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OKLAHOMA TRIBAL INJURY ATLAS Assessing the Leading Causes of Injury in American Indian and Alaska Native Populations

2021 - 2024

Contents Data Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Emergency Department Visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Fall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Struck By/Against . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Motor Vehicle Traffic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Overexertion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Cut/Pierce . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Natural/Environmental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Foreign Body . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Drug Poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Fire/Burn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Hospitalizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Fall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Drug Poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Motor Vehicle Traffic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 Natural/Environmental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20 Stuck By/Against . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 Cut/Pierce . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Foregin Body . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Fire/Burn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Non-Drug Poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 Child/Adult Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26 Firearm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Suffocation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28 2

Data Sources Inpatient hospital and emergency department discharge data are collected by the Oklahoma State Department of Health Center for Health Statistics.1 This report examines injury-related hospitalizations and emergency department visits in Oklahoma from 2020 to 2024. The data includes Oklahoma and out-of-state residents with discharge dates between 2020 and 2024. Injury-related discharge data were identified and categorized using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) external causeof-injury framework.2 This framework was developed by the National Center for Health Statistics and the National Center for Injury Prevention and Control to provide standardized categories for the reporting of injury events over time. Any initial encounter with at least one diagnosis or external cause-of-injury code corresponding to an injury event in the 2023 ICD10-CM external cause matrix was included.3 The external cause matrix divides ICD-10-CM diagnosis codes into mutually exclusive categories comprising five intents of injury (unintentional, intentional self-harm, assault, undetermined, and legal intervention/war) and 31 injury mechanisms (e.g., fall, struck by/against).

Methods Crude and age-adjusted rates are presented per 100,000 population and calculated using the U.S. Census Bureau’s Vintage 2024 annual population estimates by single race and age. Adjustment weights for direct standardization are derived using the 2000 U.S. standard population from the National Cancer Institute. Age-adjusted rates allow for meaningful comparisons over different time periods and geographic areas, and between injury mechanisms afflicting populations with different age distributions. Throughout this report, rates in the American Indian and Alaska Native (AI/AN) alone population are compared to the overall population in Oklahoma. Confidence intervals for direct standardized rates are calculated using the Fay-Feuer gamma method.4

1. Oklahoma State Department of Health, Health Care Information Division. [2020-2024] [Inpatient/Outpatient/Emergency Department] Discharge Public Use Data File (PUDF). 2. Hedegaard, Holly, Renee L Johnson, Matthew F Garnett, and Karen E Thomas. 2019. “The International Classifications of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) External Cause-of- Injury Framework for Categorizing Mechanism and Intent of Injury.” National Health Statistics Reports, no. 136. 3. National Center for Health Statistics. “ICD-10-CM External Cause Matrix.” https://www.cdc.gov/nchs/injury/injury_tools.htm. 4. Fay, Michael P, and Eric J Feuer. 1997. “Confidence Intervals for Directly Standardized Rates: A Method Based on the Gamma Distribution.” Statistics in Medicine, no. 16: 791–801.

Overview: Emergency Department (ED) Visits Injury-related ED visits made up one in four (25.9%) ED visits in Oklahoma from 2020–2024. Of these visits, 91.6 percent were discharged to home or self-care and 2.9 percent were discharged to another hospital for inpatient admission.

Injury ED visits by mechanism, Oklahoma, 2020–2024 Five-year total number of ED visits and age-adjusted rates per 100,000 population Overall

AI/AN alone

Mechanism

AAR (95% CI)

All injuries

1,928,194

9,580 (9,566, 9,594)

160,256

8,604 (8,560, 8,647)

Fall

675,200

3,231 (3,223, 3,239)

52,344

2,897 (2,871, 2,923)

Struck By/Against

297,778

1,514 (1,508, 1,519)

28,130

1,477 (1,459, 1,495)

Motor Vehicle Traffic

190,931

960 (956, 965)

14,559

782 (769, 795)

Overexertion

149,670

756.3 (752.5, 760.2)

14,181

763.9 (751.0, 776.9)

Cut/Pierce

144,773

733.6 (729.8, 737.4)

12,304

644.1 (632.6, 655.9)

Natural/Environmental

126,673

640.7 (637.1, 644.3)

11,364

598.2 (587.0, 609.6)

Foreign Body

42,485

219.4 (217.3, 221.5)

3,432

172.8 (167.0, 178.9)

Drug Poisoning

33,881

174.0 (172.1, 175.9)

3,149

163.5 (157.7, 169.4)

Fire/Burn

23,188

118.6 (117.1, 120.2)

2,016

105.5 (100.9, 110.4)

AAR: age-adjusted rate; CI: confidence interval Emergency Department Discharge PUDFs, 2020–2024, Health Care Information Division, Oklahoma State Department of Health.

There were 1,928,194 injury-related ED visits in Oklahoma from 2020–2024. Of these encounters, 160,256 (8.3%) were among patients identifying as AI/AN alone. In the overall population, ageadjusted rates (95% C.I.) for injury-related ED visits increased from 7,659 (7,631, 7,687) per 100,000 in 2020 to 10,834 (10,802, 10,867) per 100,000 in 2024. Age-adjusted rates in the AI/AN alone population increased similarly during this period, but were significantly lower than rates in the overall population: they ranged from 7,306 (7,216, 7,398) per 100,000 in 2020 to 9,223 (9,125, 9,322) per 100,000 in 2024 visits:age-adjusted-ed-all). The ratio of age-adjusted rates for the AI/AN alone population to the overall population in Oklahoma decreased from 0.95 in 2020 to 0.85 in 2024. 4

ED Visits: Injuries due to a Fall Falls were the most common injury mechanism in emergency department visits in Oklahoma from 2020–2024, amounting to 35 percent of all injury-related ED visits during this period. Nearly all fall ED visits were classified as unintentional injuries (99.9%). There were 675,200 fall ED visits in Oklahoma from 2020–2024. Of these encounters, 52,344 (7.8%) were among patients identifying as AI/AN alone. In the overall population, age-adjusted rates (95% C.I.) for fall ED visits increased from 2,542 (2,526, 2,558) per 100,000 in 2020 to 3,620 (3,602, 3,638) per 100,000 in 2024. Age-adjusted rates in the AI/AN alone population increased similarly during this period, but were significantly lower than rates in the overall population: they ranged from 2,374 (2,321, 2,428) fall ED visits per 100,000 in 2020 to 3,121 (3,063, 3,180) per 100,000 in 2024. The ratio of age-adjusted rates for the AI/AN alone population to the overall population in Oklahoma decreased from 0.96 in 2021 to 0.86 in 2024.

ED Visits: Struck By / Against Injuries Struck by/against injuries were the second most common injury mechanism in emergency department visits in Oklahoma from 2020–2024, amounting to 15.5 percent of all injury-related ED visits during this period. Diagnoses in stuck by/against ED visits involve injuries from striking against or struck by stationary, thrown, projected, or falling objects, or another person. Four out of five struck by/against ED visits were for an unintentional injury, whereas 19.3 percent of visits involved assault. There were 297,778 struck by/against ED visits in Oklahoma from 2020–2024. Of these encounters, 28,130 (9.4%) were among patients identifying as AI/AN alone. In the overall population, age-adjusted rates (95% C.I.) for struck by/against ED visits increased from 1,174 (1,163, 1,185) per 100,000 in 2020 to 1,777 (1,764, 1,791) per 100,000 in 2024. Age-adjusted rates in the AI/AN alone population increased at a slower rate from 1,247 (1,210, 1,285) to 1,638 (1,597, 1,680) per 100,000. The ratio of age-adjusted rates for the AI/AN alone population to the overall population in Oklahoma decreased from 1.06 in 2020 to 0.92 in 2024.

ED Visits: Motor Vehicle Traffic Injuries Injuries due to motor vehicle traffic accidents were the third most common injury mechanism in emergency department visits in Oklahoma from 2020–2024, amounting to 9.9 percent of all injuryrelated ED visits during this period. Nearly all motor vehicle traffic ED visits were classified as unintentional injuries (99.8%). There were 190,849 motor vehicle traffic ED visits in Oklahoma from 2020–2024. Of these encounters, 14,555 (7.6%) were among patients identifying as AI/AN alone. In the overall population, age-adjusted rates (95% C.I.) for motor vehicle traffic ED visits increased from 793.7 (784.7, 802.7) per 100,000 in 2020 to 1,039 (1,029, 1,049) per 100,000 in 2024. Age-adjusted rates in the AI/AN alone population remained relatively stable during this period and were significantly lower than rates in the overall population: they ranged from 718.8 (690.7, 748.1) per 100,000 in 2020 to 790.3 (761.9, 819.8) per 100,000 in 2024. The age-adjusted rate ratio between the AI/AN alone and overall populations decreased from 0.91 in 2020 to 0.76 in 2024.

ED Visits: Overexertion Injuries Overexertion injuries were the fourth most common injury mechanism in emergency department visits in Oklahoma from 2020–2024, amounting to 7.8 percent of all injury-related ED visits during this period. Diagnoses in overexertion ED visits include injuries from prolonged static postures; strenuous movement or load; repetitive movement; and slipping, tripping, and stumbling without falling. All overexertion ED visits were classified as unintentional injuries. There were 149,670 overexertion ED visits in Oklahoma from 2020–2024. Of these encounters, 14,181 (9.5%) were among patients identifying as AI/AN alone. In the overall population, ageadjusted rates (95% C.I.) for overexertion ED visits increased from 619.0 (611.1, 627.0) per 100,000 in 2020 to 821.6 (812.7, 830.7) per 100,000 in 2024. Age-adjusted rates in the AI/AN alone population were higher than in the overall population reaching a high of 859.7 (829.1, 891.3) per 100,000 in 2021 before decreasing to 702.9 (676.0, 730.8) per 100,000 in 2024. The age-adjusted rate ratio between the AI/AN alone and overall populations decreased from 1.18 in 2020 to 0.86 in 2024.

ED Visits: Cut / Pierce Injuries Cut/pierce injuries were the fifth most common injury mechanism in emergency department visits in Oklahoma from 2020–2024, amounting to 7.5 percent of all injury-related ED visits during this period. Common diagnoses in cut/pierce ED visits include contact with knives, sharp glass, or other sharp objects, and nails or other foreign bodies entering through skin. Most cut/pierce ED visits were for an unintentional injury (95.9%), whereas 3.7 percent of visits involved a self-harm injury. There were 144,773 cut/pierce ED visits in Oklahoma from 2020–2024. Of these encounters, 12,304 (8.5%) were among patients identifying as AI/AN alone. In the overall population, ageadjusted rates (95% C.I.) for cut/pierce ED visits increased from 665.9 (657.7, 674.2) per 100,000 in 2020 to 764.2 (755.5, 772.9) per 100,000 in 2024. Age-adjusted rates in the AI/AN alone population were relatively stable during this period, reaching a maximum of 682.8 (656.6, 710.1) visits per 100,000 in 2023 before dropping back down to 627.7 (602.6, 653.8) per 100,000 in 2024. The ratio of age-adjusted rates for the AI/AN alone population to the overall population in Oklahoma decreased from 0.92 in 2020 to 0.82 in 2024.

ED Visits: Natural / Environmental Injuries Natural/environmental injuries were the sixth most common injury mechanism in emergency department visits in Oklahoma from 2020–2024, amounting to 6.6 percent of all injury-related ED visits during this period. Diagnoses in natural/environmental ED visits include bites, stings, or other contact with (non)venemous animals, insects, and plants, as well as exposure to excessive heat and cold. Nearly all natural/environmental ED visits were classified as unintentional injuries (99.3%). There were 125,824 natural/environmental ED visits in Oklahoma from 2020–2024. Of these encounters, 11,267 (9.0%) were among patients identifying as AI/AN alone. In the overall population, age-adjusted rates (95% C.I.) for natural/environmental ED visits increased from 472.7 (465.8, 479.7) per 100,000 in 2020 to 769.5 (760.8, 778.3) per 100,000 in 2024. Age-adjusted rates in the AI/AN alone population increased similarly during this period from 464.2 (441.7, 487.8) to 689.5 (663.1, 716.8) per 100,000. The ratio of age-adjusted rates for the AI/AN alone population to the overall population in Oklahoma slightly decreased from 0.98 in 2020 to 0.9 in 2024.

ED Visits: Injuries due to a Foreign Body A foreign body is any object that enters and becomes stuck in the body. Foreign body injuries were the seventh most common injury mechanism in emergency department visits in Oklahoma from 2020–2024, amounting to 2.2 percent of all injury-related ED visits during this period. Common diagnoses in foreign body ED visits include food and foreign bodies stuck in patients’ digestive tract, ears, esophagus, nostril, eyes, and other natural orifices. All foreign body injuries are classified as unintentional injuries. There were 42,485 foreign body ED visits in Oklahoma from 2020–2024. Of these encounters, 3,432 (8.1%) were among patients identifying as AI/AN alone. In the overall population, ageadjusted rates (95% C.I.) for foreign body ED visits increased from 182.0 (177.7, 186.4) per 100,000 in 2020 to 275.6 (270.3, 280.9) per 100,000 in 2024. Age-adjusted rates in the AI/AN alone population increased similarly during this period, but were significantly lower than rates in the overall population: they ranged from 132.1 (120.7, 144.5) foreign body ED visits per 100,000 in 2020 to 233.0 (218.0, 249.0) visits per 100,000 in 2024. The age-adjusted rate ratio between the AI/AN alone and overall population in Oklahoma increased from 0.73 in 2020 to 0.85 in 2024.

ED Visits: Drug Poisoning Drug poisoning was the eighth most common injury mechanism in emergency department visits in Oklahoma from 2020–2024, amounting to 1.8 percent of all injury-related ED visits during this period. Two-thirds of drug poisoning ED visits were classified as unintentional, 29 percent of visits involved self-harm, and 4.3 percent had undetermined intent. There were 33,881 drug poisoning ED visits in Oklahoma from 2020–2024. Of these encounters, 3,149 (9.3%) were among patients identifying as AI/AN alone. Age-adjusted rates (95% C.I.) for drug poisoning ED visits increased over time and peaked in 2023 in both the AI/AN alone population and overall population in Oklahoma: 190.4 (176.6, 205.1) and 200.6 (196.2, 205.2) per 100,000, respectively. The age-adjusted rate ratio between the AI/AN alone and overall populations increased from 0.9 in 2020 to 0.97 in 2024.

ED Visits: Fire / Burn Injuries Fire/burn injuries were the ninth most common injury mechanism in emergency department visits in Oklahoma from 2020–2024, amounting to 1.2 percent of all injury-related ED visits during this period. Common diagnoses in fire/burn ED visits include contact with heat and hot substances and exposure to smoke, fire, and flames. Most fire/burn ED visits were classified as unintentional (97.9%), but 1.0 percent of visits had undetermined intent. There were 23,181 fire/burn ED visits in Oklahoma from 2020–2024. Of these encounters, 2,015 (8.7%) were among patients identifying as AI/AN alone. In the overall population, age-adjusted rates (95% C.I.) for fire/burn ED visits increased from 98.5 (95.3, 101.7) per 100,000 in 2020 to 128.8 (125.2, 132.4) per 100,000 in 2024. Age-adjusted rates in the AI/AN alone population were nearly identical to the overall population in 2020 and increased similarly during this period before dropping to 100.9 (91.1, 111.8) visits per 100,000 in 2024. The age-adjusted rate ratio between the AI/AN alone and overall populations decreased from 0.97 in 2020 to 0.78 in 2024.

Overview: Hospitalizations Hospitalizations for an injury amount to 4.7 percent of all hospitalizations in Oklahoma from 2020– 2024. This data includes readmissions and transfers from another hospital or emergency department. Of these hospitalizations, 40 percent were discharged to home or self-care, 15.4 percent were transferred to a skilled nursing facility, and 12.2 percent were discharged to home under care of organized home health service organization.

Injury hospitalizations by mechanism, Oklahoma, 2020–2024 Five Year Age Adjusted Rates per 100,000 Population Overall

AI/AN alone

Mechanism

AAR (95% CI)

All injuries

188,978

855.0 (851.1, 858.9)

12,619

757.3 (743.7, 771.2)

Fall

105,413

452.3 (449.5, 455.1)

5,631

365.0 (355.2, 375.2)

Drug Poisoning

22,083

109.3 (107.9, 110.8)

1,763

96.0 (91.5, 100.7)

Motor Vehicle Traffic

11,333

55.0 (53.9, 56.0)

924

52.2 (48.8, 55.8)

Natural/Environmental

8,181

38.8 (37.9, 39.7)

734

41.9 (38.9, 45.2)

Struck By/Against

6,400

30.6 (29.9, 31.4)

589

34.4 (31.6, 37.5)

Cut/Pierce

4,107

20.7 (20.1, 21.3)

360

19.8 (17.7, 22.0)

Foreign Body

3,327

15.8 (15.2, 16.3)

249

14.4 (12.6, 16.4)

Fire/Burn

2,585

12.5 (12.0, 13.0)

262

14.5 (12.8, 16.5)

Non-Drug Poisoning

2,471

12.3 (11.8, 12.8)

243

13.6 (11.9, 15.5)

Child/Adult Abuse

2,200

11.3 (10.8, 11.8)

191

9.5 (8.2, 11.0)

Firearm

2,140

11.0 (10.5, 11.5)

174

9.3 (8.0, 10.9)

Suffocation

2,174

9.8 (9.4, 10.2)

170

9.9 (8.4, 11.6)

AAR: age-adjusted rate; CI: confidence interval Inpatient Discharge PUDFs, 2020–2024, Health Care Information Division, Oklahoma State Department of Health.

There were 188,978 injury-related hospitalizations in Oklahoma from 2020–2024. Of these encounters, 12,619 (6.7%) were among patients who identify as AI/AN alone. Age-adjusted rates in the AI/AN alone population were relatively stable from 2020 to 2023, increasing to 830.1 (799.6, 861.7) per 100,000 in 2024. The ratio of age-adjusted rates for the AI/AN alone population to the overall population in Oklahoma slightly decreased during this period from 0.94 in 2020 to 0.89 in 2024. 15

Hospitalizations: Injuries due to a Fall Falls were the most common injury mechanism in hospitalizations in Oklahoma from 2020–2024, amounting to 55.8 percent of all injury-related hospitalizations during this period. Nearly all fall hospitalizations were classified as unintentional injuries (99.9%). There were 105,413 fall hospitalizations in Oklahoma from 2020–2024. Of these encounters, 5,631 (5.3%) were among patients who identify as AI/AN alone. In the overall population, age-adjusted rates (95% C.I.) for fall hospitalizations increased from 405.3 (399.4, 411.3) per 100,000 in 2020 to 503.5 (497.1, 510.0) per 100,000 in 2024. Age-adjusted rates in the AI/AN alone population similarly increased from 346.1 (323.6, 370.1) per 100,000 in 2020 to 401.4 (379.6, 424.2) per 100,000 in 2024. The ratio of age-adjusted rates for the AI/AN alone population to the overall population in Oklahoma was relatively stable ranging between 0.78 and 0.85.

Hospitalizations: Drug Poisoning Drug poisoning was the second most common injury mechanism in hospitalizations in Oklahoma from 2020–2024, amounting to 11.8 percent of all injury-related hospitalizations during this period. One in two drug poisoning hospitalizations were classified as unintentional, 46.8 percent of visits involved self-harm, and 3.5 percent had undetermined intent. There were 22,083 drug poisoning hospitalizations in Oklahoma from 2020–2024. Of these encounters, 1,763 (8.0%) were among patients who identify as AI/AN alone. In the overall population, age-adjusted rates (95% C.I.) for drug poisoning hospitalizations increased from 103.3 (100.1, 106.6) per 100,000 in 2020 to 113.7 (110.3, 117.1) per 100,000 in 2023, falling back down to 107.0 (103.8, 110.2) per 100,000 in 2024. Age-adjusted rates in the AI/AN alone population also increased during this period from 91.1 (81.3, 102.2) per 100,000 in 2020 to 103.2 (93.0, 114.4) per 100,000 in 2024. The age-adjusted rate ratio between the AI/AN alone and overall populations in Oklahoma increased from 0.88 in 2020 to 0.96 in 2024.

Hospitalizations: Motor Vehicle Traffic Injuries Injuries due to motor vehicle traffic accidents were the third most common injury mechanism in hospitalizations in Oklahoma from 2020–2024, amounting to six percent of all injury-related hospitalizations during this period. Nearly all motor vehicle traffic hospitalizations were classified as unintentional injuries (99.2%). There were 11,316 motor vehicle traffic hospitalizations in Oklahoma from 2020–2024. Of these encounters, 924 (8.2%) were among patients identifying as AI/AN alone. In the overall population, age-adjusted rates (95% C.I.) for motor vehicle traffic hospitalizations increased slightly from 52.3 (50.0, 54.6) per 100,000 in 2020 to 60.0 (57.7, 62.4) per 100,000 in 2024. Age-adjusted rates in the AI/AN alone population decreased from 55.5 (47.8, 64.2) per 100,000 in 2020 to 44.7 (38.0, 52.6) per 100,000 in 2023 before moving back up to 57.0 (49.3, 65.7) per 100,000 in 2024. The ratio of age-adjusted rates for the AI/AN alone population to the overall population in Oklahoma ranged between 0.81 and 1.06 during this period.

Hospitalizations: Natural / Environmental Injuries Natural/environmental injuries were the fourth most common injury mechanism in hospitalizations in Oklahoma from 2020–2024, amounting to 4.3 percent of all injury-related hospitalizations during this period. Diagnoses in natural/environmental hospitalizations include bites, stings, or other contact with (non)venemous animals, insects, and plants, as well as exposure to excessive heat and cold. Nearly all natural/environmental hospitalizations were classified as unintentional injuries (99.6%). There were 8,110 natural/environmental hospitalizations in Oklahoma from 2020–2024. Of these encounters, 727 (9.0%) were among patients who identify as AI/AN alone. In the overall population, age-adjusted rates (95% C.I.) for natural/environmental hospitalizations increased from 28.9 (27.3, 30.7) per 100,000 in 2020 to 46.7 (44.7, 48.9) per 100,000 in 2024. Age-adjusted rates in the AI/AN alone population similarly increased from 31.8 (25.8, 39.2) per 100,000 in 2020 to 55.9 (48.4, 64.6) per 100,000 in 2024. The ratio of age-adjusted rates for the AI/AN alone population to the overall population in Oklahoma also increased during this period from 1.1 in 2020 to 1.2 in 2024.

Hospitalizations: Struck By / Against Injuries Struck by/against injuries were the fifth most common injury mechanism in hospitalizations in Oklahoma from 2020–2024, amounting to 3.4 percent of all injury-related hospitalizations during this period. Diagnoses in stuck by/against hospitalizations involve injuries from striking against or struck by stationary, thrown, projected, or falling objects, or another person. Two in three struck by/against hospitalizations were for an unintentional injury, whereas 30.9 percent of visits involved assault. There were 6,400 struck by/against hospitalizations in Oklahoma from 2020–2024. Of these encounters, 589 (9.2%) were among patients who identify as AI/AN alone. In the overall population, age-adjusted rates (95% C.I.) for struck by/against hospitalizations was stable ranging between 29.6 (27.9, 31.3) per 100,000 in 2020 and 31.7 (30.0, 33.4) per 100,000 in 2024. Age-adjusted rates in the AI/AN alone population decreased during this period from 43.1 (36.0, 51.5) per 100,000 in 2020 to 32.6 (26.8, 39.4) per 100,000 in 2024. The ratio of age-adjusted rates for the AI/AN alone population to the overall population in Oklahoma decreased from 1.46 in 2020 to 1.03 in 2024.

Hospitalizations: Cut / Pierce Injuries Cut/pierce injuries were the sixth most common injury mechanism in hospitalizations in Oklahoma from 2020–2024, amounting to 2.2 percent of all injury-related hospitalizations during this period. Common diagnoses in cut/pierce hospitalizations include contact with knives, sharp glass, or other sharp objects, and nails or other foreign bodies entering through skin. One in two cut/pierce hospitalizations were for an unintentional injury, whereas 49.4 percent of visits involved a self-harm injury. There were 4,107 cut/pierce hospitalizations in Oklahoma from 2020–2024. Of these encounters, 360 (8.8%) were among patients who identify as AI/AN alone. In the overall population, ageadjusted rates (95% C.I.) for cut/pierce hospitalizations fluctuated between 19.3 (17.9, 20.7) and 21.9 (20.5, 23.5) per 100,000. Age-adjusted rates in the AI/AN alone population decreased from 23.9 (19.0, 30.0) per 100,000 in 2020 to 17.7 (13.7, 22.8) per 100,000 in 2024, reaching a low of 15.4 (11.5, 20.4) per 100,000 in 2022. The ratio of age-adjusted rates for the AI/AN alone population to the overall population in Oklahoma decreased from 1.24 in 2020 to 0.9 in 2024.

Hospitalizations: Injuries due to a Foreign Body A foreign body is any object that enters and becomes stuck in the body. Foreign body injuries were the seventh most common injury mechanism in hospitalizations in Oklahoma from 2020–2024, amounting to 1.8 percent of all injury-related hospitalizations during this period. Common diagnoses in foreign body hospitalizations include food and foreign bodies stuck in patients’ stomach, esophagus, respiratory tract, small intestine, digestive tract, and other natural orifices. All foreign body injuries are classified as unintentional injuries. There were 3,327 foreign body hospitalizations in Oklahoma from 2020–2024. Of these encounters, 249 (7.5%) were among patients who identify as AI/AN alone. In the overall population, age-adjusted rates (95% C.I.) for foreign body hospitalizations increased from 12.0 (11.0, 13.1) per 100,000 in 2020 to 20.6 (19.3, 22.1) per 100,000 in 2024. Age-adjusted rates in the AI/AN alone population similarly increased from 9.9 (6.8, 14.1) per 100,000 in 2020 to 19.9 (15.5, 25.5) per 100,000 in 2024. The ratio of age-adjusted rates for the AI/AN alone population to the overall population in Oklahoma also increased during this period from 0.82 in 2020 to 0.97 in 2024.

Hospitalizations: Fire / Burn Injuries Fire/burn injuries were the eighth most common injury mechanism in hospitalizations in Oklahoma from 2020–2024, amounting to 1.4 percent of all injury-related hospitalizations during this period. Common diagnoses in fire/burn hospitalizations include contact with heat and hot substances and exposure to smoke, fire, and flames. Most fire/burn hospitalizations were classified as unintentional (92%), 6.3 percent involved self-harm, and 1.3 percent had undetermined intent. There were 2,575 fire/burn hospitalizations in Oklahoma from 2020–2024. Of these encounters, 261 (10.1%) were among patients who identify as AI/AN alone. In the overall population, ageadjusted rates (95% C.I.) for fire/burn hospitalizations increased slightly from 11.5 (10.5, 12.6) per 100,000 in 2020 to 12.8 (11.7, 13.9) per 100,000 in 2024. Age-adjusted rates in the AI/AN alone population fluctuated between 12.8 (9.3, 17.4) and 16.1 (12.3, 20.9) per 100,000. The ratio of ageadjusted rates for the AI/AN alone population to the overall population in Oklahoma decreased from 1.37 in 2020 to 1.03 in 2024.

Hospitalizations: Non-Drug Poisoning Non-drug poisoning was the ninth most common injury mechanism in hospitalizations in Oklahoma from 2020–2024, amounting to 1.3 percent of all injury-related hospitalizations during this period. Diagnoses in non-drug poisoning hospitalizations include toxic effects of ethanol, smoke, carbon monoxide, alcohol, and other substances and gases. More than sixty percent of non-drug poisoning hospitalizations were classified as unintentional, 30.6 percent involved self-harm, and 5.7 percent had undetermined intent. There were 2,471 non-drug poisoning hospitalizations in Oklahoma from 2020–2024. Of these encounters, 243 (9.8%) were among patients identifying as AI/AN alone. In the overall population, age-adjusted rates (95% C.I.) for non-drug poisoning hospitalizations decreased from 13.6 (12.4, 14.8) per 100,000 in 2020 to 11.2 (10.2, 12.3) per 100,000 in 2024. Age-adjusted rates in the AI/AN alone population were relatively stable between 2020 and 2022 before increasing to 17.3 (13.2, 22.3) per 100,000 in 2023. The ratio of age-adjusted rates for the AI/AN alone population to the overall population in Oklahoma increased from 0.86 in 2020 to 1.38 in 2024.

Hospitalizations: Child / Adult Abuse Injuries Child/adult abuse were the tenth most common injury mechanism in hospitalizations in Oklahoma from 2020–2024, amounting to 1.2 percent of all injury-related hospitalizations during this period. This category includes confirmed and suspected cases of neglect, abandonment, maltreatment, physical abuse, psychological abuse, and sexual abuse among children and adults. All child/adult abuse injuries are classified as assault. There were 2,200 child/adult abuse hospitalizations in Oklahoma from 2020–2024. Of these encounters, 191 (8.7%) were among patients identifying as AI/AN alone. In the overall population, age-adjusted rates (95% C.I.) for child/adult abuse hospitalizations remained stable around 11.3 11.3 (10.2, 12.4) per 100,000 in 2022. Age-adjusted rates in the AI/AN alone population were slightly lower during this period, ranging from 8.3 (5.7, 11.9) to 10.7 (7.7, 14.7) per 100,000. The ratio of age-adjusted rates for the AI/AN alone population to the overall population in Oklahoma increased from 0.8 in 2020 to 0.99 in 2024.

Hospitalizations: Firearm Injuries Firearm injuries were the eleventh most common injury mechanism in hospitalizations in Oklahoma from 2020–2024, amounting to 1.1 percent of all injury-related hospitalizations during this period. This category includes injuries caused by discharge of handguns, shotguns, hunting rifles, and other firearms. More than fifty percent of firearm hospitalizations are due to accidental discharge of a firearm, 30.6 percent involved assault, 11.2 percent involved self-harm, 3.9 percent had undetermined intent, and 1.4 percent were classified under legal intervention/war. There were 2,140 firearm hospitalizations in Oklahoma from 2020–2024. Of these encounters, 174 (8.1%) were among patients who identify as AI/AN alone. In the overall population, age-adjusted rates (95% C.I.) for firearm hospitalizations decreased from 13.7 (12.5, 14.9) per 100,000 in 2020 to 9.5 (8.6, 10.6) per 100,000 in 2024. Age-adjusted rates in the AI/AN alone population similarly decreased from 12.3 (8.9, 16.6) per 100,000 in 2020 to 8.7 (5.9, 12.5) per 100,000 in 2024. The ratio of age-adjusted rates for the AI/AN alone population to the overall population in Oklahoma ranged between 0.8 and 0.91 during this period.

Hospitalizations: Suffocation Injuries Suffocation was the twelth most common injury mechanism in hospitalizations in Oklahoma from 2020–2024, amounting to 1.2 percent of all injury-related hospitalizations during this period. Diagnoses include asphyxiation caused by food or foreign objects in the respiratory tract and by hanging. Most suffocation hospitalizations were for an unintentional injury (86.3%), whereas 12.4 percent involved a self-harm injury. There were 2,174 suffocation hospitalizations in Oklahoma from 2020–2024. Of these encounters, 170 (7.8%) were among patients who identify as AI/AN alone. In the overall population, ageadjusted rates (95% C.I.) for suffocation hospitalizations slightly decreased from 10.0 (9.0, 11.0) per 100,000 in 2020 to 8.7 (7.9, 9.6) per 100,000 in 2024. Age-adjusted rates in the AI/AN alone population decreased during this period from 11.6 (8.0, 16.7) per 100,000 in 2020 to 6.8 (4.3, 10.2) per 100,000 in 2024. The ratio of age-adjusted rates for the AI/AN alone population to the overall population in Oklahoma decreased from 1.17 in 2020 to 0.78 in 2024.

For any additional variable data inquiries, jurisdiction specific statistics, injury prevention support, or other questions please contact the Oklahoma Tribal Epidemiology Center (OKTEC) Epidemiology & Biostatistics Team at

okteccorestaff@spthb.org