Statcast Number 4 Transcript

DATE: March 20, 2008

PUBLICATION: “Leading Causes of Injury Mortality in the U.S., 1999-2005”

SPOKESPERSON: Lois Fingerhut, an injury epidemiologist with the CDC National Center for Health Statistics, discusses the trends in injury deaths in the U.S.:

FINGERHUT: “Poisoning has been rising rapidly as a cause of death and in 2004 poisoning overtook firearms as the second leading cause of injury death and remained that way in 2005.”

ANNOUNCER: “STATCAST… March 20, 2008”

HOST: “Lois Fingerhut is an injury epidemiologist with the CDC National Center for Health Statistics. Fingerhut is the lead author on a new study focusing on the leading causes of injury death in the U.S. She recently sat down with us and talked abou the overall scope of injury death in the country.

FINGERHUT: “Motor Vehicle Deaths continue to be the leading cause and they’ve had highs and lows but in recent years the interesting thing about motor vehicle traffic deaths is that they seem to have plateaued in the past four or five years…. Firearm deaths, and those include unintentional deaths, homicides, and suicides…um, historically had been the second leading cause of injury death and there was a time in the mid nineties when we thought they were going to overtake motor vehicle deaths but they haven’t, they decreased and in 2003 they were still the second leading cause of injury death but in 2004, a new phenomenon came up: poisoning has been rising rapidly as a cause of death and in 2004 poisoning overtook firearms as the second leading cause of injury death and remained that way in 2005.”

HOST: “Why have poisoning deaths increased so dramatically in the past few years?”

FINGERHUT: “It’s a pretty simple answer… um, most poisoning deaths, about… close to 70% of them… are due to unintentional drug overdoses.”

HOST: “So is there a new ‘drug of choice’ out there that is responsible for all these overdoses?”

FINGERHUT: “The drugs aren’t new — what’s new is that we can now classify them… In the world of injury epidemiology we rely on statistical classification which we count different on causes of death and beginning in 1999 methadone became one of those causes that we could single out and actually count the number of deaths. Prior to that that was combined with other causes and we couldn’t single it out… Um, methadone is a narcotic drug that has increased faster than any of the other narcotics that we can count. The number of methadone deaths, however, is not greater than the number of cocaine deaths or oxycodon deaths but their increase has been much faster.”

HOST: “Why has methadone poisoning become such a major cause of poisoning death?”

FINGERHUT: “There are several reasons why methadone deaths are increasing — no one’s been able to single out a specific answer, much the same way when I used to be asked about why firearm deaths are increasing or decreasing. There are a multitude of factors for methadone, including it’s a relatively inexpensive painkiller, historically people thought of methadone as only being used in the treatment of opioid dependency, and heroin dependency specifically, but that’s changed its it’s now used as a painkiller much the same as oxycodon is, or other analgesic painkillers, but it’s much less expensive; therefore physicians are more likely to proscribe it… The problem with the prescription however is that it’s very difficult to get the right dosing — it’s not as easy as other drugs to dose… So that’s a problem — physicians may not necessarily be aware of the correct prescribing, um, mechanisms… patients on the other hand may feel their pain returning quicker than the drug is actually worn out of their system and may overdose on them unintentionally because they’re back in pain but that higher dose will have killed them. And thirdly because they’re cheap they’re easily diverted — so if somebody picks up a prescription they’re easily sold to somebody else.”

HOST: “Now that poisoning has overtaken firearms as a leading cause of injury death, does that mean that – despite high profile shootings in the news – the country is making progress in preventing gun violence?”

FINGERHUT: “We probably are but I think the more important point is is that we’re not making progress in reducing poisoning deaths.”

HOST: “Talk briefly about the trend in motor vehicle traffic fatalities.”

FINGERHUT: “Motor vehicle fatalities were significantly higher back in the early seventies, late sixties and they dropped significantly due to major changes in laws — we had seatbelt laws enforced, we had speed limits enforced… there have been graduated driver licensing in recent years that’ve been enforced… but again most recently the motor vehicle traffic death rate is seen to have plateaued and we’re not seeing great changes in that even though it is still the leading cause of injury death.”

HOST: “Anything else you’d like to add?”

FINGERHUT: “There is another very important difference between poisoning deaths and firearms and motor vehicle deaths…Motor vehicle and firearm deaths generally peak amongst young people… anywhere between their late teens and early twenties, the death rates are highest… motor vehicle deaths have a secondary peak among the elderly — those 85 and over. Poisoning on the other hand has a very different age structure — the highest death rate are among those that are middle age, 35 to 54 years of age. That’s unlike any other cause of injury and it’s an interesting aspect of poisoning deaths and who is actually dying — and most of them are men.”

HOST: “Our thanks to Lois Fingerhut for joining us on this edition of “Statcast.” This has been a production of the CDC’s National Center for Health Statistics.”


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