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CDC Telebriefing Transcript
CDC Tracks and Analyzes Trends:
This Week's MMWR Looks at Stroke Mortality and Nonfatal
Self-Inflicted Injuries
May 23, 2002
CDC MODERATOR: Thank you. This is Kathy Harben. Today, we have two CDC
authors of reports in this week's Morbidity and Mortality Weekly Report.
Our first author will talk about stroke deaths. Our second author will talk
about nonfatal self-inflicted injuries.
Dr. Janet Croft, and that is spelled capital C-r-o-f-t, is a heart disease
and stroke expert in CDC's cardiovascular health program. She'll give a
brief introduction and then we'll open it up for questions.
Dr. Croft.
DR. CROFT: Thank you.
Stroke is the third leading cause of death and one of the major causes of
disability in the United States among adults.
The current report shows that almost 48 percent of the 167,000 stroke deaths
that occurred in 1999 occurred before transport to a hospital or the
emergency department. Additionally, almost 25 percent of stroke-related
deaths among young people aged less than 65 years occurred before transport
to a hospital or the emergency department.
We feel that educating the public about signs and symptoms of stroke may
help promote prompt and effective treatment of stroke. The main message that
CDC and its official partners, which include the America Stroke Association,
the Brain Attack Coalition and other federal agencies, that we will be
promoting throughout May, is that recognizing stroke symptoms and seeking
prompt emergency assistance can reduce stroke death and disability.
CDC MODERATOR: Okay. We're now ready for questions.
AT&T MODERATOR: Ladies and gentlemen, if you do wish to ask a question,
please press the one on your touchtone phone. You will hear a tone
indicating you've been placed in queue, and you may remove yourself from the
queue at any time by pressing the pound key.
If you are using a speaker-phone, please pick up your handset before
pressing the numbers. Once again, if there are questions or comments, please
press one at this time. One moment, please.
We've had no questions come into queue. Please continue. One moment, please.
We do have a question from the line of Keith Mulvahill [ph] with Reuters.
Please go ahead; your line is open.
MR. MULVAHILL: Hi. I wanted to know if you could just sort of give me a
little bit about the signs and symptoms of stroke that people should know
about.
DR. CROFT: Okay. There are five major signs and symptoms of a stroke, and a
person could have only just one symptom but they need to recognize that
symptom and dial 911 for emergency assistance as soon as possible.
The five symptoms are, first, sudden numbness or weakness; second, sudden
dimness or loss of vision; third, sudden dizziness or loss of balance;
fourth, a sudden severe headache, and often, people say that that's the
worst headache they ever have in their lives. And fifth is confusion or
difficulty speaking.
When a person experiences one of these symptoms, they should dial 911
immediately, because if you've having an ischemic stroke--and 80 percent of
all strokes are ischemic--the patient needs to reach the hospital within
three hours to receive a type of treatment that could potentially reduce
disability.
MR. MULVAHILL: Okay; great. Thank you.
AT&T MODERATOR: If there are further questions you may press one at this
time. The next question will come from the line of Meaghan Brooks with
Reuters Health. Please go ahead.
MS. BROOKS: Hi. Yeah, I was just wondering how these rates presented in the
MMWR for 1999 compare with past data. Could you just talk about that a bit.
DR. CROFT: We have not published a paper on past rates. This is the first
report of its kind. We are working on a report that's examining the trends,
over time, in these prevalences of a proportion that are experienced
pre-transport. But at the present we can't report on that, what the trends
are.
MS. BROOKS: Thank you.
AT&T MODERATOR: At this time we have no further questions in queue. Please
continue.
CDC MODERATOR: Unless there are additional questions for Dr. Croft about
stroke mortality, we'll continue now with Dr. Alex Crosby. Again, he is a
suicide prevention expert in CDC's Injury Prevention and Control Program.
Dr. Crosby.
DR. CROSBY: Hello. I'm Dr. Alex Crosby with CDC's Center for Injury
Prevention and Control.
Deaths and injuries resulting from self-directed violence have been
increasingly recognized as an important public health issue. Two recent
documents that have demonstrated this are the Surgeon General's call to
action to prevent suicide and the national strategy for suicide prevention,
goals and objectives for action.
Today's MMWR includes a report on self-inflicted injuries treated in
emergency departments in U.S. hospitals. The findings in this report
describe the magnitude of these injuries in the United States.
We can use this information to increase our understanding of self-inflicted
injuries and to help monitor trends, direct future research, and evaluate
intervention programs.
This article makes several important points. First, more than a quarter of a
million, about 260,000 persons were treated in hospital emergency
departments for nonfatal self-inflicted injuries during the year 2000. The
highest rates occurred among adolescents and young adults, especially
females.
A majority of the self-inflicted injuries were either poisonings or
lacerations, and 60 percent were probably suicide attempts.
In this article we have identified two groups that may suffer from higher
rates of self-inflicted injury. These higher rates affect adolescents and
young adults aged 15 to 24 years of age, and females.
A few other findings are worth noting. While 60 percent of the injuries
could be identified as probable suicide attempts, the intent was unknown or
unclear for almost one-third of the injuries.
Also, almost half of the persons seen in hospital emergency departments for
self-inflicted injuries were treated and released from the emergency
department.
CDC is actively applying its expertise to studying and preventing
self-directed violence like suicide. The agency is a partner in the
development of the national strategy for suicide prevention. CDC works
closely with states and communities to do some of the following things.
First, describing and tracking the problem of self-directed violence, to use
research to increase the knowledge of the causes and consequences of
suicidal behavior, evaluating and demonstrating ways to prevent suicidal
behavior, communicating scientific information about suicide prevention, and
we integrate a wide array of suicide prevention and support services.
This report highlights the burden of self-inflicted injuries in the United
States. It provides a picture of groups that appear to be at risk for these
types of injuries and points to the potential usefulness of this information
to direct future suicide interventions and injury prevention activity.
I'll be glad to take your questions now.
AT&T MODERATOR: Once again, ladies and gentlemen, if there are questions,
please press the one at this time. One moment, please.
It appears there are no questions. None have come into queue. One moment,
please. We do have a question in queue from the line of Paul Simow [ph] of
Reuters. Please go ahead.
MR. SIMOW: Yes. Do you have any sense of how the 264,000 in 2000 compares to
other years? Is this a growing problem? Is there some sort of trend that you
can spot from the study?
DR. CROSBY: We do not have a lot of data sets that give us information about
nonfatal suicidal behavior in the United States. One of the things that we
can make a comparison to, that helps in regard to looking at this picture of
self-directed violence, is we know, for example, how many people die as a
result of suicide, and in 1999, the closest year that we've got complete
statistics for, there were about 29,000 people that died as a result of
suicide.
Comparing that with this 260,000 that have made nonfatal attempts, we can
see that there is quite a big burden, you know, a ratio of almost nine to
one. For every one person that dies as a result of suicide, about nine
people make nonfatal attempts.
MR. SIMOW: Thank you.
AT&T MODERATOR: We do have another question in queue from the line of Myra
McKenna with the Atlanta Journal-Constitution. Please go ahead.
MS. McKENNA: Hi. Thanks for doing this and I apologize for signing in late.
But to follow up on what you just said, of the--comparing the 29,000 who
died to the 264,000 whose attempts were nonfatal, there's a suggestion in
the paper that a certain proportion of the 264,000 were never intended to be
fatal. Can you expand on that a little more.
DR. CROSBY: Surely. While we at CDC have not done any particular studies in
that area, there has been other scientific research that has tried to look
at those people who make suicide attempts, or nonfatal self-directed
violence.
In looking closely at that group, a number of different causes, or
underlying factors that play a role in why a person might try nonfatal
self-directed violence, some people, when you ask them about their intent,
their intent really was that they wanted to die. Whereas others are looking
for a way to deal with their problem.
For some, it was a matter of trying to get someone to pay attention to the
difficulty that they were in.
Others, it might have been a way to try to deal with a problem that they
were currently involved in. So there are a number of different reasons why a
person might try to use self-directed violence and not always is it an
intent to die.
MS. McKENNA: Can you quantify, out of that 264,000, a percentage that might
be actual suicide attempts, that didn't, that weren't successful versus
cries for help?
DR. CROSBY: In our study, what we did do is we were able to look at medical
records, and of course we were limited by the information that's on medical
records, and what we were able to identify was that 60 percent of that total
number were probable suicide attempts, about 10 percent possible, and 30
percent were unclear.
The reason that we were limited is, as you could imagine, in an emergency
department taking care of the medical illness is the most crucial thing, and
sometimes the information about what the person's intent is is not always
available.
MS. McKENNA: If there's nobody else in queue, I'm going to keep asking
questions. Stop me at any time.
Do you know if any of these people are recidivists?
DR. CROSBY: No. Unfortunately, we're not able to look at this in this aspect
of the study but it is something for future research to take a look at.
MS. McKENNA: And are there any, among that 264,000, and then also among the
29,000 who are successful, are there any significant, I guess, demographic
differences? Male versus female, black versus white, or other race or
ethnicity?
DR. CROSBY: Well, one of the things that we did identify is that there seem
to be higher rates among adolescents and young adults, 15 to 24 years of
age. There also tended to be slightly higher rates among females, although
with not statistical difference but slightly higher among females. In
regards to looking at race with race and ethnicity, we were not able to
distinguish between different rates among the different groups there.
MS. McKENNA: That's in the nonfatal attempts within the context of the
study.
DR. CROSBY: Right.
MS. McKENNA: Can you make any kind of comparison with, over against data on
successful suicide attempts?
DR. CROSBY: Well, "successful" is not the word that we often use. We talk
about completed suicide, or those who die by suicide.
When you look at suicide, in general, in the United States, males die of
suicide about four to one over females. About 80 percent of all the suicides
in the United States are among males.
When there have been other studies that have looked at attempts, it tends to
be females that attempt suicide more than males. About two to one. So there
is definitely a difference when you look at the fatal versus nonfatal
behavior, although in our study we didn't find very much of a difference
between males and females in regard to the nonfatal self-directed.
The other thing is when you look at those who die by suicide, the highest
rates are among the elderly, those over 65, and in this case what we saw
with the nonfatal behavior was that the highest rates were among adolescents
and young adults. That is also fairly consistent with other research that
has tried to look these two types of behavior--fatal and the nonfatal.
MS. McKENNA: Okay. Is it all right if I ask another question? Am I holding
up somebody else here?
AT&T MODERATOR: There are no other questions in queue, so please go ahead.
MS. McKENNA: Okay; thanks.
As you say, the data that you evaluated in this paper was from emergency
department records, and thinking of what the atmosphere in an emergency
department is like, and what the primary purposes of emergency medicine are,
could you talk at all about mental health follow-up for any of these
attempts. Do you have any data on that?
Do you know, is it happening, is it not happening? Or is referral
successful?
DR. CROSBY: No, we do not know, based on our study. The one thing that we
were able to look at is called disposition in regards to the emergency
department, and that's why I mentioned that about half, 49 percent of those
who are seen for these nonfatal injuries were treated and released from the
emergency department, and it does point to, I believe, the necessity for the
follow-up. There were a certain percentage that were hospitalized, others
that were transferred to other hospitals.
So we were able to [inaudible] disposition.
MS. McKENNA: Is it reasonable to assume that those who are hospitalized or
transferred to another institution would have gotten some mental health
follow-up, or social work follow-up?
DR. CROSBY: We don't know.
MS. McKENNA: Okay. Okay. I think I've run out of questions. Thanks very
much.
DR. CROSBY: You're welcome.
AT&T MODERATOR: Further questions? Please press one at this time.
It appears there are no further questions. Please continue.
CDC MODERATOR: If there are no additional questions, I will give some
contact numbers for both Dr. Croft and Dr. Crosby.
Dr. Croft can be reached--and she is the stroke expert--she can be reached
at (770) 488-2424. Dr. Crosby, the suicide prevention expert, can be reached
at (770) 488-4902.
AT&T MODERATOR: Ladies and gentlemen, that does conclude your conference
call for this morning. Thank you very much for your participation and for
using AT&T Executive Teleconference Service. You may now disconnect.
