Profile of Injury
In San Francisco
The San Francisco Injury Center
San Francisco Department of Public Health
December, 2004
Funded by a grant from the National Center for Injury Prevention and Control, CDC,
R49/ CCR903697- 15
UCSF San Francisco Injury Center Department of Public Health
To the People of San Francisco:
Good injury prevention programs are data- driven, which implies a partnership between
researchers and practitioners. The San Francisco Injury Center for Research and Prevention and
the San Francisco Department of Public Health continue their collaboration in producing this 5th
Edition of the Profile of Injury in San Francisco. This document provides injury data drawn
from death certificates and hospital discharge records for the year 2001, with specialized
information spanning the years 2000- 2002.
There are many people who work tirelessly for the prevention of injury and violence in San
Francisco. This Profile is designed to assist them, by highlighting data in four areas of particular
interest: 1) traffic- related injuries, with a focus on pedestrians, 2) falls, with a focus on our senior
residents, 3) drugs and other poisons, and 4) violent injuries. An additional chapter provides
contact information on agencies and organizations working to prevent injuries and violence in
San Francisco.
The authors and staff of the San Francisco Injury Center and the SF Department of Public Health
hope that this information will help to shape prevention programs, allocate scarce resources to
solvable problems, and make life healthier and safer for all San Franciscans.
M. Margaret Knudson, M. D. Mitchell H. Katz, M. D.
Professor of Surgery Director of Health
Director, San Francisco Injury Center City & County of San Francisco
Profile of Injury in San Francisco
Acknowledgements
This is the Fifth Edition of the Profile of Injury in San Francisco. As usual, it is the
product of the hard work of many, many people. Major responsibility was shared by six
people:
Elizabeth McLoughlin, ScD— Data analyst and primary author
Anna Zacher, MPH, SF Injury Center— SFIC Profile Manager and author of resources
chapter
Peg Skaj, BA, SF Injury Center— Producer
Michael Radetsky, MPH, SF Department of Public Health— SFDPH Profile Manager
and reviewer
Stan Sciortino, PhD, SF Department of Public Health— GIS map creator
Carolyn Klassen, PhD, SFVIRS— Author of report referenced in Violence Chapter: San
Francisco Department of Public Health, San Francisco Violent Injury Reporting System ( SFVIRS): Violent
Injuries and Deaths in 2001 and Firearm Trend Data from 1999 to 2001. Local Data for Local Violence
Prevention Tracking Violent Injuries and Deaths in San Francisco County. Spring, 2004.
Two additional people contributed data:
Jerry Robbins, Transportation Planner with the SF Department of Parking and Traffic,
who contributed data on vehicles registered in and entering/ leaving San Francisco for
the motor vehicle chapter
Susan Shallow, of the SF Department of Public Health, who contributed data from
Community Substance Abuse Services for the drug/ poisoning chapter
The Profile depends entirely upon data sets collected primarily for other purposes but
which are made available to us. Therefore, we would also like to recognize the many
people contribute to these data sets: health care providers and the Medical Examiner
who record useful patient information; data enterers and coders; quality assurers and
agency directors.
Of course, we also recognize that each number in this Profile represents a real human
being, who sustained an injury. It is to aid in the prevention of such suffering that we
present this Profile.
The authors want to acknowledge the contribution of many individuals without whom
this report could not have been produced, especially to those authors of previous
editions of the Profile: Connie Heye, MPH; Gregory Nah, MA; Jennifer Balogh, MPH;
and Mary Weitzel, JD, MPH. We are also extremely grateful to the directors of the two
partner institutions that provided essential funding and support: Margaret Knudson, MD,
SF Injury Center, and Mitchell Katz, MD at the SF Department of Public Health.
i
Profile of Injury in San Francisco
Table of Contents
Overview ........................................................................................... 1
Motor Vehicle & Traffic- related Injuries .............................................. 20
Falls................................................................................................... 43
Drug/ Poisoning- related Injuries ........................................................ 58
Violent Death & Injuries..................................................................... 68
Selected Injury Prevention Resources in San Francisco................... 82
ii
Profile of Injury in San Francisco
Figures and Tables
Overview
Figure 1. Leading Cause of Injury Death for San Francisco Residents, 2001 ............................... 4
Figure 2. Leading Mechanisms of Injury Hospitalization, San Francisco Residents, 2001............ 5
Figure 3. Injury Deaths by Intentionality, San Francisco Residents, 2001 ..................................... 6
Figure 4. Injury Hospitalizations by Intentionality, San Francisco Residents, 2001 ....................... 7
Figure 5. Residency and Injury Data Deaths .................................................................................. 8
Figure 6. Residency and San Francisco Injury Data: Hospitalizations.......................................... 9
Figure 7. Residency and Mechanism of Injury: Deaths ................................................................. 10
Figure 8. Residency and Mechanism of Injury: Hospitalizations ................................................... 11
Figure 9. Residency and Intent of Injury Deaths............................................................................. 12
Figure 10. Residency and Intent of Injury Hospitalization ................................................................ 12
Figure 11. Residency and Age Groups Deaths ................................................................................ 13
Figure 12. Residency and Age Groups Hospitalizations .................................................................. 14
Figure 13. Access to Medical Care for Deceased by intent of Injury................................................ 14
Figure 14. Medical Care by Mechanism, Deaths occurring in San Francisco, 2001........................ 15
Figure 15. Injury Death by Age & Sex, San Francisco Residents, 2001 .......................................... 16
Figure 16. Injury Death Rates by Age & Sex, San Francisco Residents, 2001................................ 17
Figure 17. Injury Hospitalizations by Age & Sex, San Francisco Residents, 2001 .......................... 18
Figure 18. Injury Hospitalizations: Rates by Age and Sex............................................................... 19
Motor Vehicle & Traffic- related Injuries
Figure 19. Vehicles in San Francisco ............................................................................................... 21
Figure 20. Daily Number of Vehicles Coming into San Francisco.................................................... 22
Figure 21. Deaths from Motor Vehicle Crashes in San Francisco, 2001 ......................................... 23
Figure 22. Hospitalizations for Motor Vehicle Crashes, San Francisco, 2001 ................................. 24
Figure 23. Persons Injured in Car Crashes in San Francisco, 2000- 2002....................................... 25
Figure 24. Severity of Injury in Motor Vehicle Crashes, San Francisco ........................................... 26
Figure 25. Ten Year Trend by Travel Type....................................................................................... 27
Figure 26. Severity of Pedestrian Injuries in San Francisco, 2000- 2002 ......................................... 30
Figure 27. Pedestrian Deaths by Age in San Francisco, 2000- 2002 ............................................... 31
Figure 28. Pedestrian Injuries to Children < 18 Years, 2000- 2002, 7: 00 AM to 5: 00 PM – January
2000 to December 2002 .............................................................................................. 32
Figure 29. Pedestrian Injuries among Seniors 65+ Years, 2000- 2002 ............................................ 33
Figure30. San Francisco Neighborhood Map: Vicinity of the Tenderloin and South of Market
Pedestrian Injuries in 2000- 2002.................................................................................... 34
Figure 31. San Francisco Neighborhood Map: Vicinity of Inner Mission & Potrero Hill, Pedestrian
Injuries in 2000- 2002..................................................................................................... 35
Figure 32. San Francisco Neighborhood Map: Vicinity of Bayview, Ingleside & Excelsior,
Pedestrian Injuries in 2000- 2002................................................................................... 36
Figure 33. San Francisco Neighborhood Map: Vicinity of Haight- Ashbury & Western Addition
Pedestrian Injuries in 2000- 2002................................................................................... 37
Figure 34. San Francisco Neighborhood Map: Vicinity of Richmond District Pedestrian Injuries
in 2000 – 2002............................................................................................................... 38
Figure 35. San Francisco Neighborhood Map: Vicinity of the Sunset District Pedestrian Injuries
in 2000- 2002.................................................................................................................. 39
Figure 36. Alcohol- related Pedestrian Injuries, 2000- 2002 .............................................................. 41
Figure 37. Location of Alcohol Outlets ( non- Restaurant), 2001 ....................................................... 42
Table 1. Pedestrian Deaths by Location, 2000- 2002 ....................................................................... 40
iii
Profile of Injury in San Francisco
iv
Figures and Tables ( continued)
Falls
Figure 38. Causes of Fatal Falls, 2001............................................................................................ 44
Figure 39. Causes of Falls- related Hospitalizations, 2001 .............................................................. 45
Figure 40. Hospitalization due to Falls, by Age Group and Sex, San Francisco Residents, 2001 . 46
Figure 41. Rate of Hospitalization for Falls Injuries San Francisco Residents, 2001...................... 47
Figure 42. Zipcode of Residence of Patients Hospitalized for Falls, 2001 ...................................... 49
Figure 43. Seniors’ Leading Cause of Injury Death, San Francisco Residents, 65+ Years, 2001.. 50
Figure 44. Seniors’ Leading Cause of Hospitalization San Francisco Residents, 65+ Years,
2001........................................................................................................................... .. 51
Figure 45. Causes of Non- fatal Falls Among Seniors Aged 65+, 2001
Figure 46. Injury Deaths Among Seniors, San Francisco Residents 65+ Years of Age, 2001 ....... 54
Figure 47. Hospitalizations for Seniors by “ Intent” San Francisco Residents > 64 Years of
Age, 2001 .................................................................................................................... 55
Figure 48. Length of Hospital Stay After a Fall Among Seniors Age 65+, 2001.............................. 56
Figure 49. Discharge of Patients, Ages 65- 84, 2001....................................................................... 57
Figure 50. Discharge of Patients, Ages 85+, 2001 .......................................................................... 57
Table 2. Zipcode of Residence of Patients Hospitalized for Falls by Age Group, 2001................ 48
Drug/ Poisoning- related Injuries
Figure 51. Drug/ Poisoning- related Deaths by Intent ........................................................................ 59
Figure 52. Hospitalization by Intent for Drug/ Poisoning- related Injuries .......................................... 60
Figure 53. Drug/ Poisoning- related Deaths by Age & Intent.............................................................. 61
Figure 54. Drug/ Poisoning- related Hospitalizations by Age & Intent................................................ 62
Figure 55. Drug/ Poisoning Deaths occurring in San Francisco, 2001.............................................. 63
Figure 56. Substances Connected to San Francisco’s Substance Abuse Treatment, FY
2003- 2004 65
Table 3. Hospitalizations for Drug Overdose/ Poisoning, San Francisco, 1998............................ 64
Table 4. DAWN Emergency Department Data ............................................................................. 66
Violence
Figure 57. Violent Deaths, San Francisco Residents, 2001............................................................. 69
Figure 58. Hospitalizations for Violence, San Francisco Residents, 2001...................................... 70
Figure 59. Violent Deaths by Age Groups, 2001 ............................................................................. 71
Figure 60. Hospitalized Violent Injuries by Age Groups, 2001 ....................................................... 72
Figure 61. Data Comparison........................................................................................................... 73
Figure 62. Number of Homicide Victims ( Residents and Non- residents) in San Francisco
County from 1942 to 2002........................................................................................... 75
Figure 63. Annual Number of Handguns Purchased in California, by the San Francisco and
California Crude Homicide Rates from 1982 to 2002 ............................................... 76
Table 5. Mechanisms of Violent Death ........................................................................................ 69
Table 6. Mechanisms of non- fatal violent injury resulting in hospitalization................................. 70
Table 7. Age Groups for violent deaths........................................................................................ 71
Table 8. Age groups for violent non- fatal injury resulting in hospitalization ................................. 72
Table 9. Number of Violent Incidents and Fatal and Nonfatal Violent Injuries, San Francisco
2001........................................................................................................................... .. 74
Table 10. Length of Hospitalization by Outcome at San Francisco General Hospital, 2001........ 78
Table 11. Length of Hospitalization in Days for Assault Victims by Mechanism of Injury:
San Francisco, 2001.................................................................................................... 78
Table 12. Suicide by Mental Health Status, Intent and Circumstances, by Gender and Age
Group: San Francisco, 2001 ...................................................................................... 80
Profile of Injury in San Francisco Overview
Overview
1
Profile of Injury in San Francisco Overview
Injury Facts at a Glance, San Francisco, Year 2001
Number of injury deaths: 542
Residents killed in San Francisco: 400
Residents killed elsewhere: 61
Visitors killed in San Francisco: 81
Because rates must be calculated using known populations, such as the resident
population of the city of San Francisco, the following rates include San Francisco
residents killed in San Francisco or elsewhere in 2001 but exclude visitors who
were killed in San Francisco.
Age- adjusted injury mortality rate per 100,000 residents* for 461 residents:
55.1
Age- adjusted injury mortality rate per 100,000 residents for four leading
injury mechanisms:
Drugs & other poisonings 16.9
Falls 7.5
MV Traffic 6.8
Firearms 6.5
All others 16.7
Age- adjusted injury mortality rate per 100,000 residents for “ intent of
injury” categories:
Unintentional 33.3
Suicide 12.1
Homicide 8.0
Injury mortality rate per 100,000 San Francisco residents by age group:
Male Female Combined
0- 4 ** ** **
5- 14 ** ** 11.2
15- 24 78.2 15.7 47.0
25- 34 57.6 18.8 39.4
35- 44 93.4 41.7 70.3
45- 54 108.7 48.5 79.8
55- 64 109.1 39.2 73.5
65- 74 48.8 34.0 40.8
75- 84 174.9 102.2 131.8
85+ 321.3 253.3 253.0
* Age- adjusted rates are standardized using the population of San Francisco
from the year 2000 United States census data.
** In cells with fewer than 5 deaths, rates were not calculated. Numbers in these
categories were: 0- 4 Male ( 2), Female ( 0); 5- 14 Male ( 4), Female ( 3).
2
Profile of Injury in San Francisco Overview
Number of non- fatal injury- related hospital discharges: 8,037
Residents hospitalized in San Francisco: 5,047
Residents hospitalized elsewhere: 627
Visitors hospitalized in San Francisco: 2,363
Because rates must be calculated using known populations, such as the resident
population of the city of San Francisco, the following rates include San Francisco
residents hospitalized in San Francisco or elsewhere in 2001 but exclude visitors
hospitalized in San Francisco.
Age- adjusted injury- related hospitalization rate per 100,000 residents* for
5,674 residents: 695.5
Age- adjusted injury- related hospitalization rate per 100,000 residents for
eight leading injury mechanisms:
Falls 313.7
Drugs & other poisonings 81.0
MV Traffic 72.5
Cut/ pierce 36.9
Struck by 34.5
Nature 14.9
Fire/ burn 14.3
Over- exertion 10.9
Age- adjusted injury hospitalization rate per 100,000 residents for “ intent of
injury” categories:
Unintentional 575.1
Assault 61.2
Self- inflicted 54.5
Injury hospitalization rate per 100,000 San Francisco residents by age
group:
Male Female Combined
0- 4 411.7 325.6 369.9
5- 14 298.3 203.1 251.7
15- 24 742.2 331.4 537.0
25- 34 510.1 276.7 400.2
35- 44 671.2 360.6 532.1
45- 54 739.3 459.4 605.3
55- 64 769.7 662.8 715.3
65- 74 919.3 1041.6 981.2
75- 84 2034.5 2925.1 2562.7
85+ 5095.2 6575.5 6122.2
* Age- adjusted rates are standardized using the population of San Francisco
from the year 2000 United States census data.
3
Profile of Injury in San Francisco Overview
Mechanisms of Death by Injury
In 2001, 461 San Francisco residents died as a result of injury. This is 19 more
than the 442 injury deaths in 1998 ( the year highlighted in the 4th Edition of this
Profile).
Source: CDHS ( 2003)
Leading Cause of Injury Death
for San Francisco Residents, 2001
N= 461
Other 19% Drugs/ Poison 32%
Fire/ Burn 3%
Suffocation 9%
MV Traffic 12% Firearms 11%
Falls 14%
Figure 1.
Drugs and other poisonings, primarily drug overdose, were the leading mechanism of
injury deaths among San Franciscans in 2001.
Injuries are often classified by the object or mechanism that caused the injury.
By order of magnitude, the leading causes of injury death in San Francisco in
2001 were drugs and other poisonings ( 149 deaths), motor vehicles ( 56 deaths),
falls ( 64 deaths), firearms ( 51 deaths), suffocation ( 42 deaths), and fire/ burns ( 15
deaths). The “ other” category includes cut/ pierce injuries ( such as from a knife),
drowning, natural and environmental causes, being struck by a blunt instrument,
and “ other and unspecified” causes as reported in the original death records.
4
Profile of Injury in San Francisco Overview
Mechanism of Non- Fatal Injury Requiring Hospitalization
In 2001, there were 5,674 injury- related hospital discharges of San Francisco
residents, 508 fewer than the 6,182 that occurred in 1998. This may represent
changes in hospital admission policies or treatment protocols, rather than
numbers of injuries sustained and treated.
It is important to recognize that these are hospital discharge records. Scheduled
admissions, which suggest that the condition was not acute, accounted for 11%
of the total in 2001. It is extremely difficult to determine if these discharges were
for the same or different injury causing incidents. Therefore, we included all
discharge records, a practice that we followed in previous editions of the Profile.
Source: OSHPD ( 2003)
Leading Mechanisms of Injury Hospitalization
San Francisco Residents, 2001
N= 5,674
Other 31% Poison/ Drugs 12%
Falls 46%
MV Traffic 11%
Figure 2.
Falls accounted for almost half of all injury related hospital discharges among San
Francisco residents in 2001.
The leading causes of injury hospitalization differ from those of injury deaths.
Falls accounted for almost half of all injury- related hospital discharges. Among
all fall patients, 69% ( 1,781) were 65 years of age or older. Drugs & other
poisonings were the second leading cause of hospitalization ( n= 665), and motor
vehicle crashes were the third leading cause ( n= 597). None of the other
mechanisms account for more than 10% of injury hospitalizations apiece.
Included in the “ other/ unspecified” category are hospitalizations resulting from
cut/ pierce injuries ( such as from a knife), being struck by a blunt instrument,
fire/ burn, firearms, non- traffic bicycle or pedestrian injury, suffocation, drowning,
natural or environmental causes, machinery and other unspecified causes.
5
Profile of Injury in San Francisco Overview
Reported Intentionality in Fatal Injury
Injuries are classified by intentionality as well as by mechanism. Injuries that are
determined to be purposefully inflicted are considered intentional injuries, while
those traditionally called “ accidents” are labeled unintentional injuries. Intentional
injuries are either self- inflicted ( suicides and suicide attempts) or inflicted by
another ( homicides and assaults). With regard to intent, injuries are classified as
“ other” when they are caused by legal intervention ( such as a police action), war,
or when, in the case of a death, the intent is judged “ undetermined” by a medical
examiner or coroner.
Determining intentionality of fatal injury can be problematic. The deceased is not
able to reveal intent, and family and friends may be unwilling or unable to answer
questions about the circumstances surrounding the event. This may lead to
intentional injury deaths being misclassified as unintentional, but it is rare that
unintentional injuries are coded as intentional.
Source: CDHS ( 2003)
Injury Deaths by Intentionality
San Francisco Residents, 2001
N= 461
Unintentional 61%
Suicide 23%
Homicide 14% Undetermined 2%
Figure 3.
In 2001, a smaller percentage of deaths was judged to be unintentional than in
1998 ( 61% vs. 66.8%), but a larger proportion was judged to be suicide ( 23% vs.
21%). This shift may be due to how the intentionality of drug overdose deaths is
determined. Medical examiners make judgments about intent based on direct
evidence left by the deceased, from interviews with family and friends, or police
observations. Given the complexity of determining intent in drug overdose
deaths, one should be cautious about identifying trends in intentionality of injury
deaths in San Francisco.
6
Profile of Injury in San Francisco Overview
Reported Intentionality in Non- Fatal Injury Requiring
Hospitalization
As with fatal injuries, caution should be exercised in determining the intentionality
of injuries requiring hospitalization. A health care provider treating a patient’s
injuries has limited time to collect a detailed history of the circumstances
surrounding the injury event, and patients may not voluntarily disclose that an
injury was intentional because of fears about the legal or personal consequences
of telling a health care provider.
Source: OSHPD ( 2003)
Injury Hospitalizations by Intentionality
San Francisco Residents, 2001
N= 5,674
Unintentional 82%
Self- inflicted 8%
Assault 9% Other 1%
Figure 4.
The vast majority of injuries requiring hospitalization were classified as unintentional,
which is similar to the distribution in 1998.
Despite the difficulties in determining intent, it is of utmost importance that health
care providers attempt to reliably identify and document injuries caused by the
abuse of a child, intimate partner or elder. Training medical professionals to
identify and document abuse will provide better services for abused patients and
more accurate data to document the problem of intentional, non- fatal injuries.
7
Profile of Injury in San Francisco Overview
Residency and San Francisco Injury Data: Deaths
San Francisco is a favorite tourist destination and an employment hub for the
Bay Area. These characteristics complicate the injury profile because there are
three distinct groups to consider: SF residents killed in San Francisco, visitors
killed in San Francisco, and SF residents killed elsewhere. Below is the
distribution of these three groups; one pie chart considers all residents, and the
other represents all deaths that occurred in San Francisco.
Source: CDHS ( 2003)
Residents in SF SF travelers Residents in SF Visitors
13%
87%
17%
83%
Among SF Residents Occurring in SF
Residency and Injury Data
Deaths
Figure 5.
Residents in SF: Residents who lived and died in San Francisco ( n= 400)
SF Travelers: Residents who lived in San Francisco but died outside San Francisco ( n= 61)
Visitors: Non- residents who died in San Francisco ( n= 81)
In 2001, a total of 542 people, who were residents of or visitors to San Francisco,
died from injuries. Four hundred of those were SF residents who died of injury in
San Francisco; 81 were visitors from other counties or states who were fatally
injured in San Francisco, and 61 were SF residents who died while traveling
outside of San Francisco. The following pages discuss the differences in injury
events among these three groups.
When calculating rates, one must use a known denominator, such as the
population of San Francisco. Therefore, all residents, regardless of where they
were injured, must be included in rate calculations. On the other hand, many city
services, including trauma centers, fire and police, are most interested in the
injuries that occur in SF, regardless of residency. However, visitors cannot be
included in rates because they are not San Francisco residents. Therefore,
whenever rates are presented, they include all SF residents but not visitors.
8
Profile of Injury in San Francisco Overview
Residency and San Francisco Injury Data:
Hospitalizations
Residency complicates the profile of non- fatal injuries requiring hospitalization.
Almost one- third of all injury patients in San Francisco hospitals are residents of
other jurisdictions, while a much smaller percentage of SF residents are treated
outside of San Francisco.
Source: OSHPD ( 2003)
Residents in SF SF travelers Residents in SF Visitors
11%
89%
32%
68%
Among SF Residents In SF hospitals
Residency and Injury Data
Hospitalization
Figure 6.
Residents in SF: Residents hospitalized in San Francisco ( n= 5,047)
SF Travelers: Residents hospitalized outside San Francisco ( n= 627)
Visitors: Non- residents hospitalized in San Francisco ( n= 2,363)
In 2001, 8,037 people, who were residents of or visitors to San Francisco, were
hospitalized for non- fatal injuries. Of those, 5,047 were San Francisco residents
who were hospitalized in San Francisco; 2,363 were people from other
jurisdictions but who were hospitalized in San Francisco ( some may have been
transferred into San Francisco after an injury), and 627 San Francisco residents
were hospitalized elsewhere when traveling outside San Francisco.
When rates of hospitalization for injury are calculated, they do not reflect the
injury burden of the visitors who were hospitalized in San Francisco. Remember
that we can only calculate rates for SF residents because we do not have
accurate numbers of visitors.
9
Profile of Injury in San Francisco Overview
Residency and Mechanism of Injury: Deaths
Source: CDHS ( 2003)
Residency and Leading Mechanisms of
Injury Death
0
5
10
15
20
25
30
35
40
% of deaths in category
Poison
Fall
Firearm
MVT
N= 400 N= 81
N= 461
SF Residents in SF Visitors SF Travelers
N= 61
Figure 7.
Poisoning ( primarily drug overdose) is the most common injury death for
residents in San Francisco. Drug overdoses seem to be a lesser but still leading
problem for visitors but are even less of a problem for SF travelers.
The reverse situation holds for residents and visitors in motor vehicle traffic
( MVT) crashes. Proportionately, traffic- related death is the greatest injury risk for
SF travelers. This makes sense since travelers tend to spend time in motor
vehicles. It is less clear why MVT crashes kill a greater of proportion of visitors
than SF residents in San Francisco. One possible explanation is that visitors to
SF, like SF travelers are more likely to be in motor vehicles and more likely to be
pedestrians than SF residents. Also it may be due to the presence of the
Trauma Center at San Francisco General Hospital ( SFGH). Seven deaths of
“ visitors” injured in MVT crashes occurred at SFGH, but the data do not indicate
whether the crash occurred in San Francisco or whether the crash occurred
elsewhere, but the patient was transferred to SFGH. Police data ( SWITRS) does
not provide information on the residence of those killed in crashes in San
Francisco.
Firearm injury does not appear to be a high risk for SF travelers. Proportionally, it
is slightly higher for visitors than residents in SF.
The percentages of deaths due to falls range from 10% to 15% across the three
categories. Residents in SF and SF travelers suffer from slightly more falls than
do visitors.
10
Profile of Injury in San Francisco Overview
Residency and Mechanism of Injury: Hospitalization
Source: OSHPD ( 2003)
Residency and Mechanism of Injury
Hospitalizations, 2001
0
10
20
30
40
50
60
Residents Visitors Travelers
Drugs
Fall
Firearm
MVT
Other
N= 5,047 N= 2,363 N= 627
Figure 8.
While falls account for almost half of all non- fatal hospitalizations of SF residents
in San Francisco, they account for less than one quarter of hospitalizations
among visitors. This could be due to age differences among the groups, such as
if visitors are younger and thus less likely to fall, or the result from hospital
transfer policies. In general, if taken as a group, SF travelers are probably older
than visitors but younger than non- traveling residents.
MVT- related hospitalizations follow the same trend as for deaths. There are
proportionally more for travelers, fewer for visitors and even fewer still for non-traveling
residents.
The pattern of hospitalizations due to drugs is very different from that of drug-related
deaths. Drugs account for about 10% of hospitalizations in each of the
three groups.
Included in the “ other/ unspecified” category are hospitalizations that resulted
from cutting/ piercing, struck by a blunt instrument, natural and environmental
causes, fire/ burn, firearms, non- traffic bicycle and pedestrian, suffocation,
drowning, machinery and other unspecified causes.
11
Profile of Injury in San Francisco Overview
Residency and Intent of Injury
Source: CDHS ( 2003)
Residency and Intent of Injury
Deaths
0
10
20
30
40
50
60
70
80
SF Residents in
SF
Visitors SF Travelers
Unintent
Suicide
Homicide
Undeterm
N= 400 N= 81 N= 61
Source: OSHPD ( 2003)
Residency and Intent of Injury
Hospitalization
0
10
20
30
40
50
60
70
80
90
% hospitalizations
Residents Visitor Traveler
Unintent
Self- inflicted
Assault
Undeterm
N= 5,047 N= 2,363 N= 627
Figures 9 & 10.
The relationship between residency and the intentionality of an injury is not as
striking as it is for the leading mechanisms of injury. However, there are two
notable correlations. Both homicides and assaults are proportionally higher for
visitors than for residents. On the other hand, suicide and self- inflicted injury are
proportionally higher for residents than for visitors.
12
Profile of Injury in San Francisco Overview
Residency and Age Groups
Source: CDHS ( 2003)
Residency and Age Groups Deaths
0
10
20
30
40
50
60
70
% deaths
SF Residents in SF Visitors SF Travelers
0- 14
15- 24
25- 64
65+
N= 400 N= 81 N= 61
Source: OSHPD ( 2003)
Residency and Age Groups
Hospitalizations
0
10
20
30
40
50
60
70
% of hospitalizations
Residents Visitors Travelers
0- 14
15- 24
25- 64
65+
N= 5,047 N= 2,363 N= 627
Figures 11 & 12.
Very few children under the age of 14 died of injury. Of the 12 who died of injury,
8 were SF residents in San Francisco, 3 were visitors and 1 was a SF traveler.
Seniors have almost as many hospitalizations as adults aged 25- 64 years, even
though there are over three times more adults than seniors in the population.
13
Profile of Injury in San Francisco Overview
Access to Medical Care: the Effect of Intent of Injury
Source: CDHS ( 2003)
Access to Medical Care for Deceased
by Intent of Injury
0
10
20
30
40
50
60
70
80
90
% deaths
Unint Suicide Homicide Undeter
No Care
Emerg
In- patient
N= 292 N= 109 N= 70 N= 10
Cases includes 481 injury deaths occurring in San Francisco, 2001
Figure 13.
For all intent categories, over half of the deceased never received any form of
medical care. This is most pronounced for suicide, where over four- fifths of all
suicides were completed before help could be summoned. Homicide victims
more frequently reached an emergency department, but many died before
admission. Those sustaining unintentional injuries were most likely to reach a
hospital and be admitted, even though they did not survive their injuries.
Therefore, this chart testifies most strongly to the importance of primary
prevention, regardless of intent.
1 4
Profile of Injury in San Francisco Overview
Access to Medical Care: the Effect of Injury Mechanism
Source: CDHS ( 2003)
0
10
20
30
40
50
60
70
80
90
Poison MV Traffic Fall Firearm
No Care
In- patient
Emerg
N= 171 N= 77 N= 72 N= 63
Cases includes 383 of the 542 injury deaths involving San Francisco
Medical Care by Mechanism
Deaths occurring in San Francisco, 2001
Figure 14.
Over 80% of those who died from a drug overdose or other poisoning never
received any form of medical care. The same is true for about two- thirds of those
who were shot with firearms. Again, these numbers testify to the importance of
primary and secondary injury prevention, particularly in the areas of drugs and
firearms.
In stark contrast, almost 70% of the people whose death resulted from a fall died
after admission to a hospital. The swift response of Emergency Medical Services
in San Francisco probably accounts for the percentage of victims of motor
vehicle crashes who receive care, even though many do not survive their injuries.
15
Profile of Injury in San Francisco Overview
Injury Deaths: Counts by Age and Sex
Source: CDHS ( 2003)
Injury Death by Age & Sex
San Francisco Residents, 2001
0
20
40
60
80
100
0- 4
5- 14
15- 24
25- 34
35- 44
45- 54
55- 64
65- 74
75- 84
85+
Number of deaths
Male Female
N= 461
Figure 15.
Age 0- 4 5- 14 15- 24 25- 34 35- 44 25- 55 55- 64 65- 74 75- 84 85+
Female 0 3 7 16 25 25 13 10 23 25
Male 2 4 35 55 69 61 35 12 27 14
Nine San Franciscan children under the age of 15 died from an injury in 2001.
Overall, for most of the life span, deaths among males outnumber those among
females 68% to 32%. Only after the age of 85 do deaths among females
outnumber those among males, which may be due to the fact that the population
of women outnumbers that of men at that age.
1 6
Profile of Injury in San Francisco Overview
Injury Deaths: Rates by Age and Sex
Source: CDHS ( 2003)
Injury Death Rates by Age & Sex
San Francisco Residents, 2001
0
50
100
150
200
250
300
350
0- 4 5- 14 15- 24 25- 34 35- 44 45- 54 55- 64 65- 74 75- 84 85+
rate per 100,000
Male Female
N= 461; * = fewer than five deaths, thus rate not calculated
Figure 16.
Age 0- 4 5- 14 15- 24 25- 34 35- 44 25- 55 55- 64 65- 74 75- 84 85+
Female * * 16 19 42 49 39 34 102 253
Male * * 78 58 93 109 109 49 175 321
Injury death rates are higher for males than females in all age groups. While
more women than men aged 85+ die of injury, the injury rates for males are
higher because there are far fewer males than females who live beyond the age
of 85.
For both sexes, injury death rates spike for seniors. The rate for women 85+
years old is six times that for women aged 55- 64. For men over the age of 85,
the injury death rate is three times that for men aged 55- 64.
17
Profile of Injury in San Francisco Overview
Injury- related Hospitalizations: Counts by Age and Sex
Source: OSHPD ( 2003)
Injury Hospitalizations by Age & Sex
San Francisco Residents, 2001
0
200
400
600
800
1000
1200
0- 4 5- 14 15- 24 25- 34 35- 44 45- 54 55- 64 65- 74 75- 84 85+
# hospitalizations
Male Female
N= 5,674
Figure 17.
Age 0- 4 5- 14 15- 24 25- 34 35- 44 25- 55 55- 64 65- 74 75- 84 85+
Female 50 62 148 235 216 237 220 298 658 649
Male 67 95 332 487 496 415 247 226 314 222
Overall, injury- related hospitalizations among males outnumber those of females
( 51% versus 49%). However, the percentages vary dramatically between age
groups. For example, up until age 64, males outnumber females. However, in the
senior age groups, and most strikingly among older seniors, females outnumber
males.
1 8
Profile of Injury in San Francisco Overview
19
Injury- related Hospitalizations: Rates by Age and Sex
Source: OSHPD ( 2003)
Injury Hospitalizations Rates
by Age & Sex
San Francisco Residents, 2001
0
1000
2000
3000
4000
5000
6000
7000
8000
0- 4 5- 14 15- 24 25- 34 35- 44 45- 64 55- 64 65- 74 75- 84 85+
Rate per 100,000
Male Female
N= 5,674
Figure 18.
Age 0- 4 5- 14 15- 24 25- 34 35- 44 45- 54 55- 64 65- 74 75- 84 85+
Female 326 203 336 280 367 465 678 1042 3023 6869
Male 412 305 751 515 685 766 810 980 2164 5600
The graph of the rates of injuries requiring hospitalization reflects the same
pattern as that for deaths regarding sex: males have higher rates of
hospitalization than females through age 64. Then the rate lines cross, but the
rates for both male and female seniors still rise precipitously. The rate for women
over 85 years old is ten times that of women aged 55- 64 years. For men over
age 85, the rate of hospitalization due to injury is seven times that of men aged
55- 64.
Profile of Injury in San Francisco Motor Vehicle & Traffic- related Injuries
20
Motor Vehicle & Traffic- related Injuries
Summary
San Francisco is a completely urban county; the county and city are one and the same.
As is true in many large American cities, the predominant motor- vehicle- traffic- related
( MVT) injury risk in San Francisco is to pedestrians.
In 2001, pedestrians accounted for one half ( 20 of 40) of the MVT deaths occurring in
San Francisco, although not all were residents. Vehicle occupants accounted for 16
deaths, of which seven were on a motorcycle. Four deaths were sustained by
bicyclists.
There were 748 hospital discharges coded as MVT injuries. Of these, 290 were
occupants of vehicles, 264 were pedestrians, 121 involved motorcyclists, and 46 were
bicyclists. The circumstances were unspecified in 27 other hospitalizations.
Police data from the Statewide Integrated Traffic Reporting System ( SWITRS) shows
that 6,535 persons were injured by MVT crashes in San Francisco. Among these
persons, 4% were severely injured or killed, 23% had other visible injuries, and 73%
complained of pain. Of the reported MVT crashes, 73% involved occupants of vehicles,
and only 14% were pedestrians. These data indicate that, while the most frequent
injuries in crashes are to vehicle occupants, it is the pedestrians who sustain the most
serious injuries.
This Profile presents data on the MVT injury problem in a variety of ways:
- a social math exercise focusing on the number of vehicles in San Francisco;
- graphs drawing upon data from the Statewide Integrated Traffic Reporting
System and hospital discharge record system;
- maps indicating where MVT injuries are occurring throughout the city.
Profile of Injury in San Francisco Motor Vehicle & Traffic- related Injuries
21
Social Math: Vehicles in San Francisco
There were approximately 469,000 vehicles registered in San Francisco in 2003.1 To
put that into perspective, assume that the average vehicle is 15’ 2” ( average length of
2003 model cars2, not including trucks or 18- wheelers). If that many cars were bumper-to-
bumper in a single file, the backup would stretch along highways from San Francisco
to Vail, Colorado. 3 The Department of Parking and Traffic has estimated that an
additional 35,400 vehicles enter San Francisco and are present in the city at noon on an
average business day. Then the backup would stretch from San Francisco to Mount
Rushmore, South Dakota. 3 CalTrans also has estimated that 435,000 vehicles drive into
or through San Francisco on an average 24 hour weekday ( although a similar number
also leave the city daily). 1 If vehicles registered in San Francisco were added to the
number of those coming into or through the city, the backup would stretch along
highways from San Francisco to Atlanta, Georgia. 3
San Francisco
Vail
Atlanta
Mount Rushmore
Figure 19.
Obviously, this would never happen in the real world.
However, this exercise illustrates why San Francisco’s
pedestrians have difficulty competing with traffic as
they attempt to cross streets and avenues.
Information sources:
1. Personal communication, DPT
2. Consumer Reports, April, 2003
3. Mileage Chart, AAA Atlas, 2005
Profile of Injury in San Francisco Motor Vehicle & Traffic- related Injuries
22
Figure 20.
Daily number of vehicles
coming into San Francisco
24- hour period on weekdays
Down from North Bay
across Golden Gate Bridge = 57,500
Across from
East Bay by
Bay Bridge
= 142,000
Up from South Bay
by 101 = 159,000
Up from South Bay
by 280 = 76,000
These are in addition to the 469,000 vehicles
registered to San Francisco residents and businesses.
Profile of Injury in San Francisco Motor Vehicle & Traffic- related Injuries
23
Motor Vehicle Traffic Deaths, 2001
Mode of Travel
Deaths from Motor Vehicle
Crashes in San Francisco, 2001
Bicyclist
10%
Motorcyclist
18%
Occupant
23%
Pedestrian
49%
Source: SWITRS ( 2003)
Figure 21.
Pedestrians account for half of the motor vehicle crash deaths in San Francisco.
In the United States, motor vehicle crashes are the leading cause of injury death. In
San Francisco, they rate as the second leading cause of injury death in 2001 after drugs
and other poisoning deaths. Of the 40 motor vehicle deaths in San Francisco in 2001,
20 were pedestrians, 7 motorcyclist, 9 vehicle occupants and 4 bicyclists.
Because vital statistics records are not specific about the mode of travel of the
deceased, we obtain that information from the Statewide Integrated Traffic Reporting
System ( SWITRS). These data include any deaths that occurred within 30 days of a
traffic crash that happened in San Francisco. Thus, these deaths include SF residents
and visitors who were injured in San Francisco but exclude MVT deaths of SF residents
who were injured while traveling outside the city.
Profile of Injury in San Francisco Motor Vehicle & Traffic- related Injuries
24
Hospitalizations for Motor Vehicle Injuries, 2001
Mode of Travel
Hospitalizations for Motor Vehicle
Crashes, San Francisco, 2001
Bicyclist
6% Motorcyclist
16%
Occupant
38%
Other
4%
Pedestrian
36%
Source: OSHPD ( 2003)
Figure 22.
Hospitalizations due to injuries from motor vehicle crashes predominantly involve pedestrians
and vehicle occupants.
In 2001, 748 hospital discharges were coded as non- fatal motor vehicle traffic injuries.
Of those discharge records, 290 involved occupants of motor vehicles, 264 were
pedestrians, 121 were motorcyclists and 46 involved bicyclists. Twenty- seven were
coded to unspecified circumstances.
SWITRS indicates that 6,535 persons were injured in 4,542 MVT crashes. However,
the majority of these persons were not hospitalized as a result of their injuries.
Profile of Injury in San Francisco Motor Vehicle & Traffic- related Injuries
25
Burden of Motor Vehicle Injuries and Deaths
San Francisco, 2000- 2002
Vehicle collisions during the three- year data period ( 2000- 2002) imposed a
considerable injury burden on the city of San Francisco. SWITRS data reflects the
extent of that burden, in terms of who was injured and the extent of their injuries.
Number of Injuries in Motor Vehicle Crashes, San Francisco
0
1000
2000
3000
4000
5000
6000
7000
# Injured
2000 2001 2002
Year
Persons Injured in Car Crashes in San Francisco,
2000- 2002
Bicyclist
Pedestrian
Passenger
Driver
Figure 23.
Year Driver Passenger Pedestrian Bicyclist
2000 3,580 2,017 1,005 360
2001 3,358 1,886 942 349
2002 3,275 1,749 937 313
Source: Annual Report of Fatal and Injury Motor Vehicle Traffic Collision ( Years 2000,
2001, 2002); CHP, Statewide Integrated Traffic Records System.
The vast majority of people injured in collisions are the occupants of the vehicles
involved. However, as is clear from the next graph, most of the injuries, such as
“ complaint of pain” or “ other visible injury,” are not considered severe. Fatal or severe
injuries occur in only a few collisions, but half of the fatal injuries are suffered by
pedestrians.
Profile of Injury in San Francisco Motor Vehicle & Traffic- related Injuries
26
Severity of Injury in Motor Vehicle Crashes, San Francisco
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
# Injured
2000 2001 2002
Year
Severity of Injury / Extent of Damage, San Francisco
2000- 2002
Fatal
Severe
Visible Injury
Pain
Figure 24.
Year Fatal Severe Injury Other visible
injury
Complaint of
Pain
2000 49 236 1,578 5,099
2001 40 232 1,497 4,766
2002 40 183 1,492 4,561
Source: Annual Report of Fatal and Injury Motor Vehicle Traffic Collision ( Years 2000,
2001, 2002); CHP, Statewide Integrated Traffic Records System.
Profile of Injury in San Francisco Motor Vehicle & Traffic- related Injuries
27
Traveler Type
Ten Year Trend by Traveler Type
0
10
20
30
40
50
60
70
93 94 95 96 97 98 99 00 01 02
YEAR
# deaths
Occupant Pedestrian Bicyclist Motorcyclist Total
Source: Statewide Integrated Traffic Record System ( 1993- 2002)
Figure 25.
Year Occupant Pedestrian Bicyclist Motorcyclist Total
93 16 28 2 8 54
94 26 29 4 5 64
95 23 30 3 7 63
96 21 21 3 6 51
97 13 30 4 8 55
98 21 32 2 5 60
99 14 26 1 7 48
00 12 33 2 2 49
01 9 20 4 7 40
02 16 21 1 2 40
Over the past decade, there has been a downward trend in the total number of people
killed in motor vehicle traffic crashes in San Francisco. While the average number of
total MVT deaths per year in the ‘ 90s ( 1993- 1999) was 56 deaths, the average for the
’ 00 ( 00- 02) was 42 deaths.
On the other hand, there is not a clear downward trend within each individual category
of MVT injuries. Even when the numbers have declined, they have often increased
again, indicating that there is still plenty of variability in the types of MVT injuries from
year to year.
Profile of Injury in San Francisco Motor Vehicle & Traffic- related Injuries
28
Costs Associated with Motor Vehicle Traffic Injury
San Francisco, 2000- 2002
It is impossible to assign a dollar value to the true burden of injury. As stated by the
Centers for Disease Control, 1 the list of costs not included in most estimates include
“ loss of patient and caregiver time, non- medical expenditures ( e. g., wheelchair ramps),
insurance costs, property damage [ included in DOT estimates below], litigation,
decreased quality of life, and diminished functional capacity. Long- term – non- injury
health consequences ( e. g., mental health- care costs) are another important
component…” However, policymakers must have some financial estimates of how
costly a certain condition is as they allocate scarce resources to address it.
The 2001 SWITRS report, Annual Report of Fatal and Injury Motor Vehicle Traffic
Collisions, provides a table that permits jurisdictions to estimate the costs of motor
vehicle crashes that occur within their boundaries. The following table uses these
SWITRS estimates to calculate a cost of motor vehicle crashes in San Francisco.
While the “ costs per” estimates by the U. S. Department of Transportation include
information on individual victims as well as collisions, data for the table below focus on
collisions rather than individuals. Thus, the estimates are conservative, since they do
not include multiple victims of a single collision. For example, in 2001, there were 39
fatal collisions that involved 40 deaths, and 6,535 persons were injured in 4,542
crashes. However, this table is calculated using collisions rather than injuries for 2001.
# Collisions Cost per Totals
Fatal 125 $ 2,709,000 $ 338,625,000
Severe 599 $ 188,000 $ 112,612,000
Visible Injury 4024 $ 38,000 $ 152,912,000
Pain 9011 $ 20,000 $ 180,220,000
Property only 10131 $ 2,000 $ 20,262,000
Total $ 804,631,000
Source of SWITRS cost estimates: U. S. Department of Transportation, Federal Highway Administration,
October 31, 1994, “ Technical Advisory on Motor Vehicle Accident Costs. Costs have been updated to
2001 dollars using the Gross Domestic Product ( GDP) figure provided by the U. S. Department of
Commerce- Bureau of Economic Analysis.
Because of the high population density and the other unique characteristics of San
Francisco, there is an extremely high rate of pedestrian death and injuries. For that
reason, the remainder of this chapter will be devoted to pedestrian issues.
1 Morbidity and Mortality Weekly Report on “ Medical Expenditures Attributable to Injuries – United States,
2000”, ( January 16, 2004/ Vol. 53/ No. 1)
Profile of Injury in San Francisco Motor Vehicle & Traffic- related Injuries
29
Pedestrian Injuries and Deaths
San Francisco is considered the " air- conditioned city," with a range of average
temperatures between 48° and 65°, relative humidity averaging between 84% in the
morning and 62% in the afternoon and 20 inches annual rainfall — perfect weather for
walking. It is organized informally into 15 neighborhoods, with stores within easy
walking distance from the majority of residences. It has many parks where residents of
all ages can play, walk or sit on the grass. Public transportation systems allow people to
move around the city without using a car.
At the same time, San Francisco copes with about 900,000 vehicles: 435,000 come in
and out daily and 469,000 are registered to San Francisco residents and businesses.
These vehicles compete with pedestrians for space on San Francisco roads as they
drive along city streets to get to work places, schools, shopping areas, sports
complexes, restaurants, theaters, museums or hundreds of other destinations. The
major corridors in the city have extremely high traffic volumes, and, not surprisingly,
very high rates of pedestrian deaths and injuries. ( See map and note on next page.)
The Department of Parking and Traffic reports yearly fluctuations in pedestrian injuries
and deaths over the past decade, ranging from a high of 32 deaths in 1998 to a low of
16 deaths in 2001. The trend over these years peaked in the later-‘ 90s and has
decreased in recent years.
Several city departments are working to address pedestrian injury risk by collaborating
on pedestrian safety programs, using the three " E" s: engineering, education and
enforcement. These programs are listed in the section on community resources.
Profile of Injury in San Francisco Motor Vehicle & Traffic- related Injuries
30
Severity of Pedestrian Injuries in San Francisco, 2000- 2002
Figure 26.
This map displays where pedestrian injuries and deaths occurred in San Francisco
over a three- year period ( 2000- 2002). Clearly, the densest area of injury is the
downtown, on both sides of Market Street. However, the city streets bearing traffic
along commute routes are perilous as well. Commute traffic pours along the streets
south of Market from and to the approaches to the Bay Bridge and Highways 280 and
101. Traffic from the Golden Gate Bridge goes downtown along Lombard Street and
Van Ness Avenue. Between the Golden Gate Bridge and Highway 280, 19th Avenue
is the connector route. Mission Street, Potrero Avenue, Bayshore Boulevard and 3rd
Street also bring traffic from Highways 280 and 101 in and out of the city. Other
routes with multiple pedestrian injuries are Geary Bouevard, Haight Street, Taraval
Street, Ocean Avenue, and Geneva Avenue.
Map information: SWITRS traffic collision data. Map created by Stanley Sciortino, PhD, CHES,
SFDPH, funded by a grant from the California Office of Traffic Safety through the Business,
Transportation & Housing Agency.
1
2
3- 4
1
2
1- 2
3- 5
6- 14
15- 25
Severe Fatal Total
Profile of Injury in San Francisco Motor Vehicle & Traffic- related Injuries
31
Pedestrian Deaths by Age in San Francisco, 2000- 2002
Figure 27.
This map shows the location ( to the nearest intersection) of the 71 pedestrian deaths
that occurred in San Francisco during the years 2000- 2002. Based on the neighborhood
boundaries used throughout this Profile, the two neighborhoods with more than 10
pedestrian deaths are the Tenderloin ( 15 deaths) and the Sunset ( 14 deaths). The
impact of pedestrian deaths and injuries on each neighborhood will be examined in later
pages.
Another factor to note is the number of fatal pedestrian injury victims in each age group:
< 25 years ( 5 deaths), 25- 64 years ( 28 deaths), 65+ years ( 28 deaths); age was
unreported for 10 deaths. However, just looking at the numbers of victims can be
misleading. Instead, by comparing the rate of pedestrian deaths for adults aged 18- 64
( approximately 5 per 100,000) with that for seniors ( 26.4 per 100,000), it is evident that
seniors are at much greater risk of death from pedestrian injury. Therefore, the impact
of pedestrian deaths on seniors will be examined further in later pages.
Map information: SWITRS traffic collision data. Map created by Stanley Sciortino, PhD, and Li Yu,
CHES, SFDPH, funded by a grant from the California Office of Traffic Safety through the Business,
Transportation & Housing Agency.
Key to colored dots
age ,< 25 years
age 25- 63 years
age 64+ years
age unknown
Profile of Injury in San Francisco Motor Vehicle & Traffic- related Injuries
32
Pedestrian Injuries to Children < 18 Years, 2000- 2002
7: 00 AM to 5: 00 PM - Jan 2000 to Dec 2002
Figure 28.
During the three- year period of 2000- 2002, three pedestrians under 18 years of age
were killed. However, there was a significant number of children injured as motor
vehicle occupants.
This map illustrates the relationship between the location of schools, yellow crosswalks
and child pedestrian injuries. It is clear from the map that there are many school
vicinities and yellow crosswalks without any child pedestrian injuries. However, there is
some significant correlation between school areas and child pedestrian injuries in
certain areas, particularly in the Western Addition, the Mission District, the Sunset
( especially along Sunset Boulevard), the Excelsior ( especially along Geneva Avenue)
and at the southern end of 19th Avenue.
Map information: SWITRS traffic collision data. Map created by Stanley Sciortino, PhD, CHES,
SFDPH, funded by a grant from the California Office of Traffic Safety through the Business,
Transportation & Housing Agency.
Profile of Injury in San Francisco Motor Vehicle & Traffic- related Injuries
33
Pedestrian Injuries to Seniors 65+ Years, 2000- 2002
Figure 29.
The pedestrian injury death rate among seniors is the highest of any age group. For
example, the rate of pedestrian deaths for seniors over 64 years of age is more than
five times the rate for adults aged 18- 64 years ( approximately 26 per 100,000 versus 5
per 100,000, respectively). Walking is the way many mobile seniors get around the city.
This map illustrates the relationship between senior pedestrian injuries and the location
of senior centers and senior housing. The correlation is not high. However, there are
certain areas of the city that appear to have particularly high rate of senior pedestrian
injury. The most notable of those areas are Market Street, Chinatown, the Mission
District, the Western Addition ( particularly Webster Street), along Geary Boulevard and
Fulton Street in the Richmond, and the Sunset ( particularly 19th Avenue and Sunset
Boulevard).
Map information: SWITRS traffic collision data. Map created by Stanley Sciortino, PhD, CHES,
SFDPH, funded by a grant from the California Office of Traffic Safety through the Business,
Transportation & Housing Agency.
Profile of Injury in San Francisco Motor Vehicle & Traffic- related Injuries
34
San Francisco Neighborhood Map:
Vicinity of the Tenderloin and South of Market
Pedestrian Injuries in 2000- 2002
Figure 30.
The neighborhoods included in this map are among the poorest in the city, with the
majority of residents living well below the poverty level. The Tenderloin is also densely
populated, as are parts of the South of Market area.
Market Street, one of San Francisco’s most heavily traveled pedestrian thoroughfares
and a major nexus and transfer point for public transportation, is high in injuries to
pedestrians. There were pedestrians injured at almost every intersection including four
fatalities and many severe injuries.
The approach routes to the Bay Bridge ramps have many pedestrian injuries and/ or
deaths, as do Franklin, Van Ness, Polk and Larkin Streets, which carry commute traffic
north. Other routes with fatalities include: three on Van Ness Avenue, two on Mission,
two on Larkin Street and two on Fourth Street.
Map information: SWITRS traffic collision data. Map created by Stanley Sciortino, PhD, CHES,
SFDPH, funded by a grant from the California Office of Traffic Safety through the Business,
Transportation & Housing Agency.
1
2
3- 4
1
2
1- 2
3- 5
6- 14
15- 25
Severe Fatal Total
Profile of Injury in San Francisco Motor Vehicle & Traffic- related Injuries
35
San Francisco Neighborhood Map:
Vicinity of the Inner Mission & Potrero Hill
Pedestrian Injuries in 2000- 2002
Figure 31.
The Mission District is densely populated, with the majority of residents earning very low
incomes. These two demographic realities are high risk factors for pedestrian injuries,
and there were twelve pedestrian fatalities in this area of the city during these three
years.
The length of Mission Street had pedestrian injuries at almost every intersection. The
routes extending out from the intersection of Mission and 16th Streets show where many
pedestrians sustained severe and even fatal injury. A comparable stretch of Mission
Street extends from Cesar Chavez southwest to the merge of Mission Street and San
Jose Avenue. South Van Ness and Potrero Avenues are other north- south routes with
many pedestrian injuries. Other east- west routes with multiple pedestrian injuries are
Cesar Chavez, 24th, 22nd, 21st & 18th Streets.
Map information: SWITRS traffic collision data. Map created by Stanley Sciortino, PhD, CHES,
SFDPH, funded by a grant from the California Office of Traffic Safety through the Business,
Transportation & Housing Agency.
1
2
3- 4
1
2
1- 2
3- 5
6- 14
15- 25
Severe Fatal Total
Profile of Injury in San Francisco Motor Vehicle & Traffic- related Injuries
36
San Francisco Neighborhood Map:
Vicinity of Bayview, Ingleside & Excelsior
Pedestrian Injuries in 2000- 2002
Figure 32.
The neighborhoods depicted in this map represent the southeast quadrant of the city.
While the earnings of populations of some sections ( such as Bernal Heights, Twin
Peaks and the Castro) exceed the median household income, other sections ( such as
Bayview and Excelsior) are densely populated with mostly very low- income residents.
The locations of multiple and severe pedestrian injuries are consistent with what is
known about risk factors: heavily traveled routes carrying commuters and other high
traffic volume through poorer neighborhoods. These include 3rd Street, Mission Street,
and Bayshore and Geneva Avenues. In addition, there are clusters of severe pedestrian
injuries in Visitación Valley and in the Outer Mission.
Map information: SWITRS traffic collision data. Map created by Stanley Sciortino, PhD, CHES,
SFDPH, funded by a grant from the California Office of Traffic Safety through the Business,
Transportation & Housing Agency.
1
2
3- 4
1
2
1- 2
3- 5
6- 14
15- 25
Severe Fatal Total
Profile of Injury in San Francisco Motor Vehicle & Traffic- related Injuries
37
San Francisco Neighborhood Map:
Vicinity of Haight- Ashbury & Western Addition
Pedestrian Injuries in 2000- 2002
b
Light blue
Figure 33.
The light blue areas in the map indicate school lots.
The neighborhoods included in this map are densely populated, with the majority of the
residents earning less than the 1999 estimated median income of $ 45,400. There were
three pedestrian fatalities in the Western Addition, two of them on Fillmore Street, which
is a route with many non- fatal injuries as well. Divisadero Street had serious pedestrian
injuries at Eddy, Hayes and McAllister Streets. There was a fatality at Hayes and
Webster. Geary Boulevard had two pedestrian fatalities and had injuries at almost half
of its intersections. In Haight- Ashbury, there was a fatal crash at Fell and Stanyan
Streets and injuries at many of the intersections throughout the neighborhood.
Map information: SWITRS traffic collision data. Map created by Stanley Sciortino, PhD, CHES,
SFDPH, funded by a grant from the California Office of Traffic Safety through the Business,
Transportation & Housing Agency.
1
2
3- 4
1
2
1- 2
3- 5
6- 14
15- 25
Severe Fatal Total
Profile of Injury in San Francisco Motor Vehicle & Traffic- related Injuries
38
San Francisco Neighborhood Map:
Vicinity of Richmond District
Pedestrian Injuries in 2000- 2002
Figure 34.
The neighborhoods depicted in this map represent the northwest quadrant of the city,
where some of the wealthiest sections of the city ( such as Sea Cliff), as well as some
relatively poorer sections in central and inner Richmond, are located. There are three
east- west routes with multiple pedestrian injuries: California Street, Geary Boulevard
and Fulton Street. Geary is a major commute route for public transportation, and its
buses carry more passengers than any other line. It also has many pedestrian
destinations, such as shops and restaurants. Park Presidio ( which is also Route 1) and
Arguello Boulevard are the major north- south routes with multiple pedestrian injuries
Map information: SWITRS traffic collision data. Map created by Stanley Sciortino, PhD,
CHES, SFDPH, funded by a grant from the California Office of Traffic Safety through
the Business, Transportation & Housing Agency.
1
2
3- 4
1
2
1- 2
3- 5
6- 14
15- 25
Severe Fatal Total
Profile of Injury in San Francisco Motor Vehicle & Traffic- related Injuries
39
San Francisco Neighborhood Map:
Vicinity of the Sunset District
Pedestrian Injuries in 2000- 2002
Figure 35.
The neighborhoods depicted in this map represent the southwestern quadrant of the
city. This is a moderately affluent section of the city, which hosts a major north- south
highway ( Route 1, also known as 19th Avenue). Two other major north- south routes are
Sunset Boulevard and 9th Avenue, with Taraval, Noriega, Irving and Lincoln Avenues
being the east- west routes with the most injury collisions. A particularly high collision
zone is where cross- Golden Gate Park traffic exits onto 19th Avenue.
Map information: SWITRS traffic collision data. Map created by Stanley Sciortino, PhD, CHES,
SFDPH, funded by a grant from the California Office of Traffic Safety through the Business,
Transportation & Housing Agency.
1
2
3- 4
1
2
1- 2
3- 5
6- 14
15- 25
Severe Fatal Total
Profile of Injury in San Francisco Motor Vehicle & Traffic- related Injuries
40
Pedestrian Deaths by Location, 2000- 2002 ( Table 1.)
Year Neighborhood Intersection Age Sex
2000 Bayview AUGUSTA ST & BAY SHORE BLVD 18 F
2000 Bernal Heights KINGSTON ST & MISSION ST 39 M
2000 Bernal Heights COLLEGE AVE & JUSTIN DR 61 F
2000 Castro 16TH ST & MARKET ST 31 M
2000 Downtown BEALE ST & FOLSOM ST 51 F
2000 Downtown CLAY ST & DRUMM ST 73 F
2000 Downtown BROADWAY & VAN NESS AVE 80 M
2001 Downtown 03RD ST & MARKET ST 48 M
2001 Downtown BROADWAY & VAN NESS AVE 49 M
2000 Excelsior GENEVA AVE & MOSCOW ST 37 F
2001 Excelsior ALEMANY BLVD & SICKLES AVE 80 M
2002 Excelsior MISSION ST & ONONDAGA AVE ? F
2002 Excelsior SANTOS ST & VELASCO AVE ? M
2000 Haight- Ashbury FELL ST & STANYAN ST ? M
2002 Haight- Ashbury HAIGHT ST & STEINER ST 36 M
2002 Haight- Ashbury 06TH AVE & HUGO ST ? M
2002 Ingleside FAXON AVE & HOLLOWAY AVE 65 F
2002 Ingleside HOLLOWAY AVE & JULES AVE 67 M
2000 Mission CESAR CHAVEZ ST & MISSION ST 3 F
2000 Mission 25TH ST & CAPP ST 59 M
2000 Mission 16TH ST & UTAH ST ? M
2001 Mission 22ND ST & SOUTHVAN NESS AVE 42 M
2001 Mission 18TH ST & MISSION ST 72 M
2001 Mission 16TH ST & SOUTHVAN NESS AVE ? M
2002 Mission 18TH ST & HARRISON ST 72 M
2000 Pacific Heights FRANCISCO ST & RICHARDSON AVE 60 F
2000 Pacific Heights CHESTNUT ST & STEINER ST 75 F
2001 Pacific Heights PACIFIC AVE & VAN NESS AVE 87 M
2002 Pacific Heights LOMBARD ST & WEBSTER ST 27 F
2000 Potrero Hill 20TH ST & CAROLINA ST 50 M
2000 Potrero Hill 23RD ST & RHODE ISLAND ST 82 M
2000 Richmond 05TH AVE & GEARY BLVD 32 M
2001 Richmond MERRIE WAY & POINT LOBOS AVE 61 M
2001 Richmond CROSSOVER DR & MARTIN LUTHER KING 72 F
2002 Richmond 24TH AVE & FULTON ST 86 M
2000 Sunset HERBST RD & SKYLINE BLVD 74 M
2000 Sunset SUNSET BLVD & TARAVAL ST 74 M
2000 Sunset 17TH AVE & TARAVAL ST 85 F
2000 Sunset 41ST AVE & JUDAH ST 91 M
2001 Sunset SUNSET BLVD & TARAVAL ST 13 M
2001 Sunset 28TH AVE & QUINTARA ST 67 F
2001 Sunset 19TH AVE & IRVING ST 86 M
2001 Sunset 30TH AVE & GEARY BLVD ? M
2001 Sunset BROTHERHOOD WAY & LAKE MERCED BLVD ? M
2002 Sunset 19TH AVE & LINCOLN WAY 24 M
2002 Sunset 19TH AVE & RANDOLPH ST 41 M
2002 Sunset 21ST ST & TARAVAL ST 44 M
2002 Sunset 23RD AVE & NORIEGA ST 82 F
2002 Sunset 48TH AVE & LINCOLN WAY ? F
2000 Tenderloin HOWARD ST & LANGTON ST 44 M
2000 Tenderloin 13TH ST & FOLSOM ST 51 F
2000 Tenderloin JONES ST & O'FARRELL ST 55 F
2000 Tenderloin 04TH ST & MISSION ST 58 M
2000 Tenderloin JONES ST & MARKET ST 71 F
2001 Tenderloin LEAVENWORTH ST & SUTTER ST 36 M
2001 Tenderloin TURK ST & VAN NESS AVE 54 M
2001 Tenderloin LARKIN ST & POST ST 73 M
2001 Tenderloin 05TH ST & MARKET ST 75 M
2001 Tenderloin CALIFORNIA ST & LARKIN ST 76 F
2002 Tenderloin 07TH ST & HOWARD ST 29 F
2002 Tenderloin 04TH ST & HARRISON ST 37 M
2002 Tenderloin MARKET ST & VAN NESS AVE 47 M
2002 Tenderloin 06TH ST & MISSION ST 55 M
2002 Tenderloin 05TH ST & HARRISON ST ? M
2000 Twin Peaks ALEMANY BLVD OC & RT 280 37 F
2000 Western Addition HAYES ST & WEBSTER ST 10 F
2000 Western Addition FILLMORE ST & GOLDEN GATE AVE 83 F
2000 Western Addition GEARY BLVD & VAN NESS AVE 85 M
2000 Western Addition GOUGH ST & POST ST 89 F
2000 Western Addition ELLIS ST & FILLMORE ST 90 M
2002 Western Addition GEARY BLVD & LAGUNA ST 82 M
Profile of Injury in San Francisco Motor Vehicle & Traffic- related Injuries
41
Alcohol- Related Pedestrian Injuries, 2000- 2002
Figure 36.
An injury is considered “ alcohol- related” when the reporting police officer records that
either the driver or the pedestrian had been drinking. This is not usually confirmed by a
blood alcohol concentration test, unless there is a fatality and the test is done by the
Medical Examiner.
It is not a coincidence that where there is a concentration of alcohol outlets, there is a
cluster of alcohol- related pedestrian injuries. Market and Mission Streets are the routes
with the greatest number of alcohol- related pedestrian injuries, followed by Columbus
Avenue, Van Ness Avenue and Geary Boulevard. The area around the intersection of
Market and Castro Street, Market between 3rd and 6th Streets, and Mission Street and
24th Street are particularly at high risk.
Map information: SWITRS traffic collision data. Map created by Stanley Sciortino, PhD, CHES,
SFDPH, funded by a grant from the California Office of Traffic Safety through the Business,
Transportation & Housing Agency.
Profile of Injury in San Francisco Motor Vehicle & Traffic- related Injuries
42
Location of Alcohol Outlets ( Non- Restaurant), 2001
Figure 37.
Non- restaurant alcohol outlets include bars, liquor stores and mini- marts, i. e., all places
where one can purchase alcohol by the glass or bottle that does not serve food.
Although one can purchase alcohol throughout the city, alcohol outlets are most densely
concentrated in the Tenderloin, the Mission, Haight- Ashbury, the Richmond, the Outer
Sunset, the Marina, and along several major traffic routes ( Mission Street, Bayshore
Boulevard, 24th Street, Geary Boulevard, Irving Street, Taraval Street).
Map information: California Department of Alcohol Beverage Control ( ABC) data. Map created by
Stanley Sciortino, PhD, CHES, SFDPH, funded by a grant from the California Office of Traffic Safety
through the Business, Transportation & Housing Agency.
Profile of Injury in San Francisco Falls
43
Falls
Summary
Injuries from falls account for 14% ( n= 64) of the deaths and 46% ( n= 2,587) of the
hospitalizations due to injuries among San Francisco residents in 2001.
Unfortunately, the “ External Causes of Injury & Poisoning” codes do not capture the
multiple and complex circumstances surrounding falls. Very often, death certificates
and medical records lack specific details on the circumstances of a fall. For example,
over half of the falls- related hospital discharges have non- specific fall cause codes.
Codes are also used to describe the nature of the injury sustained. Among those
patients hospitalized for a fall- related injury, 56% of the discharges were coded as
musculoskeletal and connective tissue disorders ( fractures, sprains and strains), 11%
as nervous system disorders ( primarily brain injury), 7% as circulatory disorders, and
the remaining 26% as all other “ major diagnostic categories.”
Falls are a particularly significant injury problem among older San Francisco residents.
Seniors aged 65+ account for 24% ( n= 111) of all injury deaths; of these, 35% ( n= 39)
are due to falls. For hospitalizations, seniors and falls predominate even more. Seniors
aged 65+ comprised 14% of the population in 2001, yet accounted for 42% ( n= 2,367) of
all injury hospitalizations; of these, 75% ( n= 1,783) were due to falls.
This Profile presents data on falls, with a specific focus on older adults, through:
- graphs drawing upon vital statistics and hospital discharge records
- national data collected by the Centers for Disease Control
Profile of Injury in San Francisco Falls
44
Causes of Fatal Falls, 2001
74%
13%
13%
Unspecified
Suicide
Other
Source: CDHS ( 2003)
N= 64
Figure 38.
The coding of circumstances surrounding fatal falls is not especially informative. While
there are 19 codes in the International Classification of Diseases ( ICD- 10) for use in
classifying unintentional deaths resulting from a fall, 74% of the deaths ( n= 48) were
attributed to a single code titled “ Unspecified fall.” Eight deaths had the code for
“ Intentional self- harm by jumping from high place.” There was one homicide, one “ intent
undetermined,” and six specific codes for unintentional falls: 1 “ slip,” 2 involving steps,
1 involving a fall from a building, and 2 resulting from an “ other fall on same level.”
Profile of Injury in San Francisco Falls
45
Causes of Falls- related
Hospitalizations, 2001
9%
2%
2%
11%
19%
57%
Step/ stair Ladder From building
Levels Slip/ trip Unspecified
N= 2,587 Source: OSHPD ( 2003)
Figure 39.
Falls accounted for 46% of all hospitalizations for non- fatal injuries in 2001. While the
cause coding for fall- related hospital discharges were somewhat more informative than
those for fatal falls, more than half were coded with non- specific codes. Of those that
were specifically coded, there were 92 hospitalizations for falls from a bed, 45 for falls
from a chair, 34 for falls from a wheelchair, 21 for falls from a commode, and 12 for falls
on playground equipment. However, given that the causal circumstances of the
majority of hospitalizations for fall injuries are unspecified, it is difficult to tailor
prevention programs based solely upon hospitalization data.
Profile of Injury in San Francisco Falls
46
Falls Injuries by Age Group
Falls are, by far, the leading injury mechanism in San Francisco that results in
hospitalization because they account for nearly half of all injury hospitalizations. By
comparison, motor vehicle traffic collisions, the next leading mechanism, account for
less than one eighth of injury hospitalizations.
Almost 2,600 San Franciscans were hospitalized as the result of a non- fatal fall in 2001.
Young children ( aged 0- 14) have slightly more hospitalizations for fall injuries than do
adolescents and young adults, but falls are a special problem for older San
Franciscans. Sixty- nine percent of all hospitalizations and 61% of all deaths due to fall
injuries occur to those over age 65. The rate graph below shows how dramatic this risk
is for seniors.
From infancy until middle adulthood ( around age 55), men outnumber women as falls
patients. However, after that, the trend reverses, and women predominate with each
successive decade. In fact, in the over 95- year old age group ( not shown), 85% of the
patients are women.
Hospitalization due to Falls, by Age
Group and Sex
San Francisco Residents, 2001
0
100
200
300
400
500
600
700
0- 14 15- 24 25- 34 35- 44 45- 54 55- 64 65- 74 75- 84 85+
# hospitalizations
Male
Female
Source: OSHPD ( 2003)
N= 2,687
Figure 40.
Profile of Injury in San Francisco Falls
47
In the younger age groups, men outnumber women because they tend to take more
risks that lead to a fall. However, as women age, their bone fragility makes them more
susceptible to fall injuries than are men of the same age. Though not shown here, men
continue to have substantially greater rates of fatal falls, even in extreme old age, where
the numbers of men and men who suffer fatal falls is less than the number of women.
This may indicate that male risk taking behaviors continue.
The table below gives the raw data used for the chart above. Over the age of 75, there
are two to three times more women than men hospitalized due to falls.
Hospitalizations due to Falls, by Age Group and Sex
San Francisco Residents, 2001 ( n= 2,687)
0- 14 15- 24 25- 34 35- 44 45- 54 55- 64 65- 74 75- 84 85+
Female 37 16 34 55 82 98 203 529 584
Male 67 36 75 112 121 88 124 234 192
Similarly, the rate of hospitalization for injuries from a fall increases dramatically after
age 55. In the older years of life, the rate rises to almost 30 times that of 45 to 54 year
olds. While falls account for four times as many hospitalizations as the next leading
mechanism of injury in the general population, they account for 15 times as many
among the population over age 65.
Rate of Hospitalization for Falls Injuries
San Francisco Residents, 2001
0
1000
2000
3000
4000
5000
6000
0- 14 15- 24 25- 34 35- 44 45- 54 55- 64 65- 74 75- 84 85+
rate per 100,000 persons Source: OSHPD ( 2003)
Figure 41.
Profile of Injury in San Francisco Falls
48
Zip code of Residence of Patients Hospitalized for Falls
By Age Group, 2001
Zip 0- 14 15- 24 25- 64 65+ Total Zip 0- 14 15- 24 25- 64 65+ Total
" 94101" 2 2 " 94122" 9 5 39 159 212
" 94102" 2 3 49 59 113 " 94123" 1 14 81 96
" 94103" 3 2 40 52 97 " 94124" 11 3 52 26 92
" 94104" 4 4 " 94125" 1 1
" 94105" 3 1 4 " 94127" 4 1 9 74 88
" 94107" 3 10 26 39 " 94129" 1 1 2
" 94108" 8 40 48 " 94130" 1 1
" 94109" 3 3 59 210 275 " 94131" 3 1 18 63 85
" 94110" 14 6 81 128 229 " 94132" 1 6 17 88 112
" 94111" 1 4 18 23 " 94133" 2 2 10 88 102
" 94112" 19 3 53 133 208 " 94134" 14 4 25 59 102
" 94114" 4 2 28 56 90 " 94142" 4 2 6
" 94115" 2 2 39 87 130 " 94143" 1 2 3
" 94116" 2 2 31 135 170 " 94146" 1 1
" 94117" 2 3 29 49 83 " 94159" 1 1
" 94118" 3 1 19 103 126 " 94166" 1 1
" 94119" 2 2 4 " 94188" 1 1
" 94121" 1 1 16 118 136
Key to colors of zip code data chart (# hospitalizations)
> 200 1 00- 199 5 0 - 99 < 5 0
Table 2.
The areas with the greatest numbers of patients hospitalized for falls are zip codes
94109, 94110, 94122 and 94112, which roughly correspond to the neighborhoods of
Nob Hill/ Russian Hill, Mission, Bernal Heights, Sunset, Excelsior, Ingleside and Ocean
View. The areas with the next highest incidence of hospitalizations for falls are zip
codes 94116, 94121, 94115, 94118, 94102, 94132, 94133, and 94134. The
neighborhoods encompassed by these zip codes are: Parkside, Richmond, Western
Addition, Pacific Heights, Presidio Heights, Laurel Heights, Hayes Valley, Park Merced,
Telegraph Hill, North Beach, Portola and Visitacion Valley.
Profile of Injury in San Francisco Falls
49
Figure 42.
Map Information: City of San Francisco zip code map. Created by Stanley Sciortino,
PhD, CHES, SFDPH.
Profile of Injury in San Francisco Falls
50
Causes of Injury Death for Older San Franciscans
One hundred and eleven senior San Francisco residents died as the result of an injury
in 2001. Eight other seniors visiting from elsewhere died in San Francisco following an
injury. Among these seniors ages 65 years old and older, falls were the leading cause of
injury- related death.
Source: CDHS ( 2003)
Seniors’ Leading Causes of Injury Death
San Francisco Residents, 65+ Years, 2001
N= 111
All Other 30% Drugs/ Poison 12%
Suffocation 14%
MV Traffic 9%
Falls 35%
Figure 43.
Falls accounted for 35% of the injury deaths among seniors. None of the mechanisms
of injury included in the “ other” category accounted for more than 10 deaths.
Despite the high percentage of falls among seniors, the actual number of fatal falls in
the elderly may be understated. For example, an older person may be hospitalized for a
fall and, during a long hospital stay, could develop complications ( such as pneumonia),
which then lead to death. Depending upon the circumstances, the coding practices of
hospitals, and the judgments of medical examiners and coroners, that death may or
may not be coded as a fatal fall.
In 2001, more than 11,600 people aged 65 or older in the USA died from fall- related
injuries. More than 60% of people who die from falls are 75 or older.
Profile of Injury in San Francisco Falls
51
Causes of Injury- related Hospitalizations for Seniors
Source: OSHPD ( 2003)
Seniors’ Leading Cause of Injury Hospitalization
San Francisco Residents 65+ Years, 2001
N= 2,367
All Other 16% Poison/ Drugs 4%
Falls 75%
MV Traffic 5%
Figure 44.
Falls accounted for three quarters of all injury- related hospital discharges for older San
Franciscans. There were very few other mechanisms, such as MVT and Poison/ Drugs,
that accounted for a significant proportion of discharges.
The CDC reports that, in 2001, more than 1.6 million seniors nationally were treated in
emergency departments for fall- related injuries. Nearly 388,000 were hospitalized.
Profile of Injury in San Francisco Falls
52
Causes of Non- fatal Falls Among Seniors
Aged 65+, 2001
0
200
400
600
800
1000
1200
1400
Stair
Chair
Wheelchair
Bed
Commode
Slip/ trip
Other fall
Fall NOS
# hospitalizations
N= 1,794 Source: OSHPD ( 2003)
Figure 45. NOS= Not otherwise specified
Documentation of the specific circumstances surrounding falls is often absent from the
medical record; therefore, over 65% of these falls were coded simply as an “ other and
unspecified fall.” Of those that were noted, slip/ trips ( 18.7%), falls from stairs ( 6.8%),
beds ( 4.1%), chairs ( 1.8%), wheelchairs ( 1.5%) and commodes ( 1.1%) were the most
common. More accurate coding of falls would significantly help injury prevention efforts,
especially among the older age groups.
Profile of Injury in San Francisco Falls
53
Costs associated with Falls Among Older Adults
Hospital discharge data provides “ total charges” for patients who have been treated as
the result of a fall. There were 1,783 hospital discharges resulting from falls among
older San Franciscans in 2001.
For older adults hospitalized due to a fall:
- the median charge was $ 23,335.
- the average charge was $ 32,199.
- hospital charges totaled $ 57.4 million.
Several things should be noted.
1) The average charge is always higher than the median charge, because it factors in
the “ outliers,” or patients with very long hospital stays and very high bills. The highest
hospital bill in this data series was over $ 1 million.
2) Charges include, but are not limited to: daily hospital services, ancillary services and
any patient care services. Hospital- based physician fees are excluded.
3) Charges, costs and actual reimbursement are three very different numbers. What is
reported here is what was charged, not necessarily what is reimbursed.
4) There were 198 discharges with no charge associated with them because the
charges were not reported by the hospital. For example, Kaiser Foundation Hospitals
are exempted from reporting charges, since they charge patients a monthly capitation
fee, regardless of what health care services are provided. Thus, these cost numbers
underestimate the charges associated with hospitalization due to falls.
The National Center for Injury Prevention and Control of the CDC published a report:
The Costs of Fall Injuries Among Older Adults. “ The total cost of all fall injuries for
people age 65 or older in 1994 was $ 27.3 billion ( in current dollars). By 2020, the cost of
fall injuries is expected to reach $ 43.8 billion ( in current dollars).” This estimate is
drawn from Englander F, Hodson TJ, Terregrossa RA. Economic dimensions of slip
and fall injuries. Journal of Forensic Science 1996; 41( 5): 733- 46.
Profile of Injury in San Francisco Falls
54
Injury Intent: Unintentional, Assaultive, and Self- Inflicted
Deaths
While many seniors may be fearful of being intentionally harmed by someone else, it is
very rare for a senior to die from intentional injuries, other than from suicide. Over
three- quarters of the senior injury deaths were coded as unintentional, while 19% were
suicide. Only four seniors were victims of homicide. Again, falls are the most common
cause of injury death for San Franciscans over the age of 65.
0
10
20
30
40
50
60
70
80
90
# deaths
Unintentional Suicide Homicide Undetermined
Injury Deaths Among Seniors
San Francisco Residents 65+ Years of Age, 2001
Other
Falls
N= 111 Source: CDHS ( 2003)
Figure 46.
Profile of Injury in San Francisco Falls
55
Injury Intent: Unintentional, Assaultive, and Self- Inflicted
Hospitalizations
Older persons in San Francisco are overwhelmingly more likely to be hospitalized for
unintentional injuries, such as falls, than for assaults or even self- inflicted intentional
injuries. All of the 1,866 hospitalizations for patients 65 and older who had fallen in 2001
were coded as unintentional. While suicides accounted for 19% of injury deaths, only
1% of the hospitalizations were coded as self- inflicted and 1% as assaults.
0
500
1000
1500
2000
2500
# hospitalizations
Unintentional Assaults Self- inflicted
Hospitalizations for Seniors by " Intent"
San Francisco Residents > 64 Years of Age, 2001
Other
Falls
N= 2,476 Source: OSHPD ( 2003)
Figure 47.
Profile of Injury in San Francisco Falls
56
Consequences of a Fall for Older San Franciscans
As people get older, they gradually lose their resilience and ability to heal quickly from
an injury. One measure of this ability to heal is the number of days in an average
hospital stay. For those 65 years or older, the median stay is 5 days, compared to 3
days for younger San Franciscans. Even among seniors, the median length of stay for
those who fell was 5 days, compared to 4 days for those suffering other injuries. When
we calculate the mean stay, which takes into account the very long stays of many
seniors, it is 15 days, compared to 9 days for younger San Franciscans.
Length of Hospital Stay After a Fall
Among Seniors Age 65+, 2001
0
100
200
300
400
500
600
0- 2 days 3- 4 days 5- 7 days Up to 2
weeks
Up to 3
weeks
More than
3 weeks
# hospitalizations
N= 1866 Source: OSHPD ( 2003)
Figure 48.
Older adults who suffer from a fall have an exceptionally high rate of discharge to
institutional settings and long term care, which can mark an end to their independence.
For people over age 65, 45% of all admissions to long- term care are due to a fall.
Profile of Injury in San Francisco Falls
57
Overall, 62% of those over 65 who were hospitalized after a fall in San Francisco in
2001 were discharged to a long- term care or other care facility. The likelihood of being
admitted to a long- term care facility after a fall continues to increase with age.
Discharge of Patients, Ages 65- 84
2001
Long- term
care or
other care
facility
57%
Died
4%
Home
39%
Source: OSHPD ( 2003)
N= 1,090
Figure 49.
With age, the proportion of patients who are admitted to another care facility after
leaving the hospital increases while the percentage of those who return home
decreases.
Discharge of Patients, Ages 85+
2001
Home
26%
Long- term
care or
other care
facility
69%
Died
5%
N= 776 Source: OSHPD ( 2003)
Figure 50.
Profile of Injury in San Francisco Drug/ Poisoning- related Injuries
58
Drug/ Poisoning- related Injuries
Summary
Drugs and other poisons account for the greatest number of injury deaths in San
Francisco. In 2001, there were 149 drug or poisoning- related deaths. The
majority ( 74%) of these deaths were coded as unintentional, which should be
noted is the default code when there is no specific evidence that the deceased
intended to die.
Drug/ poisoning- related non- fatal injuries were second to falls as the leading
cause of injury hospitalizations. In 2001, these injuries accounted for 665
hospitalizations. The majority of cases were coded as self- inflicted ( 52%), but
45% were coded as unintentional. Almost one- third of the drugs involved in these
non- fatal injuries were tranquilizers and other psychotropic agents.
The Profile includes data from the San Francisco Department of Public Health’s
Community Substance Abuse Services and from a report by the Drug Abuse
Warning Network ( DAWN) on substances that were detected during emergency
department care provided in San Francisco, Marin and San Mateo counties.
Profile of Injury in San Francisco Drug/ Poisoning- related Injuries
59
Drug/ Poisoning- related Deaths
Drug/ Poisoning- related
Deaths by Intent, 2001
74%
22%
1%
3%
Unintent
Suicide
Homicide
Undeter
N= 149
Source: CDHS ( 2003)
Figure 51.
Three- quarters of the drug/ poisoning- related deaths in 2001 were coded as
unintentional. However, it must be noted that determining the intentionality of
drug/ poisoning- related deaths is problematic. It is extremely difficult to judge
after death whether someone actually intended to overdose.
Throughout the early to mid 1990s, about three- quarters of the deaths were
coded as unintentional. Then, in 1998, the percentage coded as unintentional
rose to 87%. The 2001 distribution is comparable to that of the early 1990s. This
fluctuation may be due to changes in coding practices at the Medical Examiner’s
office.
Profile of Injury in San Francisco Drug/ Poisoning- related Injuries
60
Drug/ Poisoning- related Hospitalizations
Hospitalization by Intent for
Drug/ Poisoning- related Injuries, 2001
45%
52%
3%
unintentional
self- inflicted
other
N= 665
Source: OSHPD ( 2003)
Figure 52.
In 2001, 665 San Francisco residents were hospitalized for non- fatal drug- related
injuries. The pattern of intentionality of non- fatal drug/ poisoning- related injuries is
opposite that of drug- related deaths. Hospitalizations for injuries coded as self-inflicted
outnumbered those coded as unintentional. In Table 3 on page 64, the
substances associated with these hospitalizations are identified.
As with drug/ poisoning- related deaths, it is difficult to identify the intent of a non-fatal
injury with great certainty. For example, if someone intentionally takes
several tranquilizers, seeking temporary oblivion but not seeking to injure himself,
but is not completely aware of the potential complications caused by having other
drugs and alcohol in his body, is this a “ self- inflicted” injury? This question could
be answered differently among health care providers. Thus, the distinction
between unintentional and self- inflicted harm is not as clear as might appear in
graphs and data tables.
Profile of Injury in San Francisco Drug/ Poisoning- related Injuries
61
0 5
10
15
20
25
30
35
40
45
50
# deaths
0- 4 5- 14 15- 24 25- 34 35- 44 45- 54 55- 64 65- 74 75- 84 85+
Age Group
Drug/ Poisoning- related Deaths by Age & Intent,
2001
Unintent Suicide Homicide Undeter
N= 149 Source: CDHS ( 2003)
Figure 53.
Age Groups Unintent Suicide Homicide Undeter Total Rate per 100000
0- 4 0 0 0 0 0 *
5- 14 0 0 0 0 0 *
15- 24 3 1 0 1 5 5.6
25- 34 13 5 0 2 20 11.1
35- 44 37 9 0 1 47 35.1
45- 54 43 3 0 0 46 42.7
55- 64 9 8 1 0 18 27.6
65- 74 3 2 0 0 5 9.3
75- 84 3 3 0 0 6 15.8
85+ 0 2 0 0 2 *
Total 111 33 1 4 149 19.2
* = too few deaths for rate calculation
There were no drug/ poisoning- related deaths among San Francisco children
under 15 years of age, which could be testimony to the effectiveness of
preventive interventions ( such as bubble- packs and child- proof caps on medicine
containers). Rates of drug/ poisoning- related injuries range from a low of 5.6
( deaths per 100,000 population) for 15- 24 year olds to a high of 42.7 among 45-
54 year olds. The highest rates of drug/ poisoning- related deaths are found
among adults aged 35 to 64 years. In that age range, very few of the deaths
were coded as suicide. Only among the oldest seniors ( aged 85+) do suicides
outnumber unintentional drug deaths ( although there were only 2 suicides in this
group).
Profile of Injury in San Francisco Drug/ Poisoning- related Injuries
62
0
20
40
60
80
100
120
140
# hospitalizations
0- 4 5- 14 15- 24 25- 34 35- 44 45- 54 55- 64 65- 74 75- 84 85+
Age Groups
Drug/ Poisoning- related Hospitalizations
by Age & Intent, 2001
unintentional Self- inflicted
other
N= 665 Source: OSHPD ( 2003
Figure 54.
Age Groups Unintentional Self-inflicted
Other Total Rate per
100,000
0- 4 15 0 1 16 50.6
5- 14 2 2 0 4 *
15- 24 18 66 2 86 96.2
25- 34 31 89 5 125 69.3
35- 44 57 65 4 126 94.2
5- 54 60 66 2 128 118.8
55- 64 33 42 3 78 119.5
65- 74 39 5 0 44 81.5
75- 84 29 6 2 37 97.6
85+ 16 5 0 20 140.6
Total 300 346 19 665 85.6
There were 16 drug/ poisoning- related hospitalizations among young children 0- 4
years, and 4 among children aged 5- 14 years. These two age groups had the
lowest drug/ poisoning- related hospitalization rates in the population. Seniors
aged 85+ had the highest rates, and adolescents aged 15- 24 had rates
comparable to adults aged 35- 64 years. From age 15- 64, there were more
hospitalizations coded as self- inflicted than as unintentional. This is reversed
among seniors aged 65+, whose drug/ poisoning- related injuries were more often
coded as unintentional.
Profile of Injury in San Francisco Drug/ Poisoning- related Injuries
63
Drug/ Poisoning- related Deaths
Source: CDHS ( 2003)
Drug/ Poisoning Deaths occurring in
San Francisco, 2001
0
10
20
30
40
50
60
70
80
90
100
A B Unspec Alcohol
Case include 156 drug deaths occurring in San Francisco
Figure 55.
‘ A’ drugs— ICD- 10 labels them as: antiepileptic, sedative- hypnotic,
antiparkinsonism, psychotropic, and specifically includes antidepressants,
barbiturates, hydantoin derivatives, iminostilbenes, methaqualone compounds,
neuroleptics, psychostimulants, succinimides & oxazolidinediones, and
tranquilizers.
‘ B’ drugs— ICD- 10 labels them as: narcotics & psychodysleptics
[ hallucinogens], and specifically includes: cannabis ( derivatives), cocaine, heroin,
LSD, mescaline, methadone, morphine, and opium ( alkaloids).
‘ Unspecified’— ICD- 10 labels them as: other and unspecified drugs,
medicaments & biological substances, and specifically includes agents that work
on the muscle and respiratory systems, anaesthetics, drugs affecting the cardio
& gastro systems, hormones & synthetic substances, systemic & haematological
agents, therapeutic gases, topical preparations, vaccines, and agents affecting
metabolism. It is speculated that “ multi- drug” cases are classified under this
category. Previous work suggests that the vast majority of overdose cases
involve more than one substance, which is frequently alcohol and another drug or
drugs.
Profile of Injury in San Francisco Drug/ Poisoning- related Injuries
64
Drug/ Poisoning- related Hospitalizations:
Involvement of Specific Substances
There were 855 discharges from San Francisco- based hospitals for drug/
poisoning- related incidents in 1998 ( which was the most updated information
available on the involvement of specific substances). The table below lists the
percentage distribution of the various drugs among these cases, regardless of
whether the patients were SF residents or visitors. Listing the drugs or poisons
involved in all drug/ poisoning- related cases best represents the drugs and other
poisons available in San Francisco.
When visitors were included, the drug/ poisoning- related injuries were evenly split
between unintentional and self- inflicted. Among the 655 San Francisco residents
hospitalized for drugs, a slightly larger percentage were coded as having self-inflicted
injury. Tranquilizers were the most commonly identified drug used in
suicide attempts by both men and women.
HOSPITALIZATIONS FOR DRUG OVERDOSE/ POISONING, SAN FRANCISCO, 1998
Intentionality: Unintentional Self ?* Total %
DRUGS, MEDICATIONS AND BIOLOGICAL SUBSTANCES
Tranquilizers and other Psychotropic Agents ( including
caffeine, benzodiazepines & amphetamines)
95 176 8 279 32.6%
Analgesics, Antipyretics, and Antirheumatics ( includes
heroin, aspirin and acetaminophen)
67 116 5 188 22.0%
Central Nervous System ( includes cocaine) 85 N/ A N/ A 85 9.9%
Sedatives/ Hypnotics 3 9 0 12 1.4%
Barbiturates 6 7 1 14 1.6%
Other drugs/ medications 98 79 6 183 21.4%
Unspecified drugs/ medications 7 2 2 11 1.3%
Total drugs, medications & biological substances 361 389 22 772 90.2%
SOLIDS, LIQUIDS, GASES AND VAPORS
Carbon Monoxide 4 6 1 11 1.3%
Corrosives/ Caustics 2 2 1 5 0.6%
Other and Unspecified Solids, Liquids and Gases ( including
alcohol)
44 23 0 67 7.8%
Total solids, liquids, gases & vapors 50 31 2 83 9.7%
TOTAL POISONING/ DRUG OVERDOSE DEATHS 411
48%
420
49%
24
3%
855
100%
100%
* = intent undetermined.
Table 3.
Profile of Injury in San Francisco Drug/ Poisoning- related Injuries
65
Substance Abuse Services: Substances Involved
The San Francisco Department of Public Health contracts with community- based
substance abuse programs to provide treatment to residents with drug- related
problems. Between July 1, 2003 and June 30, 2004, the city financed direct
treatment services for 10,447 residents through these programs.
Substances Connected to
San Francisco's Substance Abuse Treatment,
FY 2003- 04
33%
23%
22%
11%
9% 2%
Opiates Alcohol Cocaine Stimulants Marijuana Other*
Source: SFDPH CSAS ( 2004)
N= 10,447
* = This portion represents the last three categories in the table below.
Figure 56.
Substance Category Frequency Percent
Heroin/ non- Rx methadone/ other opiate 3,487 33.38
Alcohol 2,427 23.23
Cocaine 2,264 21.67
Methamphetamine/ amphetamine/ stimulant 1,177 11.26
Marijuana 934 8.94
PCP/ hallucinogen/ hypnotic 54 0.52
Downer 31 0.3
Other 73 0.7
TOTAL 10,447 100.00
Profile of Injury in San Francisco Drug/ Poisoning- related Injuries
66
Drug Abuse Warning Network ( DAWN)
Emergency Department Data
Table 4.
This table reports data from the San Francisco Metropolitan Area, which includes three
counties: Marin, San Francisco, and San Mateo
Drug Category1 Total
2000
Total
2001
Total 2002 % Change
2000 - 2002
% Change2
2001 - 2002
MAJOR SUBSTANCES OF ABUSE 8,675 10,033 9,402
Alcohol in combination
Cocaine
Heroin
Marijuana
Amphetamines
Methamphetamine
MDMA ( Ecstasy)
Ketamine
LSD
PCP
Miscellaneous hallucinogens
Flunitrazepam ( Rohypnol)
GHB
Inhalants
Combinations NTA
1,804
2,054
2,756
627
371
591
107
14
67
70
33
0
151
4
25
2,155
2,482
2,790
704
786
611
152
111
46
76
42
0
158
5
17
1,926
2,353
2,672
607
700
727
129
10
17
50
37
0
133
15
24
14.6
88.7
23.0
20.6
- 28.6
- 74.6
- 28.6
275.0
- 10.6
- 13.8
- 10.9
19.0
- 15.1
- 63.0
- 34.2
- 15.8
200.0
41.2
OTHER SUBSTANCES OF ABUSE 3,496 3,710 3,683
PSYCHOTHERAPEUTIC AGENTS
Antidepressants
MAO inhibitors
SSRI antidepressants
Tricyclic antidepressants
Miscellaneous antidepressants
Antipsychotics
Phenothiazine antipsychotics
Psychotherapeutic combinations
Thioxanthenes
Miscellaneous antipsychotic agents
Anxiolytics, sedatives, and hypnotics
Barbiturates
Benzodiazepines
Misc. anxiolytics, sedatives & hypnotics
CNS stimulates
CNS AGENTS
Analgesics
Antimigraine agents
Cox- 2 inhibitors
Narcotics analgesics/ combinations
Nonsteroidal anti- inflammatory agents
Salicylates/ combinations
Miscellaneous analgesics/ combinations
Analgesic combination NTA
Anorexiants
Anticonvulsants
Antiemetic/ antivertigo agents
Antiparkison agents
General anesthetics
Muscle relaxants
Miscellaneous CNS agents
RESPIRATORY AGENTS
CARDIOVASCULAR AGENTS
OTHER SUBSTANCES
1,301
284
0
102
52
130
117
25
0
3
89
885
78
664
143
14
1,389
1,194
3
0
696
130
103
263
0
10
111
3
8
0
61
0
68
43
695
1,580
328
0
124
56
149
145
23
0
1
121
1,096
115
825
157
10
1,589
1,353
2
4
839
155
65
288
0
7
112
4
5
0
109
0
82
71
387
1,402
375
0
155
48
172
151
17
…
…
130
862
57
657
148
14
1,550
1,319
…
9
813
151
90
254
0
10
119
0
13
0
90
0
90
67
574
32.0
52.0
32.3
29.1
- 32.0
…
46.1
- 26.9
11.6
…
16.8
- 100.0
62.5
47.5
32.4
55.8
25.0
- 21.4
- 50.4
- 20.4
125.0
38.5
- 100.0
160.0
- 17.4
48.3
TOTAL DRUG ABUSE EPISODES 7,857 8,575 8,571
TOTAL DRUG ABUSE MENTIONS 12,171 13,743 13,085
TOTAL ED VISITS ( in 1,000s) 503 545 589 17.2 8.2
Profile of Injury in San Francisco Drug/ Poisoning- related Injuries
67
1 This classification of drugs is derived from the Multum Lexicon, Copyright © 2003, Multum
Information Services, Inc. The classification has been modified to meet DAWN’s unique
requirements.
( 2003) The Multum Licensing Agreement governing use of the Lexicon is provided in an
appendix to this report and can be found on the Internet at http:// www. multum. com.
2 This column denotes statistically significant ( p< 0.05) increases and decreases between
estimates for the periods noted. See Relative Standard Error ( RSE tables for p- values.
Note: These estimates are based on a representative sample of non- Federal short- stay hospitals
with 24- hour emergency departments in the contiguous United States. Dots (…) indicate that an
estimate with an RSE greater than 50% has been suppressed. Dashes (---) indicate that an
estimate has been suppressed due to incomplete data.
Abbreviations:
CNS = center nervous system; ED = emergency department; GHB = gamma hydroyx butyrate;
LSD = lysergic acid diethylamide; MAO = monoamine oxidase; MDMA =
methylenedioxymethamphetamine; NTA = not tabulated above; PCP = phencyclidine; SSRI =
selective serotonin reuptake inhibitor.
SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2002 ( updated
03/ 2003).
The preceding table is a truncated version of Table 2.2.19 from “ Emergency
Department Trends From the Drug Abuse Warning Network, Final Estimates
1995– 2002” published by Substance Abuse and Mental Health Services
Administration ( SAMHSA), Office of Applied Studies ( OAS).
The full table and report are available at:
http:// dawninfo. samhsa. gov/ pubs_ 94_ 02/ edpubs/ 2002final/ files/ EDTrendFinal02
AllText. pdf
Profile of Injury in San Francisco Violent Deaths & Injuries
68
Violence- related Injuries
Summary
Violence can be interpersonal, which is called homicide when fatal and assault when
non- fatal. Violence can also be directed against the self, which is called suicide when
fatal and self- inflicted injury when non- fatal.
The Profile is based primarily upon death certificate and hospital discharge data. In
2001, there were 106 suicides and 65 homicides among San Francisco residents. An
additional 9 deaths were coded as “ undetermined” because the Medical Examiner was
unable to conclude if the death was homicide, suicide or unintentional. In 2001, there
were 459 hospital discharges related to self- inflicted injury, 503 hospitalizations
resulting from assault, and 40 hospitalizations coded as other ( undetermined intent and
legal intervention).
Since 1999, San Francisco has been participating in a national fatal violent injury
reporting project – the National Violent Injury Statistics System ( NVISS, www. nviss. org).
The Profile is able to draw upon this comprehensive database in order to present a
more complete picture of every single homicide, suicide, and unintentional firearm death
that occurs in the city. The local reporting system, the San Francisco Violent Injury
Reporting System ( SFVIRS), systematically collects all information regarding each
homicide, suicide and unintentional firearm death. One of the key features of SFVIRS is
that the Police Department, Medical Examiner and the Department of Public Health
have been working together to find a public health approach to reduce the number of
violent deaths. Information from death certificates, Medical examiner case and autopsy
records, police incident reports, criminal records, and supplemental homicide reports
( SHR) are collected and merged to form a unique record for each violent incident. The
SFVIRS is able to answer the who, what, where and why these violent incidents occur.
On pages 74- 80 of this chapter, the SFVIRS data will be presented. However, because
the SFVIRS does not use the California hospital discharge database and is heavily
weighted toward surgically- repaired, non- fatal injury, the Profile relies less upon
information from SFVIRS to describe incidents of self- inflicted non- fatal injury.
Profile of Injury in San Francisco Violent Deaths & Injuries
69
Violence in San Francisco: Deaths
Suicide
59%
Homicide
36%
*= Undetermined whether suicide, homicide or unintentional
N= 180
Source: CDHS ( 2003)
Violent Deaths, San Francisco
Residents, 2001
Undetermined*
5%
Figure 57.
Table 5. Mechanisms of violent death
Violent deaths have two major categories: suicide and homicide. This chapter also
includes nine deaths coded as “ intent undetermined” because the Medical Examiner
could not establish whether or not the death resulted from violence.
As in most cities, there were more suicides than homicides. Overall, 28% ( 50) of violent
deaths were committed with a firearm, but 51% ( 33) homicide victims were killed with a
firearm. Thirty- one percent ( 33) of suicides involved some type of drug/ poison.
Intent
Suicide Homicide Undeter Total
Cut pierce 3 7 0 10
Drowning 4 1 1 6
Jump 8 1 1 10
Fire flame 2 0 0 2
Firearm 17 33 0 50
Other land trans 0 1 0 1
Poisoning 33 1 4 38
Struck 0 1 0 1
Hanging 28 1 0 29
Other spec 2 1 1 4
NEC 3 6 0 9
Mechanism
Not spec 6 12 2 20
Total 106 65 9 180
Profile of Injury in San Francisco Violent Deaths & Injuries
70
Violence in San Francisco: Hospitalizations
Hospitalizations for Violence,
San Francisco Residents, 2001
Self-inflicted
46%
Assault
50%
*= Undetermined and legal intervention
N= 1,002
Source: OSHPD ( 2003)
Other*
4%
Figure 58.
Table 6. Mechanisms of non- fatal violent injury resulting in hospitalization
San Francisco residents suffered more non- fatal interpersonal injuries ( assaults) than
self- inflicted injuries, which is opposite the breakdown for violent deaths. Poisonings,
including drugs, accounted for 75% of the self- inflicted non- fatal injuries. Cutting with
sharp objects such as knives, cutters, razors, and picks, and beatings with blunt objects
such as fists, bats and tire irons account for 60% of the assaults.
While this table presents the data coded by intent, the 300 hospitalizations for drugs
and other poisons that were coded as unintentional should not be ignored ( under
‘ Drug/ Poisoning- related Hospitalization’ on page 60). This serves as a reminder that
judgment about intent can vary significantly among health providers.
Intent
Self-inflicted
Assault Other Total
Cut/ pierce 80 121 2 203
Drowning 0 1 0 1
Falls 11 1 2 14
Fire/ burn 4 1 0 5
Firearms 1 65 0 66
Poisonings 346 0 19 365
Struck by 0 181 6 187
Suffocation 2 1 0 3
Summary
Other/ unspecified 15 132 11 158
Total 459 503 40 1002
Profile of Injury in San Francisco Violent Deaths & Injuries
71
Violent Death by Age Groups
Violent Deaths by Age Groups,
2001
0
10
20
30
40
50
60
70
80
# deaths
0- 14 15- 24 25- 44 45- 64 65- 84 85+
Age G ro up s
Su icide Homicide Und eter
Source: CDHS ( 2003)
Figure 59.
(*= too few deaths to calculate rate)
Table 7. Age Groups for violent deaths
The patterns in violent deaths differ by age group, especially as shown by the overall
rates in the table above. In adolescence, homicides predominate. There are more
suicides than homicides among younger adults, who have the highest overall rate of
violent deaths ( 43.2 per 100,000). For all older age groups, suicides predominate.
Violent deaths among the oldest age group are attributable solely to suicide.
Intent
Category ( ages
included) Suicide Homicide
Undeter Total
Overall
rate per
100,000
Child ( 0- 14) 0 2 0 2 *
Adolescent ( 15- 24) 5 19 2 26 29.1
Younger adult ( 25- 44) 41 31 6 78 43.2
Older adult ( 45- 64) 39 9 0 48 27.7
Young old ( 65- 84) 14 4 1 19 20.7
Old old ( 85+) 7 0 0 7 *
Total 106 65 65 180 23.2
Profile of Injury in San Francisco Violent Deaths & Injuries
72
Hospitalized Non- fatal Violent Injuries by Age Groups
Hospitalized Non- fatal Violent Injuries
by Age Groups, 2001
0
100
200
300
400
500
# hospitalizations
0- 14 15- 24 25- 44 45- 64 65- 84 85+
Age Groups
Self- inflicted Assault Other
Source: OSHPD ( 2003)
Figure 60.
Table 8. Age groups for violent non- fatal injury resulting in hospitalization
Adolescents ( ages 15- 24) have the highest rates of non- fatal violent injury, primarily
involving assaults. Children under 15 years have the lowest rates of non- fatal violent
injury. Young adults have high numbers of both self- inflicted and assaultive injuries, but
although they had the highest rates of fatal violent injuries, their rates of non- fatal violent
injuries are significantly lower than the rate for adolescents.
Intent
Self-inflicted
Assault
Other Total
Overall
rate per
100,000
Child ( 0- 14) 8 13 1 22 23.4
Adolescent ( 15- 24) 84 137 3 224 250.6
Younger adult ( 25- 44) 218 241 20 479 152.4
Older adult ( 45- 64) 125 90 12 227 131.2
Young old ( 65- 84) 18 19 4 41 44.6
Old old ( 85+) 6 3 0 9 63.3
Total 459 503 40 1002 129.0
Profile of Injury in San Francisco Violent Deaths & Injuries
73
The San Francisco Violent Injury Reporting System ( SFVIRS)
San Francisco is privileged to be one of thirteen sites of the National Violent Injury
Statistics System ( NVISS), coordinated by the Harvard School of Public Health. The
local effort, named the San Francisco Violent Injury Reporting System ( SFVIRS), is led
by the San Francisco Department of Public Health with support from the San Francisco
Injury Center. The SFVIRS involves active data sharing by the San Francisco Police
Department, the San Francisco Medical Examiner and Marin Coroner’s Office and San
Francisco General Hospital ( SFGH) trauma unit.
The presence of this project helps to fine-tune
the Vital Statistics data used as the
basis of the Profile of Injury. As can be
seen in the adjacent chart, the numbers
from the two data systems do not match
exactly. Some of the differences can be
traced to peculiarities of this city. For
example, because the Coast Guard has a
landing dock on the Marin side of the
Golden Gate, suicides from the bridge are
counted by the state as happening in Marin.
Other differences derive from case
inclusion criteria or from revisions in coding
following examination of the linked data
sets. Because of their accuracy, SFVIRS
data are used to present information
Figure 61. on homicides, suicides, non-fatal
assaults that required hospitalization, unintentional firearm deaths, and all non-fatal
firearm injuries that were treated at the SFGH Emergency Department.
The NVISS serves as the pilot project of the National Violent Death Reporting System
( NVDRS), a new initiative of the National Center for Injury Prevention and Control of the
CDC. California has just received a grant from CDC to become part of this reporting
system. A state- based violent death reporting system, NVDRS will provide accurate and
timely information to:
• make informed decisions about local policies and programs geared toward
keeping citizens safe
• help decision makers answer questions about the magnitude, trends, and
characteristics of violent deaths
• evaluate and continue to improve state- based violence prevention policies and
programs.
Data Comparison
0
20
40
60
80
100
120
140
Homicide
Suicide
Other
# deaths
SFVIRS
Vital Stats
Profile of Injury in San Francisco Violent Deaths & Injuries
74
Violent Injuries and Deaths in 2001 included in the SFVIRS
Number of Violent Incidents and Fatal and Nonfatal Violent Injuries, San
Francisco, 2001
Number of
Incidents
N= 648
Overall Number
of people
Injured
N= 735
Fatal
n= 201
Nonfatal n= 534
Homicide 62 66 66 --
Assault 425 500 -- 500
Suicide 125 126 126 --
Attempted Suicide 26 26 -- 26
Legal Intervention 3 8 2 6
Accident- other
person
1 1 1 0
Accident- self-inflicted
2 2 1 1
Other 1 2 2 0
Could not be
determined
3 4 3 1
Table 9. Source: San Francisco Department of Public Health, San Francisco Violent Injury Reporting System ( SFVIRS):
Violent Injuries and Deaths in 2001 and Firearm Trend Data from 1999 to 2001. Local Data for Local Violence Prevention
Tracking Violent Injuries and Deaths in San Francisco County. Spring 2004.
In 2001, the SFVIRS identified 648 violent incidents in San Francisco. Those involved
approximately 1,548 people— 735 victims and approximately 813 suspects. Over a
quarter of these injuries resulted in death.
The major difference in the numbers presented by the SFVIRS and the Profile is the
source of the data used. The Profile is based primarily upon vital statistics and
California hospital discharge data. The SFVIRS draws upon SF Medical Examiner and
Marin Coroner reports, San Francisco police reports, death certificates, and the SFGH
trauma registries and emergency department records.
For non- fatal violent injuries, SFVIRS only collects data on those victims who were
hospitalized due to a violent injury they incurred or those who were treated at SFGH for
a gun shot injury. The SFVIRS originally intended to match a police report for each
violent incident. However, it was more likely that a violent injury where a victim was
hospitalized or was shot would be reported to the police than every violent brawl where
someone was treated and released from the hospital. Information for the Profile was
also collected from the hospital discharge data system, which includes all hospitals in
San Francisco, and therefore includes data on more patients.
For homicides and non- fatal assaults, the respective numbers for the Profile and the
SFVIRS are quite comparable: 65 vs. 66 homicides and 503 vs. 500 non- fatal assaults.
However, for suicides and non- fatal self- inflicted injury, they differ considerably: 106 vs.
126 suicides and 459 vs. 26 non- fatal self- inflicted injuries. According to the hospital
discharge data, 346 ( 75%) of these self- inflicted injuries were due to drugs or other
poisons, injuries that do not require surgery and are therefore not included in the
Trauma Registry. Because of these differences, this section of the Profile that uses
SFVIRS data will focus primarily on the descriptions of homicides, assaults and
suicides.
Profile of Injury in San Francisco Violent Deaths & Injuries
75
0
20
40
60
80
100
120
140
160
1942
1944
1946
1948
1950
1952
1954
1956
1958
1960
1962
1964
1966
1968
1970
1972
1974
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
Year
Number
Homicide
San Francisco County had the third highest homicide rate ( 8.7 per 100,0001) among
counties in California with populations greater than 500,000. Los Angeles County
( 11.2) had the highest rate, followed by San Joaquin County ( 8.9) with the second
highest rate. One factor that must be taken into account is that San Francisco is solely
an urban area. Therefore, it can be misleading to directly compare the homicide rate in
San Francisco with that of other less urban counties.
In San Francisco County from 1942 to 2002, there were 4,926 homicide victims. The
most recent spike occurred in 1993 with 133 homicide victims, and the most recent low
( of 59) occurred in 2000. In 2001, there were 66 homicide victims, which was a 12%
increase from 2000.2
Number of Homicide Victims ( Residents and Nonresidents)
in San Francisco County from 1942 to 2002
Figure 62.
1 All rates are standardized to the 2000 U. S million population and all are expressed per 100,000 persons.
2 In 2002, there were 73 homicides, and in 2003 there were 70 homicides ( preliminary data).
Source: San Francisco Police Department, Homicide Unit and SFVIRS
Profile of Injury in San Francisco Violent Deaths & Injuries
76
Annual Number of Handguns Purchased in California, by the San Francisco and
California Crude Homicide Rates from 1982 to 2002
-
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
500,000
1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
Number of Handguns Purchased in California
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
20.0
Crude Rate per 100,000
Number of Handguns Purchased
SF Homicide Crude Rate
CA Homicide Crude Rate
Figure 63. Source: San Francisco Department of Public Health, San Francisco Violent Injury Reporting System
( SFVIRS): Violent Injuries and Deaths in 2001 and Firearm Trend Data from 1999 to 2001. Local Data for Local Violence
Prevention Tracking Violent Injuries and Deaths in San Francisco County. Spring 2004.
For the past 15 years, firearms have been the primary mechanism used in homicides. In
the graph above, the number of annual handgun sales is overlaid with the homicide rate
( by all mechanisms, including firearms, knives, blunt objects, etc.) in San Francisco and
in California. These data suggest a relationship between handgun sales and the crude
rates of homicide, i. e., when handgun sales increase the homicide rate follows.
In 2001, homicides represented 12% of all violent interpersonal incidents. Sixty percent
of the homicide victims were killed by a firearm. Non- fatal victims of an assault, on the
other hand, were more likely to be injured by a sharp instrument ( 39%) rather than by a
firearm ( 24%).
Interpersonal violence ( including intimate partner violence) was the precipitating
circumstance in 58% of the homicides, with 44% of these homicide victims knowing the
suspect. Many homicides were identified to have been precipitated by another crime,
such as a drug or robbery incident. Drug and gang- related circumstances for homicides
each occurred 19% of the time.
Source: California Department of Justice and EPIC
Profile of Injury in San Francisco Violent Deaths & Injuries
77
Assault
Of the assault incidents for which a location was identified, 17% of victims were injured
in their home. A total of 40% of the victims lived at or within one mile of the assault
location.
The majority of assault victims were injured on the streets in the Inner Mission ( 48),
South of Market ( 47) and Bayview/ Hunter’s Point ( 31) neighborhoods. The Rincon/
Embarcadero ( 10) and the South of Market ( 9) neighborhoods experienced the greatest
number of violent injuries that occurred in a bar.
When a suspect was identified, it was determined that 55% of the suspects lived at or
within one mile of the incident location. In these cases, 26% of the victims identified the
suspect as someone they knew.
Nearly 14% of the assault victims were not residents of San Francisco, and nearly 14%
of the assault victims were identified as being homeless. Twenty- eight percent of
assaults occurred between July and September. When time was known, 47% of the
assaults occurred between the hours of 9: 00 p. m. and 3: 00 a. m.
Profile of Injury in San Francisco Violent Deaths & Injuries
78
Medical Services and Hospitalization
Of the 66 homicide victims, 55% ( 36) were dead at the scene. Thirty- eight percent ( 25)
of these victims died as an inpatient at SFGH, one died in the SFGH Emergency
Department, and 4 died at other facilities. Sixty- eight percent ( 17) of the homicide
victims were hospitalized for less than a day, while 31% ( 125) of the assault victims
were hospitalized for between 4 and 7 days
Of the 500 assault victims, 67% ( 337) were transported by ambulance to SFGH.
Twenty- five percent ( 124) of the assault victims were brought to the hospital by other
means— themselves ( 77), family or friends ( 35), police ( 2), strangers ( 2), or unknown
( 8). 21 assault victims either refused treatment or were treated at the scene.
Length of Hospitalization by Outcome
at San Francisco General Hospital, 2001
Overall
Homicide
Assault
Days n= 432 % n= 25 % n= 407 %
< 1 42 9.7 17 68.0 25 6.1
1 101 23.4 4 16.0 97 23.8
2- 3 89 20.6 1 4.0 88 21.6
4- 7 126 29.2 1 4.0 125 30.7
8- 28 60 13.9 0 -- 60 14.7
> 28 14 3.2 2 8.0 12 2.9
Table 10. Source: San Francisco Department of Public Health, San Francisco Violent Injury Reporting System ( SFVIRS):
Violent Injuries and Deaths in 2001 and Firearm Trend Data from 1999 to 2001. Local Data for Local Violence Prevention
Tracking Violent Injuries and Deaths in San Francisco County. Spring 2004.
Forty- two percent ( 169) of assault hospitalizations were of victims who were injured by a
knife, followed by 28% ( 116) who were injured of fist or foot, 20% ( 81) by firearms, and
9% ( 36) by blunt instruments. Assault victims who were injured by firearms had the
greatest median hospitalization stay ( 5 days).
Length of Hospitalization in Days for Assault Victims
by Mechanism of Injury: San Francisco, 2001
Mean Median Range
Firearm n= 81 8.7 5 Less than a day – 73
Knife n= 169 3.4 2 Less than a day – 22
Personal n= 116 7.7 4 Less than a day – 100
Blunt n= 36 4.4 3 Less than a day – 27
There were 120 victims who were injured by firearms; 95 hospitalized ( 81 nonfatal, 14 fatal)
There were 194 victims who were injured by a knife; 175 hospitalized ( 169 nonfatal, 6 fatal).
There were 132 victims who were injured by fist or foot; 119 hospitalized ( 116 nonfatal, 3 fatal).
There were 49 victims who were injured from a blunt object; 38 hospitalized ( 36 nonfatal, 2 fatal).
There were six other hospitalizations ( 1 nonfatal strangulation; 1 nonfatal fall, 3 by unknown cause).
Table 11. Source: San Francisco Department of Public Health, San Francisco Violent Injury Reporting System ( SFVIRS):
Violent Injuries and Deaths in 2001 and Firearm Trend Data from 1999 to 2001. Local Data for Local Violence Prevention
Tracking Violent Injuries and Deaths in San Francisco County. Spring 2004.
When the 407 assault victims with non- fatal injuries were discharged from the SFGH,
92% ( 375) went home, 12 went to rehabilitation, 11 went to skilled nursing, 5 went to
another hospital, 3 went to other facilities, and a single victim went to acute care.
Profile of Injury in San Francisco Violent Deaths & Injuries
79
Suicide
In 2001, 126 suicides occurred in San Francisco. The preferred mechanism used in
suicides in San Francisco was by drugs/ poisoning ( 31%- street drugs, gases,
prescriptions and over- the- counter medications), followed by hanging ( 26%). In fact,
San Francisco leads the state in the proportion of suicides that are committed with
poison. In San Francisco, only 15% of the suicides were committed with a firearm,
compared with 47% of suicides in California and 55% of suicides nationally.
Of those who committed suicide, 53% had greater than a 12th grade education. Half
were never married, and 22% were married at the time. Two victims were homeless,
and 11% were veterans. Of the suicide victims, 29% were foreign born and over half of
those foreign- born victims came from Asia.
Twenty- six patients who attempted suicides in 2001 were treated at SFGH. Half of
those victims were males and 58% were White. The ages ranged from 17 to 77 years of
age, with a mean and median of 37 and 34 years, respectively.
Nearly 60% ( 75) of the suicide victims had a reportable mental health disorder. Of
those, 64% ( 48) were in treatment at the time of their suicide. Almost 32% ( 40) of all
suicide victims had prior attempts. This underscores the suicide risk associated with
mental health disorders, even among those undergoing treatment. This is a reminder
that San Francisco needs to address how to better serve this population ( See Table 12).
Location and Time
Fifteen percent of the suicide victims were not San Francisco residents. Death
certificates were obtained for 114 of the victims. Of those victims who were residents
and were not living under supervised care, 74% committed suicide in their residence. Of
all suicide victims, 10% occurred at the Golden Gate Bridge, 10% occurred in residential
or low- income hotels or in hotels, and 8% were living under supervised care ( 7 in care
facilities and 3 in jail) at the time of their suicide, and 3 occurred in other areas.
Profile of Injury in San Francisco Violent Deaths & Injuries
80
Table 12. Source: San Francisco Department of Public Health, San Francisco Violent Injury Reporting System ( SFVIRS):
Violent Injuries and Deaths in 2001 and Firearm Trend Data from 1999 to 2001. Local Data for Local Violence Prevention
Tracking Violent Injuries and Deaths in San Francisco County. Spring 2004.
Note: 28 of the 75 victims who had a mental health problem had multiple mental health conditions
Suicide by Mental Health Status, Intent and Circumstances, by
Gender and Age Group: San Francisco, 2001
Mental Health
Overall
n= 126 %
Male
n= 88 %
Female
n= 38 %
Ages <= 25
n= 12 %
Ages 26- 38
n= 24 %
Ages 39 – 58
n= 54 %
Age 58+
n= 36 %
Depressed at the time 48 38.1 31 35.2 17 44.7 4 33.3 7 29.2 17 31.5 20 55.6
Mental Health Problem 75 59.5 49 55.7 26 68.4 5 41.7 14 58.3 41 75.9 15 41.7