Injury Mortality Atlas of the United States, 1979-1987

Injury is the fourth leading cause of death among all persons in the United States and, because of increased risk for injury to the young, is the leading cause of potential years of life lost before age 65 years (1). In 1988, the estimated total national cost attributable to injuries was $180 billion (2). To assist public health agencies in targeting interventions for the control and prevention of injuries in geographic areas of increased risk, CDC developed the Injury Mortality Atlas of the United States, 1979-1987, which presents county-specific maps illustrating the geographic distribution of injury-related death rates. This report summarizes methods used to create the atlas and highlights important patterns and findings.

The atlas uses color-coded maps to present death rates per 100,000 persons for injury-related deaths in 3072 counties.* Risk-group-specific maps are also presented for homicides among black males and for fall-related deaths among persons aged greater than or equal to 55 years in the United States. Rates in the atlas are based on the number of deaths and the intercensal population estimates obtained from the Compressed Mortality File produced by CDC's National Center for Health Statistics. Cause of injury was determined by the International Classification of Diseases, Ninth Revision, external cause of death codes (E-codes). Death rates were based on decedents' counties of residence rather than counties where deaths occurred. A modified empirical Bayes (EB) procedure was developed to stabilize county-level death rate estimates for counties with small populations (3,4); age-specific modified EB rates were standardized directly to the age distribution of the 1940 U.S. census population.

Counties were color-coded based on the empirical distribution of stabilized rates; for example, for homicide and drowning, counties with cause-specific death rates ranging from the 75th through 89th national percentile were colored blue, and those with rates in the 90th percentile or higher were colored red. The atlas also presents maps showing the geographic distribution of injury mortality separately for each state and tabular and graphic summaries of trends in death rates by the decedent's sex, age, year of death, and race.

The geographic distribution of injury-related deaths illustrated in the atlas include the following:

• Homicide rates were higher in counties with large metropolitan areas. Counties with high rates also were clustered across rural and urban areas in the southeast (Figure 1).

• In general, suicide rates were higher in western states; however, counties with high rates were also clustered in the central and southern Appalachian Mountains.

• Fall-related death rates were greater in western states.

• Counties with high rates of fire- and burn-related death were clustered along the southeastern coastal plain and in areas adjacent to the lower Mississippi River.

• Counties with high drowning rates were clustered along the southeast, Gulf, and northwest coastlines and in areas adjacent to the lower Mississippi River (Figure 2). Reported by: Biometrics Br, Div of Injury Control, National Center for Environmental Health and Injury Control, CDC.

  Editorial Note

Editorial Note: The injury mortality atlas was designed as a resource to assist public health professionals in 1) identifying specific regions and subpopulations at potentially elevated risk for injury-related mortality, 2) visually analyzing the geographic distribution of injury mortality across and within jurisdictional boundaries, and 3) generating hypotheses for further epidemiologic study. This atlas augments previous efforts to evaluate the geographic distribution of injury-related mortality using county-based maps (5,6) but that did not provide a comprehensive summary of the geographic distribution of cause-specific injury mortality. In addition, the EB-stabilization procedure employed in this atlas provides improved estimates of death rates in counties with small populations (3).

Because population-based data on nonfatal injuries are not available in the United States, mortality is the only measure of injury incidence available at the national level. This limitation may influence the interpretation of maps in the atlas. For example, a cluster of counties with high rates of fall-related mortality may reflect decreased survival of persons from fall-related injuries (because of limited emergency medical services and trauma care) rather than an increased incidence of fall-related injuries. Nonetheless, identification of areas characterized by high death rates is a crucial step in both etiologic studies and the development of successful intervention strategies.

Additional information about obtaining a copy of the Injury Mortality Atlas Of The United States, 1979-1987, is available from the Program Development and Implementation Branch, Division of Injury Control, National Center for Environmental Health and Injury Control, Mailstop F-36, 1600 Clifton Road, NE, Atlanta, GA 30333.

References

1. CDC. Public health surveillance of 1990 injury control objectives for the nation. MMWR 1988;37(no. SS-1).

2. Rice DP, Mackenzie EJ, Jones AS, et al. Cost of injury in the United States: a report to Congress. San Francisco: University of California, Institute of Health and Aging; Johns Hopkins University, Injury Prevention Center, 1989:282.

3. Manton KG, Woodbury MA, Stallard E, et al. Empirical Bayes procedures for stabilizing maps of U.S. cancer mortality rates. J Am Stat Assoc 1989;84:637-50.

4. Louis TA. Estimating a population of parameter values using Bayes and empirical Bayes methods. J Am Stat Assoc 1984;79:393-8.

5. Baker SP, Whitfield RA, O'Neill B. Geographic variations in mortality from motor vehicle crashes. N Engl J Med 1987;316:1384-7.

6. Baker SP, Whitfield RA, O'Neill B. County mapping of injury mortality. J Trauma 1988;28:741-5.

*Because of the absence of county-specific reporting for Alaska and the small number of counties in Hawaii, death rates were not mapped for these states. Other counties were combined to maintain consistency over calendar years or to ensure agreement between county boundary files and the reporting units used by CDC's National Center for Health Statistics.

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