Suicide Among Adults Age 55 and Older, 2021.

Suicide is a leading cause of mortality in the United States, with an ageadjusted rate of 14.1 deaths per 100,000 population in 2021 (1). Older adults tend to have higher rates of suicide, although they represent a low percentage of the total number of suicides (2). Factors that specifically affect older adults can include declines in physical and cognitive functioning, changes in mental health, and other factors often associated with getting older, like bereavement, loneliness, and lack of social connectedness (3-8). This report presents suicide rates for adults age 55 and older by sex and mechanism of suicide.

Repetitive Strain Injuries in Adults in the Past 3 Months: United States, 2021.

Objectives-This report describes the percentage of adults aged 18 and over who reported injuries from repetitive strain in the past 3 months by selected sociodemographic characteristics, including age, sex, race and Hispanic origin, and family income. The impacts of these injuries-limitation of usual activity for at least 24 hours and whether a medical professional was consulted for the injuries-are also examined. Methods-Data from the 2021 National Health Interview Survey were used to estimate the percentage of adults who had repetitive strain injuries in the past 3 months by sociodemographic characteristics. Among those who had a repetitive strain injury in the past 3 months, 24-hour limitation of activity and consultation of a medical professional are also examined by sociodemographic characteristics. Results-In 2021, for adults aged 18 and over in the United States, 9.0% had repetitive strain injuries in the past 3 months. Adults aged 35-49 (10.3%) and 50-64 (11.6%), White non-Hispanic adults (subsequently, White; 9.5%), and adults with family income at 400% or more of the federal poverty level (9.8%) tended to have higher percentages. For those who had repetitive strain injuries, 44.2% limited their activities for at least 24 hours, with the highest percentages among White adults (47.0%), women (47.1%), and adults with a family income less than 200% of the federal poverty level (51.0%). For those who limited their activity for at least 24 hours due to a repetitive strain injury, 51.4% consulted a doctor or medical professional, with the highest percentages among women (56.3%) and Black non-Hispanic adults (66.2%).

Co-involvement of Opioids in Drug Overdose Deaths Involving Cocaine and Psychostimulants, 2011-2021.

Drug overdose deaths involving cocaine and psychostimulants with abuse potential (that is, drugs such as methamphetamine, amphetamine, and methylphenidate) have risen in the past several years (1-4). A recent report highlighted that drug overdose deaths involving cocaine rose 22% and drug overdose deaths involving psychostimulants rose 33% from 2020 through 2021 (1). By the end of 2021, the report counted 24,486 drug overdose deaths involving cocaine and 32,537 drug overdose deaths involving psychostimulants (1,5). This report presents trends from 2011 through 2021 in death rates involving cocaine and psychostimulants, with and without opioid co-involvement, and by U.S. Census region in 2021.

Suicide and Homicide Death Rates Among Youth and Young Adults Aged 10-24: United States, 2001-2021.

Deaths due to suicide and homicide, often referred to collectively as violent deaths, have been a leading cause of premature death to people aged 10-24 in the United States (1-3). A previous version of this report with data through 2017 showed that suicide and homicide rates for people aged 10-24 were trending upward (4). This report updates the previous report using the most recent data from the National Vital Statistics System and presents trends from 2001 through 2021 in suicide and homicide rates for people aged 10-24 and for age groups 10-14, 15-19, and 20-24.

Suicide Mortality in the United States, 2001-2021.

In 2021, suicide was the 11th leading cause of death in the United States, changing from the 10th leading cause in 2019 and the 12th leading cause in 2020 (1). As the second leading cause of death in people aged 10-34 and the fifth in people aged 35-54, suicide contributes to premature mortality (1). After peaking in 2018, rates declined through 2020 but then increased again in 2021, according to provisional data (2,3). This report updates previous data by presenting final suicide rates from 2001 through 2021 by sex and age as well as rates by race and Hispanic origin for 2020 and 2021.

Unintentional Fall Deaths Among Adults Aged 65 and Over: United States, 2020.

Unintentional fall injuries occur most frequently among people in older age groups, with over 2 million fall events treated in emergency departments each year among adults aged 65 and over (1,2). A variety of factors contribute to the risk of falling, including difficulties in seeing, walking, and balance; disabilities; medication effects; and environmental walking obstacles, among other factors (3-6). Deaths due to unintentional falls are a leading cause of unintentional injury deaths among adults aged 65 and over (7). Reducing unintentional fall-related deaths among older adults is a key objective for Healthy People 2030 (8). This report presents unintentional fall death rates for adults aged 65 and over, by demographic characteristics.

Alcohol-induced Death Rates in the United States, 2019-2020.

Alcohol use is a known risk factor for mortality, and the rates of alcohol induced deaths have risen over the past several years (1). Alcohol use in the United States increased during the first year of the Coronavirus Disease 2019 (COVID-19) pandemic, which may have affected mortality rates, especially for alcohol-induced deaths (2). Understanding trends in alcohol-induced mortality, with a particular focus on differences from 2019 to 2020, may help identify groups particularly affected during the COVID-19 pandemic. This report presents overall and sex-specific trends in alcohol-induced death rates from 2000 to 2020, and then focuses on the rates for 2019 and 2020 by sex, age group, and underlying cause of death.

Psychological distress and the risk of drug overdose death.

BACKGROUND: Previous research has shown an association between psychological distress and overdose death among specific populations. However, few studies have examined this relationship in a large US population-based cohort. METHODS: Data from the 2010-2018 NHIS were linked to mortality data from the National Death Index through 2019. Psychological distress was measured using the Kessler 6 scale. Drug overdose deaths were examined, and deaths from all other causes were included as a comparison group. Cox proportional hazards regression was used to estimate mortality risk by psychological distress level. RESULTS: The study population included 272,561 adults. Adjusting for demographic covariates and using no psychological distress as the reference, distress level was positively associated with the risk of overdose death: low (HR = 1.8, 95 % CI = 1.1-2.8), moderate (HR = 4.1, 95 % CI = 2.5-6.7), high (HR = 10.3, 95 % CI = 6.5-16.1). A similar pattern was observed for deaths from all other causes: low (HR = 1.2, 95 % CI = 1.1-1.2), moderate (HR = 1.9, 95 % CI = 1.7-2.0), high (HR = 2.6, 95 % CI = 2.4-2.8). LIMITATIONS: Limited substance use information prevented adjustment for this potentially important covariate. DISCUSSION: Adults with psychological distress were at greater risk of drug overdose death, relative to those without psychological distress. Adults with psychological distress were also at increased risk of death due to other causes, though the association was not as strong.

Urban-Rural Differences in Drug Overdose Death Rates, 2020.

Drug overdose death rates, which have been rising over the past decade, differ by urban and rural counties across the United States (1-4). A previous report demonstrated higher drug overdose death rates in urban counties by various demographic and geographic characteristics (4). This report uses the most recent final mortality data from the National Vital Statistics System (NVSS) to describe urban and rural differences in drug overdose death rates in 2020 by sex, race and Hispanic origin, and selected types of opioids and stimulants.

Suicide Mortality in the United States, 2000-2020.

In 2020, suicide was the 12th leading cause of death for all ages in the United States, changing from the 10th leading cause in 2019 due to the emergence of COVID-19 deaths and increases in deaths from chronic liver disease and cirrhosis (1). As the second leading cause of death in people aged 10-34 and the fifth leading cause in people aged 35-54, suicide is a major contributor to premature mortality (1). Suicide rates increased from 2000 to 2018 (2-5), but recent data have shown declines between 2018 and 2020 (6,7). This report presents final suicide rates from 2000 through 2020, in total and by sex, age group, and means of suicide, using mortality data from the National Vital Statistics System (NVSS). This report updates a provisional 2020 report and a previous report with final data through 2019 (6,7).

Urban-rural Differences in Unintentional Injury Death Rates Among Children Aged 0-17 Years: United States, 2018-2019.

Unintentional injuries are the leading cause of death among children aged 0-17 years (1). In 2018-2019, 14% of children in the United States aged 0-17 years resided in rural areas but accounted 24% of all childhood injury deaths (1). Urban-rural differences in injury mortality have been associated with a variety of factors, including differences in types of activities, use of safety equipment, practice of safety-related behaviors, built environments, and access to care (2-9). This report presents rates of unintentional injury death among children aged 0-17 for 2018-2019, highlighting the differences in rates by mechanism of injury and urban-rural status.

A Revised ICD-10-CM Surveillance Case Definition for Injury-related Emergency Department Visits.

Background-Administrative data from medical claims are often used for injury surveillance. Effective October 1, 2015, hospitals covered by the Health Insurance Portability and Accountability Act were required to use the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) to report medical information in administrative data. In 2017, the National Center for Health Statistics (NCHS) and the National Center for Injury Prevention and Control (NCIPC) published a proposed ICD-10-CM surveillance case definition for injuryrelated emergency department (ED) visits. At the time, ICD-10-CM coded data were not available for testing. When data became available, NCHS and NCIPC collaborated with the Council of State and Territorial Epidemiologists and epidemiologists from state and local health departments to test and update the proposed definition. This report summarizes the results and presents the 2021 revised ICD-10-CM surveillance case definition.

Increase in Drug Overdose Deaths Involving Cocaine: United States, 2009-2018.

Deaths from drug overdose continue to contribute to mortality in the United States. The rate of drug overdose deaths involving cocaine has increased in recent years (1-3). This Data Brief provides additional information on drug overdose deaths involving cocaine by examining trends in rates by sex, age group, race and Hispanic origin, and by concurrent involvement of opioids from 2009 through 2018. Rates by urbanicity and census region in 2018 are also examined.

The 2020 International Classification of Diseases, 10th Revision, Clinical Modification Injury Diagnosis Framework for Categorizing Injuries by Body Region and Nature of Injury.

Background-Injury diagnosis frameworks, or matrices, based on the International Classification of Diseases (ICD) provide standardized categories for reporting injuries by body region and nature of injury. In 2016, the National Center for Health Statistics (NCHS) and the National Center for Injury Prevention and Control (NCIPC) published a proposed injury diagnosis matrix for use with data coded using the ICD, 10th Revision, Clinical Modification (ICD-10-CM). At the time the proposed matrix was developed, ICD-10-CM coded data were not available to evaluate the performance of the proposed matrix. As data became available, NCHS and NCIPC received recommendations from clinicians and researchers to improve the consistency and clinical applicability of categorization of codes within the matrix. This report describes the modifications made to the 2016 proposed ICD-10-CM injury diagnosis matrix and presents the final 2020 ICD-10-CM injury diagnosis matrix. Methods-Comments on the 2016 proposed matrix were received from several federal agencies, military health centers, state health departments, researchers, and others. Additionally, subject matter experts from NCHS, NCIPC, the Council of State and Territorial Epidemiologists, and others reviewed code descriptions, coding guidelines, updates to the ICD-10-CM code set, and other materials to identify possible needed changes to the 2016 proposed ICD-10-CM injury diagnosis matrix. Results-Consideration of issues raised by clinicians and researchers and from the internal review resulted in relocation of approximately 3% of the 9,000 codes in the 2016 proposed ICD-10-CM injury diagnosis matrix. These relocations generally involved changes to the assigned nature-of-injury category. Additionally, approximately 200 new injury diagnosis codes not available at the time the 2016 proposed matrix was developed were added to create the final 2020 matrix. Conclusions-The 2020 final ICD-10-CM injury diagnosis matrix provides standard categories for reporting injuries by body region and nature of injury. Use of this tool promotes consistency for comparisons across populations and over time.

Using Rural⁻Urban Continuum Codes (RUCCS) to Examine Alcohol-Related Motor Vehicle Crash Injury and Enforcement in New York State.

Rural areas of New York State (NYS) have higher rates of alcohol-related motor vehicle (MV) crash injury than metropolitan areas. While alcohol-related injury has declined across the three geographic regions of NYS, disparities persist with rural areas having smaller declines. Our study aim was to examine factors associated with alcohol-related MV crashes in Upstate and Long Island using multi-sourced county-level data that included the Crash Outcome Data Evaluation System (CODES) with emergency department visits and hospitalizations, traffic citations, demographic, economic, transportation, alcohol outlets, and Rural-Urban Continuum Codes (RUCCS). A cross-sectional study design employed zero-truncated negative binominal regression models to assess relative risks (RR) with 95% confidence interval (CI). Counties (n = 57, 56,000 alcohol-related crashes over the 3 year study timeframe) were categorized by mean annual alcohol-related MV injuries per 100,000 population: low (24.7 ± 3.9), medium (33.9 ± 1.7) and high (46.1 ± 8.0) (p < 0.0001). In multivariable analyses, alcohol-related MV injury was elevated for non-adjacent, non-metropolitan counties (RR 2.5, 95% CI: 1.6-3.9) with higher citations for impaired driving showing a small, but significant protective effect. Less metropolitan areas had higher alcohol-related MV injury with inconsistent alcohol-related enforcement measures. In summary, higher alcohol-related MV injury rates in non-metropolitan counties demonstrated a dose-response relationship with proximity to a metropolitan area. These findings suggest areas where intervention efforts might be targeted to lower alcohol-related MV injury.

The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) External Cause-of-injury Framework for Categorizing Mechanism and Intent of Injury.

Background-External cause-of-injury frameworks, or matrices, based on the International Classification of Diseases (ICD) provide standardized categories for reporting injuries by mechanism and intent of injury. In 2014, the National Center for Health Statistics (NCHS) and the National Center for Injury Prevention and Control (NCIPC) published a proposed external cause-of-injury matrix for use with data coded using the ICD, 10th Revision, Clinical Modification (ICD-10-CM). At the time the proposed matrix was developed, ICD-10-CM coded data were not available to evaluate the performance of the proposed matrix. When data became available, NCHS and NCIPC collaborated with the Council of State and Territorial Epidemiologists and state and local health departments to evaluate the proposed matrix to identify any changes needed before finalization. This report describes the results of that evaluation. Methods-With guidance from NCHS and NCIPC, state and local injury epidemiologists from five jurisdictions analyzed their hospital discharge and emergency department administrative claims data. The epidemiologists applied the ICD-9-CM matrix to ICD-9-CM coded data and the 2014 proposed ICD-10-CM matrix to ICD-10-CM coded data for similar time periods (e.g., January through December). The numbers for each mechanism and intent category in each of the two matrices were calculated and compared, and major differences were explored. Results-Based on the findings, several adjustments were made to the original placement of codes in the 2014 proposed ICD-10-CM external cause-of-injury matrix. These changes involved codes related to Drowning/submersion, Firearm, Motor vehicle-Traffic, Overexertion, and Unspecified mechanisms. In addition, new external cause codes not available at the time the 2014 proposed matrix was developed were added to create the 2019 final matrix. Conclusions-The 2019 final ICD-10-CM external cause-of-injury matrix provides standard categories for reporting injuries by mechanism and intent of injury. Use of this tool promotes consistency for comparisons across populations and over time.