Number of deaths due to injury per 100,000 population. The 2023 County Health Rankings used data from 2016-2020 for this measure.
Injuries happen when a place is unsafe or when people engage in unsafe behaviors. Injuries may be intentional or unintentional. Intentional injuries are usually related to violence caused by oneself or by another. Unintentional injuries are accidental in nature.
Injuries are one of the leading causes of death. Unintentional injuries were the fourth leading cause of U.S. mortality in 2020 and 2021.1 For all ages, the leading causes of unintentional injury deaths in 2021 were poisoning, motor vehicle collisions, and falls.2
Community conditions can impact the safety of a place differently for different age groups, genders, and for people in various occupations, neighborhoods, or socioeconomic classes.3 In 2020, firearm related injuries became the leading cause of death among children aged 1 to 19.4 Males of any age are more likely than females to die from any type of injury. This disparity has been linked to lifestyle and masculine socialization.5 People of color are more likely to experience intentional injury deaths caused by policing than non-Hispanic white people. The risk of injury death due to policing is 3.5 times higher for Black people, and nearly 2 times higher for Hispanic people of any race and for non-Hispanic Indigenous people.6 Unintentional injury death rates are higher in rural places than urban places. Injured or poisoned individuals have more difficulties obtaining rapid emergency treatment in rural areas than in urban areas.7
Injury and deaths from injury cause trauma for a family and community. Exposure to trauma, particularly in childhood, can increase risks for mental illness, suicide, chronic disease, and social hardships such as poverty, crime, and violence. Prevention of injury death preserves intergenerational family and community health, and social and economic wellbeing.8
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 that result from injuries per 100,000 people. This measure includes injuries from intentional causes (such as homicide or suicide) and unintentional causes (such as motor vehicle accidents). Rates measure the number of events (e.g., deaths, births) in a specific 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.
Injury deaths measure only a small portion of the harm of injuries to people in the U.S. Injuries cause burdens for people such as emergency room visit costs, need for time off work, follow-up healthcare needs, and potential for long-term disability. Data are not available nationwide for injuries not resulting in death.
The numerator is the number of 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 possible to obtain single-year estimates from the resource included below.
Finding More Data
Disaggregation means breaking data down into smaller, meaningful subgroups. Disaggregated data are often broken down by characteristics of people or where they live. Disaggregated data can reveal inequalities that are otherwise hidden. These data can be disaggregated by:
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.
1 Ahmad FB, Cisewski JA, Anderson RN. Provisional mortality data—United States. Morbidity and Mortality Weekly Report 2022 Apr 29; 71(17): 597–600.
2 Centers for Disease Control and Prevention (CDC). Wide-ranging ONline Data for Epidemiologic Research (WONDER).
3 Spinks A, Turner C, Nixon J, McClure RJ, Cochrane Injuries Group. The 'WHO Safe Communities' model for the prevention of injury in whole populations. Cochrane Database of Systematic Reviews 2009(3).
4 Goldstick JE, Cunningham RM, Carter PM. Current causes of death in children and adolescents in the United States. New England journal of medicine 2022;386(20), 1955-1956.
5 Sorenson SB. Gender disparities in injury mortality: consistent, persistent, and larger than you'd think. American journal of public health 2011, 101(S1): S353-S358.
6 GBD 2019 Police Violence US Subnational Collaborators. Fatal police violence by race and state in the USA, 1980-2019: a network meta-regression. The Lancet 2021; 398(10307): 1239-1255. Accessed: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01609-3/fulltext
7 Garcia MC, Faul M, Massetti G, Thomas CC, Hong Y, Bauer UE, Iademarco MF. Reducing potentially excess deaths from the five leading causes of death in the rural United States. MMWR Surveillance Summaries 2017, 66(2): 1.
8 Word Health Organization. Injuries and violence; March 19, 2021. Accessed from: https://www.who.int/news-room/fact-sheets/detail/injuries-and-violence.