Current Trends Unintentional Poisoning Mortality -- United States, 1980-1986

March 19-25, 1989, marks the 28th annual observance of National Poison Prevention Week (NPPW). NPPW is intended to alert the public to the problem of unintentional poisoning (the ingestion, injection, inhalation, or absorption of a chemical agent that results in unanticipated illness or death), the fifth leading cause of unintentional injury deaths in the United States. The traditional goal of NPPW is prevention of poisoning among children. Although childhood poisoning mortality has decreased in recent years, morbidity associated with poisoning in this age group remains a major public health problem. In 1987, 731,954 poisoning exposures among children less than 6 years of age were reported to the American Association of Poison Control Centers' National Data Collection System; 22 of these children died, and 107,844 others became ill (1). The number of exposures to household medicines and chemicals can be reduced by more widespread use of safety-packaged products by parents and other caretakers of children. The following report focuses on unintentional poisoning mortality among young adults, including poisonings from both the medical and nonmedical use of drugs.

Unintentional poisoning deaths in the United States were analyzed for 1980-1986 using final mortality data from CDC's National Center for Health Statistics (NCHS).* Age-adjusted mortality rates were directly standardized to the 1980 U.S. population.

From 1980 through 1986, the mortality rate of unintentional poisonings in the United States increased from 1.9 to 2.3 deaths/100,000 population (Figure 1). This 7-year trend appears to be explained by a 49% increase in the rate of deaths from drug poisoning, including drugs used for both medical and nonmedical purposes. Mortality rates of unintentional poisoning by other solids and liquids and by gases and vapors decreased by 15% and 25%, respectively, during 1980-1986. In 1986, the most recent year for which NCHS mortality data are available, drug poisonings accounted for 1.6 deaths/100,000 persons and 73% of all unintentional poisoning deaths (Table 1).

In 1986, the leading causes of fatal unintentional drug poisonings were opiates and related narcotics and local anesthetics including cocaine (Table 2). Most of the fatal poisonings by other solids and liquids were due to alcohol ingestion (352 deaths). Exposure to motor vehicle exhaust (475 deaths) accounted for nearly half the deaths due to unintentional poisoning by gases and vapors.

The mortality rate of unintentional poisonings for males remained more than twice that for females during 1980-1986 (Table 3). The rates for blacks of both sexes were consistently higher than those for whites. In 1986, the rate for black males was 5.4 deaths/100,000 persons, and for white males, 3.2 deaths/100,000 persons.

The highest mortality rates of unintentional poisonings for both blacks and whites were for young adult men (20-39 years of age). Men in thisthe rate for black males was 5.4 deaths/100,000 persons, and for white males, 3.2 deaths/100,000 persons.

The highest mortality rates of unintentional poisonings for both blacks and whites were for young adult men (20-39 years of age). Men in this age group accounted for 40% of all unintentional poisoning deaths and 46% of all unintentional drug poisoning deaths during 1980-1986. In 1986, among young adult men, unintentional drug poisonings were responsible for 2065 deaths or 5.1 deaths/100,000 persons, an 85% increase from 1980.

In 1986, the leading causes of fatal unintentional drug poisonings for young adult men were opiates and related narcotics (619 deaths) and local anesthetics including cocaine (436 deaths). By comparison, in 1980, among young adult men, 213 deaths resulted from poisoning by opiates and related narcotics, and 73 deaths, from poisoning by local anesthetics including cocaine. In 1980 and 1986, additional deaths occurred among young adult men from unintentional poisonings by drug combinations, and an unknown number of these deaths involved opiates or cocaine.**

The mortality rate for unintentional poisonings among children less than 15 years of age was 0.3 deaths/100,000 persons in 1986, a 10% decrease from 1980. In 1986, 147 such deaths occurred among children less than 15 years of age, including 62 deaths from gases and vapors and 54 from drugs. Reported by: Biometrics Br and Program Development and Implementation Br, Div of Injury Epidemiology and Control, Center for Environmental Health and Injury Control, CDC.

Editorial Note

Editorial Note: Unintentional poisoning mortality is predominantly a problem of young adults, particularly men 20-39 years of age. NCHS data indicate that the misuse of drugs, primarily opiates and related narcotics and cocaine, was responsible for a substantial increase in such deaths among men in this age group from 1980 through 1986. The impact of drug use on mortality is only partially conveyed by enumeration of unintentional poisoning deaths (2). The mortality rate for young adult men rose during 1980-1986 for deaths attributed to drug dependence, nondependent drug abuse, and poisoning by drugs in which the intentions of the decedent are undetermined. For suicide by drugs, the mortality rate in young adult men remained nearly constant (1.6 deaths/100,000 persons in 1986) (NCHS, unpublished data).

The National Institute on Drug Abuse (NIDA) has reported increases in morbidity and mortality associated with nonmedical use of both heroin/morphine and cocaine during 1985-1987 (3). Through its Drug Abuse Warning Network (DAWN), NIDA monitors emergency departments and medical examiners' offices in selected locations for drug-related emergency visits and deaths. In 1987, cocaine was the most frequently reported drug involved in emergency visits, and heroin/morphine and cocaine each were involved in more than one third of deaths reported to DAWN. According to DAWN data for 1987, persons 20-39 years of age accounted for 70% of all drug-abuse emergency visits and 65% of all drug-abuse deaths (4).

Reducing unintentional poisoning mortality among young adults requires prevention programs and treatment efforts that focus on the use of illicit drugs. Although medical complications of illicit drug use often emerge early in adulthood, initiation of drug use during adolescence is an important risk factor for later hazardous use. This suggests that deterring or even delaying initiation of drug use among adolescents is an appropriate goal of prevention (5). However, the recent increase in unintentional drug poisoning deaths among young adults underscores the need for drug education and treatment that focus on illicit drug users who are 20-39 years of age.

References

1. Litovitz TL, Schmitz BF, Matyunas N, Martin TG. 1987 annual report of the American Association of Poison Control Centers National Data Collection System. Am J Emerg Med 1988;6:479-515. 2.Lettieri DJ, Backenheimer MS. Methodological considerations for a model reporting system of drug deaths. In: Josephson E, Carroll EE, eds. Drug use: epidemiological and sociological approaches. Washington, DC: Hemisphere Publishing, 1974. 3.National Institute on Drug Abuse. Semiannual report: trend data through July-December 1987--data from the Drug Abuse Warning Network (DAWN). Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1988. (Series G, no. 21). 4.National Institute on Drug Abuse. Annual data 1987: data from the Drug Abuse Warning Network (DAWN). Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1988. (Series I, no. 7). 5.Battjes RJ, Jones CL. Implications of etiological research for preventive interventions and future research. In: Jones CL, Battjes RJ, eds. Etiology of drug abuse: implications for prevention. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1985; DHHS publication no. (ADM)85-1335. (National Institute on Drug Abuse research monograph no. 56). *NCHS codes the underlying cause of death according to the International Classification of Diseases (ICD). The ICD Ninth Revision (ICD-9) has been in use since the beginning of 1979. NCHS uses the ICD-9 codes E850-E858 for unintentional drug poisoning deaths, such as overdoses, regardless of whether the drug was administered for medical reasons. NCHS codes other drug-related deaths as deaths due to drug dependence (ICD-9 code 304), nondependent drug abuse (305.2-305.9), suicide by drugs (E950.0-E950.5), and poisoning by drugs in which the intentions of the decedent are undetermined (E980.0-E980.5). **The ICD-9 code for unintentional poisoning by drug combinations is E858.8.

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