Childhood and adult mortality from unintentional falls in India

Objective

To estimate fall-related mortality by type of fall in India.

Methods

The authors analysed unintentional injury data from the ongoing Million Death Study from 2001–2003 using verbal autopsy and coding of all deaths in accordance with the International statistical classification of diseases and related health problems, tenth revision, in a nationally representative sample of 1.1 million homes throughout the country.

Findings

Falls accounted for 25% (2003/8023) of all deaths from unintentional injury and were the second leading cause of such deaths. An estimated 160 000 fall-related deaths occurred in India in 2005; of these, nearly 20 000 were in children aged 0–14 years. The unintentional-fall-related mortality rate (MR) per 100 000 population was 14.5 (99% confidence interval, CI: 13.7–15.4). Rates were similar for males and females at 14.9 (99% CI: 13.7–16.0) and 14.2 (99% CI: 13.1–15.4) per 100 000 population, respectively. People aged 70 years or older had the highest mortality rate from unintentional falls (MR: 271.2; 99% CI: 249.0–293.5), and the rate was higher among women (MR: 281; 99% CI: 249.7–311.3). Falls on the same level were the most common among older adults, whereas falls from heights were more common in younger age groups.

Conclusion

In India, unintentional falls are a major public health problem that disproportionately affects older women and children. The contexts in which these falls occur and the resulting morbidity and disability need to be better understood. In India there is an urgent need to develop, test and implement interventions aimed at preventing falls.     

Unintentional injuries in the home in the United States Part I: mortality

BACKGROUND: Unintentional injuries are a leading cause of death in the United States. It is unclear, however, what proportion of these injuries occur in the home. The purpose of this paper is to quantify and describe fatal unintentional injuries that take place in the home environment. METHODS: Data from the National Vital Statistics System (NVSS) were used to calculate average annual rates for unintentional home injury deaths, with 95% confidence intervals from 1992 to 1999 for the United States overall, and by mechanism of injury, gender, and age group. RESULTS: From 1992 to 1999, an average of 18,048 unintentional home injury deaths occurred annually in the United States (6.83 deaths per 100,000). Home injury deaths varied by age and gender, with males having higher rates of home injury death than females (8.78 vs 4.97 per 100,000), and older adults (>/=70 years) having higher rates than all other age groups. Falls (2.25 per 100,000), poisoning (1.83 per 100,000), and fire/burn injuries (1.29 per 100,000) were the leading causes of home injury death. Rates of fall death were highest for older adults, poisoning deaths were highest among middle-aged adults, and fire/burn death rates were highest among children. Inhalation/suffocation and drowning deaths were important injury issues for young children. CONCLUSIONS: Unintentional injury in the home is a significant problem. Specific home injury issues include falls among older adults, poisonings among middle-aged adults, fire/burn injuries among older adults and children, and inhalation/suffocation and drowning among young children. In addition, recommendations are presented for improvements to the NVSS.     

2014年广西壮族自治区居民伤害死亡谱及疾病负担分析

目的 了解2014年广西壮族自治区疾病监测点居民伤害死亡谱及疾病负担,为制定伤害预防控制措施提供科学依据。方法 利用死亡率、标化死亡率、潜在寿命损失年（years of potential life lost,YPLL）指标, 分析广西居民伤害死亡谱及所致的疾病负担。结果 2014年广西疾病监测点居民伤害死亡率为45.58/10 万、标化死亡率46.45/10 万,男性伤害死亡率为女性的2.36 倍。居民伤害死因前5 位依次为道路交通事故、意外跌落、其他意外伤害、溺水、自杀及后遗症。伤害首位死因0～14岁组为溺水、15～64岁为道路交通事故、≥65岁年龄组为意外跌落。伤害死亡前5位YPLL为道路交通事故、溺水、其他意外伤害、意外跌落和意外中毒。因伤害“早死”导致的YPLL为269 651.9人年、28.59年/人。结论 伤害给广西居民带来沉重的负担,不同性别及城乡之间伤害谱不尽相同,应根据实际情况制定有效的伤害预防控制策略和措施。     

Trends in injury mortality among young people in the European Union: a report from the EURORISC working group.

PURPOSE: To examine the trends in injury mortality among young people aged 15-24 years residing in the 15 current member states of the European Union between 1984 and 1993. METHODS: As part of a European Commission-funded project entitled European Review of Injury Surveillance and Control (EURORISC), mortality data for all externally caused physical injuries (International Classification of Disease Codes E800-999) were obtained from the World Health Organization. Data were analyzed to generate age-specific injury mortality rates and proportional differences in rates over the study period. Linear regression was used to represent the linear component of the mortality profile. RESULTS: Almost a quarter of a million young people died as a result of sustaining an externally caused physical injury (either unintentional or intentional) in the study countries between 1984 and 1993. Injury accounted for two-thirds of all deaths in this age group. Over three-quarters (76%) of deaths were due to unintentional injury, a further 17% to self-inflicted injuries, and the remaining 7% to homicide and other violent causes. Motor vehicle traffic fatalities accounted for 84% of unintentional injury deaths. Although a decline in injury mortality was observed throughout Europe, rates of mortality owing to both unintentional injuries and suicide varied widely among study countries at both the beginning and end of the study period. CONCLUSIONS: Whereas injury mortality rates in young people in most European countries are lower than in other parts of the world (including the United States), injuries represent a major public health problem in the European Union. The death toll from motor vehicle traffic crashes is a particular cause for concern.     

2015-2019年云南省老年人非故意跌落死亡率及其趋势分析

  目的  了解2015-2019年云南省＞60岁老年人非故意跌落致死情况和变化趋势,为制定防控干预措施提供依据。  方法  利用人口死亡信息登记管理系统2015-2019年云南省死因监测数据,采用描述性流行病学方法对老年人非故意跌落死亡资料进行统计分析。  结果  2015-2019年云南省老年人非故意跌落共报告死亡数22 799人,年龄标化死亡率从2015年59.00/10万上升到了2019年的94.98/10万,5年总体呈上升趋势。各年间非故意跌落报告死亡率总体上男性高于女性,2019年分别为140.18/10万和111.62/10万;城市高于农村,2019年分别为110.33/10万和89.70/10万。非故意跌落死亡率随年龄增加呈上升趋势,其中死亡率的峰值出现在≥80岁。跌落发生场所主要在家中,占61.19%,死亡地点也主要在家中,占84.18%。  结论  2015-2019年云南省老年人非故意跌落死亡率呈上升趋势,男性、城市和高龄老人是防控重点人群,非故意跌落和死亡地点多发生在家中,宜从健康教育、居住环境改善和跌落后就医等多个环节入手,采取有针对性的防控措施,以有效减少非故意跌落的发生及其造成的伤害。     

The injury mortality burden in Guinea

ABSTRACT: BACKGROUND: The injury mortality burden of Guinea has been rarely addressed. The paper aimed to report patterns of injury mortality burden in Guinea. METHODS: We retrieved the mortality data from the Guinean Annual Health Statistics Report 2007. The information about underlying cause of deaths was collected based on Guinean hospital discharge data, Hospital Mortuary and City Council Mortuary data. The causes of death are coded in the 9th International Classification of Diseases (ICD-9). Multivariate Poisson regression was used to test the impacts of sex and age on mortality rates. The statistical analyses were performed using Statatm 10.0. RESULTS: In 2007, 7066 persons were reported dying of injuries in Guinea (mortality: 72.8 per 100,000 population). Transportation, fire/burn, falls, homicide and drowning were the five leading causes of fatal injuries for the whole population, accounting for 37%, 22%, 12%, 10% and 6% of total deaths, respectively. In general, age-specific injury causes displayed similar patterns of the whole population except that poisoning replaced falls as a leading cause among children under five years old. Males were at 30-50% more risk of dying from six commonest causes than females and old age groups had higher injury mortality rates than younger age groups. CONCLUSION: Transportation, fire/burn, falls, homicide, and drowning accounted for the majority of total injury mortality burden in Guinea. Males and old adults were high-risk population of fatal injuries and should be targeted by injury prevention. Lots of work is needed to improve weak capacities for injury control in order to reduce the injury mortality burden.     

The costs of unintentional home injuries

BACKGROUND: Unintentional home injuries impose significant, but little reported, costs to society. The most tangible are medical and indirect costs. A less-tangible cost is the value of lost quality of life due to impairment or death. METHODS: A societal perspective was adopted in estimating unintentional home injury costs. All costs associated with the injuries are included in the analysis-costs to victims, families, government, insurers, and taxpayers. The costs are incidence based, meaning all costs that will result from an injury over time are counted in the year that the injury occurs. RESULTS: Unintentional home injuries cost U.S. society at least $217 billion in 1998. The cost of fatal unintentional injuries alone was $34 billion, with nonfatal injuries accounting for the remaining $183 billion. The largest cost was the value of lost quality of life at $162 billion. Medical costs and indirect costs were $22 billion and $33 billion, respectively. CONCLUSIONS: These estimates indicate that unintentional home injuries, especially falls, are a major problem in the United States. Falls are a particular problem in need of more attention.     

Injury mortality among non-US residents in the United States 1979-1984

More than 20 million non-US residents visit the United States each year. Data on deaths in this country among these non-US residents were obtained from US vital records. These data showed that from 1979 through 1984, 17,988 deaths occurred. Cardiovascular disease (International Classification of Diseases [ICD-9] 390-459) was the leading cause of death among non-residents. Injuries (ICD-9 E800-E999) ranked second as a cause of death and accounted for 23% of the deaths (4078). More than half of these injury deaths occurred among people aged 15-34 years and 79% of the people who died from injuries were males. The most frequent causes of injury deaths were motor vehicle traffic crashes (37%), drownings (15%), and homicides (11%). Although general patterns of injury mortality among non-US residents and US residents were similar, there were differences in the proportion of deaths due to homicides, drownings, and falls. Prevention efforts targeted to the major causes of injury mortality in the US will affect both US and non-US residents.     

Unintentional injury in Ireland: a comparison of mortality and morbidity data

BACKGROUND: The aim of this study was to examine the relationship between mortality and hospital admission data for the leading causes of unintentional injury in Ireland. METHODS: Mortality data were obtained from the Central Statistics Office for the years 1980-1996. Information on hospital admissions was obtained from the Hospital In-Patient Enquiry system for the years 1993-1997. RESULTS: Motor vehicle traffic accidents were the leading cause of unintentional injury death. Falls were the most common cause of unintentional injury hospital admission. Drowning and suffocation had high ratios of deaths to admissions, 2:1 and 1:3, respectively. The ratio of deaths to admissions was 1:39 for all unintentional injuries. CONCLUSION: Neither mortality data nor admissions data alone give an adequate guide to the impact of injuries, but together the two provide a reasonable basis on which to establish policy.     

Unintentional injury mortality in the European Union: how many more lives could be saved?

AIMS: The wide variation of unintentional (accidental) injury mortality rates in the European Union (EU) member states suggests that there is high potential for prevention. This paper attempts to quantify the potential for saving lives in this part of the world if all 25 member states were to learn from the experience of countries with advanced injury prevention records. METHODS: Unintentional injury mortality data (latest three available years), including denominator population estimates, were obtained from the World Health Organization (WHO) mortality database for all 22 EU countries with a population of more than one million. Annual average age-adjusted injury mortality rates were used to derive the potential for saving of lives under two scenarios: (a) if all EU member states matched the country with the lowest unintentional rate for all causes of injury combined; (b) if the benchmark was alternatively the country with the lowest unintentional injury cause-specific rate. Separate calculations were performed for children (0-14), adults (15-64), and the elderly (65 and over). RESULTS: Under the first scenario, over 73,000 lives could have been saved in the EU 25 in a single year, notably nearly half (47.4%) fewer unintentional injury deaths could be observed in children, over half in adult (54%), and two-fifths (38%) in the elderly. Under the second, more optimistic, scenario 59% of childhood and adult and 75% of unintentional injury deaths among the elderly would have been avoided. CONCLUSIONS: A substantial proportion of lives lost due to unintentional injury might be saved if all countries were to achieve the lowest unintentional injury mortality rates in the EU. The above calculations are based on a simple theoretical model but there is increasing evidence on the array of existing effective preventive interventions and improved trauma care calls for public health action in each member state that could in practice halt, to the extent possible, the unintentional injury epidemic.     

Preventing child unintentional injury deaths: prioritising the response to the New Zealand Child and Adolescent Injury Report Card

Objective: To develop recommendations for child unintentional injury prevention by comparing New Zealand's child unintentional injury mortality and injury prevention policies with those of European countries. Methods: Unintentional child injury death rates based on external cause of injury were calculated and ranked. NZ's score for each of the 12 domains (based on external causes of injury) from the New Zealand Child and Adolescent Report Card was compared to European scoring. Policy priorities are identified by domains where mortality makes up a high proportion of overall child unintentional injury mortality (high burden of injury) and where report card score for that domain is low in comparison to other countries (under‐utilisation of effective interventions). Results: Death as a motor vehicle occupant accounts for 49% of all child unintentional injury deaths, followed by pedestrian (10%) and drowning deaths (8%). The overall score for the 12 policy domains of the NZ Report Card ranks NZ as 15^th among the 25 European countries. There are important policy and legislative actions which NZ has not implemented. Conclusions: A number of evidence‐based injury prevention policy and legislative actions are available that could target areas of greatest childhood injury mortality in NZ. Implications: A set of injury prevention policy and legislation priorities are presented which, if implemented, would result in a significant reduction in the injury mortality and morbidity rates of NZ children.     

Premature mortality in France: relative importance of the main causes of death according to the number of years of life lost

The importance of major causes of deaths in France have been studied for 1972 and 1982, using years of potential life lost before age 65 and in relation to life expectancy. These indicators of premature mortality have been compared to death rates. Unintentional injuries and malignant neoplasms are the two main causes of mortality before age 65. There is an important excess mortality for males, particularly for unintentional injuries. Total premature mortality declined between 1972 and 1982, but cancer mortality for males and suicide and chronic bronchitis mortality for both sexes have increased. Cardiac mortality decreased only for females.     

The global burden due to occupational injury

BACKGROUND: Occupational injuries are a public health problem, estimated to kill more than 300,000 workers worldwide every year and to cause many more cases of disability. We estimate the global burden of fatal and non-fatal unintentional occupational injuries for the year 2000. METHODS: The economically active population (EAP) of about 2.9 billion workers was used as a surrogate of the population at risk for occupational injuries. Occupational unintentional injury fatality rates for insured workers, by country, were used to estimate WHO regional rates. These were applied to regional EAP to estimate the number of deaths. In addition to mortality, the disability-adjusted life years (DALYs) lost, which measure both morbidity and mortality, were calculated for 14 WHO regions. RESULTS: Worldwide, hazardous conditions in the workplace were responsible for a minimum of 312,000 fatal unintentional occupational injuries. Together, fatal and non-fatal occupational injuries resulted in about 10.5 million DALYs; that is, about 3.5 years of healthy life are lost per 1,000 workers every year globally. Occupational risk factors are responsible for 8.8% of the global burden of mortality due to unintentional injuries and 8.1% of DALYs due to this outcome. CONCLUSIONS: Occupational injuries constitute a substantial global burden. However, our findings greatly underestimate the impact of occupational risk factors leading to injuries in the overall burden of disease. Our estimates could not include intentional injuries at work, or commuting injuries, due to lack of global data. Additional factors contributing to grave underestimation of occupational injuries include limited insurance coverage of workers and substantial under-reporting of fatal injuries in record-keeping systems globally. About 113,000 deaths were probably missed in our analyses due to under-reporting alone. It is clear that known prevention strategies need to be implemented widely to diminish the avoidable burden of injuries in the workplace.     

Alaska native mortality, 1979-1998

OBJECTIVES: This study compares mortality patterns for the Alaska Native population and the U.S. white population for 1989-1998 and examines trends for the 20-year period 1979-1998. METHODS: The authors used death certificate data and Indian Health Service population estimates to calculate mortality rates for the Alaska Native population, age-adjusted to the U.S. 1940 standard million. Data on population and mortality for U.S. whites, aggregated by 10-year age groups and by gender, were obtained from the National Center for Health Statistics, and U.S. white mortality rates were age-adjusted to the U.S. 1940 standard million. RESULTS: Overall, 1989-1998 Alaska Native mortality rates were 60% higher than those for the U.S. white population for the same period. There were significant disparities for eight of 10 leading causes of death, particularly unintentional injury, suicide, and homicide/legal intervention. Although declines in injury rates can be documented for the period 1979-1998, large disparities still exist. Alaska Native death rates for cancer, cerebrovascular disease, chronic obstructive pulmonary disease, and diabetes increased from 1979 to 1998. Given decreases in some cause-specific mortality rates in the U.S. white population, increased rates among Alaska Natives have resulted in new disparities. CONCLUSIONS: These data indicate that improvements in injury mortality rates are offset by marked increases in chronic disease deaths.     

四川省死因监测点伤害死亡变化趋势

目的掌握四川省死因监测点1989—2008年伤害死亡变化趋势。方法应用1989—2008年四川省死因监测资料,对伤害死亡及其构成比进行趋势变化分析。结果1989—2008年,四川省死因监测地区伤害死亡一直位居总死因的第4位,各年度构成比占总死因构成的比例在6．14％～10．01％之间;总标化死亡率由1989年的63．28／10万下降到2008年的43．83／10万,平均下降速度1．91％,标化死亡率男性（68．74／10万）高于女性（40．43／10万）,农村（65．36／10万）高于城市（51．29／10万）;但男性和女性、城市和农村的粗死亡率、标化率均呈下降趋势（P〈0．01）;居前6位的伤害种类为自杀、交通事故、淹死（溺水）、意外跌落、中毒、其他意外事故和有害效应;运输事故呈上升趋势,平均增长速度为13．59％。结论四川省监测地区伤害死亡水平呈下降趋势,在女性群体和城市中较为显著,伤害死亡种类主要为自杀、交通事故、运输事故、淹死（溺水）、意外跌落、中毒等。     

Incidence and pattern of unintentional injuries and resulting disability among children under 5 years of age: results of the National Health Survey of Pakistan

National estimates of injuries for children under 5 years based on population representative surveys are not readily available globally and have not been reported for developing countries. This study estimated the annual incidence, pattern and distribution of unintentional injuries according to age, gender, socio‐economic status, urban/rural residence and disability caused among children aged under 5 years in Pakistan. The National Health Survey of Pakistan (NHSP 1990–94) is a nationally representative survey of households to assess the health profile of the country. A two‐stage stratified design was used to select 3223 children under 5 years of age for interview and examination. Data were used for boys and girls in urban and rural areas over the preceding year. A community development index was developed to assess the relationship between socio‐economic status and injuries. Weighted estimates were computed adjusting for complex survey design using surveyfreq and surveylogistic option of SAS 9.1 software. Post hoc power calculations were made for each variable keeping the design effect at 3.0. The overall annual incidence of unintentional injuries was 47.8 [95% CI 36.6, 59.0] per 1000 per year; 50.2 [95% CI 37.0, 63.4] and 45.2 [95% CI 29.4, 61.0] per 1000 per year among boys and girls under 5 years of age respectively. An estimated 1.1 million unintentional injuries occur in Pakistan annually among these children. Injury rates increase with age among the under‐5s. Urban and rural injuries were 56.1 [95% CI 33.5, 78.7] and 44.1 [95% CI 31.1, 57.1] per 1000 per year respectively. The children living in least developed communities had almost 3 times higher risks of injuries than most developed communities. The annual incidence of types of injuries were: falls 28.7 [95% CI 19.5, 37.9], cuts/bruises 9.7 [95% CI 5.3, 14.1] and burns 6.6 [95% CI 3.0, 10.2] per 1000 per year. Falls were the most common type of injury (60%) followed by cuts/bruises (21%) and burns (14%). The majority of injuries occur at home (85%), with just 10% due to road traffic. Road traffic injuries and injuries to the female child were more likely to result in disability. There is a high burden of unintentional injuries and disability among children under 5 in Pakistan. These results are useful for planning further research and for prioritising prevention programmes nationally and in other developing countries with similar situation.     

Global Childhood Unintentional Injury Study: Multisite Surveillance Data

Objectives. We aimed to analyze the epidemiology of childhood unintentional injuries presenting to hospitals in 5 select sites in low- and middle-income countries (LMICs) (Bangladesh, Colombia, Egypt, Malaysia, and Pakistan).Methods. We collected standardized data from children ages 0 to 12 years at participating emergency departments (EDs) in 2007. Statistical analyses were conducted to compare the characteristics of these injuries and to explore the determinants of injury outcomes.Results. Among 2686 injured children, falls (50.4%) and road traffic injuries (16.4%) were the most common, affecting boys more often (64.7%). Home injuries were more common among younger children (average 5.41 vs 7.06 years) and girls (38.2% vs 31.7%). Following an ED visit, 24% of injured children were admitted to the hospital, and 6 died. Injury outcomes were associated with risk factors, such as age and sex, to varying extents.Conclusions. Standardized ED surveillance revealed unintentional injuries are a threat to child health. The majority of events took place inside the home, challenging traditional concepts of children’s safety and underscoring the need for intensified context-appropriate injury prevention.Injuries cause upwards of 5 million deaths each year, of which unintentional injuries account for approximately 80% (3.9 million).1 Unintentional injuries kill approximately 830 000 children every year, and more than 95% of child injury deaths (both intentional and unintentional) occur in low- and middle-income countries (LMICs).2 The 5 most common unintentional injuries reported by the World Health Organization (WHO) are road traffic injuries (RTIs), falls, burns, drowning, and poisoning.2 Global aggregate data reveal that the burden of childhood unintentional injuries is highest in South-East Asia and Africa, with a cause-specific mortality of 64 and 55 children per 100 000 population, respectively.1,2 The disproportionate share of the burden of unintentional childhood injury in LMICs results from a number of factors. First, children are more susceptible to injuries because of their curious nature, which, combined with their low capacity to assess and comprehend risks, and a general lack of safe play spaces in many LMICs, puts them at high risk.3 Second, global economic trends have uprooted communities and traditional forms of subsistence, necessitating persons from rural areas moving to urban slums and at times forcing children into labor, some in hazardous conditions, to contribute to a household’s income. For instance, it has become increasingly dangerous for children to share the road with the ever-growing number of motor vehicles.2,3 In this light, unintentional injuries not only affect children themselves, leaving them temporarily hospitalized or with short- or long-term disabilities, but also adversely affect their families and society as a whole.2,4–6The WHO has called for better data collection on child injury and its determinants for the purposes of national research and investment priority settings, as well as the targeting of high-risk groups.2 Reductions in child injury mortality have been observed in several high-income countries (HICs) as a result of the implementation of evidence-based programs.2,7,8 Likewise, a number of studies have provided reliable information to characterize the pattern of injuries in HICs.9,10 Despite the high burden of unintentional injuries in LMICs, there are few studies that provide standardized data from multiple sites. In the absence of reliable national population data, hospital-based data are an important source of injury information, particularly for children.11,12 In response, the Global Childhood Unintentional Injury Surveillance (GCUIS) study was initiated to collect standardized child injury data from emergency departments (EDs) at 5 sites: Bangladesh, Colombia, Egypt, Malaysia, and Pakistan.4,13 The objectives of the GCUIS study were (1) to determine the epidemiology of 5 major childhood unintentional injuries in 5 EDs in urban LMIC sites; (2) to explore potential risk factors and determinants of injury severity and outcomes, based on the injury records in the GCUIS study; and (3) to briefly summarize the characteristics of injuries sustained in homes, based on GCUIS data.6 In 2009, partial data from GCUIS were analyzed to report the initial pattern of injuries in 4 sites.13 This article adds data from an additional site and further analyses; therefore, it provides more insights into key unintentional injuries.     

Injury mortality rates in Native and non-Native children: a population-based study

OBJECTIVES: To examine injury mortality rates in Native and non-Native children in the province of Alberta, Canada, over a 10-year period, temporal trends in injury mortality rates (Native vs. non-Native), as well as relative risks of injury mortality (Native vs. non-Native) by injury mechanism and intent, were calculated. METHODS: An observational, population-based study design was used. Mortality data were obtained from provincial vital statistics, with injury deaths identified using external injury codes (E-codes). The relative risk (RR) of injury mortality (Native vs. non-Native) along with 95% confidence intervals (CIs) were calculated. Stratified analyses and Poisson regression modeling were used to calculate adjusted relative risk. RESULTS: Injury mortality rates declined over the study period, with no difference in the rate of decline between Native and non-Native children. The adjusted relative risk for all-cause injury death (Native vs. non-Native) was 4.6 (95% CI 4.1 to 5.2). The adjusted relative risks (Native vs. non-Native) by injury intent categories were: unintentional injuries, 4.0 (95% CI 3.5 to 4.6); suicide, 6.6 (95% CI 5.2 to 8.5); and homicide, 5.1 (95% CI 3.0 to 8.5). Injury mortality rates were consistently higher for Native children across all injury mechanism categories. The largest relative risks (Native vs. non-Native) were pedestrian injury (RR = 17.0), accidental poisoning (RR = 15.4), homicide by piercing objects (RR = 15.4), and suicide by hanging (RR = 13.5). CONCLUSION: The burden of injury mortality is significantly greater in Native children compared with non-Native children. Therefore, injury prevention strategies that target both intentional and unintentional injuries are needed.     

Estimating mortality and causes of death in Turkey: methods, results and policy implications

BACKGROUND: Cause-specific mortality statistics are primary evidence for health policy formulation, programme evaluation, and epidemiological research. In Turkey, a partially functioning vital registration system in urban areas yields fragmentary evidence on levels and causes of mortality. This article discusses the application of innovative methods to develop national mortality estimates in Turkey, and their implications for national health development policies. METHODS: Child mortality levels from the Demography and Health Survey (DHS) were applied to model life tables to estimate age-specific death rates. Reported causes of death from urban areas were adjusted using re-distribution algorithms from the Global Burden of Disease (GBD) Study. Rural cause structure was estimated from epidemiological models. Local epidemiological data was used to adjust model-based estimates. RESULTS: Life expectancy at birth in 2000 was estimated to be 67.7 years (males) and 71.9 years (females), about 8-10 years lower than in Western Europe. Leading causes of death include major vascular diseases (ischaemic heart disease, stroke) causing 35-38% of deaths, chronic obstructive lung disease and lung cancer in men, but also perinatal causes, lower respiratory infections and diarrhoeal diseases. Injuries cause about 6-8% of deaths, although this may be an underestimate. CONCLUSIONS: Mortality estimates are uncertain in Turkey, given the poor quality of death registration systems. Application of burden of disease methods suggests that there has been progress along the epidemiological transition. Key health development strategies for Turkey include improved access to communicable disease control technologies, and urgent attention to the development of a reliable, nationally representative health information system.