CSTE POSITION STATEMENT 1999-INJ 7

COMMITTEE: Injury

TITLE: Inclusion of Motor Vehicle Injury-Related Indicators in the National Public Health Surveillance System (NPHSS)

The following motor vehicle injury-related indicators should be put under nationwide surveillance as part of the National Public Health Surveillance System (NPHSS):

1. Fatal motor vehicle crash-related injuries: surveillance should be based on death certificates using ICD-9 External Cause of Injury Codes E810-E825.
2. Non-fatal motor vehicle crash-related injuries: surveillance should be based on statewide hospital discharge data using ICD-9 External Cause of Injury Codes E810-E825.
3. Alcohol-involved motor vehicle crash deaths: surveillance should be based on the Fatality Analysis Reporting System (FARS) of the National Highway Traffic Safety Administration.
4. Seat belt/child restraint use: surveillance should be based on information collected in the Behavioral Risk Factor Surveillance System (BRFSS).
5. Seat belt use among young motor vehicle passengers: surveillance should be based on information collected in the Youth Risk Behavior Survey (YRBS).
6. Prevalence of Alcohol-Impaired Driving - Adults age 18 or older: Surveillance should be based on information collected in the Behavioral Risk Factor Surveillance System (BRFSS).

Motor vehicle crash-related injuries are the leading cause of death in children and young adults. In all age groups, motor vehicle crash-related injuries are the leading cause of years of potential life lost (YPLL) and deaths from unintentional injuries. In addition to deaths, motor vehicle crash-related injuries cause a substantial amount of morbidity.

Alcohol-impaired driving remains a major public health concern in the United States. Of the 41,967 traffic fatalities in 1997, 39% (N=16,189) were alcohol-related. Each year, there are over 120 million episodes of alcohol-impaired driving among adults in the United States; nearly 10 million of these episodes involved underage youth 18-20 years of age. About 1.4 million arrests are made each year for impaired driving.

Not using a safety belt or child restraint is one of the major risk factors for fatalities and injuries to motor vehicle occupants. It is estimated that among front seat occupants, safety belt use reduces the risk for fatal injury by approximately 45% and the risk for moderate to critical injury by 45% - 50%. Use of child safety seats reduces the likelihood of fatal injury by an estimated 69% for infants and 47% for toddlers.

• Estimate public health burden of motor vehicle crash-related injuries
• Estimate the prevalence of safety belt and child restraint use
• Monitor trends in these indicators over time.
• Identify groups and geographic areas at high risk for motor vehicle crash-related deaths and injuries, alcohol-related motor vehicle crash deaths, and low levels of seat belt/child safety seat use in order to target interventions and prevention programs.
• Document effectiveness of current interventions
• Determine the need for additional resources to support prevention of motor vehicle crash-related deaths and injuries, deaths due to alcohol-related motor vehicle crashes, and promotion of seat belt/ child safety seat use.

1. Fatal motor vehicle crash-related injuries by death certificates with ICD-9 E-codes E810-E825. Corresponding codes from ICD-10 should be used when appropriate.
2. Non-fatal motor vehicle crash-related injuries by statewide hospital discharge records with ICD-9CM E-codes E810-E825. Corresponding codes from ICD-10CM should be used when appropriate.
3. Deaths from alcohol-related motor vehicle crashes as identified in the Fatality Analysis Reporting System (FARS). [NOTE: Surveillance of this condition is complementary to surveillance recommended in CSTE Position Statement #CD3, "Inclusion of Alcohol Use and Alcohol-Related Condition Indicators in the National Public Health Surveillance System (NPHSS)," which was proposed and approved at the 1998 CSTE Annual Meeting.]
4. Self-reported safety belt and child restraint use as reported in the Behavioral Risk Factor Surveillance System (BRFSS).

The 1998 BRFSS questions are:

• How often do you use seatbelts when you drive or ride in a car?
• What is the age of the oldest child in your household under the age of 16?
• How often does the [fill in age from above]–year old child in your household use a …

car safety seat [for child under 5]

seatbelt [for child 5 or older]

… when they ride in a car?

1. Self-reported safety belt use as reported in the Youth Risk Behavior Survey (YRBS).

The 1999 YRBS question is: "How often do you wear a seatbelt when riding in a car driven by someone else?"

2. Self-reported alcohol imparied driving as reported in the BRFSS. The 1998 BRFSS question is: "How often have you driven after having perhaps too much to drink during the last 30 days?" Reports of 1 or more times are considered a positive response for this indicator.

Death certificate files are available in every state. This indicator will capture the most severe motor vehicle crash-related injuries – those resulting in death. E-codes identify the cause of an injury. While E-coding may be incomplete in some states, even incomplete data can be of value for surveillance.

Hospital discharge data are accessible in most states and potentially available in all. This indicator will capture the most severe motor vehicle crash-related non-fatal injuries – those resulting in hospitalization.

Deaths and hospitalizations should be aggregated separately. In some situations, however, it may be desirable to combine deaths and hospitalizations to estimate the total incidence of this type of injury. In that setting, hospital discharge records with a discharge disposition of death should be deleted from the hospitalized count, to minimize double counting of records, or, if linkage of hospital discharge and death records is possible, aggregation of cases should be done in a way that avoids double counting of cases.

The Fatality Analysis Reporting System (FARS) of the National Highway Traffic Safety Administration includes detailed information on fatal motor vehicle injuries on public roads. The information in FARS can provide the basis for surveillance of deaths due to alcohol-related motor-vehicle crashes, a measure of the most serious sequelae of alcohol-impaired driving. State-level FARS data are available to all states. Because FARS analyses at the national level include imputation of unreported blood alcohol levels, states should access and use the original FARS data without the imputed values.

BRFSS is conducted in every state, and YRBS is conducted in most states and several smaller jurisdictions. Since BRFSS only includes respondents over age 18, data from YRBS can reveal information about safety belt use among drivers under 18, a high-risk group for motor vehicle crash injury. Both surveys collect demographic information that can assist in targeting high risk groups. For some states, BRFSS and YRBS provide estimates for regions within states.

BRFSS is a telephone survey, and so persons without telephones would not be sampled. Similarly, YRBS is a school-based survey, and so young people not in school would not be sampled. While these methodological considerations may limit the generalizability of these data, no more representative and widely available datasets exist.

Both BRFSS and YRBS only collect self-reported information. While data from direct observation of safety belt and child safety seat use are available from the National Occupant Protection Use Survey (NOPUS), these data are used primarily to monitor compliance with safety standards for the purpose of awarding federal highway safety funds to states, and this may introduce bias into these observations.

Alcohol-impaired driving is more common than alcohol-involved motor vehicle crash death,
and a more proximal measure of the effects of efforts to prevent alcohol-impaired driving. These characteristics make it a more useful indicator for evaluation of some intervention programs.

States with more resources and access to more detailed information are strongly encouraged to collect, organize and use that information. While the use of these other data sources should be encouraged, at this time they are not widely enough available to recommend their routine use for surveillance in all states. Efforts to integrate these data sets should be encouraged.

A motor vehicle is a transport vehicle (not on rails) that is mechanically or electrically powered. A motor vehicle crash-related death is defined as a death occurring as a result of a crash involving a motor vehicle. These crashes can be identified by ICD-9 codes E810-E825.

A motor vehicle crash-related non-fatal injury is defined as a non-fatal injury occurring as a result of a crash involving a motor vehicle. These crashes can be identified by ICD-9CM codes E810-E825

A motor vehicle traffic crash is one that occurs on a public roadway. An alcohol-related crash death is defined as a death in a motor vehicle traffic crash where either the driver or nonoccupant (e.g., pedestrian) had a blood alcohol concentration (BAC) ³0.01 g/dL in a police-reported traffic crash.

Safety belt and child restraint use are defined as the frequency of use as reported in BRFSS or YRBS.

1. Vital records (death certificates)
2. Statewide hospital discharge data systems.
3. Fatality Analysis Reporting System (FARS) of the National Highway Traffic Safety Administration (NHTSA)
4. Behavioral Risk Factor Surveillance System (BRFSS)
5. Youth Risk Behavior Survey (YRBS)

Permanent

State and Territorial Injury Prevention Directors Association (STIPDA)

National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (NCIPC)