lifetime medical cost of unintentional injury-related ED visits among those aged ≥ 65 years was $40 billion. Conclusion Increasing rates of ED-treated unintentional injuries, driven mainly by falls among older adults, will challenge our health care system and increase the economic burden on our society. Prevention efforts to reduce falls and resulting injuries among adults aged ≥ 65 years have the potential to increase well-being and reduce health care spending, especially the costs covered by Medicare. Practical applications With the aging of the U.S. population, unintentional injuries, and especially fall-related injuries, will present a growing challenge to our health care system as well as an increasing economic burden. To counteract this trend, we must implement effective public health strategies, such as increasing knowledge about fall risk factors and broadly disseminating evidence-based injury and fall prevention programs in both clinical and community settings.

US hospital discharge datasets typically report facility charges (ie, room and board), excluding professional fees (ie, attending physicians' charges). We aimed to estimate professional fee ratios (PFR) by year and clinical diagnosis for use in cost analyses based on hospital discharge data. The subjects consisted of a retrospective cohort of Truven Health MarketScan 2004-2012 inpatient admissions (n=23,594,605) and treat-and-release emergency department (ED) visits (n=70,771,576). PFR per visit was assessed as total payments divided by facility-only payments. Using ordinary least squares regression models controlling for selected characteristics (ie, patient age, comorbidities, etc.), we calculated adjusted mean PFR for admissions by health insurance type (commercial or Medicaid) per year overall and by Major Diagnostic Category (MDC), Diagnostic Related Group, Healthcare Cost and Utilization Project Clinical Classification Software, and primary International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) diagnosis, and for ED visits per year overall and by MDC and primary ICD-9-CM diagnosis. Adjusted mean PFR for 2012 admissions, including preceding ED visits, was 1.264 (95% CI, 1.264, 1.265) for commercially insured admissions (n=2,614,326) and 1.177 (1.176, 1.177) for Medicaid admissions (n=816,503), suggesting professional payments increased per-admission costs by an average 26.4% and 17.7%, respectively, above facility-only costs typically calculated from hospital discharge data. Adjusted mean PFR for 2012 ED visits was 1.286 (1.286, 1.286) for commercially insured visits (n=8,808,734) and 1.440 (1.439, 1.440) for Medicaid visits (n=2,994,696). Supplemental tables report 2004-2012 annual PFR estimates by clinical classifications. Adjustments for professional fees are recommended when hospital facility-only financial data from US hospital discharge datasets are used to estimate health care costs.

This paper examines the epidemiology of fatal and nonfatal firearm violence in the United States. Trends over two decades in homicide, assault, self-directed and unintentional firearm injuries are described along with current demographic characteristics of victimization and health impact. Fatal firearm injury data were obtained from the National Vital Statistics System (NVSS). Nonfatal firearm injury data were obtained from the National Electronic Injury Surveillance System (NEISS). Trends were tested using Joinpoint regression analyses. CDC Cost of Injury modules were used to estimate costs associated with firearm deaths and injuries. More than 32,000 persons die and over 67,000 persons are injured by firearms each year. Case fatality rates are highest for self-harm related firearm injuries, followed by assault-related injuries. Males, racial/ethnic minority populations, and young Americans (with the exception of firearm suicide) are disproportionately affected. The severity of such injuries is distributed relatively evenly across outcomes from outpatient treatment to hospitalization to death. Firearm injuries result in over $48 billion in medical and work loss costs annually, particularly fatal firearm injuries. From 1993 to 1999, rates of firearm violence declined significantly. Declines were seen in both fatal and nonfatal firearm violence and across all types of intent. While unintentional firearm deaths continued to decline from 2000-2012, firearm suicides increased and nonfatal firearm assaults increased to their highest level since 1995. Firearm injuries are an important public health problem in the United States, contributing substantially each year to premature death, illness, and disability. Understanding the nature and impact of the problem is only a first step toward preventing firearm violence. A science-driven approach to understand risk and protective factors and identify effective solutions is key to achieving measurable reductions in firearm violence. Copyright © 2015. Published by Elsevier Inc.

Suicide is the second leading cause of death among persons aged 10-24 years in the United States and accounted for 5,178 deaths in this age group in 2012. Firearm, suffocation (including hanging), and poisoning (including drug overdose) are the three most common mechanisms of suicide in the United States. Previous reports have noted that trends in suicide rates vary by mechanism and by age group in the United States, with increasing rates of suffocation suicides among young persons. To test whether this increase is continuing and to determine whether it varies by demographic subgroups among persons aged 10-24 years, CDC analyzed National Vital Statistics System mortality data for the period 1994-2012. Trends in suicide rates were examined by sex, age group, race/ethnicity, region of residence, and mechanism of suicide. Results of the analysis indicated that, during 1994-2012, suicide rates by suffocation increased, on average, by 6.7% and 2.2% annually for females and males, respectively. Increases in suffocation suicide rates occurred across demographic and geographic subgroups during this period. Clinicians, hotline staff and others who work with young persons need to be aware of current trends in suffocation suicides in this group so that they can accurately assess risk and educate families. Media coverage of suicide incidents and clusters should follow established guidelines to avoid exacerbating risk for "suicide contagion" among vulnerable young persons.* Suicide contagion is a process by which exposure to the suicide or suicidal behavior of one or more persons influences others who are already vulnerable and thinking about suicide to attempt or die by suicide. Early prevention strategies are needed to reduce the likelihood of young persons developing suicidal thoughts and behavior.

Indoor tanning exposes users to intense UV radiation, which is a known carcinogen.¹ However, little is known about the more immediate adverse outcomes of indoor tanning. To our knowledge, this study provides the first national estimates of indoor tanning–related injuries treated in US hospital emergency departments (EDs). Article InformationCorresponding Author: Gery P. Guy Jr, PhD, MPH, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS-F76, Atlanta, GA 30341 (irm2@cdc.gov). Published Online: December 15, 2014. doi:10.1001/jamainternmed.2014.6697. Author Contributions: Dr Guy and Mr Haileyesus had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Guy, Watson, Annest. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: Guy, Watson, Annest. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: Guy, Haileyesus, Annest. Administrative, technical, or material support: Guy, Watson, Annest. Conflict of Interest Disclosures: None reported. Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Additional Contributions: Tom Schroeder, MS, and other staff of the Division of Hazard and Injury Data Systems, US Consumer Product Safety Commission, Bethesda, Maryland, collected the nonfatal injury data. They were not compensated for their contributions.

Recent changes in health information technology and Meaningful Use of electronic health records (EHRs), as part of the Affordable Care Act in the United States, provide new opportunities for the use of external cause of injury data. Also, implementation of ICD-10-CM, in place of ICD-9-CM, for morbidity coding in the United States on October 1, 2014 will provide much more detailed coding of external cause of injury (mechanism, intent, place of occurrence, and activity). Widespread adoption of EHRs in hospital and outpatient settings potentially will bring about more timely external cause-coded data for use in (1) monitoring trends in nonfatal injury rates and characterizing injured patients at the national, state, and local levels, (2) identifying/tracking injured patients with clinical referrals for cause-specific follow-up preventive care services (e.g., elderly fall risk reduction plan of care), (3) defining injury-related clinical quality measures (e.g., proportion of patients attempting suicide who were referred for follow-up psychology evaluation/other care), and (4) measuring health care utilization and cost of injury in a local health care setting. The injury field should be aware of these opportunities and emphasize the important role of high quality external cause-coded data for injury surveillance, epidemiologic research, prevention program planning and evaluation, and tracking quality of care measures for injured patients. This presentation will provide a forum for discussion of these opportunities and how the injury field might demonstrate the need and usefulness of collecting high quality external cause-coded data through EHRs in hospital inpatient, emergency department, and other outpatient data systems.

Health information technology is an emerging area of focus in clinical medicine with the potential to improve injury and violence prevention practice. With injuries being the leading cause of death for Americans aged 1-44 years, greater implementation of evidence-based preventive services, referral to community resources, and real-time surveillance of emerging threats is needed. Through a review of the literature and capturing of current practice in the field, this paper showcases how health information technology applied to injury and violence prevention can lead to strengthened clinical preventive services, more rigorous measurement of clinical outcomes, and improved injury surveillance, potentially resulting in health improvement. Published by Elsevier Inc.

Injuries resulting from contact with animals and insects are a significant public health concern. This study quantifies nonfatal bite and sting injuries by noncanine sources using data from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP). The NEISS-AIP is an ongoing nationally representative surveillance system used to monitor all types and causes of injuries treated in US hospital emergency departments (EDs). Cases were coded by trained hospital coders using information from medical records on animal and insect sources of bite and sting injuries being treated. Data were weighted to produce national annualized estimates, percentages, and rates based on the US population. From 2001 to 2010 an estimated 10.1 million people visited EDs for noncanine bite and sting injuries, based on an unweighted case count of 169,010. This translates to a rate of 340.1 per 100,000 people (95% CI, 232.9-447.3). Insects accounted for 67.5% (95% CI, 45.8-89.2) of bite and sting injuries, followed by arachnids 20.8% (95% CI, 13.8-27.9). The estimated number of ED visits for bedbug bite injuries increased more than 7-fold-from 2156 visits in 2007 to 15,945 visits in 2010. This study provides an update of national estimates of noncanine bite and sting injuries and describes the diversity of animal exposures based on a national sample of EDs. Treatment of nonfatal bite and sting injuries are costly to society. Direct medical and work time lost translates to an estimated $7.5 billion annually.

This year's session will continue the tradition of past of meetings, where members discuss current and emerging issues surrounding injury and emergency health data. Topics for this year's Injury and Emergency Health Data Issues session include: The soon-to-be released WISQARS Mobile App for Injury Data. The Mobile App provides a user-friendly interactive tool for presenting injury statistics through state-level maps, charts, tables and graphs with the tap of a finger. We will also discuss future directions to meet users' data needs. Standard tools for categorizing injuries coded using ICD-10-CM. A draft of the ICD-10-CM diagnosis matrix for categorizing injuries by body region and nature of injury will be presented. Session participants will be asked to provide comments and feedback. The ICD-10-CM External Cause Matrix for categorizing injuries by mechanism and intent of injury, presented at the Data Issues session in 2012 and subsequently modified, has been nearly finalized and will be shared. Development of a tool for categorizing injury severity from ICD-9-CM codes for populations of hospital treated patients. Coordination of public health activities in Medical Examiner/Coroner offices. This topic will involve an interactive discussion on an initiative from the National Center for Health Statistics to develop and promote standards for death investigation; automation of the collection of death investigation data; and death certificate reporting.

Objective: The objective of this study was to investigate the epidemiology of nonfatal choking on food among US children. Methods: Using a nationally representative sample, nonfatal pediatric choking-related emergency department (ED) visits involving food for 2001 through 2009 were analyzed by using data from the National Electronic Injury Surveillance System-All Injury Program. Narratives abstracted from the medical record were reviewed to identify choking cases and the types of food involved. Results: An estimated 111,914 (95% confidence interval: 83,975-139,854) children ages 0 to 14 years were treated in US hospital EDs from 2001 through 2009 for nonfatal food-related choking, yielding an average of 12,435 children annually and a rate of 20.4 (95% confidence interval: 15.4-25.3) visits per 100,000 population. The mean age of children treated for nonfatal food-related choking was 4.5 years. Children aged ≤ 1 year accounted for 37.8% of cases, and male children accounted for more than one-half (55.4%) of cases. Of all food types, hard candy was most frequently (15.5% [16,168 cases]) associated with choking, followed by other candy (12.8% [13,324]), meat (12.2% [12,671]), and bone (12.0% [12,496]). Most patients (87.3% [97,509]) were treated and released, but 10.0% (11,218) were hospitalized, and 2.6% (2911) left against medical advice. Conclusions: This is the first nationally representative study to focus solely on nonfatal pediatric food-related choking treated in US EDs over a multiyear period. Improved surveillance, food labeling and redesign, and public education are strategies that can help reduce pediatric choking on food.