Accidental deaths among kids down but more needs to be done: CDC report

By Dr. Ananya Mandal, MDApr 17 2012

According to U.S. mortality data the overall death rate from unintentional injury among children and teens fell 29% from 2000 to 2009. What was concerning however, was that rates of death by poisoning in young adults - mostly from prescription drug overdose - and suffocation in infants rose. And unintentional injury still accounted for 37% of all deaths in the 19-and-under age group in 2009 and was the fifth leading killer of patients younger than 1, the report said. The CDC report was published in the April 16 issue of Morbidity and Mortality Weekly Report.

The report compiled data from the CDC's National Vital Statistics System, which included death certificate data from the 50 states and the District of Columbia. The study categorized the mechanisms for death by unintentional injury as drowning, fall, fires and burns, motor vehicle traffic-related, other transportation-related, poisoning, suffocation, and other. Motor vehicle-related deaths were subcategorized by occupant, pedestrian, pedal cyclist, other, or unspecified.

For all age groups, the overall accidental death rate declined except in those less than a year old, where the rate increased from 23.1 to 27.7 deaths per 100,000 from 2000 to 2009. In patients under age 1, suffocation was the primary driver of the increased overall death rate - rising by 54% from 13.8 to 21.3 per 100,000 over the 9-year period.

The decrease was mainly due to the drop in accidental motor vehicle-related deaths, which decreased overall by 41%, from 9.3 per 100,000 people in 2000 to 5.5 per 100,000 people in 2009. By subcategory, occupant and pedal cyclist deaths showed the largest decreases, by 47% and 52% respectively.

Although the overall death rate in patients ages 15 to 19 decreased over the study period by 33% (33.4 to 22.3 per 100,000), accidental poisoning deaths increased by 91% in patients ages 15 to 19 over the study period -- from 1.7 to 3.3 per 100,000.

The 11 states with death rates significantly lower than the national average in 2009 included: Ohio, Minnesota, Oregon, Virginia, Illinois, Maryland, California, New York, Connecticut, New Jersey, and Massachusetts. Twenty-one states had death rates significantly higher than the U.S. average: Mississippi, South Dakota, Montana, Wyoming, Louisiana, Oklahoma, Alaska, South Carolina, New Mexico, Arkansas, Alabama, North Dakota, Kentucky, Missouri, Kansas, Nevada, Florida, Tennessee, North Carolina, Indiana, and Texas. States with the lowest death rates tended to have more laws on the books addressing child safety and more programs aimed at keeping children and teens safe.

“This variation is important because it demonstrates what is possible,” CDC Principal Deputy Director Ileana Arias said during a teleconference. “In 2009 more than 5,700 children's lives would have been saved if the lowest state death rate had been achieved nationally…Most of these deaths are predictable and preventable,” Arias said.

In a conference call Monday, lead author Julie Gilchrist, of the CDC's Division of Unintentional Injury Prevention, said that empowered parents and safer environments could help curb accidental child deaths in the U.S. Gilchrist and co-authors noted that suffocation deaths in infants can be prevented by following safe sleep environment recommendations made by the American Academy of Pediatrics. Those recommendations include always positioning an infant on his or her back, using a firm sleep surface, room-sharing without bed-sharing, and avoiding loose bedding.

Gilchrist also noted that poisoning rates in young adults was mostly attributed to the abuse of opioid painkillers. Drugs were made available at home, at friends' homes, through drug sharing, or through alternate illegal sales. The researchers wrote that misuse of these prescription painkillers could be curbed through “appropriate prescribing, proper storage and disposal, discouraging medication sharing, and state-based prescription drug monitoring programs.”

“We have made progress, and because of this our children are safer than ever before, but injury continues to be a leading cause of death among children,” said Arias, in a news conference. “Injury continues to be a leading cause of death among children, and we know more can be done to keep our children safe.”

Out of the 34 Organization for Economic Cooperation and Development countries, the U.S. ranked 30th in patients 14 and younger in 2008, “with a [death] rate four times higher than the top-performing nations,” the authors noted. In 2004 and among patients 19 and younger, the U.S. had nearly twice the combined accidental death rates of the high-income countries in the World Health Organization's European and Western Pacific Regions.

In conjunction with the report, the CDC and more than 60 partner groups are releasing a National Action Plan on Child Injury Prevention. Its general goals are to boost awareness about the problem of child injury and its effects on the nation, highlight prevention solutions by adopting a common set of goals and strategies and push for a national, coordinated effort to reduce child injury.

Two major shortcomings of the report were possible misclassification errors on death certificates and unintentional injury death reporting.