Fatal Injuries to Children -- United States, 1986

Injuries are a leading cause of mortality among children less than or equal to 19 years of age in the United States (1). As part of the Injury Prevention Act of 1986,* Congress requested that the Secretary of Health and Human Services, through CDC, analyze the causes and incidence of childhood injuries in the United States and make recommendations for injury prevention and control legislation. The Secretary's report, Childhood Injuries in the United States: A Report to Congress (2), was presented to Congress in October 1989; it was based on national data for 1986 maintained by CDC's National Center for Health Statistics and on research conducted by pediatric injury experts in the United States. This report summarizes mortality data from Childhood Injuries in the United States for children (defined as persons aged less than or equal to 19 years) from the five leading causes of fatal injuries to children in the United States in 1986 (i.e., motor vehicle crashes, homicide, suicide, drowning, and fires/burns). Motor Vehicle Crashes

Motor vehicle crashes accounted for almost half of the 22,411 fatal injuries among children in the United States (Table 1); a substantial proportion (an estimated 15%-30%) of these deaths were associated with alcohol use (3). Of all motor vehicle-related fatalities, 70% occurred among motor vehicle occupants, and 17%, among pedestrians. Occupant fatality rates for 15-19-year-olds (30.7 per 100,000) from motor vehicle crashes were 10 times those for children less than 10 years of age (3.0 per 100,000).

Among children aged 5-9 years, pedestrian injuries were associated with more deaths (502 (24%) of 2133) than any other cause of injury. Regardless of race, fatality rates for male pedestrians less than or equal to 19 years of age (3.2 per 100,000) were nearly twice as high as those for females (1.8 per 100.000); rates for children of races other than white (3.5 per 100,000) were 1.5 times those for white children (2.3 per 100,000). Homicide

In 1986, deaths due to homicide accounted for nearly 13% of fatal injuries among children (Table 1). Nearly two thirds of childhood homicide deaths were among 15-19-year-olds; however, 23% were among children less than 5 years of age. Sixty-eight percent of homicide deaths were among males. Rates for black children (12.2 per 100,000) were approximately five times those for white children (2.6 per 100,000). Sixty-one percent of homicides among males and 32% of homicides among females involved firearms. Suicide

Suicide was the third leading cause of childhood fatal injuries (Table 1). Among 10-19-year-olds, males accounted for 80% of suicides; of these, an estimated 60% were associated with firearms. Age-specific rates among white children were generally 1.5-2.5 times the suicide rate for black children. Drowning

Drowning, the fourth leading cause of childhood fatal injuries, was most common among children less than or equal to 4 years of age and males aged 15-19 years. Among the latter group, drownings occurred in a wide variety of aquatic environments; alcohol use was associated with an estimated 40%-50% of these events. Drowning rates for black children (4.5 per 100,000) were almost twice those for white children (2.6 per 100,000). In three states (Arizona, California, and Florida), drowning was the leading cause of fatal injuries for children less than or equal to 4 years of age. In all states, up to 90% of drownings among this age group occurred in residential swimming pools. Fire/Burns

Fire/burns were the fifth leading cause of childhood death from injury. Fifty-three percent of childhood burn deaths occurred among children aged less than or equal to 4 years and 73% among children less than or equal to 9 years of age. Fire/burn deaths were more common among black children (5.1 per 100,000) than among children of other races (1.8 per 100,000). For children less than or equal to 9 years of age, black males (8.4 per 100,000) were three times more likely than white males (2.8 per 100,000) and black females (8.6 per 100,000) 4.5 times more likely than white females (2.0 per 100,000) to die in a house fire. Overall, 80% of deaths from fire/burns resulted from house fires, 9% from electrical burns, and 2% from scalding. Reported by: Div of Injury Control, Center for Environmental Health and Injury Control, CDC.

Editorial Note

Editorial Note: Childhood Injuries in the United States: A Report to Congress (2) provides the first comprehensive assessment of childhood injuries in the United States and underscores how the relative importance of childhood injuries has increased over the last 20 years. From 1968 through 1986, death rates for children from noninjury causes have declined 56%, while death rates from injuries have declined 22% (Figure 1). Injuries are the leading cause of death among children and account for as many years of potential life lost before age 65 as the next two leading categories--congenital anomalies and prematurity--combined (Figure 2).

Each year, injuries account for 20% of all hospitalizations among U.S. children, nearly 16 million emergency room visits, and permanent disability to more than 30,000 children (4). Although the direct and indirect costs of these injuries are difficult to measure, in 1982, the estimated costs exceeded $7.5 billion (5); in 1985, they were nearly $8.3 billion, with lifetime costs exceeding $13 billion (6).

For many childhood injuries, effective interventions are being developed or already exist and have been implemented. For example, morbidity and/or mortality from injuries could be reduced for 1) motor vehicle crashes by air bags, automatic occupant restraints, antilock brakes, programs to reduce drug and alcohol abuse, and barriers to separate pedestrians from traffic; 2) homicide by teaching conflict resolution skills and by reduction of access to lethal weapons such as firearms (7); 3) suicide by improved identification and referral of persons at high risk for suicide and efforts to limit access to lethal means of suicide such as firearms, high places, and prescription drugs (7,8); 4) drowning by enclosure of swimming pools with fencing and self-latching gates; and 5) fires/burns by use of smoke detectors and antiscald devices in shower heads and faucets.

Child abuse is a major contributor to childhood injuries from interpersonal violence--in 1986, an estimated 1.6 million children were abused or neglected. The occurrence of child abuse may be reduced through visits by public health nurses to mothers at high risk for child abuse. Other interventions include instructing parents at high risk for abuse in appropriate parenting skills; teaching children skills in identifying and reporting abusive situations; and conducting support groups for parents identified as being at high risk for child abuse.

An abridged version of Childhood Injuries in the United States: A Report to Congress was published in the June 1990 issue of The American Journal of Diseases of Children (4) and is available from the Division of Injury Control, Center for Environmental Health and Injury Control, CDC, Mailstop F36, Atlanta, Georgia 30333.

References

1. Committee on Trauma Research, Commission on Life Sciences, National Research Council, Institute of Medicine. Injury in America: a continuing public health problem. Washington, DC: National Academy Press, 1985.

2. Secretary of Health and Human Services. Childhood injuries in the United States: a report to Congress. Atlanta: US Department of Health and Human Services, Public Health Service, CDC, 1989.

3. Agran P, Castillo D, Winn D. Childhood motor vehicle occupant injuries. Am J Dis Child 1990;144:653-62.

4. CDC. Childhood injuries in the United States. Am J Dis Child 1990;144:627-46.

5. Azzara CV, Gallagher SS, Guyer B. The relative health care and social costs for specific causes of injury (Abstract). In: Program and abstracts of the 113th annual meeting of the American Public Health Association. Washington, DC: American Public Health Association, 1985.

6. Rice DP, MacKenzie EJ, Jones AS, et al. The cost of injury in the United States: a report to Congress. San Francisco: Institute for Health and Aging, University of California; Injury Prevention Center, Johns Hopkins University, 1989.

7. Department of Health and Human Services, Department of Justice. Surgeon General's Workshop on Violence and Public Health: report. Washington, DC: US Department of Health and Human Services, Public Health Service, 1986; DHHS publication no. HRS-D-MC 86-1.

8. Alcohol, Drug Abuse, and Mental Health Administration. Report of the Secretary's Task Force on Youth Suicide. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1989:115-28; DHHS publication no. (ADM)89-1624. *Public Law no. 99-649, Section 1, 100 Stat. 3633 (42 U.S.C. Section 201 (1989)).

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