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OBJECTIVE: To standardize the presentation of the more than 1200 ICD-10 'S' and 'T' codes from Chapter XIX by cross classifying the body region of injury by the nature of injury using the ICD-10 injury mortality diagnosis matrix. This paper explains the rationale for decisions made when developing the matrix and presents mortality data using the matrix. DESIGN: ICD-10 codes are organized by diagnosis groups and body regions of injury for the purpose of standardizing presentation. The categories can be collapsed to facilitate analysis at varying levels of detail. Findings from the United States 2002 injury mortality data are used as an example. MAIN OUTCOME MEASURES: All injury diagnoses mentioned in deaths with an underlying cause of injury. RESULTS: There were a total of 247,195 injury diagnoses mentioned in the 161,269 deaths with an underlying cause of injury in 2002 in the United States. The matrix can be used to show that 30% of all injury diagnoses mentioned were to the head and neck region; 28% were system wide injuries, 17% were to the torso. Open wounds accounted for 17% of all injury diagnoses mentioned, and close to half of all open wounds were traumatic brain injuries. Twenty eight percent of injury diagnoses mentioned were unspecified as to their nature and 9.5% had no body region specified. CONCLUSIONS: Multiple cause of death data are a rich but underused source of injury data often due to the complexity of the data and of the ICD classification system. Analytic techniques will need to be refined to accommodate deaths with multiple contributing injury diagnoses. The injury mortality diagnosis matrix will facilitate analysis as it is a useful tool for summarizing diagnosis data associated with injury deaths. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The Barell body region by nature of injury diagnosis matrix standardizes data selection and reports, using a two dimensional array (matrix) that includes all International Classification of Diseases (ICD)-9-CM codes describing trauma. AIM: To provide a standard format for reports from trauma registries, hospital discharge data systems, emergency department data systems, or other sources of non-fatal injury data. This tool could also be used to characterize the patterns of injury using a manageable number of clinically meaningful diagnostic categories and to serve as a standard for casemix comparison across time and place. CONCEPT: The matrix displays 12 nature of injury columns and 36 body region rows placing each ICD-9-CM code in the range from 800 to 995 in a unique cell location in the matrix. Each cell includes the codes associated with a given injury. The matrix rows and columns can easily be collapsed to get broader groupings or expanded if more specific sites are required. The current matrix offers three standard levels of detail through predefined collapsing of body regions from 36 rows to nine rows to five rows. MATRIX DEVELOPMENT: This paper presents stages in the development and the major concepts and properties of the matrix, using data from the Israeli national trauma registry, and from the US National Hospital Discharge Survey. The matrix introduces new ideas such as the separation of traumatic brain injury (TBI), into three types. Injuries to the eye have been separated from other facial injuries. Other head injuries such as open wounds and burns were categorized separately. Injuries to the spinal cord and spinal column were also separated as are the abdomen and pelvis. Extremities have been divided into upper and lower with a further subdivision into more specific regions. Hip fractures were separated from other lower extremity fractures. FORTHCOMING DEVELOPMENTS: The matrix will be used for the development of standard methods for the analysis of multiple injuries and the creation of patient injury profiles. To meet the growing use of ICD-10 and to be applicable to a wider range of countries, the matrix will be translated to ICD-10 and eventually to ICD-10-CM. CONCLUSION: The Barell injury diagnosis matrix has the potential to serve as a basic tool in epidemiological and clinical analyses of injury data. [ABSTRACT FROM AUTHOR]

Context: Homicide rates for persons 15 through 24 years old began to decline between 1993 and 1994, but recent trends in homicide rates by mechanism of homicide and urbanization group have not been described.Objective: To examine homicide trends from 1987 through 1995 for persons 15 through 24 years old by urbanization level.Design: Homicide rates by urbanization level were analyzed using the Compressed Mortality File, a county-level mortality and population database maintained by the National Center for Health Statistics, Centers for Disease Control and Prevention, and the rural-urban continuum codes developed by the Economic Research Service, US Department of Agriculture.Setting: United States, 1987 through 1995, according to 5 urbanization strata: core, counties with the primary central city of a metropolitan statistical area (MSA) of 1 million or more; fringe, remaining counties within an MSA of 1 million or more; medium, counties within an MSA of 250000 to 999999; small, counties in an MSA of less than 250000; and nonmetropolitan, counties not in an MSA.Subjects: All persons 15 through 24 years old by race whose cause of death was homicide (International Classification of Diseases, Ninth Revision codes E960-E969).Main Outcome Measures: Firearm and nonfirearm homicide rates and average annual percentage changes by 5 urbanization levels, race, and sex.Results: From 1987 through 1991, the average annual firearm homicide rates among persons 15 through 24 years old among all 5 urbanization strata increased between 10.7% in small counties and 19.8% in fringe counties. From 1991 through 1993, the rates increased between 3.3% in core counties and 11.7% in small counties. From 1993 through 1995, the rates declined between 4.4% in fringe counties and 15.3% in medium counties. By 1995, firearm homicide rates among persons 15 through 24 years old ranged from 6.5 and 7.3 per 100000 in the nonmetropolitan and small counties, respectively, to 9.6 and 13.3 per 100000 in the fringe and medium strata, respectively, to 33.5 per 100000 in the core stratum. During 1987 through 1990, nonfirearm homicide rates either were stable or increased, and from 1990 through 1995, nonfirearm homicide rates declined in all 5 strata, on average 3.7% to 8.0% per year, with rates in 1995 ranging from 2.1 to 4.7 per 100000 across the strata.Conclusions: After increasing since 1987, firearm and nonfirearm homicide rates began declining between 1993 and 1995 among persons 15 through 24 years old. These declines are taking place across all urbanization strata and among white and black males and females. [ABSTRACT FROM AUTHOR]

POISONING WAS REPORTED as the underlying cause of death for 18,549 people in the United States in 1995 and was ranked as the third leading cause of injury mortality, following deaths from motor vehicle traffic injuries and firearm injuries. Poisoning was the leading cause of injury death for people ages 35 to 44 years. Poisoning death rates were higher in 1995 than in any previous year since at least 1979. From 1990 to 1995, the age-adjusted rate of death from poisoning increased 25%; all of the increase was associated with drugs. About three-fourths of poisoning deaths (77%) in 1995 were caused by drugs. The age-adjusted rate of drug-related poisoning deaths for males (7.2 per 100,000) in 1995 was more than twice that for females (3.0 per 100,000). From 1985 to 1995, poisoning death rates for males ages 35-54 years nearly doubled to 20.4 per 100,000, and the drug-related poisoning death rate for males ages 35-54 years nearly tripled, reaching 16.1 per 100,000. From 1990 to 1995, death rates associated with opiates and cocaine more than doubled among males ages 35-54 years. The numbers of opiate and cocaine poisoning deaths for 1995 more than doubled when all multiple cause of death codes were examined instead of only the underlying cause of death codes. [ABSTRACT FROM AUTHOR]

Objective: To assess the availability and quality of global death registration data used for estimating injury mortality., Methods: The completeness and coverage of recent national death registration data from the World Health Organization mortality database were assessed. The quality of data on a specific cause of injury death was judged high if fewer than 20% of deaths were attributed to any of several partially specified causes of injury, such as "unspecified unintentional injury"., Findings: Recent death registration data were available for 83 countries, comprising 28% of the global population. They included most high-income countries, most countries in Latin America and several in central Asia and the Caribbean. Categories commonly used for partially specified external causes of injury resulting in death included "undetermined intent," "unspecified mechanism of unintentional injury," "unspecified road injury" and "unspecified mechanism of homicide". Only 20 countries had high-quality data. Nevertheless, because the partially specified categories do contain some information about injury mechanisms, reliable estimates of deaths due to specific external causes of injury, such as road injury, suicide and homicide, could be derived for many more countries., Conclusion: Only 20 countries had high-quality death registration data that could be used for estimating injury mortality because injury deaths were frequently classified using imprecise partially specified categories. Analytical methods that can derive national estimates of injury mortality from alternative data sources are needed for countries without reliable death registration systems.

Objectives: This report presents injury mortality data for 2002 using the external-cause-of-injury mortality matrix for the International Classification of Diseases, Tenth Revision (ICD-10). The external cause matrix is a detailed and comprehensive framework for tabulating and presenting injury deaths by mechanism and intent of death. Data are presented by age, sex, race, Hispanic origin, and State. In addition, trend data are shown for 1999-2002 by age, sex, and mechanism and intent of injury. This report also introduces the injury mortality diagnosis matrix. This latter is another framework that categorizes the nearly 1,200 injury diagnosis codes from ICD-10's chapter 19 according to body region and nature of the injury diagnosis information captured in the multiple-cause-of-death fields of the national mortality file. This report supplements the annual report of final mortality statistics., Methods: Data in this report are based on information from all death certificates filed in the 50 States and the District of Columbia in 2002. Causes of death and nature of injury are processed and coded in accordance with the ICD-10., Results: In 2002, 161,269 resident deaths occurred as the result of injuries. Of these injury deaths, 66.2 percent were classified as unintentional, 19.6 percent were suicides, 10.9 percent were homicides, 3.0 percent were of undetermined intent, and 0.3 percent involved legal intervention or operations of war. The five leading mechanisms of injury death were motor vehicle traffic, firearm, poisoning, falls, and suffocation, accounting for 81 percent of all injury deaths. The rate of poisoning deaths increased by 17.9 percent between 2001 and 2002, but the reader is advised to interpret these numbers cautiously as a portion of this increase is due to stricter procedures concerning data processing that were implemented in 2002. Thirty percent of injuries resulting in death were to the head and neck region with the vast majority of these classified as traumatic brain injury. Injuries involving the whole body system accounted for 28 percent of all injuries mentioned (17 percent were poisoning and 7 percent were other effects of external causes, such as submersion or asphyxiation)., Conclusions: Injury mortality data presented in this report using the external cause-of-injury mortality matrix for ICD-10 provide detail on the mechanism of death needed for research and other activities related to injury prevention. This report highlights the importance of multiple causes-of-death data when analyzing injury mortality--special attention is given to the issue of accuracy and completeness of information as it pertains to these data. The Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS) is involved in several ongoing projects related to the study of injury and injury mortality.

Objective: To examine effects of length of time between injury or poisoning and interview on the number of reported injury and poisoning episodes in the National Health Interview Survey (NHIS). (Hereinafter, both injuries and poisonings will be referred to as "injuries".), Design: The NHIS collects data continuously on medically attended injuries occurring to family members during the three months before interview. Time between injury and interview was established by subtracting the reported injury date from the interview date. Values were multiply imputed for the 25% of the episodes for which dates were only partially reported., Main Outcome Measures: An analysis of mean square error (MSE) was used to quantify the extent of errors in estimated annual numbers of injuries and to compare the contributions of bias and variance to these errors., Results: The lowest estimated MSEs for annualized estimates for all injuries and for less severe injuries were attained when the annualized estimates were based on 3--6 elapsed cumulative weeks between injury and interview. The average weighted number of injuries reported per week per year was 8% lower in later weeks (weeks 6--13) than in earlier weeks (weeks 1--5) for all episodes, and 24% lower in later weeks than in earlier weeks for contusions/superficial injuries, with both differences being statistically significant. For fractures, however, the averages in the two periods were statistically similar., Conclusions: The error associated with the estimated annual number of injuries was large with a three month reference period for all injuries and for less severe injuries. Limiting analysis to episodes with up to five weeks between injury and interview has statistical, intuitive, and analytic appeal for all injuries and for less severe injuries.

Objectives: We estimated the contribution of nonfatal work-related injuries on the injury burden among working-age adults (aged 18-64 years) in the United States., Methods: We used the 1997-1999 National Health Interview Survey (NHIS) to estimate injury rates and proportions of work-related vs non-work-related injuries., Results: An estimated 19.4 million medically treated injuries occurred annually to working-age adults (11.7 episodes per 100 persons; 95% confidence interval [CI]=11.3, 12.1); 29%, or 5.5 million (4.5 per 100 persons; 95% CI=4.2, 4.7), occurred at work and varied by gender, age, and race/ethnicity. Among employed persons, 38% of injuries occurred at work, and among employed men aged 55-64 years, 49% of injuries occurred at work., Conclusions: Injuries at work comprise a substantial part of the injury burden, accounting for nearly half of all injuries in some age groups. The NHIS provides an important source of population-based data with which to determine the work relatedness of injuries. Study estimates of days away from work after injury were 1.8 times higher than the Bureau of Labor Statistics (BLS) workplace-based estimates and 1.4 times as high as BLS estimates for private industry. The prominence of occupational injuries among injuries to working-age adults reinforces the need to examine workplace conditions in efforts to reduce the societal impact of injuries.

International comparisons of injury data may be useful for examining differences in risk and for suggesting potential interventions or hypotheses for future studies. However important issues to be considered in conducting comparisons are related to both the underlying quality of the data and how the data is collected. The International Collaborative Effort (ICE) on Injury Statistics grew out of concerns over the comparability of international injury data. This article outlines the history behind the development of the injury ICE, brief descriptions of current and past projects, collaborations, and reflections on the value of collaboration.

Objectives: This report presents injury mortality data for 2001 using the external cause of injury mortality matrix for the International Classification of Diseases, Tenth Revision (ICD-10), a detailed and comprehensive framework for tabulating and presenting injury deaths by mechanism and intent of death. Data are presented by age, sex, race, Hispanic origin, and State. This report also presents data on injury deaths classified according to the nature of the injury sustained. Deaths resulting from the terrorist attacks on September 11, 2001, are presented and the impact of these deaths on the trends in injury mortality is discussed. This report supplements the annual report of final mortality statistics., Methods: Data in this report are based on information from all death certificates filed in the 50 States and the District of Columbia in 2001. Causes of death and nature of injury are processed and coded in accordance with the ICD-10., Results: In 2001, 157,078 resident deaths occurred as the result of injuries. Of these injury deaths, 64.6 percent were classified as unintentional, 19.5 percent were suicides, 12.9 percent were homicides, 2.7 percent were of undetermined intent, and 0.3 percent involved legal intervention or operations of war. The five leading mechanisms of injury death were motor vehicle traffic, firearm, poisoning, falls, and suffocation, accounting for 78 percent of all injury deaths. A head injury was mentioned in 32 percent of injury deaths and was the most commonly mentioned injury condition resulting in death. Poisoning and toxic effects were the second most common, mentioned in 16 percent of injury deaths and were the underlying cause of 14 percent of injury deaths. In 2001, 36,753 deaths (1.6 percent of deaths) had a natural underlying cause of death but included one or more mentions of an external cause on the death certificate., Conclusions: Injury mortality data presented in this report using the external cause of injury mortality matrix for ICD-10 provide detail on the mechanism of death needed for research and other activities related to injury prevention. This report also highlights the importance of multiple causes of death when analyzing injury mortality data. The Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS) is involved in several ongoing projects related to the study of injury and injury mortality.

Objective: To characterize national trends in non-fatal BB/pellet gun related injury rates for persons aged 19 years or younger in relation to trends in non-fatal and fatal firearm related injury rates and discuss these trends in light of injury prevention and violence prevention efforts., Setting: The National Electronic Injury Surveillance System (NEISS) includes approximately 100 hospitals with at least six beds that provide emergency services. These hospitals comprise a stratified probability sample of all US hospitals with emergency departments. The National Vital Statistics System (NVSS) is a complete census of all death certificates filed by states and is compiled annually., Methods: National data on BB/pellet gun related injuries and injury rates were examined along with fatal and non-fatal firearm related injuries and injury rates. Non-fatal injury data for all BB/pellet gun related injury cases from 1985 through 1999, and firearm related injury cases from 1993 through 1999 were obtained from hospital emergency department records using the NEISS. Firearm related deaths from 1985 through 1999 were obtained from the NVSS., Results: BB/pellet gun related injury rates increased from age 3 years to a peak at age 13 years and declined thereafter. In contrast, firearm related injury and death rates increased gradually until age 13 and then increased sharply until age 18 years. For persons aged 19 years and younger, BB/pellet gun related injury rates increased from the late 1980s until the early 1990s and then declined until 1999; these injury rates per 100 000 population were 24.0 in 1988, 32.8 in 1992, and 18.3 in 1999. This trend was similar to those for fatal and non-fatal firearm related injury rates per 100 000 which were 4.5 in 1985, 7.8 in 1993, and 4.3 in 1999 (fatal) and 38.6 in 1993 and 16.3 in 1999 (non-fatal). In 1999, an estimated 14 313 (95% confidence interval (CI) 12 025 to 16 601) cases with non-fatal BB/pellet gun injuries and an estimated 12 748 (95% CI 7881-17 615) cases with non-fatal firearm related injuries among persons aged 19 years and younger were treated in US hospital emergency departments., Conclusions: BB/pellet gun related and firearm related injury rates show similar declines since the early 1990s. These declines coincide with a growing number of prevention efforts aimed at reducing injuries to children from unsupervised access to guns and from youth violence. Evaluations at the state and local level are needed to determine true associations.

As the articles in this journal issue show, gun violence affects children and youth in many ways: psychologically, emotionally, financially, and legally. But first and foremost, gun violence affects children's physical safety. Therefore, this issue opens with an overview of the physical toll that firearms exact upon children and youth, reviewing the incidence of firearm-related injury and death among Americans under age 20. This article analyzes trends and current status in firearm death and injury, based on nationwide data collected by the federal government. Several key findings emerge from the data: Firearm death rates among children and youth in the United States have declined dramatically since 1993, but remain high compared with historical rates in this country and rates in other developed nations. A majority of these deaths are homicides. Certain groups of children and youth, especially adolescents, boys, minority youth, and those residing outside the Northeast, are particularly at risk for firearm death. The problem is most acute among black teenage males. Firearm injuries are much more likely to result in death than are other injuries for which children and youth visit emergency departments--a reflection of the extreme lethality of firearms. Given these findings, the authors call for a concerted effort to reduce youth firearm deaths to levels comparable to those of other industrialized nations, using a wide variety of approaches that span the public health, criminal justice, and educational spheres. They also recommend improved data systems to track firearm injury and death, so that researchers can better analyze these incidents and evaluate intervention strategies.

Objective: This report provides a descriptive overview of the first year of data from the injury section of the redesigned National Health Interview Survey. It documents the Survey's design methodologies and presents detailed national estimates of nonfatal injury and poisoning episodes for 1997., Methods: Data for the U.S. civilian noninstitutionalized population were collected using Computer Assisted Personal Interview (CAPI). The data on all medically attended injuries and poisonings occurring to any family member during the 3-month period prior to the interview were obtained from an adult member of the family., Results: In 1997, 34.4 million medically-attended episodes of injury and poisoning were reported, resulting in an age-adjusted rate of 128.9 episodes per 1000 persons. Injury episodes resulted in 40.9 million injury conditions for a rate of 153.7 conditions per 1,000 persons. Falls were the leading external cause of injury, followed by episodes resulting from being struck by or against a person or an object, transportation, overexertion, cutting and piercing instruments, and poisoning. Sprains and strains were the most frequently reported injury condition followed by open wounds, fractures, and contusions. Upper extremity and lower extremity injuries were the leading body regions for these conditions. Leisure activities and paid work were most often reported as the activities the person was engaged in when the injury episode occurred, and. the home was the most likely place for the injury to have occurred., Conclusion: The redesigned NHIS is a useful source of information about medically-attended nonfatal injuries and poisonings. A single year now provides enough data to produce stable national estimates on details of injury and poisoning episodes.

Introduction: More military personnel die of injuries each year than any other cause. This paper provides a basic epidemiologic description of injury deaths in the military., Methods: Using fatality data from the Department of Defense Directorate of Information and Operations Reports and population data from the Defense Manpower Data Center, death rates of men and women in the military services for unintentional injury, suicide, homicide, and illness were calculated for the 1980-1992 period., Results: From 1980 to 1992, injuries (unintentional injuries, suicides, and homicides combined) accounted for 81% of all nonhostile deaths among active duty personnel in the Armed Services. The overall death rate due to unintentional injuries was 62.3 per 100,000 person-years. The suicide rate was 12.5, the homicide rate 5.0, and the death rate due to illness 18.4. From 1980 to 1992 mortality from unintentional injuries declined about 4% per year. The rates for suicide and homicide were stable. Men in the services die from unintentional injuries at about 2.5 times the rate of women and from suicides at about twice the rate of women. Women in the military, however, have a slightly higher homicide rate than men., Conclusion: Injuries (unintentional injuries, suicides, and homicides) are the leading cause of death among active duty members of the U.S. Armed Forces, accounting for about four out of five deaths. The downward trend for fatal unintentional injuries indicates the success that can be achieved when attention is focused on preventing injuries. Further reduction in injury mortality would be facilitated if collection and coding of data were standardized across the military services.

Objective: This report investigates international differences in injury mortality rates among 11 of the countries participating in the International Collaborative Effort on Injury Statistics., Methods: The cause, intent, and age-specific injury mortality rates are calculated and presented from Australia, Canada, Denmark, England & Wales, France, Israel, New Zealand, The Netherlands, Norway, Scotland, and the United States. Data are presented by cause (or mechanism) and intent (or manner of death) according to the matrix framework for presenting injury mortality statistics published in August 1997. The benefits of this matrix approach to investigating injury mortality are explained with numerous examples., Results: Injury death rates are higher in France and Denmark and lower in England & Wales, Israel, and The Netherlands than elsewhere. New Zealand, the United States, and Norway had similar average annual injury death rates of 56-57 per 100,000 population. As an example of the benefit of presenting data in the matrix framework, the total poisoning death rate in Denmark for all categories of intent (13 per 100,000) is about twice the rate in the United States. Unintentional poisoning death rates, however, are similar in the United States and Denmark (about 4 per 100,000) and are higher than elsewhere. However, the suicide poisoning death rate in Denmark is 3 times the rate in the United States., Conclusion: Using these results, the ICE on Injury will be investigating death registration practices in each of the countries to better understand international variation in injury mortality due to reporting or registration procedures.

Objectives: This report describes ambulatory care visits for injuries to hospital emergency departments in the United States. Statistics are presented on selected patient, hospital, and visit characteristics., Methods: The data presented in this report were collected in the National Hospital Ambulatory Medical Care Survey (NHAMCS) over a period of 4 years from 1992 through 1995. The NHAMCS is a national probability survey of visits to hospital emergency and outpatient departments of non-Federal, short-stay, and general hospitals in the United States. Sample data were combined across years and weighted to produce annual estimates., Results: From 1992 through 1995, an estimated 147 million visits for injuries were made to hospital emergency departments in the United States, an average of 36.8 million visits per year with an annual utilization rate of 14.3 visits per 100 persons. Persons 15-24 years had a higher rate of injury-related emergency department visits compared with other age groups. The injury visit rate was higher in the Midwest than in the South or West. Injury visits represented 37.8 percent of all visits to hospital emergency departments but 53.5 percent of all visits for children between 5 and 14 years and 48.5 percent of all visits for persons 15-24 years. Open wounds accounted for the largest proportion of injuries (22.0 percent). The leading external causes of injuries included falls, being struck by or striking against a person or object, and motor vehicle traffic injuries. For all ages, 6.3 percent of the injury visits had a disposition of admission for inpatient care, while almost one-quarter of injury visits by persons 65 years and over resulted in hospitalization. ED visits caused by poisonings or firearm injuries were more likely to result in hospitalization compared with other causes.

We used data from the 1991 Longitudinal Follow-up to the National Maternal and Infant Health Survey to examine cumulative risk of injury among children from birth to three years old and to provide national-level cause-specific estimates of medically attended nonfatal injuries for this age group. Almost 25% of the 8,145 children reportedly received care for an injury between birth and three years old. Among the children with injuries, 25.4% reportedly had more than one medically attended injury. Risk of reported injury was higher for boys and upper level socioeconomic groups. Falls were the most frequently reported injury (51%), followed by burns (11.7%), striking or cutting injuries (9.8%), poisonings (9.8%), and injuries from devices not intended for the child's use (7.9%). Nonfatal injuries for preschool-age children present a pattern strikingly different from that of fatal injuries among this age group, and the need for this data is important in targeting prevention strategies.

Objective: To examine trends (1979 through 1989) and current status in firearm and nonfirearm homicide rates by level of urbanization among persons 15 through 19 years of age., Design: The Compressed Mortality File, a county-level mortality and population database maintained by the National Center for Health Statistics, Centers for Disease Control, Hyattsville, Md, and the 1980 Human Resource Profile County Codes are used to analyze age-, sex-, and race-specific firearm and nonfirearm homicide rates by urbanization level., Setting: United States, 1979 through 1989., Subjects: Black and white males and females 15 through 19 years of age whose underlying cause of death was either firearm homicide (E965.0 through E965.4 or E970) or nonfirearm homicide (E960 through E964, E965.5 through E969, or E971 through E978) in the ICD-9 (International Statistical Classification of Diseases, Injuries, and Causes of Death, Ninth Revision)., Main Outcome Measures: Urbanization level-specific firearm and nonfirearm homicide rates., Results: The 1989 firearm homicide rate in metropolitan counties was nearly five times the rate in nonmetropolitan counties (13.7 vs 2.9 deaths per 100,000 population). Firearm homicide rates were highest in core metropolitan counties, 27.7 per 100,000 population; rates were higher for black males than for any other race-sex group in each of five county urbanization strata for 1979 through 1989. Nonfirearm homicide rates are considerably lower, with smaller urban differentials; the rate in metropolitan counties was 1.4 times the rate in nonmetropolitan counties (2.6 vs 1.8 per 100,000 population). From 1979 through 1984, firearm homicide rates declined in each of the county strata. From 1984 through 1987, firearm homicide rates increased, and from 1987 through 1989 they increased rapidly, from 23% to 35% per year in the four metropolitan strata. From 1979 through 1989, nonfirearm homicide rates declined or remained stable., Conclusions: Large urbanization differentials in firearm homicide and smaller differentials in nonfirearm homicide are identified. Firearm homicide rates are highest and increasing the fastest among black teenage males in the core, fringe, and medium metropolitan strata.

Objective: To identify US counties (1) that had either significantly high or significantly low firearm homicide rates among black males 15 through 19 years of age in 1983 through 1985 and in 1987 through 1989, and/or (2) that experienced a significant increase in the firearm homicide rate between 1983 through 1985 and 1987 through 1989., Design: Using the Compressed Mortality File, a county-level mortality and population database maintained by the National Center for Health Statistics, Centers for Disease Control, Hyattsville, Md, county-level firearm homicide rates are analyzed., Setting: Eighty counties with a population of at least 10,000 black males 15 through 19 years of age in 1987 through 1989., Subjects: Black males 15 through 19 years of age whose underlying cause of death was classified as firearm homicide (E965.0 through E965.4, or E970) in the ICD-9 (International Statistical Classification of Diseases, Injuries, and Causes of Death, Ninth Revision)., Main Outcome Measure: County-specific firearm homicide rate., Results: In 1983 through 1985 and in 1987 through 1989, seven and 13 counties, respectively, were identified that had significantly high firearm homicide rates. Firearm homicide rates were significantly high in both time periods in the following counties: Los Angeles, California; Wayne, Michigan; Kings, New York; St Louis City, Missouri; and Baltimore City, Maryland. Firearm homicide rates increased significantly between 1983 through 1985 and 1987 through 1989 in 34 of the 80 counties. Twenty counties had significantly low rates in both time periods. Several counties with low rates in 1983 through 1985 experienced significant increases and by 1987 through 1989 were among those with high rates., Conclusions: Surveillance of firearm homicide rates at the county levels in counties with high and with low rates is a necessary first step in the development of successful violence prevention programs. Those counties where rates are high and increasing are the counties that are in greatest need for intervention strategies. Knowledge of the incidence of nonfatal firearm injuries is also needed.

The objective of this study was to examine the effects of nativity status (native vs foreign born) and other maternal characteristics (age, parity, education, and marital status) on infant, neonatal, and postneonatal mortality among white and black mothers. The design of this nonrandomized cohort study was based on birth and death certificates. The setting involved live births among US residents (excluding California, Texas, and Washington) in 1983 and 1984. The participants included white mothers with 4.4 million births and black mothers with 926,000 births in single deliveries. There were no interventions. With regard to measurements (the main results), after adjusting for other risk factors, neonatal mortality risk was 22% lower among the black foreign-born mothers than among the black native-born mothers, while among white infants, there was no risk difference by nativity. Relative risks were more similar for postneonatal mortality, ie, 24% lower among black foreign-born mothers and 20% lower among white foreign-born mothers. Combining the several categories of risk factors into three broad maternal risk groups, there was a near-doubling of black and near-tripling of white infant mortality rates between the low and high levels of maternal risk. We concluded that if the infant mortality rate in the low-risk groups could be achieved by the moderate- and high-risk groups, there would be a 30% reduction in infant deaths within each race. Since the black infant mortality rate is twice the white infant mortality rate and black foreign-born mothers have much lower rates than black native-born mothers, it is likely that further improvement is possible among black infants.

The homicide rate for males 15 through 24 years of age in the United States was compared with the rates in 21 other developed countries. The US homicide rate, 21.9 per 100,000, was more than four times higher than the next highest rate in Scotland (5.0). Most countries had rates that were between 1 and 3 per 100,000. The lowest rates were in Japan and Austria, each with rates below 0.6 per 100,000 males 15 through 24 years of age. Three quarters of the homicides in the United States resulted from the use of firearms contrasted with less than a quarter of all homicides in the comparison countries. The US homicide rate for black males 15 through 24 years of age (85.6) was more than seven times the rate for white males (11.2). In 1987 there were only four states that had homicide rates among white males that were as low as the rates among males in the comparison countries. The lowest state rate among young black males was still seven times the highest rate abroad. There are about 4000 homicides per year among young males in the United States. If the US homicide rate could be reduced to that in the country with the next highest rate, more than 3000 lives would be saved.

We report the first national data on smoking before, during, and after pregnancy. Estimates are based on the 1986 Linked Telephone Survey that reinterviewed 1,550 White women 20-44 years of age who were respondents to the 1985 National Health Interview Survey. An estimated 39 percent of White women who had smoked before pregnancy quit smoking while pregnant (27 percent when they found out they were pregnant and 12 percent later during pregnancy). Women with less than 12 years of education were five times as likely to smoke and one-fourth as likely to quit as those with 16 or more years of education. Women who smoked more than one pack of cigarettes per day before pregnancy were one-fifth as likely to quit as those smoking less. Of the women who quit, 70 percent resumed smoking within one year of delivery. Of those who relapsed, 67 percent resumed smoking within three months of delivery and 93 percent within six months. There is little evidence of educational differentials in relapse rates. The fact that relapse remains high suggests that while health of the fetus is a strong influence on women's smoking habits, women may be less aware of the effect of passive smoke on the infant.