Descriptive epidemiology.

1. European region: Injury
as a Major Global
Health Problem
Raimundas Lunevicius
King’s College Hospital NHS Foundation Trust
21 Oct, 2011

2. Maps: meaning and content

3. EU Europe European region / WHO

4. Definition of Injury
n Any damage to the human being body
resulting from acute exposure to thermal,
mechanical, electrical, or chemical energy
or from the absence of such essentials as
heat or oxygen
¨ Causes of injury = external causes
¨ External causes are causes of events

5. Classification of events from external causes
n Unintentional:
¨ Road traffic events (crashes, accidents)
¨ Burns / fire
¨ Drowning / sinking
¨ Poisoning
¨ Falls
¨ Frosts, bites, etc.
n Intentional:
¨ Suicide
¨ Homicide

6. NB! Injuries are not accidents
Accident Injury
An event (crash, fall..) Human damage,
a pathological condition
Accidents are
unpredictable
Predictable
Preventable (pre-event, event)
Controllable (post-event)

7. GH: common language / terms

8. GH common language / terms
1. Mortality
2. Incidence
3. Morbidity
4. Disability
5. Cost
¨ Composite metrics (DALYs, HeaLYs, etc.)

9. Mortality (SDR) from external causes in
European region in age group 0 – 64
Atlas of health in Europe, p. 55, 2008; http://www.euro.who.int/Document/E91713.pdf

10. Mortality from external causes in Eu
region
Atlas of health in Europe, p.54, 2008
http://www.euro.who.int/Document/E91713.pdf

11. Injury: a major public health problem
n MORTALITY due to
external causes is highest
in 0-44 age group
¨ MVI is 1st mortality
cause in age gr.0-34
¨ Cardiovascular diseases, cancer,
and injuries are 3 key causes of
death in general population

12. Emergency Department Visits
~ 29.8 million
Other Outpatient Visits
~ 85.0 million
Hospital
Discharges
~ 2.0 million
Deaths
173,753
BURDEN OF INJURY, UNITED STATES 2005:
Injury and death pyramid
Source: National Center for Health Statistics

13. Injury-related risk factors: lots
results of population-based study among middle age men : Tamosiunas, 2005
n The risk of death from an ExC
¨ among divorced men was 3-fold that of married middle age men (and 9-
fold for suicide)
¨ among widowers men was 2.7-fold that of married middle age men
n A lower education level is associated with a higher risk of death
n Among men with arterial hypertension, the risk of death from injuries
was higher by 63.4%
n Smoking habits had increased the risk of death from injuries at an
average of 25.8%
n Risk of suicide among workers was 3.6-fold that among employees
n Risk of death was 2.0-fold higher among men with a total cholesterol
level in the lowest quintile (1.37-5.02 mmol.l)

14. Lifestyle: Alcohol (just one of them)
Source: Atlas of health in Europe, p. 99,101, 2008

15. Lifestyle: Alcohol
Source: Atlas of health in Europe, p. 100, 2008

16. Mortality distribution by cause, Eu
n The leading causes of unintentional injury
death (blunt trauma)
¨ transport injuries
¨ poisoning
¨ falls (20%)
¨ drowning
¨ burns/fires
n The leading causes of intentional injury death is
suicide

17. Firearms: 30,694
Mot Veh.: 43,667
Fire/Burn: 3736
Falls: 20,426
Poison: 32,691
Drowning: 4248
Cut/Pierce: 2795
Other: 35,496
Firearm:18%
MVA:
25%
Fire/Burn:2%Falls
12%
Poison:19%
Cut/Pierce: 2%
Other: 20%
INJURY DEATH BY CAUSE, UNITED STATES 2005
All Injury Deaths: 173,753 Source:
CDC, NCIPC
Drown: 2%

18. Traffic events / injuries overview

19. Mortality (SDR) from MVI in Eu region
Atlas of health in Europe, p. 56, 2008

20. Human and environmental risk factors for death in urban RTI
Vorko-Jović, Kern, Biloglav, Journal of Safety Research, 2006
ATRIBUTES RISK-FACTOR Odds Ratio 95% CI
Gender Male 2.69 1.24-5.84
Time of day 0-6 am. 3.78 2.08-6.85
Weekdays Fr,St,Su 1.89 1.06-3.34
Type of road Junctions ‘T’, ‘Y’ ‘+’ 5.27 2.21-12.57
Type of road Road links 2.33 1.30-4.19
Bad visibility Night, sunset,
sunrise
2.29 1.28-4.08
Speed Speed over upper
limit
2.56 1.43-4.61
Seat belt Not used 2.33 1.22-4.45

21. Combinations of risk factors for death for
male road users: dead vs injured (pedestrians exc)
Vorko-Jović, Kern, Biloglav, Journal of Safety Research, 2006
Combinations of risk
factors for death
Numbers
(%)
OR 95% CI
Male +night hours (0-6
am)
20 (42.5)
56 (17.2)
3.56 1.9-6.8
Male + high speed 33 (70.2)
134 (44.1)
2.99 1.5-5.8
Male + no using seat
belt
34 (73.9)
100 (39.5)
4.34 2.1-8.8
Male + high speed + no
using seat belt
25 (75.7)
40 (38.1)
5.08 2.1-12.3

22. Not risk factors
Vorko-Jović, Kern, Biloglav, Journal of Safety Research, 2006
1. The state of road surface
2. Public light(ing)
3. Bad weather condition
4. Type of motor vehicle
5. Vehicle’s years, and
6. Summer and winter months
¨ (problem: drivers under the influence of alcohol;
underreported)
¨ Data from other report: ABS (Anti-lock Braking
System) (Chipman, Traffic Inj Prev, 2004)

23. Other risk factors for increased risk of
death from RTI
n Age (≥ 65)
n Age-related medical conditions (e.g., dementia)
n Drivers under the influence of alcohol
n Rural area (conflicting data; Italy) ?
n Disparity in the size of the two vehicles in crash

24. Injuries due to RTE involving alcohol
Atlas of health in Europe, p. 98-99, 2008

25. PH / GH language / terms:
specific event related terms
n Some of them are briliant
n Example

26. Motor Vehicle Crash Fatality Rate per 100 Million
Vehicle Miles Traveled, 1966-2003
Jon S. Vernick and Susan P. Baker lecture, 2008, JH
0
1
2
3
4
5
6
1966
1969
1972
1975
1978
1981
1984
1987
1990
1993
1996
1999
2002
Fatalitiesper100MillionVMT
Source: NHTSA, USA

27. Drowning-related injury

28. Situation regarding accidental
drowning (Anamort study 2008; 2005 data)
n 6,156 deaths in 26 EU
n 3.4% of deaths due to ExC
n
n SDR for ad: 1.8
n Variations: 0.2 and 11.2 /
100,000 / year
n The highest SDRs:
¨ Lithuania,
¨ Latvia,
¨ Romania
¨ Estonia

29. Poisoning-related injury

30. Accidental poisoning
n Represents 4.4% of deaths from ExC
n SDR: 2.1
n Variations between 0.2 and 20.0
n The highest risks of death from AP
were observed in northeastern
countries
¨ Lithuania, Estonia, Latvia, Finland, Norway
and Poland
n The highest CDRs were observed
among people between 30-59 y.-old

31. Intentional injury: suicide

32. Mortality (SDR) from suicides
Atlas of health in Europe, p. 58, 2008

33. Statistics / Facts from the UKhttp://www.medicine.manchester.ac.uk/mentalhealth/research/suicide/prevention/nci/inquiryannualreports/Annual_Report_July_2011.pdf
n Patient suicides have fallen from a peak of 1,315 in 2004 to 1,196 in 2008
n The number of patient suicides has been under
1,200 for the last three years
n Suicide rates among the general population are significantly greater in
Scotland than in England and Wales
n A slight increase in patient suicide rates in England between 2007 and 2008
Annual Report (19 July, 2011).
The University of Manchester’s National Confidential Inquiry (NCI) into Suicide and Homicide by People with Mental Illness.
22/10/20

34. Intentional injury: homicide
n death coded X85 to Y09 in the 10th
revision of ICD (ICD-10).
Homicide-related deaths in an enlarged European Union. Collection: European Project ANAMORT Monographs. Institut de veille
sanitaire Jun 2008

35. Homicide in EU
n 4 743 deaths in 2005, EU25
n 2.1% of deaths from Ext causes
n SDR : 1.0
n Variations between 0.2 and 10.0
n Much higher SDRs were observed in 4
countries
¨ Latvia(10.0).
¨ Lithuania (8.8)
¨ Estonia (8.8),
¨ Albania (4.3),

36. Key issue: a reduction of unnecesarry mortality in most
productive segment of society
Key question: how
Inclusive trauma system:
1 thing of 12 (9)

37. Take-homes
1. Injury is a global health issue indeed
2. Prevention is a key (90%)
3. Inclusive trauma systems plays little but
important role in reduction of mortality from
external causes / it is needed