Focusing on Injury-Related Deaths in Virginia: An Analysis of Local and Statewide Data, 1990-2011

BACKGROUND:  Studies have noted that injury burden is not equal across populations; even within smaller areas such as states, there may be significant differences in the risk for injury death for particular demographic groups and areas. Rates also may not be constant over time, as economic conditions, social conditions and long-term demographic shifts drive changes in risk. This analysis is a comprehensive review of trends in injury death in Virginia in 1990-2011, focusing on local injury burden.  

METHODS:  Injury deaths were compiled from Virginia’s death certificate database. SAS 9.3 was used to calculate annual death rates by health planning region and district, intent, mechanism, and selected demographic characteristics. Rates were smoothed using log transformation. Ordinary least squares regression was used to determine trends over time; years of potential life lost were calculated and mapped using ArcGIS 10.1.

RESULTS:  The injury death rate for Virginia did not significantly change over the period. However, the rate in the more rural Southwestern region increased to 78.7 per 100,000 (p<0.0001), even as other regions saw significant declines. Of note, while Virginia’s overall poisoning death rate more than doubled between 1990 and 2011, the Southwestern region saw a fourfold increase (p<0.0001) and had the highest rate in the state at 18.8 in 2011, supporting reports from Virginia’s Office of the Chief Medical Examiner of an increase in opiate overdoses in that region.  Additionally, the injury death rate for black males declined from a high of 123.4 in 1991 to a low of 69.5 in 2011 (p<0.0001), led by significant declines in rates of death by unintentional injury (p<0.0001), suicide (p=0.0003), and homicide (p<0.0001), which declined 60% from its peak rate of 51.6 in 1991, consistent with a statewide decline in the rate of violent crime. By contrast, the white male injury death rate increased (p=0.0002), reflecting a statistically significant increase in unintentional injury death (p<0.0001). 

CONCLUSIONS: Black makes saw significant decreases in homicide, suicide and unintentional injury death, and by 2011, white males were more likely to die by injury than black males in Virginia, representing a significant shift in both groups’ risk profiles. Rates of injury death, specifically poisoning death, in the Southwest are also of concern, particularly given the current attention at the national level to the problem of prescription drug overdoses.