Violent injuries among adolescents: Declining morbidity and mortality in an urban population

Study objective: Adolescent homicide rates are decreasing nationally for un clear reasons. We explore changes in intentional injury morbidity and morta lity within the context of other injuries and specific causes. Methods: We performed surveillance of hospital, medical examiner, and vital records for nonfatal injury among adolescents age 10 to 19 years living in the District of Columbia from June 15, 1996, to June 15, 1998, and fatal i njury from 1989 to 1998. Results: Over the 2-year study period, 15,190 adolescents were seen for inj ury, resulting in an event-based rate of 148 injuries per 1,000 adolescents per year; 7% required hospitalization, and 0.8% died. Interpersonal intent ional injuries accounted for 25% of all injuries, 45% of hospitalizations, and 85% of injury deaths. Assault morbidity decreased with no change noted for unintentional and self-inflicted injury. Firearm injuries, stabs, and a ssaults with other objects showed the largest decrease, with no decrease in unarmed assaults. Injury mortality peaked in 1993 and has declined since. Firearms caused 72% to 90% of all injury deaths from 1989 to 1998, most the result of homicide. Conclusion: There has been a decline in intentional injury rates over the s tudy periods related to decreased weapon injury; data suggest a change in t he lethality of fighting methods but no change in unarmed fighting behavior .