Injuries Due to Venomous Insects and Plants
Among Arizona Residents, 2012

Resources for the development of this report were provided through funding to the
Arizona Department of Health Services from the Centers for Disease and Control and
Prevention, Cooperative Agreement 1U17CE002023-01, Core Violence and Injury
Prevention Program
Permission to quote from or reproduce materials from this publication is granted when
acknowledgment is made.

Prepared by: Jennifer Dudek, MPH
th
150 North 18 Avenue, Suite 320
Phoenix, AZ 85007
Office of Injury Prevention
Bureau of Women’s and Children’s Health
Arizona Department of Health Services
April 2014

This brief includes mortality data with an underlying cause of death coded to ICD-10 codes X20X29, and hospital discharge data coded to ICD-9 codes 905.0-905.9. The hospital discharge
data only include information from private, acute-care facilities. Data from urgent care centers or
federal facilities, including Indian Health Services or Veteran’s Administration facilities, are not
available.
In 2012, there were 2 fatalities among Arizona residents due to envenomation by bee stings.
Six thousand nine hundred eighty five Arizona residents were hospitalized or treated in
emergency departments in 2012 for non-fatal insect or reptile envenomation. While males
generally have higher rates of injury than females for most types of injury, females had slightly
higher age-adjusted rates of non-fatal insect or reptile envenomation. In 2012, there were 105.7
injuries per 100,000 males (n=3,417) and 111.3 injuries per 100,000 females (n=3,568). These
numbers show that females were 6 percent more likely to incur injuries from insect or reptile
envenomation than males in 2012.
The highest number of hospitalizations and emergency department visits due to envenomation
by insects or reptiles occurred during the hot summer months. There were not significant
differences in the distribution of cases by type of envenomation. Figure 1 shows the distribution
of cases by month.

Figure 1. Percentage of Non-Fatal Venomous Creature
Hospitalizations and Emergency Department Visits
by Month, Arizona, 2012 (n=6,985)
Percentage of Cases

16%
14%

14%

13%

13%
11%

12%

12%
10%

10%
7%

8%

6%

6%
4%

5%
3%

3%

3%

2%
0%
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
(n=202) (n=236) (n=323) (n=521) (n=754) (n=903) (n=877) (n=976) (n=894) (n=719) (n=401) (n=179)

Rural counties had the highest age-adjusted rates of hospitalizations and emergency
department visits for non-fatal injuries due to insect or reptile envenomation in 2012. While there
were 108.4 cases per 100,000 residents across Arizona, La Paz, Gila and Graham Counties
had rates at least twice that high. Counties located at higher elevations had lower rates of
injuries related to venomous creatures; this is most likely attributable to the fact those venomous
invertebrates cannot survive in colder climates. There is not a definitive reason regarding why
Yuma County residents sought medical care at such a low rate. It is possible that residents
sought care on the local military base, resulting in an artificially low rate. Figure 2 shows the
age-adjusted rates of hospitalizations and emergency department visits per 100,000 residents
due to venomous creature by county of residence.

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Figure 2. Age-adjusted rates of Hospitalizations and
Emergency Department Visits per 100,000 residents by
County, Arizona 2012 (n=6,984)
350
281.1 288.5

300
250
200

155.7

150
100
50

232.6

215.2

87.9
54.9

48.3

132.4

110.9 106.2

134.5
108.4

62.7

83.6

61.3

0

Inpatient Hospitalizations
In 2012, there were 274 non-fatal inpatient hospitalizations among Arizona residents for
treatment of insect or reptile envenomation. Scorpion stings accounted for 15 percent of nonfatal inpatient hospitalizations (n=41). Bites by venomous snakes and lizards accounted for the
highest percentage of non-fatal inpatient hospitalizations (59 percent, n=163). Figure 3 shows
non-fatal inpatient hospitalizations by type of bite/sting.

Figure 3. Non-Fatal Inpatient Hospitalizations due to
Venomous Animals or Plants, Arizona 2012 (n=274)
Venomous spiders
8% (n=22)
Scorpions 15%
(n=41)

Venomous
snakes/lizards, 59%
(n=163)

Hornets, wasps,
bees 13% (n=38)
Ants, caterpillars 2%
(n=6)
Other or unspecified
venomous animal or
plant 4% (n=10)

Hospital charges for non-fatal inpatient hospitalizations due to venomous animals or plants
totaled more than $18.2 million, with an average hospital stay lasting 2 days and resulting in
$550,323 in hospital charges. The median hospital charge was $39,020. Arizona residents
spent a total of 274 days hospitalized, with the longest stay lasting 54 days.

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Emergency Department Visits
In 2012, there were 6,711 non-fatal emergency department visits by Arizona residents for
treatment of insect or reptile envenomation. Scorpion stings accounted for a majority of these
visits (59 percent, n=3,935). The second highest number of visits resulted from stings by
hornets, bees, and wasps (25 percent, n=1,647). Figure 4 shows non-fatal emergency
department visits by type of bite/sting.

Figure 4. Non-Fatal Emergency Department Visits due to
Venomous Animals or Plants, Arizona 2012 (n=6,711)
Hornets, wasps, bees
25% (n=1647)
Centipede or tropical
millipede <1% (n=14)
Ants, caterpillars 7%
(n=460)
Venomous marine
animal/plant <1% (n=14)
Other/Unspecified
venomous animal or
plantt 2% (n=118)

Scorpions 59%
(n=3,935)

Venomous
snakes/lizards 2%
(n=161)
Venomous spiders 5%
(n=364)

Hospital charges for non-fatal emergency department visits due to venomous animals or plants
totaled more than $24.9 million. Visits to treat scorpion stings totaled more than $18.4 million in
hospital charges. While scorpion stings resulted in 59 percent of the total non-fatal emergency
department visits for venomous animals or plants, they accounted for 74 percent of the total
hospital charges.
All Hospitalizations and Emergency Department visits
Among the 3,976 non-fatal hospital visits due to scorpion stings in 2012, the highest rate of
events was among children ages 1 to 4 (164.5 ED visits per 100,000 residents). Children ages 1
to 4 also had the highest age-specific rate of emergency department visits due to hornet, wasp,
and bee stings, the second leading cause of emergency department visits due to venomous
creatures (65.9.0 ED visits per 100,000 residents). Figure 5 shows the rate of non-fatal
hospitalizations emergency department visits due to scorpion and bee stings by age group.

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Figure 5. Age-Specific Rates of Non-Fatal Hospital Visits due to
Scorpion and Hornet, Wasp and Bee Stings per 100,000 Residents,
Arizona 2012 (n=5,661)

180.0

164.5

Rate per 100,000 residents

160.0
140.0
120.0
100.0

81.2

80.0
60.0

65.9

61.2

52.6

56.2

40.0

49.0

50.2

40.8
27.4

25.5

19.5

20.4

18.5

20.0

47.3

42.0
16.3

47.7

40.6
16.6

15.7

14.5

0.0
Under 1
Year

1-4
Years

5-14
Years

15-24
Years

25-34
Years

Scorpion Stings (n=3,976)

35-44
Years

45-54
Years

55-64
Years

65-74
Years

75-84
Years

85 Years
and Older

Hornet, Wasp or Bee Stings (n=1,685)

Among the 386 non-fatal hospital and emergency department visits due to venomous spider
bites in 2012, the highest rate of events was among adults ages 25 to 34 (9.4 visits per 100,000
residents). Children ages 1 to 4 had the second highest age-specific rate of hospital visits (8.4
per 100,000 residents) followed closely by those 15 to 24 years of age. Among the 324 hospital
and emergency department visits for snakes and lizards, adults aged 65 to 74 years of age had
the highest rate of 7.2 per 100,000 residents. Figure 6 shows the rate of non-fatal
hospitalizations and emergency department visits due to venomous spiders and snakes/lizards
by age group.

Figure 6. Age-Specific Rates of Non-Fatal Hospital Visits due to
Spiders and Snakes/Lizards per 100,000 Residents,
Arizona 2012 (n=710)
Rate per 100,000 residents

10

9.4

9

8

8.4

8

7.2
6.5

7

6.6

6.2

6
5

4.4

4.6

4
3

5.9
5.4

3.4

4.5

4.4

3.7
3.3

2.8

2.8
2.4

2.3

2
1

1.8

0

0
Under 1
Year

1-4
Years

5-14
Years

15-24
Years

25-34
Years

Spiders (n=386)

35-44
Years

45-54
Years

55-64
Years

65-74
Years

75-84
Years

85 Years
and Older

Snakes/Lizards (n=324)

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Figure 8. An Arizona Bark Scorpion

Figure 9. A Striped Scorpion

Source: http://phoenix.about.com/od/arizonapicturesandphotos/ig/Arizona-Bark-Scorpions/Scorpion-01.htm;
http://phoenix.about.com/od/arizonapicturesandphotos/ig/Arizona-Bark-Scorpions/Scorpion-06.htm

Hospital discharge data do not specify the species of scorpion, so it is not possible to further
classify injuries. Bark scorpions, as shown in Figure 8, are the most venomous scorpions in
North America, and extreme reactions to their stings can cause paralysis and convulsions,
though fatalities are rare. Medical attention is recommended for stings to pets, young children,
older adults, and people with compromised immune systems.
Visit the following websites for more information on Arizona’s venomous creatures:
 The University of Arizona’s Cooperative Extension:
o Venomous Wildlife: http://cals.arizona.edu/pubs/natresources/az1481g
o Scorpions: http://ag.arizona.edu/pubs/insects/az1223.pdf
 The Arizona Game and Fish Department:
http://www.azgfd.gov/w_c/nongameandendangeredwildlifeprogram/reptiles.shtml
 Arizona’s Poison Control Centers:
o Banner Good Samaritan Poison & Drug Information Center:
http://www.bannerhealth.com/Locations/Arizona/Banner+Good+Samaritan+Poiso
n+and+Drug+Information+Center/_Banner+Poison+Control+Center.htm
o The University of Arizona College of Pharmacy Poison and Drug Information
Center: http://www.pharmacy.arizona.edu/outreach/poison/scorpions.php
 The Arizona-Sonora Desert Museum:
http://www.desertmuseum.org/books/nhsd_inverts.php

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