Report on Nation's Health Documents Toll of injuries in U.S.

Firearm Mortality Down 11%, Traffic Fatality Rates up 2%, 1993­1995

Injuries continue to have a major impact on the health of Americans, according to the latest federal government report on the nation's health, issued today by HHS Secretary Donna E. Shalala.

In 1995, 6 percent of all deaths, 8 percent of all hospital discharges, and 37 percent of all emergency department visits were injury-related.

"The toll of injuries on our society continues to be a big concern, especially since the victims are often children and young people," said Secretary Shalala. "In fact, injuries cause more deaths among youth than disease or natural causes."

The report, "Health, United States: 1996­97," prepared by National Center for Health Statistics, CDC, is a comprehensive profile of the nation's health which examined a wide range of topics. This year's report includes a special section on injuries.

The report finds that in recent years, long-standing trends in firearm and motor vehicle injury mortality have reversed themselves. Age-adjusted firearm mortality, which increased 22 percent between 1985 and 1993, dropped 11 percent between 1993 and 1995. Meanwhile, aged-adjusted motor vehicle fatality rates, which declined 15 percent between 1985 and 1993, increased 2 percent from 1993 to 1995. This reversal appears to have continued through June 1996, according to preliminary data.

Other injury-related findings include:

Motor vehicle traffic injuries, firearm injuries, and poisoning were the three leading causes of injury death in 1995, accounting for nearly two-thirds of all injury deaths.

In 1994­95, unintentional injury death rates and suicide rates for persons 15­34 years were higher for American Indians than for other racial or ethnic groups. Homicide rates for ages 15­34 years were higher for black persons of the same age than for other groups. Among persons 75 years and over, injury mortality was lower for Hispanic persons than for other groups primarily as a result of their lower unintentional injury death rates due to falls and suffocation.

In 1992­94, three out of five injury hospitalizations among elderly persons 75 years of age and over were for fractures, and more than one-half of the fractures were to the hip. Hip fracture rates for elderly females were twice the rates for males.

In 1993­94, three causes of injury morbidity -- falls, being struck by or against something, and motor vehicle traffic-related injuries -- accounted for nearly 1 in 5 emergency department visits.

"Health, United States: 1996­97," also documents the latest trends on subjects like health status, fertility and natality, mortality, health resources, utilization, expenditures, and insurance coverage. In 1995, average life expectancy at birth continued to increase for Americans, reaching 75.8 years, up from 75.7 years in 1994. Some other findings include:

Overall mortality for black Americans continues to be about 60 percent higher than for white Americans. For most leading causes of death, mortality is higher for black Americans than for other racial and ethnic groups. In 1995 the age-adjusted homicide rate for black Americans was 6 times the rate for white Americans and the AIDS death rate was nearly 5 times that for white Americans.

Death rates for American Indians under 55 years of age are higher than those for white Americans. In 1993­95 the age-adjusted death rates for American Indian males and American Indian females under 55 years of age were about 40 percent higher than the corresponding rates for white males and white females. The death rate for American Indian children 1­4 years of age was almost double that for white children.

Death rates for Hispanic American males 15­44 years of age are higher than those for non-Hispanic white males. In 1995 the death rate for Hispanic males 15­24 years of age was 53 percent higher than for non-Hispanic white males.

Breast cancer is the most frequently diagnosed cancer in women and the second leading cause of cancer deaths among women (after lung cancer). In 1995 the age-adjusted death rate for breast cancer for black females was 34 percent higher than for white females. Between 1990 and 1995 breast cancer death rates for black females were relatively stable while those for white females decreased 10 percent.

The risk of breast cancer among women is greatest among the elderly. Between 1987 and 1993 the use of mammography within the past 2 years among women 65 years of age and over more than doubled increasing from 23 percent to 54 percent and then leveled off at 55 percent in 1994.

Between 1993 and 1995 the number of inpatient short-stay hospital days of care for persons discharged with a diagnosis of human immunodeficiency virus (HIV) decreased from 2.6 million to 2.1 million after increasing two-fold during the previous 5-year period, 1988 to 1993.

Between 1990 and 1994 the age-adjusted prevalence of current cigarette smoking among persons 18 years of age or over has remained stable at 25­26 percent. In 1994 the age-adjusted prevalence of current cigarette smoking among persons 25 years of age and over ranged from 12 percent for college graduates to 38 percent for persons with less than a high school education.

Between 1976­80 and 1988­94 the age-adjusted prevalence of hypertension for adults 20­74 years declined from 39 to 23 percent.

Between 1960­62 and 1988­94 the age-adjusted mean serum total cholesterol level for adults 20­74 years declined from 220 to 203 mg/dL. During the same period the age-adjusted percent of adults with high serum cholesterol (greater than or equal to 240 mg/dL) declined from 32 to 19 percent.

Between 1993 and 1995 the age-adjusted proportion of the population under 65 years of age with private health insurance has remained stable at 70­71 percent after declining from 77 to 71 percent between 1989 and 1993. Changes in eligibility rules in the Medicaid program resulted in an increase in the proportion of the population with Medicaid coverage from 6 percent in 1989 to 10­11 percent during 1993 to 1995.

The age-adjusted proportion of the population under 65 years of age without any health care coverage has stayed around 17 percent from 1989 to 1995. Hispanic persons were more than twice as likely to have no coverage as non-Hispanic white persons in 1995 (32 percent and 13 percent).

In 1995 the age-adjusted percent of persons under 65 years of age with no health care coverage declined steadily with increasing income from 34 percent among those with family incomes of less than $14,000 to 5 percent among those with family incomes of $50,000 or more.

Between 1995 and 1996, enrollment in health maintenance organizations (HMOs) increased 14 percent to 52.5 million persons, an increase of 6.3 million over 1995. Most of this increase was attributable to greater use of HMOs by Medicaid enrollees.

Copies of the report are available from NCHS at 6525 Belcrest Road, Hyattsville, MD 20782 and can be downloaded from the NCHS Home Page on the Internet at http://www.cdc.gov/nchswww/nchshome.htm.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES