In the model
Use County Health Rankings’ model of health to explore the measures that influence how long and how well we live.
Number of deaths due to injury per 100,000 population. The 2022 County Health Rankings used data from 2016-2020 for this measure.
Injuries are one of the leading causes of death; unintentional injuries were the third leading cause, and intentional injuries were the 10th leading cause, of U.S. mortality in 2019. The leading causes of death in 2019 among unintentional injuries, respectively, were: poisoning, motor vehicle traffic deaths, and falls. Among intentional injuries, the leading causes of death in 2019, respectively, were: firearm suicides, suffocation suicides, and firearm homicides. Unintentional injuries are a substantial contributor to premature death. In 2019, unintentional injuries were the leading cause of death for all groups under age 45. Injuries account for 21.7% of all emergency department visits, and falls account for more than one-quarter of those visits.
Data and methods
National Center for Health Statistics - Mortality Files
Data on deaths and births were provided by NCHS and drawn from the National Vital Statistics System (NVSS). These data are submitted to the NVSS by the vital registration systems operated in the jurisdictions legally responsible for registering vital events (i.e., births, deaths, marriages, divorces, and fetal deaths). In prior years of the Rankings, Premature Death was calculated by the National Center for Health Statistics, but this year the Mortality-All County (micro-data) file was requested. This allowed us to calculate Premature Death and Life Expectancy ourselves. While most calculations of mortality rates can be downloaded from CDC WONDER, the calculation of Years of Potential Life Lost and Life Expectancy requires raw data files.
Key Measure Methods
Injury Deaths is a rate
Injury Deaths is the number of deaths from planned (e.g. homicide or suicide) and unplanned (e.g. motor vehicle deaths) injuries per 100,000 population. This measure includes injuries from all causes and intents. Rates measure the number of events (e.g., deaths, births) in a given time period (generally one or more years) divided by the average number of people at risk during that period. Rates help us compare data across counties with different population sizes.
Deaths are counted in the county of residence for the person who died, rather than the county where the death occurred
It is important to note that deaths are counted in the county of residence of the deceased. So, even in an injury death occurred across the state, the death is counted in the home county of the individual who died.
Some data are suppressed
A missing value is reported for counties with fewer than 10 injury deaths in the time frame.
This measure is being used to estimate the overall risk of injury in a county. Ideally, we would include injury hospitalizations and ER visits due to injuries, but these data are not available nationwide. The overall burden of injuries is not captured by the injury mortality rate; injuries that are not fatal have large costs due to emergency room visits and time off work.
The numerator is the number of injury deaths with an underlying cause of injury (ICD-10 codes *U01-*U03, V01-Y36, Y85-Y87, Y89) during the five-year period.
The denominator is the aggregate annual population for the five-year period.
Can This Measure Be Used to Track Progress
This measure can be used to track progress with some caveats. It is important to note that the estimate provided in the County Health Rankings is a 5-year average. However, in most counties, it is relatively simple to obtain single-year estimates over time from the resource included below.
We recommend starting with the CDC WONDER database, which contains information on injury death rates by race, ethnicity, age, gender, geography, cause of death, and more. Rates can be exported as raw or age-adjusted. Small counties might need to combine multiple years of data to see rates, as CDC suppresses any rates when there are fewer than 10 deaths.
In addition, many states support databases of injury-related hospitalizations or emergency department visits. You can find links to these databases in State-Specific Data Sources.
 Xu J, Murphy SL, Kochanek KD, Arias E. Deaths: Final data for 2019. National Vital Statistics Reports. July 26, 2021; 70(8). Accessed February 14, 2022. https://www.cdc.gov/nchs/data/nvsr/nvsr70/nvsr70-08-508.pdf
 Heron M. Deaths: Leading causes for 2019. National Vital Statistics Reports. July 26, 2021; 70(9). Accessed February 15, 2022. https://www.cdc.gov/nchs/data/nvsr/nvsr70/nvsr70-09-508.pdf
 Cairns C, Kang K, Santo L. National Hospital Ambulatory Medical Care Survey: 2018 Emergency Department Summary Tables. https://www.cdc.gov/nchs/data/nhamcs/web_tables/2018-ed-web-tables-508.pdf