A new report that identifies the most distinctive cause of injury death for each state, compared to national rates, has some findings that might be expected:
Seven states in Appalachia and the Southwest, for example, had unintentional firearms deaths roughly two to four times the national rate. Those states have high gun ownership rates and lack safe-storage laws.
Three states – Montana, South Dakota and Nebraska – had as their most distinctive injury motor vehicle crashes involving passengers. Four safety provisions – primary seatbelt laws, mandatory key ignition locks for drunk drivers, booster seats, and nighttime driving restrictions for teens – are absent in Montana, while South Dakota and Nebraska have only one each.
Connecticut had as its most distinctive cause of injury death “unintentional suffocation” – the only state with that outlier cause. The state’s rate was 1.3 times, or 30 percent higher than, the national average, according to the report in the journal Injury Prevention, led by researchers from Johns Hopkins Bloomberg School of Public Health.
The report analyzed data from 2004-2013 from the Centers for Disease Control and Prevention to identify one type of injury death for each state that was “disproportionately popular” -- with a rate that was the largest multiple of the U.S. rate.
While the report does not point to factors responsible for Connecticut’s relatively high suffocation rate, child health advocates say they suspect that unsafe sleeping conditions among infants, which led to a public health “alert” by the state’s Office of the Child Advocate in 2014 and other action, may be one factor.
Between 2002 and 2010, there were 211 infant deaths in Connecticut classified as due to SIDS (Sudden Infant Death Syndrome) or other undetermined causes, with at least 140 of those cases associated with unsafe sleep environments, such as infants in bed with adults, older children, or adult pillows and other large items, according to a report by the Child Advocate. In 2013 alone, 18 infants who died of SIDS or undetermined causes were found to have risk factors associated with their sleep environments.
Child Advocate Sarah Eagan said accidental asphyxiation from unsafe sleep practices remains a concern, with the state continuing to see 17 to 23 deaths per year of infants. “It remains definitely a high priority issue,” she said. “It’s still the leading cause of death of healthy infants in Connecticut” – higher than child abuse.
Eagan said the state has made strides to better educate parents about safe sleeping – passing legislation in 2015 that requires hospitals to disseminate materials to new parents about safe sleep practices. Also, the state Department of Children and Families for the past several years has instructed workers to counsel parents about safe sleep and distributes “Pack N’ Play” cribs to households lacking adequate sleeping arrangements.
Eagan said state agencies have been working recently to more broadly disseminate information on the issue through a variety of organizations.
A 2015 Fact Sheet by the Children’s Safety Network National Injury and Violence Prevention Resource Center lists suffocation as the leading cause of injury deaths of children ages 1-4 in Connecticut from 2008-2012. Suffocation also is listed as the fourth-highest cause of death among Connecticut children ages 5 to 9.
Sara Heins, lead author of the national injury study, said the suffocation rates cited in the report represent not just infants, but people of all ages. She noted that not all suffocation deaths are caused by unsafe sleeping, and that not all infant sleep deaths are classified as suffocation.
Heins said that most states have laws designed to reduce the risk of sudden unexpected infant deaths, through training, raising public awareness, and reporting. Many are more stringent than Connecticut’s 2015 law.
The injury study also calculates the “most frequent” injury death for each state, based on CDC data counts. In Connecticut and 28 other states, the most frequent cause is unintentional drug poisoning, or overdose. In four states – Alaska, Arkansas, Utah and Wyoming – suicide by firearm is the most frequent cause.
Heins and colleagues noted that while the distinctive injury rates are, by definition, high compared to the national average, they might actually account for a small number of fatalities.
The most frequent distinctive cause of injury death among all states was unintentional death by firearm. Five states clustered in the West – California, Oregon, Nevada, New Mexico and Utah -- had rates of “legal intervention” deaths – when police kill someone, or officers are killed in the line of duty – up to 3.5 times higher than the U.S. average.
For Maine, Rhode Island and eight other states, suicide – by falls, drowning and other means – was the category with the largest multiple of the national rate.
Rural states in the Midwest and West tended to have higher rates of vehicle, machinery and natural/environmental injury deaths.
Heins said she hoped the findings would help policymakers identify injuries that, while not the most burdensome, may warrant special prevention efforts.
“In states where injuries are distinctive due to differences in policy or culture, the results could be a useful tool for advocates who could assert, ‘Not only is this injury a problem, it is a problem that we as a state are distinctively bad at addressing,’” she said.