Nursing News

Suicide Outranks Car Crashes as Leading Cause of Injury Mortality in U.S.

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By Kelly Brooks, contributor

October 6, 2012 - Suicide is on the rise in the United States, and surpassed motor vehicle crashes as the leading cause of injury mortality over the past decade.

As revealed in a new report in the American Journal of Public Health, the five top causes of injury mortality in 2009 included suicide, ranked first, followed by motor vehicle crashes, poisoning, falls and homicide.

Together, these five categories accounted for more than four-fifths of all injury mortality deaths in the United States.  The mortality rate for such injuries climbed 10 percent between 2000 and 2009--a period of time when, paradoxically, disease mortality rates fell and life expectancy rose. 

Contributing to the overall injury mortality increase were rising rates of unintentional poisoning (128 percent), greatly attributable to prescription overdoses; unintentional falls (71 percent), particularly among the elderly; and suicide (15 percent), possibly related to the declining economy.  On the other hand, the country saw declining rates of homicide (8 percent) and unintentional motor vehicle crashes (25 percent) during the same period. 

“Motor vehicle traffic crash mortality declined primarily because of sustained and concentrated prevention efforts by scientists, policy makers, legislators, public health experts, criminal justice communities, and local communities,” said lead author Ian Rockett, PhD, MPH, a professor at West Virginia University’s School of Public Health. “By contrast, the major increases we see in suicide, poisoning and fall mortality rates reflect a pressing need for similar attention from all stakeholders.”

But before public health professionals and health care providers can reduce such mortalities, we have to better understand them, including the reasons behind some statistical anomalies.  For instance, why was total injury mortality 2.2 times higher for men than for women in 2009?  Why did blacks and Hispanics have lower adjusted motor vehicle crash and suicide mortality rates than whites, yet higher adjusted rates of homicide? And what can be done about any of these differences?

“Nurses already play a crucial role from prevention, treatment, and rehabilitation perspectives,” said Rockett.  “Perhaps they could increase their involvement even more across all fronts.”

Nurses can have an impact in at least three of the top five injury mortality causes: 

36,909 deaths in 2009* 

• Americans commit suicide at a rate of more than 1 person every 15 minutes.
• More than 1.1 million adults attempted suicide in the past year.
• Suicide claims more than twice as many lives each year than homicide.

“It’s really interesting this research came out right around the time the national suicide prevention strategy was released,” said Holly C. Wilcox, PhD, assistant professor at the Johns Hopkins Bloomberg School of Public Health, referring to the U.S. Surgeon General’s 2012 National Strategy for Suicide Prevention.

It’s crucial that nurses know how to screen for suicide risk, said Wilcox.  Useful resources include the Columbia-Suicide Severity Rating Scale (C-SSRS) and the proposed Clinician Rating of Current Concern About Potential Suicidal Behavior, which will be released with the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in May 2013.  CE courses in suicide prevention are also available.

31,758 deaths in 2009* 

• In 2008, there were over 14,800 deaths caused by prescription painkillers, outnumbering heroin and cocaine deaths combined.
• Drug overdose death rates have more than tripled in the United States since 1990.
• Most fatal poisonings are due to an illegal, prescription or over-the-counter drug. 

Medical use of opioids is more than 10 times greater than it was just 20 years ago, so nurses are well positioned to identify, address and even prevent its abuse. These fact sheets from the Centers for Disease Control and Prevention (CDC) can help you be prepared: Poisoning in the United States, Unintentional Drug Poisoning in the United States and Policy Impact: Prescription Painkiller Overdoses.  Look for CE courses in administering and monitoring patient medications.

24,792 deaths in 2009* 

• Each year, 1 in 3 adults over age 65 falls.
• Falls are the leading cause of injury death among adults over age 65.
• Traumatic brain injuries (TBI) account for 46 percent of fatal falls among older adults.

Nurses can help older patients avoid falls by working with a physician or pharmacist to review their medicines, screening for osteoporosis, encouraging regular exercise, recommending calcium and vitamin D supplementation, and advising patients to have annual vision appointments.  Check out the CDC’s fact sheet on Falls Among Older Adults and look for CE courses to reduce patient falls.

*National Vital Statistics Report.  Deaths: Final Data for 2009.

See also:
“Leading Causes of Unintentional and Intentional Injury Mortality: United States, 2000-2009,” American Journal of Public Health.



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