National Health Statistics Reports, Number 99, November 18, 2016

National Health Statistics Reports

Number 99  November 18, 2016

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Sports- and Recreation-related Injury Episodes in the

United States, 2011–2014

by Yahtyng Sheu, Ph.D., Li-Hui Chen, Ph.D., and Holly Hedegaard, M.D., Office of Analysis and Epidemiology

Abstract

Objective—Much of the research on sports- and recreation-related injuries

focuses on a specic population, activity, or type of injury, and national estimates

of the total burden of sports- and recreation-related injuries are limited. This study

provides national estimates of the injury burden and examines the distribution of

sports- and recreation-related injuries across demographic groups, activities, and injury

circumstances.

Methods—Information on medically attended injury episodes for persons aged

5 years and over were obtained from the 2011–2014 National Health Interview Survey.

Sports- and recreation-related injuries are categorized by the associated activity using

a classication scheme based on the International Classication of External Causes of

Injury.

Results—An average annual estimate of 8.6 million sports- and recreation-related

injury episodes was reported, with an age-adjusted rate of 34.1 per 1,000 population.

Males (61.3%) and persons aged 5–24 years (64.9%) accounted for more than one-half

of injury episodes. Injury rates were higher among males, children aged 5–14 years,

and non-Hispanic white persons than for their counterparts. One-half of the sports- and

recreation-related injury episodes (50.0%) resulted in treatment at a doctor’s ofce or

other health clinic without an emergency department visit or hospitalization. Overall,

general exercise was the most frequently mentioned activity associated with sports- and

recreation-related injuries, but types of activities varied across sex and age groups. Body

regions injured while engaging in sports and recreation activities included the lower

extremity (42.0%), upper extremity (30.3%), and head and neck (16.4%).

Conclusion—As the nation continues to recognize the importance of physical

activity to maintain health, more research efforts are needed to examine sport and

recreation injury across various activities, demographic groups, and health care

settings, especially settings other than emergency departments and hospitals.

Keywords: exercise • nonfatal injury • National Health Interview Survey

Introduction

Clinicians and public health

advocates frequently promote physical

activity to maintain health and reduce the

risk of obesity. Recent estimates show

that 213 million Americans aged 6 years

and over took part in sports and tness

activities in 2015, up from 209 million

in 2014 (1). As more people engage in

sports and recreation activities, injuries

resulting from these activities pose an

increasingly important public health

concern (2–5).

Many epidemiological studies of

sports- and recreation-related injuries

focus on specic populations, activities,

and outcomes. For example, multiple

studies have looked at sports injuries

among pediatric patients and athletes in

organized sports (6). Football, soccer, and

basketball are among the most frequently

studied sports, and knee injuries, ankle

sprains, and concussions are common

outcomes in studies identifying risk

factors for sports-related injuries (6).

A limited number of studies provide

national estimates on sports- and

recreation-related injuries among all

populations. These studies generally

focus on emergency department (ED)

visits using data from the National

Center for Health Statistics’ (NCHS)

National Hospital Ambulatory Medical

Care Survey (NHAMCS) (5,7–9), or the

Consumer Product Safety Commission’s

National Electronic Injury Surveillance

Page 2 National Health Statistics Reports  Number 99  November 18, 2016

System–All Injury Program (2,10–12).

Using NHAMCS data, researchers have

provided several national estimates of

sports- and recreation-related injury visits

to the ED. For example, during 1997–

1998, an estimated 3.7 million visits were

made annually, and among them,

2.6 million involved persons aged

5–24 years (7). Sports and recreation

activities were also the most frequently

reported cause of injury-related ED visits

among pediatric patients, representing

approximately 1 in 5 injury-related ED

visits among patients aged 19 and under

(8,9). One study using data from 1999–

2008 showed that sports accounted for

14% of all ED visits for life-threatening

injuries, with a higher proportion seen for

children aged 18 and under (32%) than

for adults aged 19 and over (9%) (5).

Because they tend to include more

severe injuries, studies using ED data

may underestimate the overall burden

of injury from sports and recreation

activities. For a more comprehensive

look, researchers have used NCHS’

National Health Interview Survey (NHIS)

to obtain estimates on all medically

attended injuries, not just those resulting

in an ED visit or hospitalization. A

study using NHIS data from 1997–1999

estimated that 7 million Americans

received medical attention for sports-

and recreation-related injuries each

year, and found that men, persons aged

5–24 years, and white persons reported

higher rates than their counterparts (13).

With increased participation in sports

and recreation activities in recent years,

updated estimates of the burden of

sports- and recreation-related injuries

in the United States are needed. In this

study, the overall sex- and age-specic

estimated numbers, percentages, and

rates of medically attended sports- and

recreation-related injuries are described

across various demographic groups, sport

activities, and injury circumstances using

NHIS data from 2011–2014.

Methods

Source of injury data

NHIS collects information on various

health topics via face-to-face interviews

of a nationally representative sample

of the noninstitutionalized population

residing in the United States (14). Injury-

related information is captured from

questions in the Family Core section of

the survey. These questions ask about

medically attended nonfatal injuries that

occurred for any family member in the

3 months prior to interview. An injury

episode refers to a traumatic event in

which a person was injured from an

external cause. A medically attended

injury episode is one for which a health

care professional was contacted, either

in person or by telephone, for advice or

treatment. Up to 10 injury episodes are

recorded for each person. The family

respondent provides all information about

the episode.

NHIS injury questions include both

open-ended verbatim questions and

structured multiple-choice questions. In

the open-ended questions, respondents

are asked to describe the conditions for

each injury episode, including (1) the

cause of injury, (2) the parts of the body

that were injured, and (3) the type of

injury (e.g., fractures, sprains or strains,

or contusion). This information is used

to assign International Classication

of Diseases, Ninth Revision, Clinical

Modication (ICD–9–CM) injury

diagnosis and external cause codes (E

codes) for all episodes.

Up to eight diagnosis (nature of

injury) codes are assigned to each injury

episode. Each injury episode must have

at least one diagnosis code of 800–909.2,

909.9, 910–994.9, 995–995.59, or

998.80–995.85 and one external cause of

injury code of E800–E848, E850–E869.9,

E880–E929.9, or E950–E999. The

diagnosis codes are categorized by body

region and nature of injury according to

the Barell Injury Diagnosis Matrix (15),

with the exception of traumatic brain

injury (TBI). Cases of TBI are identied

using the surveillance case denition

from the National Center for Injury

Prevention and Control (16). In addition

to the open-ended questions, respondents

are asked to provide information about

the activity at the time of the injury, the

date and place of the injury occurrence,

where the person received medical advice

or treatment, and whether the person

missed any days from work or school.

Creating the analysis data

set

Using NHIS data from 2011–2014,

initial case selection began with all

medically attended injury episodes

reported within 5 weeks prior to the date

of interview. A reference period of 5

weeks was chosen to minimize the recall

bias for less severe injuries (17). Episodes

involving children aged 4 years and under

were excluded because their participation

in sports and recreation activities

differed from that of older children

and adults. Data from 5,052 injury

episodes (unweighted) were reviewed for

sports and recreation eligibility. Three

researchers independently reviewed the

verbatim text and coded information

(e.g., activity and place of injury

occurrence) for each record to determine

whether an injury episode was related to

sports and recreation. Differences among

reviewers on whether a record should be

included as a case were discussed and

consensus reached. Twenty episodes had

either missing or poor narratives such

that eligibility for inclusion could not

be determined. The nal analysis le

included 1,080 (unweighted) sports- and

recreation-related injury episodes.

After determination of eligibility,

each episode was assigned an activity

code based on the sports module of the

International Classication of External

Causes of Injury (ICECI) (18). The sports

module includes 20 broad categories

of various sport activities as well as

coded subcategories within each broad

category. For comparative purposes,

the sports and recreation categories

reported in this study match those used

in previous studies using data from NHIS

(13) and NHAMCS (7). Rules for case

determination and assignment of sports

and recreation activities to an ICECI

category were established for coding

consistency. For example, all injury

episodes involving pedal cycling were

included. Riding a bicycle can serve

the purpose of transportation, exercise,

or both. Because some narratives for

National Health Statistics Reports  Number 99  November 18, 2016 Page 3

injuries from pedal cycling did not

provide sufcient detail, all pedal

cycling, regardless of the purpose, was

considered sports- and recreation-related.

Due to lack of detailed information, all

injuries related to skating (i.e., both ice

skating and roller skating) were grouped

into the same category. School-related

injury episodes (i.e., physical education

class) without a named activity were

assigned to “School related (non-specic

activity).” Details on the specic activity

involved were lacking for 106 episodes;

these were assigned to the activity

category of “Unspecied.”

Statistical analysis

NHIS is designed to provide national

estimates by applying weights to a

nationally representative sample. Data

weighting procedures are described

elsewhere (14). Point estimates and

the corresponding 95% condence

intervals were calculated using SAS-

callable SUDAAN, version 11.0.0 (RTI

International, Research Triangle Park,

N.C.), a software package that accounts

for the complex sample design of NHIS.

The denominators used in the calculation

of rates were based on the NHIS study

population aged 5 years and over for

2011–2014. Age-adjusted rates were

calculated using the year 2000 standard

population.

Annualized national estimates

were computed by multiplying the

5-week injury episode weights by 10.4.

The estimates for overall sports- and

recreation-related injuries were calculated

across sex, race and ethnicity, age

group, place of occurrence, and place of

medical care. Because the injured person

might have received care in a variety of

settings, injury episodes were categorized

into mutually exclusive categories using

the highest level of medical care received

based on the following hierarchy:

hospitalized overnight, ED visit,

attendance by an emergency vehicle,

doctor’s ofce or clinic visit, call to a

medical professional or poison control

center, or care received anyplace else.

Age-adjusted injury rates and percentages

across various sports- and recreation-

related activities were estimated for the

entire study population and by sex. To

identify differences by age group, injury

estimates were calculated for the ve

leading sports- and recreation-related

activities for age groups 5–14, 15–24,

and 25 and over. Additionally, the annual

number and percentage of injuries by

external cause, nature of injury, and body

region involved were also calculated.

Reliability of estimates was

evaluated using the relative standard

error (RSE), which is the standard error

divided by the point estimate. Estimates

were considered reliable if the RSE

was less than 30%. Estimates by age

group, gender, race and ethnicity, place

of occurrence, place of medical care,

activity at the time of injury, cause of

injury, type of injury, and body region

of injury were compared for statistically

signicant differences. The highest

rate or percentage within each group is

footnoted in Tables 1–4. For activity at

the time of injury (Table 2), only the top

ve frequently mentioned activities were

compared. To assess the signicance

of differences, two-tailed tests with no

adjustments for multiple comparisons

were performed. The critical value used

for two-sided tests at the 0.05 level of

signicance was 1.96.

Results

Overall estimates

From 2011 through 2014, Americans

aged 5 years and over sustained an

average 8.6 million sports- and

recreation-related injury episodes per

year, or 34.1 episodes per 1,000 persons

(Table 1). Sixty-ve percent of these

injury episodes involved persons aged

5–24 years, with the highest rate observed

among children aged 5–14 years (76.6

per 1,000 persons). Males accounted for

61% of the sports- and recreation-related

injury episodes, with a rate of 41.2 per

1,000 persons. In both sexes, the highest

rate was seen for children aged 5–14,

with rates of 86.0 episodes per 1,000

persons for boys and 66.8 episodes per

1,000 persons for girls. Among racial

and ethnic groups, non-Hispanic white

persons had the highest age-adjusted

sports- and recreation-related injury rate

(42.5 per 1,000 persons).

Among place of injury occurrence,

approximately one-third of the sports-

and recreation-related injury episodes

occurred at a sport facility, athletic eld,

or playground, representing about

2.9 million episodes annually. One-half

of the sports- and recreation-related

injury episodes (or 4.3 million annually)

resulted in treatment at a doctor’s ofce

or other health clinic without an ED visit

or hospitalization, and more than one-

third (36.6% or 3.2 million) resulted in an

ED visit without further hospitalization.

Approximately 230,000 sports- and

recreation-related injury episodes (2.7%)

resulted in hospitalization.

Activity-specic estimates,

by sex

Table 2 shows the estimated annual

number, percentage, and rate of sports-

and recreation-related injury episodes

by type of activity. General exercise

was the most frequently mentioned

activity in injury episodes for all persons

(16.3%) and for females (18.6%). For

males, the most frequently mentioned

activities were general exercise (14.9%),

football (12.4%), and basketball (12.2%)

(estimates were not signicantly

different), followed by pedal cycling

(7.1%) and recreational sports (6.5%).

General exercise was further categorized

into “Aerobics, exercising or weight-

training,” “Running or jogging,” and

“School related (non-specic) activity”

such as recess or a physical education

class without a specic sport mentioned.

For all persons and for males, injury

episodes resulting from aerobics,

exercising, or weight training were

more common than episodes resulting

from running or jogging or nonspecic

school-related activities. For females,

the proportion of injuries that involved

aerobics, exercising, or weight training

(8.2%) was similar to the proportion

involving running or jogging (7.2%).

Activity-specic estimates,

by age group

The sports and recreation activity

at the time of injury also differed by

age group. Table 3 shows the top ve

activities among age groups 5–14 years,

15–24, and 25 and over. General exercise

was frequently mentioned in all three age

groups, accounting for 13.1%, 14.3%,

Page 4 National Health Statistics Reports  Number 99  November 18, 2016

and 21.9% of the injury episodes for age

groups 5–14 years, 15–24, and 25 and

over, respectively. While gymnastics/

cheerleading and football were frequently

identied in the age groups 5–14 and

15–24, basketball was most common

in age groups 15–24 and 25 and over.

Pedal cycling was among the top ve

activities for age groups 5–14 years and

25 and over, but not for teenagers and

younger adults aged 15–24. Injuries from

playground activity were frequently seen

for age group 5–14 years, and injuries

from recreational sports and water-related

activities were frequently seen for those

aged 25 and over.

Estimates of injury by

external cause, nature of

injury, and body part injured

More than one-quarter of sports- and

recreation-related injury episodes (27.9%)

resulted from falls. Other causes such as

overexertion, being struck by or against

a person or object, or transportation

each accounted for 12%–17% of the

injury episodes (Table 4). The majority

of the injury diagnoses involved strains

and sprains (41.4%), fractures (20.0%),

and supercial injuries and contusions

(19.0%). Sports-related TBI, which has

received increasing public and research

attention, accounted for 4.5% of the total

injury diagnoses. The parts of the body

most frequently injured while engaging

in sports and recreation activities were

lower extremity (42.0%), upper extremity

(30.3%), and head and neck (16.4%).

Discussion

Research efforts to understand the

patterns, risk factors, and physiology of

sport injuries provide insights that can

help inform prevention and treatment

approaches. While many studies have

focused on specic sport activities,

particularly organized sports, the patterns

of injury associated with individual

sports, especially those engaged in

by nonathletes, have not been well-

described. The narratives from NHIS

injury data not only provide an in-depth

understanding of the circumstances

surrounding the injury event, but also

enable researchers to better estimate the

burden of sports- and recreation-related

injuries for both organized and individual

activities. In addition, the inclusion of

all medically attended injury episodes

in NHIS provides estimates on injury

episodes beyond traditional ED visits and

hospitalizations.

This study presents updated

estimates on nonfatal medically attended

sports- and recreation-related injuries

across various demographic groups,

activities, and injury circumstances in

the United States. From 2011 through

2014, an estimated 8.6 million sports-

and recreation-related injury episodes

occurred annually, with a rate of 34.1

episodes per 1,000 persons for persons

aged 5 years and over. Although the

2011–2014 estimate was greater than

that reported in 1997–1999 (6.8 million

episodes, 27.2 per 1,000 persons) (13),

suggestion of an increase in the sports-

and recreation-related injuries in the

past 15 years should be considered with

caution. Differences in survey design,

duration of reference (recall) period,

and classication of certain sport and

recreation activities may hinder direct

comparison. However, this study’s

ndings of higher proportions and rates

of sports- and recreation-related injuries

for males, non-Hispanic white persons,

and persons aged 24 and under were

consistent with the earlier NHIS study

(13).

Although differences in methodology

limit the direct comparison of estimates

between 1997–1999 and 2011–2014,

distribution of the injury episodes by

activity provides insight into the patterns

of these injuries in recent years. In

2011–2014, general exercise (16.3%

of sports- and recreation-related injury

episodes), basketball (9.9%), and football

(8.3%) were among common activities

resulting in sports- and recreation-related

injury. In contrast, during 1997–1999, the

most common activities identied were

basketball (14.4%), pedal cycling (9.6%),

and recreational sports (9.5%).

Results from this study also indicate

that the activities at the time of sports-

and recreation-related injuries differ

by sex and age group. In contrast to

males, none of the three most frequently

mentioned activities for females included

team sports. While injuries related to

general exercise, playground equipment,

and gymnastics were more common

for children aged 5–14, injuries from

organized sports such as basketball,

soccer, and football were frequently seen

among those aged 15–24. For adults aged

25 and over incurring injuries, individual

activities such as general exercise,

recreational sports, pedal cycling, and

water sports were more common.

The differences in the distribution of

activities among sports- and recreation-

related injury episodes by sex and age

group may be partially explained by the

level of participation in these sports.

According to the Sport and Fitness

Industry Association (19), from 2009

through 2012, the U.S. population aged

6 years and over showed a trend in higher

participation rates in exercise and tness

activities, particularly in aerobic activities

(including use of stationary exercise

machines), running and jogging, strength-

training activities, and gymnastics than

in organized sports. Among organized

sports, more Americans participated in

basketball than any other team sports,

while participation rates from 2009

through 2012 decreased for baseball

and football (19). In addition, according

to a 2015 telephone poll developed by

Harvard Opinion Research Program (20)

and the 2003–2010 American Time Use

Survey (21), males are more likely to

participate in sports and exercise than

females. Compared with males, females

also had a lower participation rate in team

sports but a higher participation rate in

aerobics, yoga, and dancing (21).

In terms of the cause or mechanism

of injury, this study found that falls,

overexertion, and being struck by or

against an object or a person accounted

for more than one-half of the injury

episodes (60.1%), with falls being

the most common cause. This nding

was similar to that reported in a study

using NHIS data, which identied the

most common mechanisms involved

in recreational injury (22). In the

body regions injured and the type of

anatomical injury that occurred, the upper

and lower extremities were the most

common body regions associated with

sports and recreation injuries. Similar to

other studies, the most common injury

diagnoses were sprains and strains,

fractures, supercial injuries, contusions,

and open wounds (7,9,13).

National Health Statistics Reports  Number 99  November 18, 2016 Page 5

One-half of the sports- and

recreation-related injury episodes were

presented to a doctor’s ofce or other

health clinic without a further ED visit

or hospitalization (4.3 million episodes).

This supports earlier observations from

the Netherlands that one-half of all

sports- and recreation-related injuries

were seen by general practitioners (23).

The current study estimates that

2.2 million sports- and recreation-related

injury episodes among children aged

5–19 years were presented to a doctor’s

ofce annually, which is similar to

estimates from a study using National

Ambulatory Medical Care Survey data

from 1997–1998 (2.7 million injury visits

to a primary care ofce) (24). Although

sports- and recreation-related injuries

presenting to a doctor’s ofce are likely

to be less severe than ones presenting to

EDs, the ndings suggest a need for more

injury research in alternative non-ED and

nonhospitalization settings.

Several study limitations should be

noted. NHIS injury data may be subject

to recall bias due to the retrospective

reporting method and use of proxy.

Although NHIS interviews are conducted

year-round and weights are used for

annualized estimates, the 5-week recall

period used in this study may still

introduce seasonal effects. In addition,

the narratives for approximately 10% of

the sports- and recreation-related injury

episodes lacked essential details for

categorizing the sport activity involved.

It is unknown how the appropriate

categorization of these episodes would

affect the overall distribution across the

sport activity categories. Compared with

episodes that mention specic sports

and recreation activities, episodes that

could not be categorized had a similar

demographic distribution but were less

likely to occur at school or on a river,

lake, stream, or ocean, or to result from

transportation-related events (data not

shown). Finally, the lack of data on

participation rates for different sports and

recreation activities prevents evaluation

of the risk of injury for individual sports.

The ndings from this study

provide updated information on the

demographics, types of activity, and

injury diagnoses associated with

sports- and recreation-related injuries.

These ndings can be used to develop

recommendations for prevention

strategies and further research. Results

from this study also suggest that a

substantial proportion of sports- and

recreation-related injuries are treated

in health care facilities other than a

hospital or ED. As the nation continues

to recognize the importance of physical

activity, more research efforts are needed

to address the complexity of these injuries

across various activities, demographic

groups, and medical settings.

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the United States. Pediatrics 109(4):559–

65. 2002.

National Health Statistics Reports  Number 99  November 18, 2016 Page 7

Table 1. Estimated annual number, percentage, and age-adjusted rate of sports- and recreation-related injury episodes among persons

aged 5 years and over, by selected characteristics: United States, 2011–2014

Characteristic Number, in thousands (percent)

Rate (95% CI)

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,599 (100.0) 34.1 (31.6–36.5)

Sex

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,275 (61.3)

41.2 (37.6–44.8)

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,324 (38.7) 27.0 (23.7–30.2)

Age group (years)

5–14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,179 (37.0)

76.6 (68.4–84.8)

15–24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,400 (27.9) 55.6 (47.9–63.4)

25–44. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,790 (20.8) 21.9 (18.4–25.3)

45 and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,229 (14.3) 9.8 (7.9–11.7)

Male:

5–14

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,823 (34.7)

86.0 (74.4–97.6)

15–24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,498 (28.4) 68.7 (57.1–80.2)

25–44 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,179 (22.3) 29.2 (23.5–34.9)

45 and over. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 775 (14.7) 13.1 (10.0–16.2)

Female:

5–14

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,356 (40.8)

66.8 (55.6–78.1)

15–24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 902 (27.1) 42.3 (32.2–52.4)

25–44 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 612 (18.4) 14.7 (10.7–18.8)

45 and over. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 454 (13.7) 6.8 (4.7–9.0)

Race and ethnicity

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 961 (11.2) 18.3 (15.1–21.6)

Non-Hispanic white . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,172 (71.8)

42.5 (38.8–46.2)

Non-Hispanic black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 769 (8.9) 23.6 (18.5–28.7)

Non-Hispanic other races . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 696 (8.1) 33.1 (25.1–41.2)

Place of injury occurrence

Home (inside) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 374 (4.0) 1.3 (0.8–1.8)

Home (outside) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,101 (12.8) 4.6 (3.7–5.5)

School . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,961 (22.9) 8.6 (7.4–9.8)

Street, highway, curb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 494 (5.8) 1.8 (1.3–2.3)

Sport facility, athletic eld, playground . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,973 (34.7)

11.4 (9.9–12.8)

Park or recreation area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 785 (9.1) 2.9 (2.2–3.6)

River, lake, stream, ocean . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361 (4.2) 1.3 (0.8–1.8)

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 547 (6.4) 2.1 (1.5–2.7)

Place of medical care

Call to medical professional . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250 (2.9) 0.9 (0.6–1.3)

Doctor’s office or clinic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,298 (50.0)

16.5 (14.7–18.2)

Emergency vehicle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 388 (4.5) 1.4 (1.0–1.9)

Emergency department . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,150 (36.6)

13.1 (11.6–14.6)

Hospitalized overnight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229 (2.7) 0.9 (0.5–1.3)

Anyplace else . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283 (3.2) 1.2 (0.6–1.7)

Numbers and percentages may not sum to total due to rounding.

Rates are per 1,000 persons with 95% condence interval (CI).

Indicates highest rate within the group (p < 0.05).

Mutually exclusive categories using the highest level of medical care received based on the following hierarchy: hospitalized overnight, emergency department visit, attendance by an emergency

vehicle, doctor’s office or clinic visit, call to a medical professional or poison control center, or care received anyplace else.

Indicates rates were similar between doctor’s office or clinic and emergency room, but higher than other places of medical care (p < 0.05).

SOURCE: NCHS, National Health Interview Survey, 2011–2014.

Page 8 National Health Statistics Reports  Number 99  November 18, 2016

Table 2. Estimated annual number, percentage, and age-adjusted rate of sports- and recreation-related injury episodes among persons aged 5 years and over, by type of activity and

sex: United States, 2011–2014

Activity

Total Male Female

Number, in thousands

(percent)

Rate (95% CI)

Number, in thousands

(percent)

Rate (95% CI)

Number, in thousands

(percent)

Rate (95% CI)

General exercise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1,404 (16.3) 5.3 (4.4–6.2)

786 (14.9) 5.9 (4.6–7.2)

618 (18.6) 4.8 (3.5–6.0)

Aerobics, exercising, or weight training . . . . . . . . . . . . . . . .

678 (7.9) 2.2 (1.6–2.7)

408 (7.8) 2.7 (1.8–3.7)

270 (8.2) 1.6 (1.0–2.3)

Running or jogging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 457 (5.3) 1.8 (1.3–2.4) 224 (4.3) 1.7 (1.0–2.4)

234 (7.1) 1.9 (1.1–2.8)

School-related (nonspecic). . . . . . . . . . . . . . . . . . . . . . . . . 269 (3.1) 1.3 (0.8–1.8) 154 (2.9) 1.4 (0.8–2.1)

115 (3.5) 1.2 (0.5–1.9)

Basketball . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 851 (9.9) 3.3 (2.6–4.0)

642 (12.2) 4.7 (3.6–5.9) 209 (6.3) 1.8 (1.1–2.6)

Football . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 712 (8.3) 3.1 (2.3–3.8)

653 (12.4) 5.5 (4.1–6.9)

59 (1.8)

0.5 (0.0–1.0)

Pedal cycling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 615 (7.2) 2.5 (1.8–3.1) 375 (7.1) 3.0 (2.0–3.9) 240 (7.2) 1.9 (1.1–2.8)

Soccer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 545 (6.3) 2.1 (1.5–2.7) 313 (5.9) 2.5 (1.6–3.4) 233 (7.0) 1.7 (1.0–2.4)

Recreational sport

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 520 (6.0) 1.8 (1.2–2.3) 342 (6.5) 2.0 (1.2–2.7) 179 (5.4) 1.3 (0.7–1.9)

Gymnastics/cheerleading . . . . . . . . . . . . . . . . . . . . . . . . . . . . 474 (5.5) 2.1 (1.5–2.8)

95 (1.8)

0.9 (0.3–1.5) 379 (11.4) 3.4 (2.2–4.5)

Baseball/softball. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403 (4.7) 1.6 (1.1–2.1) 232 (4.4) 1.8 (1.0–2.6) 171 (5.1) 1.4 (0.7–2.0)

Other team sport

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 372 (4.3) 1.5 (0.9–2.0) 180 (3.4) 1.4 (0.7–2.0) 192 (5.8) 1.7 (0.8–2.5)

Water sport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 364 (4.2) 1.4 (0.9–1.8) 207 (3.9) 1.5 (0.8–2.2) 158 (4.7) 1.3 (0.6–1.9)

Other individual sport

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 358 (4.2) 1.4 (0.9–1.9) 210 (4.0) 1.6 (0.9–2.3) 148 (4.5) 1.1 (0.5–1.8)

Playground equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 330 (3.8) 1.7 (1.1–2.2) 177 (3.4) 2.2 (1.4–3.1)

153 (4.6) 1.6 (0.8–2.4)

Combative sport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291 (3.4) 1.2 (0.7–1.6) 231 (4.4) 1.9 (1.1–2.6)

60 (1.8)

0.5 (0.1–0.8)

Snow sport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285 (3.3) 1.1 (0.6–1.6) 148 (2.8) 1.1 (0.5–1.7)

137 (4.1)

1.1 (0.4–1.8)

Ice or roller skating/skateboarding . . . . . . . . . . . . . . . . . . . . . . 162 (1.9) 0.7 (0.3–1.0)

76 (1.4)

0.7 (0.2–1.2)

86 (2.6)

0.7 (0.2–1.1)

Unspecied . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 910 (10.6) 3.5 (2.7–4.3) 607 (11.5) 4.7 (3.3–6.1) 303 (9.1) 2.3 (1.4–3.1)

Numbers and percentages may not sum to total due to rounding.

Rates are per 1,000 persons with 95% condence interval (CI).

Indicates highest percentage among the top ve frequently mentioned activities (p < 0.05).

Indicates percentages were similar between general exercise, basketball, and football, but higher than pedal cycling and recreational sports among the top ve frequently mentioned activities (p < 0.05).

Indicates percentages were higher than running or jogging and school-related (nonspecic) activities (p < 0.05).

Indicates percentages were similar between “aerobics, exercising, or weight training” and “running or jogging” but higher than school-related (nonspecic) activities (p < 0.05).

Estimates may be unstable because they are based on fewer than 20 cases or have a relative standard error of 30% or more.

Includes tennis, racquetball, badminton, and other racquet sports, as well as golf, bowling, shing, hunting, hiking, mountain climbing, and other leisure sports.

Includes volleyball, rugby, hockey, lacrosse, cricket, and other team sports.

Includes all other sport and recreation categories, such as horseback riding, riding an all-terrain vehicle, playing catch, and other nonteam activities.

SOURCE: NCHS, National Health Interview Survey, 2011–2014.

National Health Statistics Reports  Number 99  November 18, 2016 Page 9

Table 3. Estimated annual number, percentage, and rate of sports and recreation injury episodes for persons aged 5 years and over, by

leading types of activities and age group: United States, 2011–2014

Order

5–14 years 15–24 years 25 years and over

Activity

Number, in

thousands

(percent) Rate (95% CI)

Activity

Number, in

thousands

(percent) Rate (95% CI)

Activity

Number, in

thousands

(percent) Rate (95% CI)

General

exercise

417 (13.1) 10.1 (7.2–13.0) Basketball 343 (14.3) 7.9 (5.2–10.6)

General

exercise

662 (21.9) 3.2 (2.4–4.0)

2 Football 375 (11.8) 9.0 (6.1–11.9)

General

exercise

324 (13.5) 7.5 (4.5–10.5)

Recreational

sport

362 (12.00) 1.7 (1.1–2.3)

3 Playground 309 (9.7) 7.4 (4.9–10.0) Soccer 257 (10.7) 6.0 (3.6–8.3) Basketball 264 (8.8) 1.3 (0.8–1.8)

Gymnastics/

cheerleading 302 (9.5) 7.3 (4.7–9.9) Football 243 (10.1) 5.6 (3.1–8.2) Pedal cycling 222 (7.4) 1.1 (0.6–1.5)

5 Pedal cycling 257 (8.1) 6.2 (3.8–8.6)

Gymnastics/

cheerleading 145 (6.0) 3.4 (1.2–5.3) Water sport 213 (7.1) 1.0 (0.6–1.5)

… Total 3,179 (100.0) 76.6 (68.4–84.8) Total 2,400 (100.0) 55.6 (17.9–63.4) Total 3,019 (100.0) 14.6 (12.8–16.3)

… Category not applicable.

Rates are per 1,000 persons with 95% condence interval (CI).

Includes aerobics, exercising, weight training, running, and nonspecic school-related sports- and recreation-related activities.

Includes tennis, racquetball, badminton, and other racquet sports, as well as golf, bowling, shing, hunting, hiking, mountain climbing, and other leisure sports.

SOURCE: NCHS, National Health Interview Survey, 2011–2014.

Page 10 National Health Statistics Reports  Number 99  November 18, 2016

Table 4. Estimated annual number and percentage of sports- and recreation-related injury episodes, by external cause of injury, nature of

injury, and body region: United States, 2011–2014

Injury characterisitic Number, in thousands Percent (SE)

External cause of injury

Fall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,403

27.9 (1.6)

Overexertion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,449 16.8 (1.4)

Struck by or against . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,321 15.4 (1.3)

Transportation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,054 12.3 (1.1)

Cut or pierce . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1422

1.7 (0.6)

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,230 25.9 (1.6)

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,599 100.0 ...

Nature of injury

Sprains/strains . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,262

41.4 (1.7)

Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,055 20.0 (1.4)

Supercial/contusions . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,953 19.0 (1.4)

Open wound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,044 10.1 (1.0)

Traumatic brain injury . . . . . . . . . . . . . . . . . . . . . . . . . . . 460 4.5 (0.7)

Dislocation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 296 2.9 (0.5)

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228 2.2 (0.5)

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,298 100.0 ...

Body region

Lower extremity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,326

42.0 (1.6)

Upper extremity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,122 30.3 (1.5)

Head & Neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,691 16.4 (1.4)

Trunk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,037 10.1 (1.0)

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 1.2 (0.3)

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,299 100.0 ...

. . . Category not applicable.

Indicates highest percentage (p < 0.05) among external cause-of-injury categories, except for “Other” external cause.

Estimates may be unstable because they are based on fewer than 20 cases or have a relative standard error of 30% or more.

Up to eight ICD–9–CM codes were assigned to each injury episode. Diagnosis codes were categorized by body region and nature of injury according to the Barell Injury Diagnosis Matrix, except for

traumatic brain injury, where the classication was based on the National Center for Injury Prevention and Control surveillance case denition.

Indicates highest percentage (p < 0.05).

NOTE: SE is standard error.

SOURCE: NCHS, National Health Interview Survey, 2011–2014.

National Health Statistics Reports  Number 99  November 18, 2016 Page 11

National Health Statistics Reports  Number 99  November 18, 2016

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Suggested citation Copyright information National Center for Health Statistics

Sheu Y, Chen LH, Hedegaard H. Sports- and All material appearing in this report is in

Charles J. Rothwell, M.S., M.B.A., Director

recreation-related injury episodes in the the public domain and may be reproduced

Jennifer H. Madans, Ph.D., Associate Director

United States, 2011–2014. National health or copied without permission; citation as to

for Science

statistics reports; no 99. Hyattsville, MD: source, however, is appreciated.

National Center for Health Statistics. 2016.

Office of Analysis and Epidemiology

Irma E. Arispe, Ph.D., Director

Makram Talih, Ph.D., Associate Director for

Science

Acknowledgment

Co-author Li-Hui Chen is currently with the U.S. Consumer Product Safety Commission.