摘要：Objectives. We have described national trends for the 5 leading external causes of injury mortality. Methods. We used negative binomial regression and annual underlying cause-of-death data for US residents for 2000 through 2009. Results. Mortality rates for unintentional poisoning, unintentional falls, and suicide increased by 128%, 71%, and 15%, respectively. The unintentional motor vehicle traffic crash mortality rate declined 25%. Suicide ranked first as a cause of injury mortality, followed by motor vehicle traffic crashes, poisoning, falls, and homicide. Females had a lower injury mortality rate than did males. The adjusted fall mortality rate displayed a positive age gradient. Blacks and Hispanics had lower adjusted motor vehicle traffic crash and suicide mortality rates and higher adjusted homicide rates than did Whites, and a lower unadjusted total injury mortality rate. Conclusions. Mortality rates for suicide, poisoning, and falls rose substantially over the past decade. Suicide has surpassed motor vehicle traffic crashes as the leading cause of injury mortality. Comprehensive traffic safety measures have successfully reduced the national motor vehicle traffic crash mortality rate. Similar efforts will be required to diminish the burden of other injury. Estimated life expectancy at birth in the United States rose steadily from 73.7 years in 1980 to 78.0 years in 2008. 1 However, life expectancy’s 2 fundamental determinants, total disease and injury mortality rates, displayed disparate overall trends ( Figure 1 ). 2 The age-adjusted disease mortality rate trended downward throughout the 29-year period, whereas the age-adjusted injury mortality rate reverted upward between 2000 and 2007. Moreover, crude and age-adjusted injury mortality rates shared a common trajectory. Open in a separate window FIGURE 1— Annual crude and age-adjusted mortality rates from (a) disease and (b) injury: United States, 1980–2008. Note . ICD = International Classification of Diseases . The vertical dashed lines demarcate the transition between revisions ICD-9 and ICD-10. The 5 leading external causes of injury deaths comprise 3 unintentional (motor vehicle traffic crashes, poisoning, and falls) and 2 intentional (suicide and homicide) or violence-related categories. They account for more than four fifths of all such deaths nationally. 3 The unintentional poisoning mortality rate has been rising rapidly since the 1990s, 4,5 with prescription drug overdose deaths now predominant. 6 Previous studies also reported a substantial rate increase for unintentional elderly fall mortality 7 and a smaller increase for suicide. 5 In addition, declining rates have been documented for homicide 8 and unintentional motor vehicle traffic crash mortality. 9 Two of the national studies examined racial/ethnic differences in unintentional injury mortality trends. The first study found an increase in the rate between 1992 and 2002 for non-Hispanic Whites and a decline for minorities. 10 The second study reported a change in the unintentional injury mortality rate between 1999 and 2005, an increase, for non-Hispanic Whites only. 11 Both studies reported excess rate increases for this group in various unintentional causes, most notably poisoning and falls. Unknown are how proportionate shares of the leading causes of injury fatalities may have changed during the first decade of the twenty-first century and race/ethnicity and other demographics featured in rate trends. We have characterized patterns and trends in rates of total combined national unintentional and intentional injury mortality and its 5 leading external causes for the decade 2000–2009. Specifically, we have described and analyzed these rates in terms of time and 4 population-level demographic characteristics: age, gender, race/ethnicity, and major US geographic region. Incorporating recently released data, we addressed the absence of current research on unintentional and intentional injury mortality as a whole.
