Youth Injury in Chicago and Its Surrounding Areas: A Look at the Data

Jenifer Cartland, PhD

aSpring 2001

In the United States,  injury is the leading cause of death for youth after infancy.[1] The types of injury to which children and adolescents are vulnerable vary substantially by the immediate environment in which they find themselves.[2] Injury risks in certain areas of Chicago, for example, are quite different than in other areas. Pedestrian injuries are a far greater problem where children play in alleys and close to streets; serious falls are especially a cause for concern for families living in multistory buildings.

Injury can be prevented to the extent that these local environments can be made safer. Parents, community leaders, and state and federal policy makers make choices about how to shape the immediate environment in which children and adolescents live. Smoke detectors at home can prevent burns and smoke inhalation, stop signs can slow traffic and prevent pedestrian injuries, and child safety seats can prevent death in the case of motor vehicle crashes. Each of these choices to protect children from preventable injury is made by parents, community leaders, and policy makers—often, by a combination of the three.

Pediatricians and other child health care providers have a critical role to play in educating parents and policy makers about injury prevention. Studies have shown that when it comes to injury prevention, parents take the advice of pediatricians and other child health care providers more than any other source.[3] These health professionals can also provide leadership in their communities and can be persuasive advocates for children with policy makers. For this reason, these health professionals need information about injury rates in their local communities. Pediatricians and other child health care providers need to understand which injuries their patients are most likely to face and to focus education and advocacy efforts appropriately.

To provide local information to pediatricians, other child health care providers, parents, community leaders, and policy makers about the causes of injury that should concern them, the Child Health Data Lab (CHDL) at Children’s Memorial Hospital analyzes vital statistics and hospitalization data related to injury. CHDL employs data collected by the Illinois Department of Public Health—in fact, CHDL is the first research group to analyze and publicize these data for such a purpose. We categorized types of injury using the International Classification of Diseases external cause of injury codes (e-codes). The codes allow us to talk in a precise way about which causes of injury are most pressing in very small geographic areas.

This paper focuses on child and adolescent injury rates in four geographic areas: Chicago, suburban Cook County, and five of the six collar counties (Kendall is excluded because frequencies are too low to compute rates). A report we released last year, Child and Adolescent Injury in Illinois (the first in a series titled State and Community Reports on Injury Prevalence and Targeted Solutions, or SCRIPTS), contains more detailed information about other counties in Illinois. It is available on our website (www.chdl.org). A second SCRIPTS report now in press contains a more detailed report on Chicago community areas.

Data and Methods

The data presented here are from the Illinois Vital Statistics, which register every death occurring in Illinois, and the Illinois Trauma Registry, which catalogs a significant portion of serious injuries presenting to emergency departments in Illinois. The years included in this analysis are 1994, 1995, and 1996. All rates are annualized (i.e., averaged over 3 years).

Not included in this report are injuries that required less than a 12-hour visit in the emergency department and injuries that were treated at nontrauma centers. Of the 200 hospitals in Illinois, 67 are level 1 trauma centers. These hospitals treat more than 90% of trauma admissions in the state.[4] The data presented here, therefore, provide a good picture of the most serious injuries, but do not reflect the wide range of less severe injuries.

In grouping e-codes into injury categories, we generally followed the classification recommendations provided by the Centers for Disease Control and Prevention (CDC).[5] Where the classification did not work well for children (e.g., firecracker burns are not included in fire burns by the CDC), we changed the system slightly. We also created a new category called “sports injuries” which draws a subset of injuries out from the CDC’s “other unintentional injuries” category. Our purpose was to draw attention to as many modes of prevention as possible, which descriptive categories can do more easily than large, blanket categories.

Sports injuries include playground falls, water sports injuries, pushing, falling and shoving injuries from sports activities, all terrain vehicle injuries, snowmobile injuries, animal riding injuries, and other clearly identifiable sports- and recreation-related injuries. The sports category does not include pushing, shoving and falling injuries that are not specified as sports-related. For example, roller-blade skating is cited as a frequent cause of sports injuries. However, there is no e-code for roller-blade injuries (or roller skates, or skateboards) and so roller-blade injuries cannot be identified or inferred using e-codes.

All population data for Chicago were drawn from the 1990 United States Census, the most accurate data available for cities at the time the analysis was performed. The county data are from the 1994, 1995, and 1996 United States Current Population Survey (performed by the United States Bureau of the Census). All persons identified in the Trauma Registry and vital statistics are assigned to the city or county in which they live, not where the injury occurred (the data do not allow us to reliably link an injury to the place where it occurred).

Findings

This section will explore four items. First, an overview of the relative significance of unintentional and intentional injury will be given for the six geographic areas under study. Intentional injuries include all injuries caused by violence, such as firearm and child abuse injuries, and unintentional injuries include all nonviolent injuries, such as pedestrian and motor vehicle occupant injuries. The second and third sections will examine deaths and hospitalizations, respectively. Particular causes of injury death and hospitalization will be compared across the geographic areas under study. Finally, a breakdown of cause of injury by age group will be looked at for Chicago and Suburban Cook County to clarify how injury risks vary by age.

Figure 1 Relative prevalence of intentional and unintentional injuries in Chicago, Cook and collar Counties, 1994–1996.

Figure 2 Relative prevalence of intentional and unintentional injuries, exclusive of firearm homicides and assaults, in Chicago, Cook and collar Counties,

INTENTIONAL AND UNINTENTIONAL INJURY

A broad picture of the relative prevalence of intentional and unintentional injury in each area can be seen in Figure 1, which compares these injury rates for deaths and hospitalizations for each city and county under study.

While death data tell an essential piece of the story about injury risks, hospitalization data add to our understanding of the risks youth face. For example, where intentional injury dominates the mortality data for some geographic areas, it takes a less dominant role in the hospitalization data in all areas. The implication is that, although reducing intentional injury death should remain a priority, unintentional injury surfaces as a more urgent problem when hospitalization is taken into account.

As Figure 1 shows, the importance of intentional and unintentional injury varies substantially by geographic area. This can be seen by looking at the ratio of intentional to unintentional injury. For deaths, the ratio ranges from 1:6 intentional to unintentional injury deaths in McHenry County to a 1:1 ratio for Kane and Suburban Cook and a 2:1 ratio for Chicago (i.e., intentional injuries caused from 14% to 65% of all injury deaths). For hospitalizations, the ratio is much lower, but continues to vary substantially by geographic area. The ratio of intentional to unintentional injury hospitalizations ranges from 1:30 in McHenry County to 3:5 in Chicago (i.e., intentional injuries cause from 3% to 37% of all injury hospitalizations).

The variation in the death ratios reflects the overwhelming role of firearms in some areas. When firearm injuries are removed from the data, the ratio between intentional and unintentional injury is far more consistent across geographic areas (Figure 2). For deaths, the firearm-free ratio falls between 1:6 in McHenry County to 2:5 in Suburban Cook County (i.e., intentional injuries cause from 14% to 27% of all injury deaths). For hospitalizations, the ratio of intentional to unintentional injuries ranges from 1:30 in McHenry County to 1:5 in Chicago (i.e., intentional injuries cause from 3% to 17% of all injury hospitalizations).

* Fewer than 6 cases in a 3-year period; could not compute rate. All rates are per 100,000 persons ages 0–19 years, averaged over a 3-year period. MVI = motor vehicle injury.

TYPES OF INJURIES RESULTING IN DEATH

Chicago leads the other six areas in the rate of deaths caused by injuries to youth (Table 1). This is largely attributable to the rate of intentional deaths in the city, the vast majority of which, as noted above, are caused by firearm injuries. With respect to rates of unintentional injury deaths, McHenry and Will counties exceed Chicago slightly.

The leading types of injury vary by geographic area. For example, motor vehicle injury death rates in McHenry and Will counties are three times higher than those in Chicago and almost twice as high as in Suburban Cook and Lake counties. However, burns and pedestrian injury death rates are far higher in Chicago than in the other areas under study.

Two findings are surprising. First, McHenry County shows a very high rate of “other” causes of injury death. It is unclear why. Perhaps this is because McHenry is more rural than some other counties, and rural youth are subject to different kinds of injury risks than city and suburban youth. Secondly, in Kane County the rate of firearm homicide (8.1 per 100,000) is 3 to 4 times the rate of other outlying counties and is also significantly higher than Suburban Cook County (5.4 per 100,000). These two findings persist for McHenry and Kane counties when hospitalization data are taken into account (Table 2).

* Fewer than 6 cases in a 3-year period; could not compute rate. * All rates are per 100,000 persons ages 0–19 years, averaged over a 3-year period. MVI = motor vehicle injury.

TYPES OF INJURIES RESULTING IN HOSPITALIZATION

Because hospitalizations are more numerous than deaths, hospitalization data give a more thorough account of the causes of injury for each of these areas. Consistent with the mortality data, McHenry and Will counties lead in the rate of injuries due to motor vehicle crashes, and Chicago shows the highest rate of pedestrian injury by a wide margin. Bicycle injuries are most prevalent in McHenry, DuPage and Will and least prevalent in Chicago. Sports injuries are the most prevalent in these three counties as well. Both of these categories of injury are related to outdoor recreational activities, which are more likely to be performed in non-urban settings. Chicago’s rate of burn-related hospitalizations is about twice as high as Lake, McHenry, and DuPage and about 50% higher than Suburban Cook, Kane and Will.

It is often thought that cities have elevated rates of fall injuries. However, Chicago does not have the highest rates of fall-related hospitalizations in this study. McHenry, DuPage and Kane have similarly high rates of fall injuries, about 50% higher than in the other four areas under study.

Unintentional firearm injuries are almost twice as likely to occur in McHenry and Kane counties than in Chicago, Suburban Cook, and Lake counties and are 25–50% higher than in DuPage and Will counties. Chicago leads in the rate of firearm assault hospitalization and other forms of intentional injury hospitalization by wide margins. However, a surprising degree of variability is seen among counties outside of Chicago. In addition to the high rate of firearm assault in Kane county noted earlier, Kane and Suburban Cook counties have nonfirearm assault injury rates 30–100% higher than the other counties. DuPage and Lake counties show very low rates of firearm assault (at 3 and 4.1 per 100,000 youth, respectively).

* Excludes unintentional other and intentional other categories.

INJURY RISKS BY AGE

Because of the small numbers, the patterns of injury affecting children of different ages could be examined only for Chicago and Suburban Cook County. Table 3 lists the three leading causes of injury death and hospitalization by age in Chicago and Suburban Cook County.

For children under 5, the leading causes of injury death are similar for Chicago and Suburban Cook (Table 3). In both areas, burns and drowning are among the leading causes of injury death, while burns and falls are leading causes of hospitalization. In Chicago, however, pedes-trian injury replaces motor vehicle injury in the top three causes of injury death and hospitalization for this age group.

For 5- to 9-year-olds, the most frequent causes of injury death and hospitalization are again quite similar for Chicago and Suburban Cook County. In both areas, pedestrian injury, burns, and firearm homicide are among the leading causes of injury death, although motor vehicle injury is the leading cause in Suburban Cook County. Hospitalization data for both Chicago and Suburban Cook County show that children ages 5–9 are most likely to require hospitalization for injuries related to pedestrian mishaps, falls, and motor vehicle crashes.

For 10- to 14-year-olds, firearm homicide leads the causes of injury death for both Chicago and Suburban Cook County. Pedestrian and motor vehicle injuries are also among the leading causes of injury death. In Chicago, drowning is a frequent cause of injury death for this age group. This is not true for Suburban Cook County, where bicycle injuries are among the most frequent causes of injury death. With respect to hospitalizations, pedestrian injuries in Chicago and fall-related injuries in Suburban Cook County lead. Firearm assault is the second leading cause of injury hospitalization in Chicago for this age group, and fall-related injuries are the third most frequent cause of injury hospitalization. For Suburban Cook County youth, bicycle and sports-related injuries are the second and third causes of injury hospitalization for 10- to 14-year-olds, respectively.

Firearm homicide and assault are the leading causes of injury death in Chicago and Suburban Cook County, the leading causes of injury hospitalization in Chicago, and the second leading causes for injury hospitalization in Suburban Cook County for adolescents, ages 15–19. Firearm suicide is a leading cause of injury death for this age group in Chicago and Suburban Cook County. Motor vehicle injury is also a leading cause of injury death and hospitalization in both geographic areas. Pedestrian injury continues to be a prominent cause of hospitalization in Chicago for adolescents, and sports injuries are a leading cause of hospitalization in Suburban Cook County.

Conclusions

In setting injury prevention priorities, it is essential to understand the risks of injury in the immediate environment of youth. As these findings show, youth face different risks in different environments. For example, firearm assault and homicide are pervasive problems in Chicago, Suburban Cook, and Kane counties, but a far less common problem in Lake and DuPage counties. Recognizing the need to look locally at risks is the first step in developing sound injury prevention policies and practices.

The second step in setting sound policy is to explore the risks that are the most prevalent in a given area. Even where the causes of injury in different geographic areas are similar, the prevalence can be quite different. For example, although youth are at risk for pedestrian injury in every region under study, only in Chicago does the risk of pedestrian injury exceed the risk of motor vehicle injury, and only in Chicago does this risk continue throughout youth, from toddlerhood through adolescence.

The use of well-gathered data that address different levels of severity is essential to completing the second step of setting sound policy. The use of hospitalization data allows unintentional injury to be explored in far more depth than death data alone. Not only is hospitalization a more frequent event (allowing for a closer analysis of relatively infrequent injury causes), but hospitalization reveals a different set of priorities. For example, falls are a relatively infrequent cause of death but the most frequent cause of injury hospitalization. With this knowledge, prevention priorities can be shifted towards falls, and parent education for fall prevention can be shaped by the fall-related risks in the immediate environment of the child (stairways for children living in houses, window safety for children living in multistory buildings).

Armed with these data, child health care providers, local policy makers, and parents can reduce risks of injury by considering carefully how to reshape the local environment where youth live and play. The data reveal that each geographic area studied has a unique set of priorities and actions to be taken to reduce youth injury. Considering the relative prevalence of injury as a cause of death and hospitalization for children and adolescents, these data and the action they inspire can go a long way toward improving the health and wellbeing of Illinois youth.

Acknowledgement: This research project was carried out with financial support from the Illinois Department of Public Health.

REFERENCES

1. CHDL tabulations of WISQAR data. Atlanta, Ga. Centers for Disease Control and Prevention.

2. Bonnie RJ, Fulco CE, Liverman CT, eds. Reducing the Burden of Injury: Advancing Prevention and Treatment. Washington, DC: National Academy Press; 1999: 60–61.

3. Kohn M, Chausmer K, Flood H. Anticipatory guidance about child safety seat misuse. Lessons from safety seat checkups. Arch Pediatr Adolesc Med. 2000;154(6):606–609.

4. Tanz RR. Youth hospitalized for gunshot wounds in Illinois, 1992–1995. Data and Policy Program Report. April 1997;2(1):4.

5. Cartland J, Meleedy-Rey P, Christoffel KK. State and Community Reports on Injury Prevalence and Targeted Solutions: Child and Adolescent Injury in Illinois. Appendix A. Chicago, Ill: Child Health Data Lab; 2000. Available on-line at www.chdl.org.

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