Health and Science

New Yorkers Brawl and Kentuckians Fall: How America Gets Hurt, State by State

Susan Rinkunas, news editor for Tonic, Vice's health channel
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People in Maine are more likely to break their ankles (ski crashes?) and residents of Oklahoma are more likely to sprain their rotator cuffs (too much lassoing?) compared with the rest of the United States. Those are some of the curious findings of a new analysis from healthcare-database site Amino.

After the company noticed that almost one out of six patients in its pool of data was diagnosed with an injury last year, they thought they'd look into how people are getting hurt. So they trawled electronic insurance claims data from 2012 to 2016 to determine which injuries are more common in each state compared to the national average.

Specifically, they looked at claims containing one of the 3,000 International Classification of Diseases, or ICD codes, for physical injuries alone (sprains, cuts, broken bones). The analysts grouped these into 170 sets and gave them common names (so, for instance, all 38 types of contusions became "bruising"). There were 244 million claims in Amino's database during that time period, including those injury code sets, and they figured out the distribution of the cases nationally and in each state. Then, the fun part: calculating which injuries were disproportionately more or less common in each state compared to nationwide rates.

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Because there are oh so many ways you can hurt yourself, no one injury accounts for more than 7 or 8 percent of the total diagnoses in any state. That said, the most common ones are pretty similar across the country: Bruising and open wounds or cuts are the the most frequent injury claim in every state except for Colorado, where residents are most likely to maim themselves as the result of a fall. The map of these findings is pretty boring, to say the least.'

But when they looked at the rates of injuries in each state compared to frequency nationwide, the data got a lot less homogeneous. The map below shows which injury code was the most disproportionately common in each state, compared to national averages.

For example, car accident injuries account for 1.5 percent of all injuries in the United States. In Tennessee, the rate is 2.5 percent, which is 1.6 times higher than the national frequency. That factor of 1.6 was the biggest of any injuries in Tennessee, so it goes on the map.

One trend they noticed immediately: The most disproportionate injury in six of the eight mountain states was suffocation, a broad category related to oxygen deficiency. Diagnoses related to suffocation were between 1.8 times and 3.1 times more common compared to national rates in Colorado, Idaho, Nevada, New Mexico, Utah, and Wyoming. They're not sure why this is but most of these diagnoses were for hypoxemia, or low blood oxygen, which can be caused by exertion at high altitudes where there's less oxygen.

Amino only looked at diagnoses that appeared on at least 1 percent of injury claims in each state as a way to exclude extreme outliers, but just for kicks, they loosened the standard to 0.1 percent to see what cropped up. They found that "near drowning" diagnoses in Hawaii, our island state, were 6.2 times the national average, and that claims related to "unarmed fight or brawl" were much higher in New York State. Nationwide, there were nearly 296,000 medically documented fights between 2012 and 2016 and 35,000 of them happened in New York, or 11.8 percent. They also observed that "animal-drawn vehicle accident" diagnoses, which include riding an animal, were disproportionately common in Idaho, Montana, Nebraska, North Dakota, and Wyoming.

Amino points out that this exercise shines a light on doctors' coding behavior in addition to state-by-state injury rates. That is, the data probably reflect the fact that doctors in different practices code diagnoses in a variety of ways, focusing on different details. But it nonetheless also surely captures some realities about the variability of state-by-state mishaps and risk-taking.