Leading Causes of Child Injury Deaths in New York City By Age *

BACKGROUND:  The New York City (NYC) Child Fatality Review Advisory Team, led by the NYC Department of Health and Mental Hygiene (DOHMH), is a multidisciplinary, multi-institution group of experts that each year retrospectively examines and reports on injury deaths among NYC children. The annual report describes trends and patterns in child injury deaths and informs policy and prevention activities. 

METHODS:  The primary data source used to describe injury deaths among children aged 0-17 years from 2002-2011 was death certificates from the NYC DOHMH Bureau of Vital Statistics. Deaths were identified using International Classification of Disease (ICD-10) codes consistent with an unnatural, external cause of death (V01-Y34). To augment death certificate information for some leading causes, previously matched files from the Office of the Chief Medical Examiner were included: 2004-2011 for infant deaths and 2001-2010 for children aged 1-4. Data on pedestrian deaths from 2002-2011 were obtained from the NYC Department of Transportation Traffic Fatality Database. We calculated counts, proportions, and age-specific rates for the leading causes of injury deaths by age group. US child injury fatality rates were calculated using CDC’s Wide-ranging Online Data for Epidemiologic Research (WONDER) detailed mortality files.

RESULTS:  From 2002-2011, there were 1,613 injury deaths among NYC children aged 0-17 (8.9 deaths per 100,000). NYC child injury fatality rates were consistently lower than US rates; trends were stable in NYC and declining nationally. Among infants <1 year, 80% of injury deaths were sleep-related; injury death rates were disproportionately greater among black non-Hispanic infants, infants living in the Bronx, and infants living in very high poverty neighborhoods. Among children aged 1-4, fire/flame injury was the leading cause of injury death (n=40, 1.0 per 100,000). Rates were highest among males, black non-Hispanic children, and those in high poverty neighborhoods. Among children aged 5-9 and 10-14, motor vehicle-related injury was the leading cause of injury death (n=44, 0.9 per 100,000 and n=57, 1.1 per 100,000, respectively).The majority of motor vehicle-related deaths in these age groups were among pedestrians (73%). Among youth aged 15-17, the leading cause of injury death was firearm-related injury (n=200, 6.5 per 100,000); most firearm deaths were homicides (91%). Rates were highest for males, black non-Hispanic youth, and those living in the Bronx and very high poverty neighborhoods.

CONCLUSIONS:  Leading causes of injury death vary across a child’s development. Effective interventions and prevention policies, therefore, should focus on specific mechanisms of injury at specific development stages.