Emergency Department Visits and Hospitalizations for Selected Nonfatal Injuries Among Adults Aged ≥65 Years — United States, 2018

Approximately 60,000 older adults (aged ≥65 years) die from unintentional injuries each year; in 2019 these included 34,000 fall deaths, 8,000 traffic-related motor vehicle crash deaths, and 3,000 drug poisoning deaths (1). In addition, >9,000 suicide deaths occur among older adults each year (1). Deaths among older adults account for 33% of these unintentional injury deaths and 19% of suicide deaths among all age groups (1). Nonfatal injuries from these causes are more common in this age group and can lead to long-term health consequences, such as brain injury and loss of independence. This study included 2018 data from the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project (HCUP) to determine the prevalence of selected nonfatal injuries among older adults treated in emergency departments (EDs) and hospitals. Injury mechanisms among the leading causes of injury death in older adults were studied, including unintentional falls, unintentional traffic-related motor vehicle crashes, unintentional opioid overdoses, and self-harm (suicidal and nonsuicidal by any mechanism). In 2018, an estimated 2.4 million ED visits and >700,000 hospitalizations from these injuries occurred among adults aged ≥65 years. Unintentional falls accounted for >90% of the selected ED visits and hospitalizations. Injuries among older adults can be prevented (2). Educational campaigns, such as CDC’s Still Going Strong* awareness campaign, that use positive messages can encourage older adults to take steps to prevent injuries. Health care providers can help prevent injuries by recommending that older patients participate in effective interventions, including referrals to physical therapy and deprescribing certain medications.^†

Data from the 2018 HCUP Nationwide Emergency Department Sample (NEDS) and National Inpatient Sample (NIS) were analyzed for rates of nonfatal injuries resulting in ED visits and hospitalizations among adults aged ≥65 years.^§ NEDS included data from 990 hospital EDs across 36 U.S. states and the District of Columbia. NIS included data from 47 participating states and the District of Columbia, which covered >97% of the U.S. population. ED visit diagnosis codes selected for analysis were International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) injury codes in any position^¶ and an ICD-10-CM code of one of the following injury mechanisms: unintentional falls,** unintentional traffic-related motor vehicle crashes,^†† or self-harm^§§ in any position. Hospitalizations were selected if the primary diagnosis was an injury (ICD-10-CM injury code) and one of the aforementioned injury mechanisms (ICD-10-CM code in any position).^¶¶ ED visits and hospitalizations were considered unintentional opioid overdose–related if ICD-10-CM codes or ICD-10 Procedure Coding System codes (used to collect inpatient procedures) for unintentional opioid overdoses*** were present in any field (3). To identify the full effect of selected injuries on ED visits and hospitals, all encounter types (initial, subsequent, and sequalae) were included. Among the selected injuries, 98.4% of ED visits and 94.1% of hospitalizations were for an initial encounter. Overdose visits were limited to opioid overdose (prescription and heroin) because opioid use is related to the other injuries included in this study and opioids are frequently prescribed to older adults (3,4). ED visits and hospitalizations with missing sex or age data or those resulting in deaths were excluded, as were ED visits leading to patient hospitalizations to avoid overlap between data systems. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.^†††

ED visits and hospitalizations were weighted to represent the U.S. population using survey procedures in SAS statistical software (version 9.4; SAS Institute). Rates of ED visits and hospitalizations were age-adjusted to the 2000 U.S. standard population using the direct method. Injuries were analyzed by sex and age group (65–74, 75–84, and ≥85 years). T-tests were used for selected pairwise comparisons; p-values <0.05 were considered statistically significant.

In 2018, an estimated 2.4 million ED visits among adults aged ≥65 years (4,744 per 100,000) were associated with unintentional falls, unintentional motor vehicle crashes, unintentional opioid overdoses, and self-harm (Table). Unintentional falls accounted for 91.8% of the selected injury-related ED visits, followed by unintentional crashes (7.8%). The rate of ED visits for unintentional fall injuries among women (5,003 per 100,000) was 41.7% higher than that among men (3,530 per 100,000). Rates of ED visits for unintentional fall injuries per 100,000 persons increased with age, from 2,678 among adults aged 65–start highlight74end highlight years to 4,900 among adults aged 75–84 years and 9,867 among adults aged ≥85 years. Unintentional crash injury–related ED visits decreased with age; among adults aged 65–74, 75–84, and ≥85 years, ED visits per 100,000 persons were 401, 337, and 236, respectively. The rate of unintentional opioid overdose–related ED visits was higher among men (18 per 100,000) than among women (14 per 100,000). Compared with other older adults, those aged 65–74 years had the highest rates of visits for unintentional opioid overdose (20 per 100,000) and self-harm (13 per 100,000).

In 2018, >700,000 hospitalizations associated with unintentional falls, unintentional motor vehicle crashes, unintentional opioid overdoses, and self-harm occurred among older adults. Unintentional falls accounted for 91.3% of the selected injury-related hospitalizations followed by unintentional motor vehicle crashes (5.9%). The rate of hospitalizations for unintentional falls was higher among women (1,494 per 100,000) than among men (1,035 per 100,000), and increased with age; among adults aged 65–74, 75–84, and ≥85 years, hospitalization rates for unintentional fall–related injuries were 561, 1,504, and 3,857 per 100,000, respectively. Hospitalization rate of unintentional motor vehicle crashes was higher among men (91 per 100,000) than among women (74 per 100,000), whereas the rate of unintentional opioid overdose–related hospitalizations was higher among women (30 per 100,000) than among men (24 per 100,000). Unintentional opioid overdose–related hospitalizations decreased with age: among adults aged 65–74, 75–84, and ≥85 years, hospitalization rates per 100,000 were 31, 24, and 18, respectively. Hospitalization rates for unintentional opioid overdose (27 per 100,000) and self-harm (16 per 100,000) were higher than rates of ED visits during which patients were treated and released (16 and 11 per 100,000, respectively).

Acknowledgments

Alana Vivolo-Kantor, Deborah Stone, Gwen Bergen, National Center for Injury Prevention and Control, CDC.

Corresponding author: Briana Moreland, bmoreland@cdc.gov.

¹Synergy America, Inc., Duluth, Georgia; ²Division of Injury Prevention, National Center for Injury Prevention and Control, CDC.

References

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Abbreviations: CI = confidence interval, ED = emergency department; ref = reference group.
* ED visits/hospitalizations per 100,000. Rates are age adjusted using the 2000 U.S. standard population except for the age group-specific rates.
^† Records for patients who were hospitalized or died in the ED were excluded; weighted number estimates were weighted to be representative of the U.S. population.
^§ Records were excluded if the patient died in the hospital; weighted number estimates were weighted to be representative of the United States.
^¶ For all the selected injuries, observations were included for all encounters (initial, subsequent, and sequalae).
** All causes category represents the number of unique injury visits for unintentional falls, unintentional motor vehicle crashes, unintentional opioid overdoses, and self-harm. The sum of the individual mechanisms is higher than the total because some injury-related emergency department visits and hospitalizations had more than one mechanism of injury code.
^†† Totals for each mechanism of injury might not sum to totals across sex and age group because of rounding the weighted estimates.
^§§ P-value <0.05 when compared with reference group by t-test.
^¶¶ ICD-10-CM codes were the following: injury diagnosis code in any position (ED) or primary position (hospital) M97, S00–S99, T07–T34, T36–T76 (T36–T50 with sixth character = 1–4, except T36.9, T37.9, T39.9, T41.4, T42.7, T43.9, T45.9, T47.9, and T49.9 with a fifth character = 1–4), T79; and an unintentional fall code in any position: V00.11–V00.89 (with sixth character = 1), W00–W17 (W16 with a sixth character = 2, except W16.4 and W16.9 with a fifth character = 2), W18.1–W18.3, and W19.
*** ICD-10-CM codes were the following: injury diagnosis code in any position (ED) or primary position (hospital) M97, S00–S99, T07–T34, T36–T76 (T36–T50 with sixth character = 1–4, except T36.9, T37.9, T39.9, T41.4, T42.7, T43.9, T45.9, T47.9, and T49.9 with a fifth character = 1–4), T79; and an unintentional motor vehicle crash code in any position: V02–V04 (.1 or .9), V09.2, V09.3, V12–V14 (.3–.9), V19.4–V19.6, V19.9, V20–V28 (.3–.9), V29.4–V29.9, V30–V79 (.4–.9), V80.3–V80.5, V81.1, V82.1, V83–V86 (.0–.3), V87.0–V87.8, V89.2 in any position.
^†††. ICD-10-CM codes were the following: T40.0X1, T40.1X1, T40.2X1, T40.3X1, T40.4X1, T40.601, and T40.691.
^§§§ ICD-10-CM codes were the following: injury diagnosis code in any position (EDs) or primary position (hospital) M97, S00–S99, T07–T34, T36–T76 (T36–T50 with sixth character = 1–4, except T36.9, T37.9, T39.9, T41.4, T42.7, T43.9, T45.9, T47.9, and T49.9 with a fifth character = 1–4), T79; and a self-harm code in any position: T36–T65 with sixth character = 2 (except for T36.9, T37.9, T39.9, T41.4, T42.7, T43.9, T45.9, T47.9, T49.9, T51.9, T52.9, T53.9, T54.9, T56.9, T57.9, T58.0, T58.1, T58.9, T59.9, T60.9, T61.0, T61.1, T61.9, T62.9, T63.9, T64.0, T64.8, and T65.9 with fifth character = 2), T71 with sixth character = 2, T14.91, and X71–X83.