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Topics in Minority Health Injuries in an Indian Community -- Cherokee, North Carolina

The American Indian/Alaskan Native population experiences a disproportionate amount of morbidity and mortality from injuries (1). To address this public health problem, the Cherokee Service Unit of the Indian Health Service studied the injury morbidity and mortality of the Eastern Band of the Cherokee Indians in North Carolina. Investigators reviewed the emergency room (ER) records from the Cherokee Indian Hospital for the period July 1, 1984, through June 30, 1985.* This ER is the only emergency care facility within the 56,000 acres of the rural Cherokee Indian Reservation, located near the Smoky Mountain National Park.

During this period, 1,448 injured persons visited the ER, for an incidence rate of 240 visits per 1,000 population. Sixty-three percent of those who sought care were male. The male to female injury rate ratio was 1.6:1. Injury rates for males exceeded rates for females in all age groups up to age 40 (Figure 1). After age 40, females had a higher injury rate than males. Rates for males peaked at 10-19 years of age and declined sharply thereafter. For females, rates generally decreased with increasing age.

Falls (25.2%) were the most frequent cause of ER visits, followed by sports-related injuries (14.0%) and unintentional cutting/piercing injuries (13.1%) (Table 1). Motor vehicles were involved in 56.9% of the 144 vehicle-related injuries; bicycles were involved in 30.6%; and motorcycles, in 5.5%. The highest rates for all injuries occurred during the late summer and early fall.

The category, "other unintentional injuries," included 12 poisonings, nine of which involved children less than 4 years of age. Three of these children had consumed gasoline, and three had consumed household cleaning agents. Cutting wood with an axe resulted in 11 injuries. Four injuries (including one death) involved firearms.

Most (1,389, or 95.9%) of the injured persons were treated and released. Fifty-one (3.5%) had serious injuries--49 of these were admitted to a local hospital or transferred to a referral hospital, and two died. Eight (0.6%) of the outcomes were unknown. Over half (58.5%) of the patients who were treated and released had lacerations, punctures, contusions, or abrasions. Thirteen (25.5%) of the seriously injured patients had fractures; 12 (23.5%) had lacerations; 7 (13.7%), contusions; 6 (11.8%), head/skull injuries; and 13 (25.5%), other injuries. One-third of the serious injuries were intentional (assaults, stabbings, and gunshot wounds); 23.5% were vehicle-related; and 23.5% were due to falls. Less than 3.0% of the patients with lacerations, punctures, and contusions required hospitalization, whereas 20.0% of those with head/skull injuries and 11.0% of those with fractures required hospitalization. Forty-six percent of those admitted to a hospital required more than 1 day of care. One of the two deaths resulted from a motor vehicle crash, and the other, from a gunshot wound. Reported by: J Moore, J Mills, Cherokee Svc Unit, Indian Health Svc (IHS), Cherokee, North Carolina. J Meredith, Nashville Area IHS, Nashville, Tennessee. RJ Smith III, Environmental Health Br, IHS, Rockville, Maryland. HJ Winick, MPH, Univ of Minnesota School of Public Health, Minneapolis. Div of Injury Epidemiology and Control, Center for Environmental Health and Injury Control, CDC.

Editorial Note

Editorial Note: The combined unintentional and intentional injury mortality rate among the American Indian/Alaskan Native population is three times the rate for the general U.S. population (1). Injuries account for more than 12.0% of all hospitalizations in Indian Health Service (IHS) hospitals and over 5.0% of the outpatient visits at IHS clinics (2).

ER records offer a unique opportunity to develop population-based surveillance for injuries. One limitation of ER-based surveillance, however, is that it does not include data on injuries resulting in death at the scene. Data analyzed in this study noted two deaths. However, during the same period, the North Carolina Medical Examiner received reports on five injury-related deaths involving American Indians residing in the five counties of the Cherokee Indian Reservation.

This study indicated that the most serious injuries occurring in the Cherokee Service Unit are intentional injuries, vehicle-related injuries, and falls. As a result of these findings, the tribal council, the Community Injury Control Committee, and other community leaders and organizations have planned interventions to decrease sports- related injuries, improve roads, and reduce intentional injuries. In addition, activities encouraging the use of seat belts and child-restraint seats to reduce vehicle-related injuries have been planned.

The IHS, working with the tribes, the Bureau of Indian Affairs, and other community groups, coordinates a variety of injury prevention activities including health fairs, national poster and essay contests, and school safety programs. This campaign provides an opportunity for a variety of interested health professionals and organizations to participate in injury prevention programs. To increase the awareness of injuries as a preventable health problem, the IHS designated November as the 5th Annual American Indian/Alaskan Native Safety Awareness Month.


  1. Indian Health Service. Bridging the gap: report on the task force on parity of Indian health services. Washington, DC: US Department of Health and Human Services, Public Health Service, 1986.

  2. Smith SM, Molloy BK, Graitcer PL. Intentional and unintentional injuries at three Indian Health Service units, 1981-1985 (Abstract). In: Program and abstracts of the 22nd annual meeting of the U.S. Public Health Service Professional Association. Washington, DC: Commissioned Officers Association of the U.S. Public Health Service, 1987. *Analysis based on 1984 population of the Eastern Band of the Cherokee Indians (6,089).

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