Identification and Characterization of Nonfatal Injuries among Persons with Disabilities in Kentucky

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Bunn, Jacqueline Seals, Dana Quesinberry, Alaina Murphy, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5333206/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 09 May, 2025 Read the published version in Injury Epidemiology → Version 1 posted 11 You are reading this latest preprint version Abstract Background Vulnerable populations at risk of injury include persons with intellectual and developmental disabilities (IDD), and persons who are deaf or hard of hearing (DHH). The increased risk of physical injury among children and older adults with IDD is well-documented, but information on the non-elderly population is lacking. The purpose of this study was to describe and compare emergency department (ED) + inpatient hospitalization (IP) injury rates among persons under age 65 with IDD or DHH by injury type and other variables with ED + IP rates among those without the same disabilities. Methods Injury data were extracted from Kentucky ED and IP discharge datasets from 2019 to 2023. Rates and rate ratios for injuries were calculated for those under age 65 with and without IDD and DHH, using number of persons under age 65 with and without the related disability as the denominator. Results T he overall injury rate was lower for persons under age 65 with an IDD or DHH compared to those without those disabilities in 2023. Both disability types had lower overall ED + IP injury rate ratios compared to those without those disabilities. In contrast with the lower overall injury rate, persons under age 65 with IDD and DHH had higher ED + IP injury rate ratios for self-harm, assault, unintentional falls, and drug poisonings compared to those without those disabilities. Those with DHH had the same unintentional motor vehicle crash ED + IP rate ratio as those without the disability, whereas those with IDD had a lower unintentional motor vehicle crash ED + IP injury rate ratio. Importantly, those with IHH and DHH who were treated for injuries incurred charges that were triple the charges for patients without these conditions. Conclusions This study provides a better understanding of increased risk for injury intent and mechanism that highlights areas for improved injury prevention because exposure to common causes of injury varies from those of populations without these disabilities. For IDD and DHH individuals, it is important to target education and interventions to the prevention of self-harm, assaults, unintentional falls, and drug poisonings available to the individuals, their caregivers, and healthcare providers. INTRODUCTION Injuries take an enormous toll on the US population in terms of financial, physical, and mental well-being. According to the National Safety Council, 63 million persons who were injured and treated in 2022, a 162% increase over the last 30 years (National Safety Council, 2023). In 2021, the associated costs of injuries total approximately $ 1.3 billion (National Safety Council, 2023). Injuries affect vulnerable populations such as persons with intellectual and developmental disabilities (IDD), and those who are deaf or hard of hearing (DHH). In the United States, it has been estimated that 28.7% of all adults have a disability; 13.9% have a cognition disability and 6.2% have a hearing disability (Centers for Disease Control and Prevention, 2024). The increased risk of physical injury among children with intellectual or developmental disability is well-documented, but data on non-elderly adults with IDD has not been as well-studied. IDD is associated with increased prevalence of many chronic conditions (Zandam et al., 2024), so it is not surprising that injuries are also more common in this population. Calver et al. (2021) found a 1.79 higher rate of hospitalized intentional and unintentional injuries in IDD compared with non-IDD children and adolescents. However, a prospective cohort study found the increase in injury prevalence among young people with IDD was limited to those who also had attention deficit-hyperactivity disorder (White 2018). A particularly concerning finding regarding non-accidental trauma (NAT) by Baghdadi et al (2024) was that children with IDD were 9 times as likely to be hospitalized with NAT injuries than those without IDD. Similarly, Samuel and colleagues (2023) found that children with developmental disabilities were over-represented among children who died because of abusive injuries. This phenomenon is not limited to children and adolescents. For example, a Swedish study documented increased risk of injury in adults aged 65 and older with autism and of fall-related injury in older adults with IDD (Liu et al., 2023). In a study of U.S. emergency department (ED) visits by intellectual and development disability status and race or ethnicity, the authors found that persons with IDD had higher rates of multiple chronic condition-related ED visits (Zandam et al., 2024). They also showed that Black and Latinx persons with IDD had higher rates than whites for multiple chronic condition ED visits. Unintentional injury is less studied in the DHH population, but several investigations have identified heightened risk of self-harm in this population (Vanderminden et al., 2023). Focus on the non-elderly DHH population is important because the high prevalence of hearing impairments in older adults is a confounding factor in analyses of their relationship to injury rates and types. It is also important to note that third-party coverage for assistive hearing devices is widely available for children and adolescents but rarely so for older adults, so individuals coded as DHH in our data may not live with serious functional impairments. The purpose of this study was to describe and compare ED + inpatient hospitalization (IP) injury rates among persons under age 65 with IDD and DHH by injury type and other variables with ED + IP rates among those without such disabilities. We hypothesized that rates of ED visits and IP for injuries of persons with IDD and DHH would be higher compared with rates of ED visit and IP for injuries of persons without such disabilities. The IDD and DHH groups were chosen for study because their representation in Kentucky health records was robust enough to support detailed analysis. METHODS Data Sources We conducted a population-based cross-sectional study using combined ED visit and IP data. The datasets contained information for all patients who were treated and discharged from either the ED or an IP admission at Kentucky hospitals. To avoid duplication of cases in the combined ED and IP dataset, encounters that were discharged from an IP admission were removed from the ED dataset. Fatal encounters were removed from the dataset and were not analyzed for this study. Study Population The study population included all nonfatal injury-related ED + IP encounters in Kentucky hospitals for all Kentucky residents 64 years and younger, classified by disability status: 1) IDD; 2) DHH; and 3) no IDD or DHH recorded. Nonfatal injury-related encounters were defined using ICD-10-CM codes, following guidance from the Council of State and Territorial Epidemiologist Surveillance (CSTE) Toolkit (Hedegaard and Johnson, 2019; Hedegaard et al., 2021). Developmental and intellectual disabilities were defined using the following ICD-10-CM codes: F70-F73, F78-F79, F81, F849, and Z736. Deaf and hard of hearing disabilities were defined using ICD-10-CM codes H90-H91. The group without the targeted disabilities was identified by excluding all cases with the ICD-10-CM disability code groups of interest. Variable Selection Demographic variables that were analyzed included age group, biological sex, race, ethnicity, metro status, Appalachian status, injury type, expected payer, and location of treatment. Averages of total charges by disability status group were calculated. Age groups included 0-17, 18-34, and 35-64 years. Race was identified as black, white or other. Ethnicity was defined as either Hispanic or non-Hispanic, and biological sex was identified as either male or female. Metro status was based on the Rural-Urban Continuum Codes (RUCC) defined as a residence in either a metropolitan (RUCC 1-3) or non-metropolitan area (RUCC 4-9) (USDA, 2024). Appalachian Status was defined as resident counties served by the Appalachian Regional Commission (Appalachian Regional Commission, 2024). Expected payer was categorized into Medicare, Medicaid, Commercial, Self-Pay/Charity, and ‘other’ categories. Location of treatment was identified from the discharge status from either the ED or from an IP. Self-harm, assault, unintentional fall, unintentional motor vehicle crash, and drug poisoning injuries were defined using ICD-10-CM codes, following guidance from the CSTE Surveillance Toolkit (Hedegaard and Johnson, 2019; Hedegaard et al., 2021) . The CSTE Surveillance Toolkit does not include definitions for struck by/against and overexertion injuries. Therefore, struck by/against and overexertion injuries were defined using the National Center for Health Statistics External Cause of Injury Matrix (Hedegaard et al., 2019). Statistical Analysis Population-based injury rates for the year 2023 were calculated as the number of injuries per 1000 disability population group and were adjusted by age. The denominator numbers for persons with or without the related disability were derived from the 1-year estimates from the American Community Survey disability characteristics table (U.S. Census Bureau, 2023). ED + IP injury rates for the years 2019-2023 were calculated as injury encounters per total number of ED + IP encounters for each disability status. Rates were stratified by the disability and demographic variables, except for injury type. Rates were calculated using the following equation: (Injury Encounters (per disability status))/ (All hospital encounters (per disability status)) * 1,000 Adjusted rate ratios and 95% confidence intervals were calculated by demographic/injury categories. Adjusted rate ratios were calculated comparing rates of injury between disability status groups. Adjusted rate ratios were calculated using the following equation: (Adjusted injury rate for males in IDD group)/ (Adjusted injury rate for males in no disability group (reference group)) All analyses were conducted using SAS version 8.16 for Windows (SAS Institute Inc). RESULTS The 2023 overall injury rate when the denominator was the number of persons with or without the related disability was lower for persons with IDD or DHH compared to those without such disabilities (Table 1 ). Injury rates were highest in the 0–17 and 18- 34-year age categories for the DHH group compared to those age categories for IDD group. Table 1 Nonfatal Emergency Department (ED) Visit and Inpatient Hospitalization (IP) Injury Rates by Disability Status in Kentucky, 2023. Injuries Treated in ED and Inpatient Hospitalizations Developmental and Intellectual Disabilities Deaf and Hard of Hearing Disabilities No Developmental and Intellectual, Deaf and Hard of Hearing Disabilities Number of Injuries 443 314 351,885 Rate (Number of Injuries/1000 disability population group) Overall Injury Rate 1 3 106 Age Group 0–17 1 10 110 18–34 2 6 112 35–64 2 2 101 The highest ED + IP injury rate was for the 0- 17-year age category in persons without IDD or DHH (Table 2 ). The lowest injury rate was for the 35- 64-year age category in DHH persons. Comparing the two disability groups, the DHH group had elevated injury rates for the younger and middle age groups. The IDD group, in contrast, had a higher injury rate in the 35-64-year age category than the DHH group of the same age. Males overall had higher injury rates than females in all three groups. Table 2 Demographics of Nonfatal Injury Emergency Department (ED) Visits and Inpatient Hospitalizations (IP) by Disability Status in Kentucky, 2019–2023. Injuries Treated in ED and IP Developmental and Intellectual Disabilities Deaf and Hard of Hearing Disabilities No Developmental and Intellectual, Deaf and Hard of Hearing Disabilities Number of Injuries 2,414 2,700 1,735,237 Rate (Number of Injuries/ 1,000 Disability Group ED + IP) Overall Injury Rate 133 131 199 Age Group (in Years) 0–17 123 196 253 18–34 140 173 193 35–64 130 111 178 Sex Female 131 124 170 Male 134 138 236 Race Black 98 127 179 White 138 131 204 Other 99 151 175 Ethnicity Hispanic 108 117 169 Non-Hispanic 133 131 201 Metro Status Metro 139 137 196 Non-Metro 126 122 204 Appalachian Status Non-Appalachian 131 136 200 Appalachian 135 117 198 Regarding race, the highest ED + IP injury rate was for Whites without IDD. Blacks and ‘other’ races had elevated injury rates in the deaf and hard of hearing group compared to Blacks and ‘other’ races in the IDD group. Overall, injury rates were higher for non-Hispanics but DHH Hispanics had a higher injury rate than Hispanics with IDD. Metro and non-metro ED + IP injury rates were lower for those with both types of disability compared to those without them (Table 2 ). Non-Appalachian and Appalachian injury rates were elevated for those without IDD or DHH although the Appalachian IDD group had a higher injury rate compared to the Appalachian DHH group. The highest injury causal rate for all three groups was for unintentional falls (Table 3 ). The self-harm injury rate was highest for the IDD group compared to the other two groups. The unintentional motor vehicle crash rate was elevated among the DHH group compared to the other two groups. Last, drug poisoning was highest for persons with IDD and lowest for those without the targeted disabilities. Table 3 Injury Characteristics of Nonfatal Injury Emergency Department (ED) Visits and Inpatient Hospitalizations (IP) by Disability Status in Kentucky, 2019–2023. Injuries Treated in ED and IP Developmental and Intellectual Disabilities Deaf and Hard of Hearing Disabilities No Developmental and Intellectual, Deaf and Hard of Hearing Disabilities Rate (Number of Injuries/ 1,000 Disability Group ED + IP) Injury Type Self-harm 120 24 14 Assault 58 54 42 Unintentional fall 385 323 251 Unintentional motor vehicle crash 36 127 119 Drug poisoning 91 61 38 Struck by/ Against 106 119 132 Overexertion 16 45 69 Expected Payer Medicare 142 105 144 Medicaid 124 134 184 Commercial 118 139 216 Self-Pay/Charity 140 153 226 Other 192 239 421 Average Charges $ 17,086 $ 19,550 $ 5,216 Location of Treatment ED 223 201 230 IP 56 52 36 The average charges for injuries in the IDD and DHH groups were more than triple the average charges for those without (Table 3 ). Medicare was the most frequent expected payer for injuries in the IDD group (excluding ‘other’), whereas self-pay or charity was the most frequent expected payer for the deaf and hard of hearing group and for those without the related disabilities. Not surprisingly, the injury rates were higher in the ED for all three groups compared to the IP. Both disability groups had lower overall ED + IP injury rate ratios compared to those without the targeted disabilities (Table 4 ). Both disability groups also had lower injury rate ratios by age group, sex, ethnicity, metro status, and Appalachian status compared to those without those disabilities. The DHH injury rate ratio for the ‘other’ races was the same as for those without the disabilities. Table 4 Rate Ratios for Nonfatal Injuries by Disability Status and Demographics in Kentucky, 2019–2023. Stratified Model Overall Model Developmental and Intellectual Disabilities Deaf and Hard of Hearing Disabilities No Developmental and Intellectual and Deaf and Hard of Hearing Disabilities (Ref Group) Adjusted Rate Ratio 95% CI Adjusted Rate Ratio 95% CI Adjusted Rate Ratio 95% CI Adjusted Rate Ratio 95% CI Disability Status Overall 0.9985 0.9964–1.0006 0.6664 0.6403–0.6935 0.6577 0.6334–0.6830 1.000 0.9979–1.0021 Age Group 0–17 0.9993 0.9953–1.0033 0.4840 0.4202–0.5561 0.7743 0.7098–0.8446 1.000 0.9960–1.0040 18–34 0.9993 0.9954–1.0032 0.7263 0.6781–0.7779 0.8952 0.8230–0.9737 1.000 0.9961–1.0039 35–64 0.9980 0.9948–1.0012 0.7313 0.6940–0.7706 0.6219 0.5925–0.6527 1.000 0.9968–1.0032 Sex Female 0.9991 0.9961–1.0022 0.7738 0.7285–0.8221 0.7310 0.6917–0.7726 1.000 0.9970–1.0031 Male 0.9978 0.9949–1.0007 0.5664 0.5371–0.5974 0.5827 0.5534–0.6136 1.000 0.9971–1.0029 Race Black 0.9987 0.9928–1.0046 0.5478 0.4793–0.6262 0.7092 0.6288–0.7998 1.000 0.9941–1.0059 White 0.9984 0.9961–1.0007 0.6781 0.6502–0.7072 0.6437 0.6182–0.6702 1.000 0.9977–1.0023 Other 0.9994 0.9868–1.0122 0.5622 0.3665–0.8623 0.8585 0.6756–1.0909 1.000 0.9874–1.0128 Ethnicity Hispanic 0.9994 0.9881–1.0108 0.6415 0.4223–0.9743 0.6949 0.5372–0.8990 1.000 0.9887–1.0114 Non-Hispanic 0.9985 0.9964–1.0006 0.6638 0.6377–0.6909 0.6554 0.6309–0.6809 1.000 0.9979–1.0021 Metro Status Metro 0.9986 0.9958–1.0015 0.7083 0.6721–0.7466 0.6989 0.6668–0.7325 1.000 0.9971–1.0029 Non-Metro 0.9984 0.9953–1.0015 0.6167 0.5800-0.6557 0.5983 0.5616–0.6374 1.000 0.9969–1.0031 Appalachian Status Non- Appalachian 0.9986 0.9961–1.0011 0.6585 0.6261–0.6927 0.6800 0.6515–0.7096 1.000 0.9975–1.0025 Appalachian 0.9984 0.9946–1.0023 0.6807 0.6377–0.7265 0.588 0.5424–0.6374 1.000 0.9962–1.0039 When ED + IP injury type rate ratios were compared, persons with IDD and DHH persons had higher injury rate ratios for self-harm, assault, unintentional falls, and drug poisonings compared to those without such disabilities (Table 5 ). DHH persons had the same unintentional motor vehicle crash rate ratio as those without the disabilities, whereas those with IDD had a lower unintentional motor vehicle crash rate ratio. Lower overexertion and struck by/against injury rate ratios were observed for those with IDD, while that group’s struck by/against injury rate ratio was equivalent to that of persons without such disabilities. Table 5 Rate Ratios for Nonfatal Injuries by Disability Status and Injury Type in Kentucky, 2019–2023. Stratified Model Overall Model Developmental and Intellectual Disabilities Deaf and Hard of Hearing Disabilities No Developmental and Intellectual and Deaf and Hard of Hearing Disabilities (Reference Group) Adjusted Rate Ratio 95% CI Adjusted Rate Ratio 95% CI Adjusted Rate Ratio 95% CI Adjusted Rate Ratio 95% CI Injury Type Self-harm 1.0119 0.9939–1.0302 8.7403 7.7831–9.8153 1.7846 1.4016–2.2723 1.00 0.9822–1.0181 Assault 1.1000 0.9907–1.0114 1.3857 1.1733–1.6366 1.3103 1.1145–1.5404 1.00 0.9897–1.0104 Unintentional fall 1.0012 0.9970–1.0054 1.5400 1.4355–1.6328 1.2833 1.2008–1.3716 1.00 0.9958–1.0042 Unintentional motor vehicle crash 0.9991 0.9931–1.0053 0.3027 0.2453–0.3735 1.0637 0.9567–1.1828 1.00 0.9939–1.0061 Drug poisoning 1.0029 0.9921–1.0138 2.4007 2.1030–2.7404 1.6195 1.3907–1.8860 1.00 0.9893–1.0109 Struck by/ Against 0.9996 0.9938–1.0054 0.8040 0.7113–0.9089 0.9042 0.8106–1.0086 1.00 0.9942–1.0058 Overexertion 0.9984 0.9905–1.0064 0.2276 0.1656–0.3127 0.6532 0.5469–0.7801 1.00 0.9920–1.0080 Location of Treatment ED 0.9998 0.9976–1.0019 0.9675 0.9246–1.0124 0.8716 0.8359–0.9088 1.00 0.9979–1.0021 IP 1.0064 0.9942–1.0187 1.5316 1.4080–1.6661 1.4230 1.3032–1.5539 1.00 0.9878–1.0124 DISCUSSION This study shows that while IDD and DHH individuals did not experience higher overall rates of injuries, their rate ratios by injury type were elevated for self-harm, assault, unintentional falls, and drug poisonings. This finding is confirmed using nationally representative survey data sources. In a study using National Health Interview survey data, Brophy et al. (2008) found that falls were the leading cause of injury regardless of disability status. The odds ratios for suicidal ideation and suicide attempt among individuals with a cognitive disability were found to be higher relative to those with a hearing limitation using National Survey on Drug Use and Health data (Marlow et al., 2022). Using the same survey data, Park et al., 2021, showed that substance use disorders were prevalent among DHH persons. The adjusted rate ratio for intentional self-harm was larger for those with a developmental or intellectual disability compared those of DHH patients or those with no disabilities. Intentional self-harm among individuals with disabilities has been documented to be higher than among individuals without disabilities (Brophy et al., 2008; Cree et al., 2020; Marlow et al., 2022). In a study that focused on suicide outcomes, Marlow et al. (2022) found that those with more complex disabilities and cognitive disabilities were more likely to have an attempted suicide reported vs suicidal ideation alone. Cree et al. (2020) found that individuals with a cognitive disability were more likely to have a diagnosed depressive disorder or to binge drink. As with self-harm, we found that individuals with IDD were more likely to be treated for a drug poisoning compared to either the DHH patients or those with no disabilities. While our drug poisoning results do not differentiate by intent, other studies have found that individuals with cognitive disabilities or with more than one disability are at higher risk to have an overdose, substance use, substance misuse, or substance disorder.(Aram et al., 2024; Aram et al., 2023; Hong et al., 2023). In these same studies, individuals who are DHH also had elevated substance use outcomes (Aram et al., 2024; Aram et al., 2023; Hong et al., 2023). Comparable to other studies on injuries among individuals with disabilities (Brophy et al., 2008; Shi et al., 2015; Smulders et al., 2013), we found adjusted rate ratios for falls for individuals with IDD and DHH were elevated. The adjusted rate ratio of assault injuries was larger for those with IDD or DHH compared to those with no disabilities. Unlike other injury characterizations, the assault rates for both disability types were similar. Studies have shown that regardless of disability type, individuals with disabilities are at greater risk of being victims of violence (Hayes & Powers, 2022; Lin et al., 2010; Malihi et al., 2021; Vanderminden et al., 2023). Falls, unintentional struck by/ against, and motor vehicle crashes were the three highest injury rates in those without either disability and DHH individuals, similar to the leading causes of nonfatal injuries for the general population of all ages, sex, and races treated in the ED in 2022 (National Electronic Injury Surveillance System, 2024) but unlike those with an IDD. The variation in injury rates between the population without disability and those with an IDD may be attributable to the lower rate of engagement in activities with elevated risks of injury because of their physical, developmental or cognitive limitations (Brophy et al., 2008; Shi et al., 2015; Schwebel and Brezausek, 2010). Variations in injury rates from the general population may also be attributable to the perception of risk in the populations with disabilities, the use of aids, or assistance/intervention from a caretaker (Schwebel & Brezausek, 2010). Limitations There are limitations to this study, predominantly due to the data source. The hospital discharge data is deidentified so we could only identify injury incidence and were not be able to easily control for injured patients who were transferred between hospitals. Also, the data source only contains visits to a Kentucky hospital. We know there is missing data in areas around the border of Kentucky where larger out-of-state hospitals are closer. Since the data set was based on encounters, we could not calculate rates based on number of persons treated in the ID or IP. Fourth, cases and variables were identified using ICD-10-CM codes, and we know that there could be a small overlap of disability types. Last, self-harm ICD-10-CM codes do not indicate intent (intentional or unintentional). CONCLUSIONS This study contributes to understanding of the increased risk for different injury intent and mechanism to support areas for improved injury prevention. Targeted injury prevention education should address populations whose specific disabilities increase their risk of harm. For individuals with IDD and DHH, such education and interventions should address prevention of self-harm, assaults, unintentional falls, and drug poisonings. Education and interventions should be available to the individuals, their caregivers, and their healthcare providers. Abbreviations IDD- intellectual or developmental disability NAT- non-accidental trauma ED- emergency department IP- inpatient hospitalization Declarations Ethic approval and consent to participate: This study was approved by the University of Kentucky Internal Review Board under the Kentucky State Injury Prevention Program. Consent for publication: Not applicable. Availability of data and material: The Kentucky Injury Prevention and Research Center is not the owner of the Emergency Department visit or inpatient hospitalization data. All requests for the data should be made to the data owner, the Office of Data Analytics in the Kentucky Cabinet for Health and Family Services. Competing interests: There are no competing interests. Funding: Funding for this study was provided by a Kentucky Department for Public Health State Injury Prevention Program contract to the University of Kentucky Research Foundation. Authors’ contributions: TB conceived the study, collaborated on study design and analysis, and participated in the writing and editing of the draft manuscript; JS collaborated on study design and analysis, and participated in the writing and editing of the draft manuscript; DQ collaborated on study design and analysis, and participated in the writing and editing of the draft manuscript; AM conducted the statistical analysis and participated in the writing and editing of the draft manuscript; and JC collaborated on study design and analysis, and participated in the writing and editing of the draft manuscript. 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Association between functional disability type and suicide-related outcomes among U.S. adults with disabilities in the National Survey on Drug Use and Health, 2015–2019. Journal of Psychiatric Research , 153 , 213-222. https://doi.org/https://doi.org/10.1016/j.jpsychires.2022.07.014 National Electronic Injury Surveillance System-All Injury Program for WISQARS Nonfatal data, an estimated number of hospital visits for injury care that start in an emergency department based on a U.S. nationally representative probability sample of hospitals. Accessed October 21, 2024. URL https://wisqars.cdc.gov/lcnf/?y1=2022&y2=2022&ct=10&cc=0&s=0&g=00&a=lcd1age&a1=0&a2=199&d=0 National Safety Council. Injury Facts, 2023. Accessed October 21, 2024. URL https://injuryfacts.nsc.org/all-injuries/overview/ Park, D., Lee, O. E., Park, J., & Minnick, D. (2021). Substance use disorders among adults who are deaf or hard of hearing in the United States. Drug and Alcohol Dependence , 228 , 109106. https://doi.org/https://doi.org/10.1016/j.drugalcdep.2021.109106 Samuel D, O'Malley F, Brink FW, Crichton KG, Duffy B, Letson MM, Michaels NL. Characterizing child maltreatment fatalities among child victims with disabilities in the United States, 2010-2019. Child Abuse Negl. 2023 Oct;144:106354. doi: 10.1016/j.chiabu.2023.106354. Epub 2023 Jul 28. PMID: 37517210. Schwebel, D. C., & Brezausek, C. M. (2010). Brief Report: Unintentional Injury Risk among Children with Sensory Impairments. Journal of Pediatric Psychology , 35 (1), 45-50. https://doi.org/10.1093/jpepsy/jsp033 Shi, X., Wheeler, K. K., Shi, J., Stallones, L., Ameratunga, S., Shakespeare, T., & Xiang, H. (2015). Increased risk of unintentional injuries in adults with disabilities: a systematic review and meta-analysis. Disabil Health J , 8 (2), 153-164. https://doi.org/10.1016/j.dhjo.2014.09.012 Smulders, E., Enkelaar, L., Weerdesteyn, V., Geurts, A. C. H., & van Schrojenstein Lantman-de Valk, H. (2013). Falls in older persons with intellectual disabilities: fall rate, circumstances and consequences. Journal of Intellectual Disability Research , 57 (12), 1173-1182. https://doi.org/https://doi.org/10.1111/j.1365-2788.2012.01643.x U.S. Census Bureau, U.S. Department of Commerce. (2023). Disability Characteristics. American Community Survey, ACS 1-Year Estimates Subject Tables, Table S1810. Retrieved October 23, 2024, from https://data.census.gov/table/ACSST1Y2023.S1810?t=Disability&g=040XX00US21.USDA, Economic Research Service, Rural-Urban Continuum Codes data product, updated January 2024. Vanderminden, J., Finkelhor, D., Hamby, S., & Turner, H. (2023). Victimization and abuse among children with disabilities: Age adjusted rates in a US national sample. Child Abuse & Neglect , 146 , 106495. https://doi.org/https://doi.org/10.1016/j.chiabu.2023.106495 White D, McPherson L, Lennox N, Ware RS. Injury among adolescents with intellectual disability: A prospective cohort study. Injury. 2018. 49(6) 1091-1096. ISSN 0020-1383, https://doi.org/10.1016/j.injury.2018.04.006 Zandam H, Akobirshoev I, Mitra M. Multiple Chronic Condition Emergency Department Visits Among U.S. Adults: Disparities at the Intersection of Intellectual and Developmental Disabilities Status and Race or Ethnicity. Health Equity. 2024 Mar 21;8(1):198-205. doi: 10.1089/heq.2023.0228. PMID: 38559846; PMCID: PMC10979663. Additional Declarations No competing interests reported. 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We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5333206","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":374008644,"identity":"cbe61b69-7896-4f20-99e5-670a75a60357","order_by":0,"name":"Terry L. Bunn","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAq0lEQVRIiWNgGAWjYBAC++M8IMpGjgFMsxGhhY0ZrDTNmGQthxMbSNDCe0y6cAdz+oYzZwwYPpQdJkYLX5r0zDNsuRvO9hgwzjhHlBYeM2neNp7cDed5DJh524jXIpFuANLylwQtBgkGQIcxMxKnhS/ZmrctwXDmmWMFB3vOpROhhb334G3etv/yfGeSNz74UWZNWAsS4DA4QJJ6IGB/QKqOUTAKRsEoGCEAAMdtMUw/GTirAAAAAElFTkSuQmCC","orcid":"","institution":"University of Kentucky College of Public Health","correspondingAuthor":true,"prefix":"","firstName":"Terry","middleName":"L.","lastName":"Bunn","suffix":""},{"id":374008645,"identity":"fd516122-bbcf-47eb-8820-cf41259d5ad9","order_by":1,"name":"Jacqueline Seals","email":"","orcid":"","institution":"University of Kentucky College of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Jacqueline","middleName":"","lastName":"Seals","suffix":""},{"id":374008646,"identity":"7072f211-d627-4693-b7bd-7901e3b166be","order_by":2,"name":"Dana Quesinberry","email":"","orcid":"","institution":"University of Kentucky College of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Dana","middleName":"","lastName":"Quesinberry","suffix":""},{"id":374008647,"identity":"17b1f17c-97c3-46e8-9a6d-e9907cc221ca","order_by":3,"name":"Alaina Murphy","email":"","orcid":"","institution":"University of Kentucky College of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Alaina","middleName":"","lastName":"Murphy","suffix":""},{"id":374008648,"identity":"90fefc1c-8376-4b3c-a04f-c075868cf1dc","order_by":4,"name":"Julia F. Costich","email":"","orcid":"","institution":"University of Kentucky College of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Julia","middleName":"F.","lastName":"Costich","suffix":""}],"badges":[],"createdAt":"2024-10-25 14:53:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5333206/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5333206/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s40621-025-00580-2","type":"published","date":"2025-05-09T15:57:24+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":82537506,"identity":"4da8e7ab-f477-4e64-b68c-293e7e3bfd67","added_by":"auto","created_at":"2025-05-12 16:07:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1402890,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5333206/v1/4565af26-8bbb-462a-b921-fbad0e941550.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Identification and Characterization of Nonfatal Injuries among Persons with Disabilities in Kentucky","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eInjuries take an enormous toll on the US population in terms of financial, physical, and mental well-being. According to the National Safety Council, 63\u0026nbsp;million persons who were injured and treated in 2022, a 162% increase over the last 30 years (National Safety Council, 2023). In 2021, the associated costs of injuries total approximately \u003cspan\u003e$\u003c/span\u003e1.3\u0026nbsp;billion (National Safety Council, 2023).\u003c/p\u003e \u003cp\u003eInjuries affect vulnerable populations such as persons with intellectual and developmental disabilities (IDD), and those who are deaf or hard of hearing (DHH). In the United States, it has been estimated that 28.7% of all adults have a disability; 13.9% have a cognition disability and 6.2% have a hearing disability (Centers for Disease Control and Prevention, 2024). The increased risk of physical injury among children with intellectual or developmental disability is well-documented, but data on non-elderly adults with IDD has not been as well-studied. IDD is associated with increased prevalence of many chronic conditions (Zandam et al., 2024), so it is not surprising that injuries are also more common in this population. Calver et al. (2021) found a 1.79 higher rate of hospitalized intentional and unintentional injuries in IDD compared with non-IDD children and adolescents. However, a prospective cohort study found the increase in injury prevalence among young people with IDD was limited to those who also had attention deficit-hyperactivity disorder (White 2018). A particularly concerning finding regarding non-accidental trauma (NAT) by Baghdadi et al (2024) was that children with IDD were 9 times as likely to be hospitalized with NAT injuries than those without IDD. Similarly, Samuel and colleagues (2023) found that children with developmental disabilities were over-represented among children who died because of abusive injuries.\u003c/p\u003e \u003cp\u003eThis phenomenon is not limited to children and adolescents. For example, a Swedish study documented increased risk of injury in adults aged 65 and older with autism and of fall-related injury in older adults with IDD (Liu et al., 2023). In a study of U.S. emergency department (ED) visits by intellectual and development disability status and race or ethnicity, the authors found that persons with IDD had higher rates of multiple chronic condition-related ED visits (Zandam et al., 2024). They also showed that Black and Latinx persons with IDD had higher rates than whites for multiple chronic condition ED visits.\u003c/p\u003e \u003cp\u003eUnintentional injury is less studied in the DHH population, but several investigations have identified heightened risk of self-harm in this population (Vanderminden et al., 2023). Focus on the non-elderly DHH population is important because the high prevalence of hearing impairments in older adults is a confounding factor in analyses of their relationship to injury rates and types. It is also important to note that third-party coverage for assistive hearing devices is widely available for children and adolescents but rarely so for older adults, so individuals coded as DHH in our data may not live with serious functional impairments.\u003c/p\u003e \u003cp\u003eThe purpose of this study was to describe and compare ED\u0026thinsp;+\u0026thinsp;inpatient hospitalization (IP) injury rates among persons under age 65 with IDD and DHH by injury type and other variables with ED\u0026thinsp;+\u0026thinsp;IP rates among those without such disabilities. We hypothesized that rates of ED visits and IP for injuries of persons with IDD and DHH would be higher compared with rates of ED visit and IP for injuries of persons without such disabilities. The IDD and DHH groups were chosen for study because their representation in Kentucky health records was robust enough to support detailed analysis.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cstrong\u003eData Sources\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe conducted a population-based cross-sectional study using combined ED visit and IP data. The datasets contained information for all patients who were treated and discharged from either the ED or an IP admission at Kentucky hospitals. To avoid duplication of cases in the combined ED and IP dataset, encounters that were discharged from an IP admission were removed from the ED dataset. Fatal encounters were removed from the dataset and were not analyzed for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study population included all nonfatal injury-related ED + IP encounters in Kentucky hospitals for all Kentucky residents 64 years and younger, classified by disability status: 1) IDD; 2) DHH; and 3) no IDD or DHH recorded. Nonfatal injury-related encounters were defined using ICD-10-CM codes, following guidance from the Council of State and Territorial Epidemiologist Surveillance (CSTE) Toolkit (Hedegaard and Johnson, 2019; Hedegaard et al., 2021). Developmental and intellectual disabilities were defined using the following ICD-10-CM codes: F70-F73, F78-F79, F81, F849, and Z736. Deaf and hard of hearing disabilities were defined using ICD-10-CM codes H90-H91. The group without the targeted disabilities was identified by excluding all cases \u0026nbsp;with the ICD-10-CM disability code groups of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVariable Selection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDemographic variables that were analyzed included age group, biological sex, race, ethnicity, metro status, Appalachian status, injury type, expected payer, and location of treatment. Averages of total charges by disability status group were calculated. Age groups included 0-17, 18-34, and 35-64 years. Race was identified as black, white or other. Ethnicity was defined as either Hispanic or non-Hispanic, and biological sex was identified as either male or female. Metro status was based on the Rural-Urban Continuum Codes (RUCC) defined as a residence in either a metropolitan (RUCC 1-3) or non-metropolitan area (RUCC 4-9) (USDA, 2024). Appalachian Status was defined as resident counties served by the Appalachian Regional Commission (Appalachian Regional Commission, 2024). Expected payer was categorized into Medicare, Medicaid, Commercial, Self-Pay/Charity, and \u0026lsquo;other\u0026rsquo; categories. Location of treatment was identified from the discharge status from either the ED or from an IP.\u003c/p\u003e\n\u003cp\u003eSelf-harm, assault, unintentional fall, unintentional motor vehicle crash, and drug poisoning injuries were defined using ICD-10-CM codes, following guidance from the CSTE Surveillance Toolkit (Hedegaard and Johnson, 2019; Hedegaard et al., 2021) . The CSTE Surveillance Toolkit does not include definitions for struck by/against and overexertion injuries. Therefore, struck by/against and overexertion injuries were defined using the National Center for Health Statistics External Cause of Injury Matrix (Hedegaard et al., 2019).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePopulation-based injury rates for the year 2023 were calculated as the number of injuries per 1000 disability population group and were adjusted by age. The denominator numbers for persons with or without the related disability were derived from the 1-year estimates from the American Community Survey disability characteristics table (U.S. Census Bureau, 2023).\u003c/p\u003e\n\u003cp\u003eED + IP injury rates for the years 2019-2023 were calculated as injury encounters per total number of ED + IP encounters for each disability status. Rates were stratified by the disability and demographic variables, except for injury type. Rates were calculated using the following equation:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(Injury Encounters (per disability status))/ (All hospital encounters (per disability status)) * 1,000\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAdjusted rate ratios and 95% confidence intervals were calculated by demographic/injury categories. Adjusted rate ratios were calculated comparing rates of injury between disability status groups. Adjusted rate ratios were calculated using the following equation:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(Adjusted injury rate for males in IDD group)/ (Adjusted injury rate for males in no disability group (reference group))\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll analyses were conducted using SAS version 8.16 for Windows (SAS Institute Inc).\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe 2023 overall injury rate when the denominator was the number of persons with or without the related disability was lower for persons with IDD or DHH compared to those without such disabilities (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Injury rates were highest in the 0\u0026ndash;17 and 18- 34-year age categories for the DHH group compared to those age categories for IDD group.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eNonfatal Emergency Department (ED) Visit and Inpatient Hospitalization (IP) Injury Rates by Disability Status in Kentucky, 2023.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eInjuries Treated in ED and Inpatient Hospitalizations\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDevelopmental and Intellectual Disabilities\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDeaf and Hard of Hearing Disabilities\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo Developmental and Intellectual, Deaf and Hard of Hearing Disabilities\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of Injuries\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e443\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e314\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e351,885\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eRate (Number of Injuries/1000 disability population group)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOverall Injury Rate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge Group\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u0026ndash;64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe highest ED\u0026thinsp;+\u0026thinsp;IP injury rate was for the 0- 17-year age category in persons without IDD or DHH (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The lowest injury rate was for the 35- 64-year age category in DHH persons. Comparing the two disability groups, the DHH group had elevated injury rates for the younger and middle age groups. The IDD group, in contrast, had a higher injury rate in the 35-64-year age category than the DHH group of the same age. Males overall had higher injury rates than females in all three groups.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographics of Nonfatal Injury Emergency Department (ED) Visits and Inpatient Hospitalizations (IP) by Disability Status in Kentucky, 2019\u0026ndash;2023.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eInjuries Treated in ED and IP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDevelopmental and Intellectual Disabilities\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDeaf and Hard of Hearing Disabilities\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo Developmental and Intellectual, Deaf and Hard of Hearing Disabilities\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of Injuries\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,414\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,700\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,735,237\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eRate (Number of Injuries/ 1,000 Disability Group ED\u0026thinsp;+\u0026thinsp;IP)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOverall Injury Rate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e199\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge Group (in Years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e253\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e193\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u0026ndash;64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e178\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e170\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e236\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRace\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e179\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e204\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e175\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Hispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e201\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMetro Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMetro\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e196\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Metro\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e204\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAppalachian Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Appalachian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e200\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAppalachian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e198\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eRegarding race, the highest ED\u0026thinsp;+\u0026thinsp;IP injury rate was for Whites without IDD. Blacks and \u0026lsquo;other\u0026rsquo; races had elevated injury rates in the deaf and hard of hearing group compared to Blacks and \u0026lsquo;other\u0026rsquo; races in the IDD group. Overall, injury rates were higher for non-Hispanics but DHH Hispanics had a higher injury rate than Hispanics with IDD.\u003c/p\u003e \u003cp\u003eMetro and non-metro ED\u0026thinsp;+\u0026thinsp;IP injury rates were lower for those with both types of disability compared to those without them (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Non-Appalachian and Appalachian injury rates were elevated for those without IDD or DHH although the Appalachian IDD group had a higher injury rate compared to the Appalachian DHH group.\u003c/p\u003e \u003cp\u003eThe highest injury causal rate for all three groups was for unintentional falls (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The self-harm injury rate was highest for the IDD group compared to the other two groups. The unintentional motor vehicle crash rate was elevated among the DHH group compared to the other two groups. Last, drug poisoning was highest for persons with IDD and lowest for those without the targeted disabilities.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInjury Characteristics of Nonfatal Injury Emergency Department (ED) Visits and Inpatient Hospitalizations (IP) by Disability Status in Kentucky, 2019\u0026ndash;2023.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eInjuries Treated in ED and IP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDevelopmental and Intellectual Disabilities\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDeaf and Hard of Hearing Disabilities\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo Developmental and Intellectual, Deaf and Hard of Hearing Disabilities\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eRate (Number of Injuries/ 1,000 Disability Group ED\u0026thinsp;+\u0026thinsp;IP)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInjury Type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-harm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssault\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnintentional fall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e385\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e323\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e251\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnintentional motor vehicle crash\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrug poisoning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStruck by/ Against\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e132\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverexertion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExpected Payer\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedicare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e144\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedicaid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommercial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e216\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-Pay/Charity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e226\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e192\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e239\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e421\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAverage Charges\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e17,086\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e19,550\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e5,216\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLocation of Treatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eED\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e230\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe average charges for injuries in the IDD and DHH groups were more than triple the average charges for those without (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Medicare was the most frequent expected payer for injuries in the IDD group (excluding \u0026lsquo;other\u0026rsquo;), whereas self-pay or charity was the most frequent expected payer for the deaf and hard of hearing group and for those without the related disabilities. Not surprisingly, the injury rates were higher in the ED for all three groups compared to the IP.\u003c/p\u003e \u003cp\u003eBoth disability groups had lower overall ED\u0026thinsp;+\u0026thinsp;IP injury rate ratios compared to those without the targeted disabilities (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Both disability groups also had lower injury rate ratios by age group, sex, ethnicity, metro status, and Appalachian status compared to those without those disabilities. The DHH injury rate ratio for the \u0026lsquo;other\u0026rsquo; races was the same as for those without the disabilities.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRate Ratios for Nonfatal Injuries by Disability Status and Demographics in Kentucky, 2019\u0026ndash;2023.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c9\" namest=\"c4\"\u003e \u003cp\u003eStratified Model\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eOverall Model\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eDevelopmental and Intellectual Disabilities\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eDeaf and Hard of Hearing Disabilities\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eNo Developmental and Intellectual and Deaf and Hard of Hearing Disabilities (Ref Group)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdjusted Rate Ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAdjusted Rate Ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAdjusted Rate Ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAdjusted Rate Ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDisability Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9985\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9964\u0026ndash;1.0006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6664\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6403\u0026ndash;0.6935\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.6577\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.6334\u0026ndash;0.6830\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.9979\u0026ndash;1.0021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge Group\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9993\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9953\u0026ndash;1.0033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4840\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.4202\u0026ndash;0.5561\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.7743\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.7098\u0026ndash;0.8446\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.9960\u0026ndash;1.0040\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9993\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9954\u0026ndash;1.0032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7263\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6781\u0026ndash;0.7779\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.8952\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.8230\u0026ndash;0.9737\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.9961\u0026ndash;1.0039\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u0026ndash;64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9980\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9948\u0026ndash;1.0012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7313\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6940\u0026ndash;0.7706\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.6219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.5925\u0026ndash;0.6527\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.9968\u0026ndash;1.0032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9991\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9961\u0026ndash;1.0022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7738\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.7285\u0026ndash;0.8221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.7310\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.6917\u0026ndash;0.7726\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.9970\u0026ndash;1.0031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9978\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9949\u0026ndash;1.0007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5664\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5371\u0026ndash;0.5974\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.5827\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.5534\u0026ndash;0.6136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.9971\u0026ndash;1.0029\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRace\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9987\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9928\u0026ndash;1.0046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5478\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.4793\u0026ndash;0.6262\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.7092\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.6288\u0026ndash;0.7998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.9941\u0026ndash;1.0059\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9984\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9961\u0026ndash;1.0007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6781\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6502\u0026ndash;0.7072\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.6437\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.6182\u0026ndash;0.6702\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.9977\u0026ndash;1.0023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9994\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9868\u0026ndash;1.0122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5622\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.3665\u0026ndash;0.8623\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.8585\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.6756\u0026ndash;1.0909\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.9874\u0026ndash;1.0128\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9994\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9881\u0026ndash;1.0108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6415\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.4223\u0026ndash;0.9743\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.6949\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.5372\u0026ndash;0.8990\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.9887\u0026ndash;1.0114\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Hispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9985\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9964\u0026ndash;1.0006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6638\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6377\u0026ndash;0.6909\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.6554\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.6309\u0026ndash;0.6809\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.9979\u0026ndash;1.0021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMetro Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMetro\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9986\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9958\u0026ndash;1.0015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7083\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6721\u0026ndash;0.7466\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.6989\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.6668\u0026ndash;0.7325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.9971\u0026ndash;1.0029\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Metro\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9984\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9953\u0026ndash;1.0015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5800-0.6557\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.5983\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.5616\u0026ndash;0.6374\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.9969\u0026ndash;1.0031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAppalachian Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon- Appalachian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9986\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9961\u0026ndash;1.0011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6585\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6261\u0026ndash;0.6927\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.6800\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.6515\u0026ndash;0.7096\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.9975\u0026ndash;1.0025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAppalachian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9984\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9946\u0026ndash;1.0023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6807\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6377\u0026ndash;0.7265\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.588\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.5424\u0026ndash;0.6374\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.9962\u0026ndash;1.0039\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWhen ED\u0026thinsp;+\u0026thinsp;IP injury type rate ratios were compared, persons with IDD and DHH persons had higher injury rate ratios for self-harm, assault, unintentional falls, and drug poisonings compared to those without such disabilities (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). DHH persons had the same unintentional motor vehicle crash rate ratio as those without the disabilities, whereas those with IDD had a lower unintentional motor vehicle crash rate ratio. Lower overexertion and struck by/against injury rate ratios were observed for those with IDD, while that group\u0026rsquo;s struck by/against injury rate ratio was equivalent to that of persons without such disabilities.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRate Ratios for Nonfatal Injuries by Disability Status and Injury Type in Kentucky, 2019\u0026ndash;2023.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c9\" namest=\"c4\"\u003e \u003cp\u003eStratified Model\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eOverall Model\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eDevelopmental and Intellectual Disabilities\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eDeaf and Hard of Hearing Disabilities\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eNo Developmental and Intellectual and Deaf and Hard of Hearing Disabilities (Reference Group)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdjusted Rate Ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAdjusted Rate Ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAdjusted Rate Ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAdjusted Rate Ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInjury Type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-harm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.0119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9939\u0026ndash;1.0302\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.7403\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.7831\u0026ndash;9.8153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.7846\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.4016\u0026ndash;2.2723\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.9822\u0026ndash;1.0181\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssault\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.1000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9907\u0026ndash;1.0114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.3857\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.1733\u0026ndash;1.6366\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.3103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.1145\u0026ndash;1.5404\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.9897\u0026ndash;1.0104\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnintentional fall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.0012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9970\u0026ndash;1.0054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.5400\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.4355\u0026ndash;1.6328\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.2833\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.2008\u0026ndash;1.3716\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.9958\u0026ndash;1.0042\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnintentional motor vehicle crash\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9991\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9931\u0026ndash;1.0053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.3027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.2453\u0026ndash;0.3735\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.0637\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.9567\u0026ndash;1.1828\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.9939\u0026ndash;1.0061\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrug poisoning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.0029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9921\u0026ndash;1.0138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.4007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.1030\u0026ndash;2.7404\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.6195\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.3907\u0026ndash;1.8860\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.9893\u0026ndash;1.0109\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStruck by/ Against\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9996\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9938\u0026ndash;1.0054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8040\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.7113\u0026ndash;0.9089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.9042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.8106\u0026ndash;1.0086\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.9942\u0026ndash;1.0058\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverexertion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9984\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9905\u0026ndash;1.0064\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2276\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.1656\u0026ndash;0.3127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.6532\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.5469\u0026ndash;0.7801\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.9920\u0026ndash;1.0080\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLocation of Treatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eED\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9976\u0026ndash;1.0019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.9675\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.9246\u0026ndash;1.0124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.8716\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.8359\u0026ndash;0.9088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.9979\u0026ndash;1.0021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.0064\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9942\u0026ndash;1.0187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.5316\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.4080\u0026ndash;1.6661\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.4230\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.3032\u0026ndash;1.5539\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.9878\u0026ndash;1.0124\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study shows that while IDD and DHH individuals did not experience higher overall rates of injuries, their rate ratios by injury type were elevated for self-harm, assault, unintentional falls, and drug poisonings. This finding is confirmed using nationally representative survey data sources. In a study using National Health Interview survey data, Brophy et al. (2008) found that falls were the leading cause of injury regardless of disability status. The odds ratios for suicidal ideation and suicide attempt among individuals with a cognitive disability were found to be higher relative to those with a hearing limitation using National Survey on Drug Use and Health data (Marlow et al., 2022). Using the same survey data, Park et al., 2021, showed that substance use disorders were prevalent among DHH persons.\u003c/p\u003e \u003cp\u003eThe adjusted rate ratio for intentional self-harm was larger for those with a developmental or intellectual disability compared those of DHH patients or those with no disabilities. Intentional self-harm among individuals with disabilities has been documented to be higher than among individuals without disabilities (Brophy et al., 2008; Cree et al., 2020; Marlow et al., 2022). In a study that focused on suicide outcomes, Marlow et al. (2022) found that those with more complex disabilities and cognitive disabilities were more likely to have an attempted suicide reported vs suicidal ideation alone. Cree et al. (2020) found that individuals with a cognitive disability were more likely to have a diagnosed depressive disorder or to binge drink.\u003c/p\u003e \u003cp\u003eAs with self-harm, we found that individuals with IDD were more likely to be treated for a drug poisoning compared to either the DHH patients or those with no disabilities. While our drug poisoning results do not differentiate by intent, other studies have found that individuals with cognitive disabilities or with more than one disability are at higher risk to have an overdose, substance use, substance misuse, or substance disorder.(Aram et al., 2024; Aram et al., 2023; Hong et al., 2023). In these same studies, individuals who are DHH also had elevated substance use outcomes (Aram et al., 2024; Aram et al., 2023; Hong et al., 2023).\u003c/p\u003e \u003cp\u003eComparable to other studies on injuries among individuals with disabilities (Brophy et al., 2008; Shi et al., 2015; Smulders et al., 2013), we found adjusted rate ratios for falls for individuals with IDD and DHH were elevated. The adjusted rate ratio of assault injuries was larger for those with IDD or DHH compared to those with no disabilities. Unlike other injury characterizations, the assault rates for both disability types were similar. Studies have shown that regardless of disability type, individuals with disabilities are at greater risk of being victims of violence (Hayes \u0026amp; Powers, 2022; Lin et al., 2010; Malihi et al., 2021; Vanderminden et al., 2023).\u003c/p\u003e \u003cp\u003eFalls, unintentional struck by/ against, and motor vehicle crashes were the three highest injury rates in those without either disability and DHH individuals, similar to the leading causes of nonfatal injuries for the general population of all ages, sex, and races treated in the ED in 2022 (National Electronic Injury Surveillance System, 2024) but unlike those with an IDD. The variation in injury rates between the population without disability and those with an IDD may be attributable to the lower rate of engagement in activities with elevated risks of injury because of their physical, developmental or cognitive limitations (Brophy et al., 2008; Shi et al., 2015; Schwebel and Brezausek, 2010). Variations in injury rates from the general population may also be attributable to the perception of risk in the populations with disabilities, the use of aids, or assistance/intervention from a caretaker (Schwebel \u0026amp; Brezausek, 2010).\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eThere are limitations to this study, predominantly due to the data source. The hospital discharge data is deidentified so we could only identify injury incidence and were not be able to easily control for injured patients who were transferred between hospitals. Also, the data source only contains visits to a Kentucky hospital. We know there is missing data in areas around the border of Kentucky where larger out-of-state hospitals are closer. Since the data set was based on encounters, we could not calculate rates based on number of persons treated in the ID or IP. Fourth, cases and variables were identified using ICD-10-CM codes, and we know that there could be a small overlap of disability types. Last, self-harm ICD-10-CM codes do not indicate intent (intentional or unintentional).\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eThis study contributes to understanding of the increased risk for different injury intent and mechanism to support areas for improved injury prevention. Targeted injury prevention education should address populations whose specific disabilities increase their risk of harm. For individuals with IDD and DHH, such education and interventions should address prevention of self-harm, assaults, unintentional falls, and drug poisonings. Education and interventions should be available to the individuals, their caregivers, and their healthcare providers.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eIDD- intellectual or developmental disability\u003c/p\u003e\n\u003cp\u003eNAT- non-accidental trauma\u003c/p\u003e\n\u003cp\u003eED- emergency department\u003c/p\u003e\n\u003cp\u003eIP- inpatient hospitalization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthic approval and consent to participate:\u003c/strong\u003e This study was approved by the University of Kentucky Internal Review Board under the Kentucky State Injury Prevention Program.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material:\u003c/strong\u003e\u0026nbsp; The Kentucky Injury Prevention and Research Center is not the owner of the Emergency Department visit or inpatient hospitalization data. All requests for the data should be made to the data owner, the Office of Data Analytics in the Kentucky Cabinet for Health and Family Services.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e There are no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e Funding for this study was provided by a Kentucky Department for Public Health State Injury Prevention Program contract to the University of Kentucky Research Foundation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions:\u003c/strong\u003e TB conceived the study, collaborated on study design and analysis, and participated in the writing and editing of the draft manuscript; JS collaborated on study design and analysis, and participated in the writing and editing of the draft manuscript; DQ collaborated on study design and analysis, and participated in the writing and editing of the draft manuscript; AM conducted the statistical analysis and participated in the writing and editing of the draft manuscript; and JC collaborated on study design and analysis, and participated in the writing and editing of the draft manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e The authors would like to thank the Kentucky Cabinet for Health and Family Services, Office of Data analytics, for the provision of the secondary ED and inpatient hospitalization data.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAppalachian Regional Commission. About the Appalachian Region. URL available at: https://www.arc.gov/appalachian-counties-served-by-arc/. Accessed October 15, 2024.\u003c/li\u003e\n \u003cli\u003eAram, J., Dallal, C. M., Cosgrove, C., Arria, A., Liu, H., \u0026amp; Slopen, N. (2024). 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Brief Report: Unintentional Injury Risk among Children with Sensory Impairments. \u003cem\u003eJournal of Pediatric Psychology\u003c/em\u003e,\u003cem\u003e\u0026nbsp;35\u003c/em\u003e(1), 45-50. https://doi.org/10.1093/jpepsy/jsp033\u003c/li\u003e\n \u003cli\u003eShi, X., Wheeler, K. K., Shi, J., Stallones, L., Ameratunga, S., Shakespeare, T., \u0026amp; Xiang, H. (2015). Increased risk of unintentional injuries in adults with disabilities: a systematic review and meta-analysis. \u003cem\u003eDisabil Health J\u003c/em\u003e,\u003cem\u003e\u0026nbsp;8\u003c/em\u003e(2), 153-164. https://doi.org/10.1016/j.dhjo.2014.09.012\u003c/li\u003e\n \u003cli\u003eSmulders, E., Enkelaar, L., Weerdesteyn, V., Geurts, A. C. H., \u0026amp; van Schrojenstein Lantman-de Valk, H. (2013). Falls in older persons with intellectual disabilities: fall rate, circumstances and consequences. \u003cem\u003eJournal of Intellectual Disability Research\u003c/em\u003e,\u003cem\u003e\u0026nbsp;57\u003c/em\u003e(12), 1173-1182. https://doi.org/https://doi.org/10.1111/j.1365-2788.2012.01643.x\u003c/li\u003e\n \u003cli\u003eU.S. Census Bureau, U.S. Department of Commerce. (2023). Disability Characteristics. American Community Survey, ACS 1-Year Estimates Subject Tables, Table S1810. Retrieved October 23, 2024, from https://data.census.gov/table/ACSST1Y2023.S1810?t=Disability\u0026amp;g=040XX00US21.USDA, Economic Research Service, Rural-Urban Continuum Codes data product, updated January 2024.\u003c/li\u003e\n \u003cli\u003eVanderminden, J., Finkelhor, D., Hamby, S., \u0026amp; Turner, H. (2023). Victimization and abuse among children with disabilities: Age adjusted rates in a US national sample. \u003cem\u003eChild Abuse \u0026amp; Neglect\u003c/em\u003e,\u003cem\u003e\u0026nbsp;146\u003c/em\u003e, 106495. https://doi.org/https://doi.org/10.1016/j.chiabu.2023.106495\u003c/li\u003e\n \u003cli\u003eWhite D, McPherson L, Lennox N, Ware RS. Injury among adolescents with intellectual disability: A prospective cohort study. Injury. 2018. 49(6) 1091-1096. ISSN 0020-1383, https://doi.org/10.1016/j.injury.2018.04.006\u003c/li\u003e\n \u003cli\u003eZandam H, Akobirshoev I, Mitra M. Multiple Chronic Condition Emergency Department Visits Among U.S. Adults: Disparities at the Intersection of Intellectual and Developmental Disabilities Status and Race or Ethnicity. Health Equity. 2024 Mar 21;8(1):198-205. doi: 10.1089/heq.2023.0228. PMID: 38559846; PMCID: PMC10979663.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"injury-epidemiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"inep","sideBox":"Learn more about [Injury Epidemiology](https://injepijournal.biomedcentral.com)","snPcode":"40621","submissionUrl":"https://submission.nature.com/new-submission/40621/3","title":"Injury Epidemiology","twitterHandle":"@InjuryEpi","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-5333206/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5333206/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eVulnerable populations at risk of injury include persons with intellectual and developmental disabilities (IDD), and persons who are deaf or hard of hearing (DHH). The increased risk of physical injury among children and older adults with IDD is well-documented, but information on the non-elderly population is lacking. The purpose of this study was to describe and compare emergency department (ED)\u0026thinsp;+\u0026thinsp;inpatient hospitalization (IP) injury rates among persons under age 65 with IDD or DHH by injury type and other variables with ED\u0026thinsp;+\u0026thinsp;IP rates among those without the same disabilities.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eInjury data were extracted from Kentucky ED and IP discharge datasets from 2019 to 2023. Rates and rate ratios for injuries were calculated for those under age 65 with and without IDD and DHH, using number of persons under age 65 with and without the related disability as the denominator.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e \u003cb\u003eT\u003c/b\u003ehe overall injury rate was lower for persons under age 65 with an IDD or DHH compared to those without those disabilities in 2023. Both disability types had lower overall ED\u0026thinsp;+\u0026thinsp;IP injury rate ratios compared to those without those disabilities. In contrast with the lower overall injury rate, persons under age 65 with IDD and DHH had higher ED\u0026thinsp;+\u0026thinsp;IP injury rate ratios for self-harm, assault, unintentional falls, and drug poisonings compared to those without those disabilities. Those with DHH had the same unintentional motor vehicle crash ED\u0026thinsp;+\u0026thinsp;IP rate ratio as those without the disability, whereas those with IDD had a lower unintentional motor vehicle crash ED\u0026thinsp;+\u0026thinsp;IP injury rate ratio. Importantly, those with IHH and DHH who were treated for injuries incurred charges that were triple the charges for patients without these conditions.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis study provides a better understanding of increased risk for injury intent and mechanism that highlights areas for improved injury prevention because exposure to common causes of injury varies from those of populations without these disabilities. For IDD and DHH individuals, it is important to target education and interventions to the prevention of self-harm, assaults, unintentional falls, and drug poisonings available to the individuals, their caregivers, and healthcare providers.\u003c/p\u003e","manuscriptTitle":"Identification and Characterization of Nonfatal Injuries among Persons with Disabilities in Kentucky","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-06 05:02:24","doi":"10.21203/rs.3.rs-5333206/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-03-18T12:01:17+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-03-18T09:27:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"107912305514644579622533725607642284355","date":"2025-03-14T05:33:18+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-03-13T14:36:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"252708423572905044830734544135553854168","date":"2025-02-15T07:38:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"154489929540923507111807085555245140209","date":"2025-02-14T21:26:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"48398151819424157842528189803276154197","date":"2025-02-03T15:51:22+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-04T16:57:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-27T01:05:57+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-25T18:59:54+00:00","index":"","fulltext":""},{"type":"submitted","content":"Injury Epidemiology","date":"2024-10-25T14:41:30+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"injury-epidemiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"inep","sideBox":"Learn more about [Injury Epidemiology](https://injepijournal.biomedcentral.com)","snPcode":"40621","submissionUrl":"https://submission.nature.com/new-submission/40621/3","title":"Injury Epidemiology","twitterHandle":"@InjuryEpi","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"47fd3750-e325-45ec-8f05-ae337fc8ab8c","owner":[],"postedDate":"November 6th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-05-12T16:01:15+00:00","versionOfRecord":{"articleIdentity":"rs-5333206","link":"https://doi.org/10.1186/s40621-025-00580-2","journal":{"identity":"injury-epidemiology","isVorOnly":false,"title":"Injury Epidemiology"},"publishedOn":"2025-05-09 15:57:24","publishedOnDateReadable":"May 9th, 2025"},"versionCreatedAt":"2024-11-06 05:02:24","video":"","vorDoi":"10.1186/s40621-025-00580-2","vorDoiUrl":"https://doi.org/10.1186/s40621-025-00580-2","workflowStages":[]},"version":"v1","identity":"rs-5333206","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5333206","identity":"rs-5333206","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}