Statistical bulletin: Injury and Poisoning Mortality in England and Wales, 2010

Key findings

• Injury and poisoning deaths accounted for 3.5 per cent of all deaths registered in England and Wales in 2010. This proportion has remained largely unchanged over the last decade
• Seventy-nine per cent of female injury and poisoning deaths in 2010 were unintentional, compared with 62 per cent for males
• The highest rate of accidental deaths in 2010 were from falls, replacing transport accidents which had the highest rate in 2009
• The mortality rate for transport accidents fell 41 per cent between 2001 and 2010, from 56.6 deaths per million population in 2001, to 33.6 deaths per million in 2010

Summary

This statistical bulletin presents annual data and analysis on the main causes of death from injury and poisoning in England and Wales in 2010. Trends in accidental deaths and suicides since 2001 are also reported. All statistics are based on deaths registered in England and Wales in a particular year and have been calculated from previously published figures.

Background

Deaths from injury and poisoning have a large impact in terms of premature deaths and potential years of life lost. In 2010 there were 17,201 deaths from external causes of injury and poisoning in England and Wales. There were 10,545 male deaths and 6,656 female deaths, which accounted for 3.5 per cent of all deaths registered in 2010. This proportion has remained largely unchanged for the last decade. Detailed statistics for injury and poisoning mortality in 2010 can be found in Table 5.19 of Deaths registered in England and Wales, 2010.

The analysis in this bulletin uses an internationally accepted standard framework specifically designed for presenting data on injury. The matrix, developed by the International Collaborative Effort (ICE) on injury statistics, displays injury and poisoning data by intent (for example, unintentional, intentional self-harm and injury and poisoning of underdetermined intent, or homicide and probable suicide) and by mechanism (for example, poisoning, transport, firearm or drowning). See background note 2 for more information on the ICE classification. The analysis excludes deaths with an external cause attributed to complications of surgical and medical care (codes Y40–Y84) and sequelae (see definition below) with surgical and medical care (Y88). There were 436 such deaths in 2010. Deaths attributed to legal intervention or operations of war are also excluded (Y35–Y36), together with sequelae of legal intervention and sequelae of war operations (Y89.0–Y89.1); there were 11 such deaths in 2010. These exclusions mean that figures for 2010, and previous years, may differ from previously reported totals of deaths from external causes (U50.9, V01–Y89) published as part of the annual published mortality figures. In the data table which accompanies this bulletin the total of injury and poisoning deaths used in ICE matrix are 10,316 male deaths and 6,438 female deaths.

Sequelae means that the death resulted from the late (residual) effects of a given disease or injury one year or more after the original event (WHO 1992–1994).

The Office for National Statistics (ONS) combine deaths from intentional self-harm and injury or poisoning deaths of undetermined intent to give an overall estimate of suicides in England and Wales. Accelerated registration deaths (adjourned inquests pending further investigation) have been classified as 'probable homicides' and combined with homicides to give an overall estimate of homicides.

The mechanism of death is important when looking at preventing the incidence of injury and poisoning deaths. For example, changes to the law (such as gun control legislation) or developments in technology to improve car safety are implemented to try and reduce the number of avoidable deaths from these mechanisms.

Categorising deaths by intent is important when looking at interventions which aim to prevent deaths across mechanisms of death for the same intent. For example, the removal of potential ligature points in psychiatric units and prison cells to reduce the risk of hanging as a means of suicide (NMHDU 2009).

Main Causes of Death from Injury and Poisoning

In 2010 almost four-fifths (79 per cent) of female injury and poisoning deaths were unintentional (accidental), compared with 62 per cent for males. Thirty-three per cent of male injury and poisoning deaths were due to suicide (intentional self-harm and event of undetermined intent) compared with 17 per cent of female injury and poisoning deaths. Research shows that males are more likely than females to commit suicide at all age groups (NMHDU 2009), although no single risk factor can account for this difference. These risk factors include mental illness, unemployment, imprisonment and other stressful life events.

Homicides (including probable homicides) accounted for 4.5 and 3.3 per cent of male and female injury and poisoning deaths respectively.

Injury and poisoning mortality: by intent and sex

England and Wales, 2010

Source: Office for National Statistics

Notes:

1. Injury and poisoning deaths attributed to complications of medical and surgical care (Y40-Y84), sequelae with surgical and medical care (Y88), legal intervention or operations of war (Y35–Y36), sequelae of legal intervention (Y89.0) and sequelae of war operations (Y89.1) are not included in these figures.

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For males the majority of unintentional deaths (where the cause of the accident was known) resulted from falls or transport accidents (29 and 23 per cent respectively). Similarly for females, falls were the most common cause, accounting for 35 per cent of unintentional deaths. Transport accidents comprised 10 per cent of unintentional deaths for females.

Although transport accidents remain a major cause of accidental death, various national and local government campaigns and regulations, which have targeted road safety, are considered to have led to a fall in these types of deaths in recent years. Regular improvements in car safety may also have contributed to the decline in motor vehicle deaths over the last decade, while rises in unintentional deaths due to falls are likely to be related to the ageing population. Directly age-standardised mortality rates are reported later in this bulletin; these take account of differences in the age structure of the population and are particularly useful for making comparisons over time (see background note 10).

The most common mechanism for suicide deaths was suffocation (56 and 38 per cent for males and females respectively). The majority of suicides by suffocation were hangings, reflecting the availability, and simplicity, of the method. Research has indicated that the likelihood of committing suicide will depend in part on the ease of access to, and knowledge of, an effective means (NMHDU 2009). Suicides from poisoning in England and Wales usually involve drugs or exposure to noxious substances including gases.  

Causes of Injury and Poisoning Mortality by Age and Sex

For both males and females, mortality rates for unintentional deaths were higher than those for homicide (including probable homicide) or suicide (intentional self-harm and event of undetermined intent) for most ages, except for males aged 35 to 54. The oldest age group (75 years and over) had the highest age-specific mortality rates for unintentional deaths for both males and females (132.3 and 132.4 deaths per 100,000 population respectively).

Age-Specific Mortality Rates for Injury and Poisoning Deaths: Intent by Age Group and Sex

England and Wales, 2010

Table source: Office for National Statistics

Mortality rates from suicides (intentional self-harm and event of undetermined intent) were highest among the 35 to 54 age group for both males and females (20.0 and 6.1 deaths per 100,000 population respectively). For homicides and probable homicides the mortality rate was very low but highest for males aged 15 to 34 (2.7 deaths per 100,000 population) and for females aged 35 to 54 (1.0 death per 100,000 population). Homicide remains a rare cause of death in England and Wales, even after the standard ONS addition of adjourned inquest (probable homicides) as in this bulletin (see background note 2).

Injury and Poisoning Deaths by Mechanism

Mortality rates for injury and poisoning deaths vary by age group according to the mechanism of death. In 2010, other than unspecified mechanisms, the four most common mechanisms for injury and poisoning deaths were transport, poisoning, falls and suffocation.

Suffocation and transport and were the most common mechanisms for males in the 15 to 34 age group (8.7 and 8.2 deaths per 100,000 population respectively), while suffocation and poisoning were the most common mechanisms in the 35 to 54 age group, (12.8 and 11.1 deaths per 100,000 population, respectively). For males the rate for falls increases with age, rising sharply for those aged 75 years and over, reaching 66.2 deaths per 100,000 population in 2010. Despite the overall decline in male deaths rates from motor vehicle accidents over the last decade, they remain a major cause of premature death among young males in England and Wales.

Male age-specific mortality rates for injury and poisoning deaths: four main mechanisms

England and Wales, 2010

Source: Office for National Statistics

Notes:

1. Injury and poisoning deaths attributed to complications of medical and surgical care (Y40-Y84), sequelae with surgical and medical care (Y88), legal intervention or operations of war (Y35–Y36), sequelae of legal intervention (Y89.0) and sequelae of war operations (Y89.1) are not included in these figures.
2. Excludes other and unspecified mechanisms

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Within ages 35 to 54 years, poisoning was the principal mechanism for female deaths (5.0 deaths per 100,000 population). This age group also had the highest female suicide rate at 6.1 deaths per 100,000 population.

As for males, falls were by far the most common mechanism in the oldest female age group (75 and over) accounting for 54.5 deaths per 100,000 population. Female rates for transport accidents were lower than for males in all age groups. The highest female rate for these deaths was in the oldest age group accounting for 4.7 deaths per 100,000 population. The female rates for suffocation were also lower than for males in all age groups.

Female age-specific mortality rates for injury and poisoning deaths: four main mechanisms

England and Wales, 2010

Source: Office for National Statistics

Notes:

1. Injury and poisoning deaths attributed to complications of medical and surgical care (Y40-Y84), sequelae with surgical and medical care (Y88), legal intervention or operations of war (Y35–Y36), sequelae of legal intervention (Y89.0) and sequelae of war operations (Y89.1) are not included in these figures.
2. Excludes other and unspecified mechanisms

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Trends in Injury and Poisoning Mortality Rates 2001–10

Over the period 2001 to 2010, transport accidents had the highest age-standardised rate for accidental deaths up until 2009. In 2010 they dropped below the rate for falls. The rate for transport related deaths fell from 56.6 deaths per million population in 2001 to 33.6 deaths per million population in 2010 (a decrease of 41 per cent). Government campaigns and regulations which have targeted improvements in both in road and car safety are considered to have contributed to this fall.

The rate for accidental falls increased by 11 per cent between 2001 and 2010 from 35.1 to 39.1 deaths per million population. This rate may well be an underestimate as the majority of accidental deaths with an unspecified mechanism are thought likely to be falls (see background note 6). Age UK has highlighted the need for more preventative measure to reduce the number of deaths from falls in older people. Their 'Make your home "falls-free" campaign' aims to reduce the risk of people falling in their own home by promoting various support services including home improvement schemes.

The mortality rate for deaths from accidental poisonings peaked at 27.8 deaths per million population in 2009 and fell very slightly to 27.4 deaths per million population in 2010. The lowest rate for accidental poisonings was 15.8 deaths per million population in 2003. Accidental suffocation deaths remained relatively stable between 2001 and 2007 (around 8 deaths per million population), rising to 10.3 deaths per million population in 2008 and 2009 and falling slightly to 9.6 deaths per million population in 2010.

Age-standardised mortality rates: by selected mechanism for accidental deaths

England and Wales, 2001–10

Source: Office for National Statistics

Notes:

1. Injury and poisoning deaths attributed to complications of medical and surgical care (Y40-Y84), sequelae with surgical and medical care (Y88), legal intervention or operations of war (Y35–Y36), sequelae of legal intervention (Y89.0) and sequelae of war operations (Y89.1) are not included in these figures.

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Suffocation and poisoning were the two most common methods for suicide over the period 2001 to 2010. The age-standardised rate for suicide due to poisoning fell by 43 per cent between 2001 and 2010 from 30.4 to 17.4 deaths per million population. Conversely, the rate for suicide due to suffocation increased by 13 per cent, from 36.4 deaths per million population in 2001 to 41.1 deaths per million population in 2010. The rate for suicide due to drowning fell from 4.9 deaths per million population in 2001 to 3.5 deaths per million population in 2010. As the likelihood of committing suicide can be affected by access to the lethal method, the fall in suicides from drug poisoning may in some part be due to restrictions on the availability of certain drugs commonly associated with suicide deaths. For example, the prescription only painkiller coproxamol has gradually been phased out in England and Wales since 2007 (NMHDU 2009).

Suicides from firearms and from cuts and piercings remained at a low level throughout the period, with around 2 deaths per million population each year for both types of mechanism.

Age-standardised mortality rates: by selected mechanism for suicides

England and Wales, 2001–10

Source: Office for National Statistics

Notes:

1. Injury and poisoning deaths attributed to complications of medical and surgical care (Y40-Y84), sequelae with surgical and medical care (Y88), legal intervention or operations of war (Y35–Y36), sequelae of legal intervention (Y89.0) and sequelae of war operations (Y89.1) are not included in these figures.

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Additional commentary and analysis of suicide rates and figures for the UK, England, Wales and Regions in England is available in the statistical bulletin Suicide rates in the United Kingdom, 2006 to 2010. An article looking at the impact of narrative verdicts on the quality of injury and poisoning statistics in England and Wales also provides additional context for this bulletin (Hill and Cook 2011). The findings of this study showed that in the last ten years there has been a substantial increase in the use of narrative verdicts by coroners in England and Wales. Some of these narrative verdicts are difficult to code with an underlying cause of death. This is especially true for injury and poisoning deaths where the intent behind the event which led to the death may not always be clear from the information provided by the coroner. However, the study concluded that the increase in ‘hard to code’ narrative verdicts has not yet had a significant impact on suicide rates in England and Wales. 

Users and Uses of Injury and Poisoning Mortality Statistics

ONS uses injury and poisoning mortality statistics to carry out further analysis on suicides and deaths related to drug poisoning.

The Department of Health (DH) is a key user of mortality statistics. Data are used, for example, to inform policy decisions and to reduce avoidable mortality from the major causes of premature death including road traffic accidents and suicides.

Users also include other public sector organisations such as the Police and the Home Office who are interested in data on external causes of death.

Other users include academics, demographers and health researchers who conduct research into mortality trends. Lobby groups and charities use injury and poisoning mortality statistics to support their cause, for example, campaigns for the prevention of accidents on the road, in the home and at work. Organisations such as Eurostat and the UN use mortality statistics for making international comparisons. The media also report on key trends in mortality, including suicides and road traffic accidents.

Further Information

Data on Injury and poisoning mortality in England and Wales, 2010. Data for 2005-09 (142 Kb Excel sheet) are also available.

Detailed mortality data for England and Wales by underlying cause of death.

Information on data quality, legislation and procedures relating to mortality statistics:

Mortality metadata (775.7 Kb Pdf) and Mortality Summary Quality Report (178.8 Kb Pdf) .

Further information on drug poisoning deaths in England and Wales.

Further information on suicides.

Injury and poisoning data for other UK countries:

Statistics on injury and poisoning deaths in Scotland and Statistics on injury and poisoning deaths in Northern Ireland.

References

Fingerhut L A, Cox C S, Warner M et al (1998). ‘International comparative analysis of injury mortality. Findings from the ICE on injury statistics’. Advance data from vital and health statistics, 303, National Center for Health Statistics: Hyattsville, Maryland.

Hill C and Cook L (2011) ‘Narrative verdicts and their impact on mortality statistics in England and Wales’, Health Statistics Quarterly 49, pp 81–100.

McLoughlin E, Annest JL, Fingerhut L A et al (1997). Recommended framework for presenting injury mortality data. MMWR Centers for Disease Control and Prevention. 46 (no. RR-14): 1N32. 

National Center for Health Statistics (2004). ‘Deaths: injuries, 2001’, National Vital Statistics Reports, Volume 52 (21), p 87.

National Mental Health Development Unit (NMHDU) (2009). National Suicide Prevention Strategy of England, Annual Report on Progress 2008.

Rooney C and Devis T (1999) ‘Recent trends in deaths from homicide in England and Wales’, Health Statistics Quarterly 03, pp 5–13.

Background notes

1. Deaths are classified according to the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD–10) (WHO 1992–1994). Injury and poisoning deaths are accidental or violent deaths that are attributed to external causes. They exclude those deaths that have disease and other internal conditions as their underlying cause. External cause of injury codes are taken from Chapter XX of ICD–10 (prefixes V01 to Y89).

2. This bulletin presents injury and poisoning data according to an internationally accepted standard framework, known as the International Collaborative Effort on Injury Statistics (ICE) matrix, specifically designed for presenting data on injury (McLoughlin et al. 1997; NCHS 2004). Two aspects of the cause of injury and poisoning deaths are captured by the ICD codes for the underlying cause of death. The first is the intent of the deceased, or third party (sometimes called manner of death) and includes accident, suicide, homicide, undetermined intent. The second is the mechanism of death and includes drowning, poisoning, suffocation, transport. Presenting information solely on either one of these masks important information on the other factor. Presentation of data using the ICE matrix allows easy access to information on both mechanism and intent. The ICE matrix shows the ICD–10 codes used in classifying deaths according to the matrix. The matrix is used in other countries and has been used to present international comparisons of injury mortality (Fingerhut et al. 1998). The matrix has been modified slightly to incorporate accelerated registration deaths (adjourned inquests pending further investigation) as 'probable homicides' in line with other ONS publications. From 2007 onwards, ONS has used ICD–10 code U50.9 for deaths with adjourned inquests. In the past, these deaths were coded to Y33.9. The principal reason for the change was to exclude these deaths from the Y10–Y34 range, making the tabulation of events of undetermined intent easier. Deaths from intentional self-harm have also been combined with deaths from injury or poisoning of undetermined intent to provide an estimate for suicide deaths in line with other ONS publications.

3. In this bulletin suicides (intentional self-harm and injury and poisoning of undetermined intent) include deaths at all ages unlike the ONS publication Suicide rates in the United Kingdom, 2010 which only includes suicides for adults aged 15 years and over.

4. Injury and poisoning deaths attributed to complications of medical and surgical care (Y40–Y84), sequelae with surgical and medical care (Y88), legal intervention or operations of war (Y35–Y36), sequelae of legal intervention (Y89.0) and sequelae of war operations (Y89.1) are not included in the analysis.

5. Since 1 January 2007, accelerated registrations that are not transport incidents have been assigned to code U50.9 (event awaiting determination of event), these would have previously been coded to Y33.9 (other specified events, undetermined intent). Most of these are eventually reassigned to assault (X85–Y09), but the delays before this happens can affect the published figures in the under estimation of deaths from assault (Rooney and Devis 1999). Accelerated registrations that are motor vehicle incidents are assigned to a code in the range V01–V89 (land transport accidents) if sufficient information is available on the coroner’s certificate of adjournment.

6. The majority of accidental deaths with an unspecified mechanism are thought likely to have been falls and thus the figures for falls presented here are probably an underestimate of the true contribution of falls to injury and poisoning mortality.

7. The statistics presented here are based on deaths registered in a reference year and may differ from any previously published data which was based on deaths that occurred in a calendar year.

8. The tables and figures are based on the final underlying cause of death. This takes account of additional information on the cause of death that becomes available after the death has been registered. Around 0.2 per cent of all deaths have their underlying cause amended.

9. The population estimates used for the calculation of mortality rates are the latest consistent estimates available at the time of production. Further information on population estimates and their methodology can be found on the ONS website.

10. The directly age-standardised mortality rates in this release are for all ages and are expressed per million population. They are directly age-standardised to the European Standard Population, which allow comparisons between populations with different age structures and over time.

11. Special extracts and tabulations of mortality data for England and Wales are available to order for a charge (subject to legal frameworks, disclosure control, resources and agreements of costs, where appropriate). Such enquiries should be made to:
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