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Atlas of Injury Mortality Among American Indian and Alaska Native Children and Youth, 1989-1998 PDF Version


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Cause of Injuries
The causes of death included in this Atlas and the associated International Classification of Diseases, Ninth Revision, External Cause Codes (ICD9 E-Codes), are shown in Table 1.

Data Files
Data for the Atlas were drawn from two sources:

  1. Detailed mortality data files prepared by CDC's National Center for Health Statistics (NCHS), based on data from state death certificates.

  2. NCHS mortality data that Indian Health Service (IHS) has categorized by Area. All data were restricted to children and youth 0–19 years of age.

The data derived from these sources follows:

Source Type of Data Population


IHS death rates—Area Maps, age,and sex


Native Americans in IHS service Areas (1989–1998)




Death rates—all other races


Entire United States (1989–1998)




10 leading causes of death


All U.S. Native Americans (1999–2000)


Indian Health Service Injury Death Data

Each year, NCHS provides IHS with a multiple-cause-of-death mortality tape of all U.S. decedents. IHS categorizes these data by IHS area offices to create its own mortality data set. The IHS data include those Native Americans who lived within an IHS area at the time of death and were eligible for IHS services (IHS service population). The service population is estimated by counting those Native Americans (as identified during the census) who live in the geographic areas in which IHS has responsibilities (“on or near” reservations). Some individuals who are included in the IHS service population do not live on reservations. The IHS service population comprises about 60% of all Native Americans who live in 1the United States. States that make up the service population have been grouped by IHS into twelve administrative Areas, or IHS Areas: Aberdeen, Alaska, Albuquerque, Bemidji, Billings, California, Nashville, Navajo, Oklahoma City, Phoenix, Portland, and Tucson.

Table 1. Underlying causes of death and associated ICD9 E-codes included in the IHS Childhood Injury Mortality Atlas

Cause of Death ICD9 E-Code
Motor vehicle-related* E810–E825
Pedestrian-related E810–E825 (.7) **
Drowning E830, E832, E910
Fire/burn-related E890–E899, E924
Suffocation E911–E913
(intentional, unintentional,
and undetermined intent)
E965.0–E965.4, E970
Suicide E950–E959
Homicide E960–E969
* Motor vehicle-related coding includes pedestrian-related injury deaths. Codes 810–819 indicate traffic-related injury deaths. Codes 820–825 indicate nontraffic-related injury deaths.

** This parenthetical notation implies that the decimal should be applied to each individual three-digit E-code in the grouping.

*** Firearm-related coding includes firearm-related deaths, homicide, suicide, and unintentional events.

Calculation of Rates and Leading Causes

Rates per 100,000 population were calculated using estimates of the IHS service population for 1989 to 1998, based on the revised 2000 census as denominators. At the time of this project, 1998 was the most recent year of data available through IHS. Data from 1981 to 1988 were used in conjunction with data from 1989 to 1998 for illustrating injury trends by race group and two-year periods. Calculations were based on injury deaths of children and youth (0–19 years of age). Native American deaths were adjusted using the IHS Area factors outlined in Adjusting for Miscoding of 4Indian Race on State Death Certificates. These methods are similar to those used by IHS in Regional Differences in Indian Health (JoAnn Papalardo, IHS Program Statistics, personal communication 2004). All rates specific to IHS Areas, race, and sex were age-adjusted by the direct method using the projected 2000 U.S. population as the standard. Injury death rates based on a small number of deaths (< 20) may be unstable and should be interpreted with caution.

Data for the ten leading causes of death charts were taken from the compressed mortality file produced by NCHS and include the deaths of all U.S. Native Americans. Race-specific data presented for white and black children were also taken from the compressed mortality file produced by NCHS.

Both the U.S. national rate and the Area rates were used to calculate excess deaths due to injury by Area.

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Content Source: National Center for Injury Prevention and Control, Division of Violence Prevention
Page last modified: May 18, 2007