About the MIDAS Self-Harm Data

• If you want to understand what the magnitude or how big the overall burden is, then use the number.
• The number indicates the total number of deaths or hospitalizations/ED visits due to self-harm injuries.
• For hospital/ED visits, the number refers to the number of visits (individuals may be counted more than once).
• To protect an individual's privacy, counts from 1 to 5 are suppressed.

Age-adjusted Rate:

• Age-adjusted rates are useful when comparing the rates of two population groups that have different age distributions.
• A weighted average, called the direct method, is used to adjust for age in this analysis. Age-specific rates in a given population are adjusted to the age distribution in a standard population by applying a weight. The U.S. 2000 Standard population is used as the basis for weight calculations.
• To limit the unreliability of rates, those based on counts < 6 are not calculated if the underlying population is less than or equal to 100,000.

Age-specific rate:

• A rate of an event (such as disease or death) measured within a particular age group. It is similar to a crude rate but is calculated within an age group (e.g. an age-specific rate of hospitalizations in adults 35-44 years of age).

These data use ICD–10–CM coded data to identify events involving nonfatal suicide attempts and intentional self-harm. Because personal identifiers are removed from the hospital discharge data before analysis, individuals who have multiple hospitalizations or ED visits cannot be identified. Hospitalization data are extracted from Minnesota Hospital Discharge Data (MNHDD), which is maintained by the Minnesota Hospital Association (MHA).

• MHA represents Minnesota's hospitals and health systems. Hospitals submit ED and inpatient discharge data to MHA using a standardized billing form. Submitting data to MHA is voluntary, but the MNHDD typically represents data from more than 95% of hospitals (with some variation year to year).
• MHA began data-sharing agreements with several states in 2005. Minnesota residents receiving care from Emergency Departments and hospitals from the participating border states of South Dakota and Iowa are also included in hospitalization measures. MHA data are periodically revised by the MHA to reflect more complete and accurate discharge information.

Hospitalizations are identified as suicide attempt or self-harm if any of the following ICD 10-CM codes are included:
ICD-10-CM Codes: Intentional self- harm due to:

• X71 – X83: Drowning/submersion, firearm, explosive material, fire/flame, hot vapors/objects, sharp object, blunt object, jumping from a high place, jumping or lying in front of a moving object, crashing of motor vehicle, other specified means
• T36 – T50 with the 6th character of the code = 2 (except for T36.9, T37.9, T39.9, T41.4, T42.7, T43.9, T45.9, T47.9, and T49.9, which are included if the 5th character of the code = 2): Poisoning by drugs, medications and biological substances
• T51 – T65 with the 6th character of the code = 2 (except for T51.9, T52.9, T53.9, T54.9, T56.9, T57.9, T58.0, T58.1, T58.9, T59.9, T60.9, T61.0, T61.1, T61.9, T62.9, T63.9, T64.0, T64.8, and T65.9, which are included if the 5th character of the code = 2): Toxic effects of nonmedicinal substances
• T71 with the 6th character of the code = 2: Asphyxiation, suffocation, hanging
• T14.91: Suicide attempt

Hospital Discharge Data Limitations

• Hospital Discharge Data includes data for hospital visits rather than for individual people. To the extent possible, the data are not duplicated. However, multiple hospital visits by the same patient for the same condition/injury may be included.
• Minnesota residents discharged from North Dakota and Wisconsin hospitals are not currently included, so hospitalization and ED visit rates for counties in which residents are likely to receive care in those states may be underestimated. Rates for counties in which residents are likely to visit hospitals that do not submit data to the Minnesota Hospital Association (e.g., Veteran's Administration or Indian Health Services hospitals) may also be artificially low.