Struck-by-lightning deaths in the United States.(FEATURES)

Introduction

In the United States, the average annual numbers of deaths from lightning exceeds the number from other natural disasters (e.g., earthquakes, tornadoes, and blizzards) (Cooper & Andrews, 1995). Millions of lightning strikes occur every year, and although the risk of being struck is low, the consequences of lightning injuries are serious. Published data indicate that an average of 82 persons die each year, and a preponderance of deaths occur among males and people 15-44 years of age (Centers for Disease Control and Prevention [CDC], 1998). Sequelae of lightning injuries include neurologic and neuropsychologic disorders, seizures, brain injury, spinal artery syndrome, blindness, amnesia, anxiety attacks, and peripheral nerve damage (Cooper, 1995). Fatalities and sequelae are common among young people (Cherington, 2003). Data on the direct and indirect costs of lightning injuries are lacking, yet the magnitude of morbidity and mortality has been documented for decades.

Not everyone struck by lightning dies, and although the National Weather Service issues weather warnings for severe thunderstorms, safety from lightning remains each person's responsibility because no OSHA regulations exist to protect workers. Ongoing analyses of struck-by-lightning deaths are needed to alert and remind the public of this danger.

To determine the recent epidemiologic characteristics of lightning-related deaths in the United States, two data sources were analyzed: the National Center for Health Statistics (NCHS) mortality tapes, and the Census of Fatal Occupational Injuries (CFOI).

Methods

The authors analyzed data from CDC's National Center for Health Statistics (NCHS) multiple-cause-of-death public-use data tapes (CDC, 2003) for the interval from January 1, 1995, through December 31, 2000. These mortality data were compiled from death certificates submitted from the vital-records offices of all 50 states in the United States and the District of Columbia. Unnatural causes of death are recorded on the death certificate by the medical examiner or coroner--whenever an autopsy is performed, whenever a case is referred for investigation, or whenever the death falls under his or her jurisdiction (e.g., unnatural or suspicious deaths)--according to a format specified by the World Health Organization and endorsed by CDC. NCHS data were coded according to the International Classification of Diseases codes (ICD-9) (World Health Organization, 1977) for cause of death, including underlying external cause of death. The authors identified lightning deaths through external-cause-of-death Code E907 (lightning) for the years 1995 through 1998 (ICD-9). Multiple-cause-of-death tapes for 1999 and 2000 were coded in accordance with the ICD-10. The external-cause-of-death code corresponding to lightning in this new coding scheme is X33. The different coding schemes did not affect lightning deaths because the match from ICD-9 to ICD-10 was simple and straightforward. The issue of comparability between the two revisions of the ICD is more complicated, however, and goes beyond simply finding a comparable code (Anderson, Minino, Hoyert, & Rosenberg, 2001).

The frequencies of lightning incidence during the reporting period were presented for specific age groups (0-19 years, 20-44 years, and [greater than or equal to]45 years) and race (white, black, other). The authors did not calculate fatality rates for characteristics such as race or by state because of low cell counts. Rates were calculated on the basis of U.S. resident estimates from population microdata files maintained by the Census Bureau for individual years (U.S. Census Bureau, 2003). Appropriate 95 percent confidence intervals were calculated for the rates on the basis of standard errors for random variation in the number of deaths each year, as recommended by NCHS (Murphy, 2000). Negative binomial regression was used to determine the significance of the decline in rates during the interval (Cummings, Norton, & Koepsell, 2001).

The Census of Fatal Occupational Injuries (CFOI) is maintained by the Bureau of Labor Statistics (BLS) (Windau, Jack, & Toscano, 1998). Because the CFOI is compiled from different federal, state, and local administrative sources, the data cover all …