Fatalities and injuries from falls among older adults--United States, 1993-2003 and 2001-2005

Unintentional falls are a common occurrence among older adults, affecting approximately 30% of persons aged > or =65 years each year. The injuries received from a fall can result in death, disability, nursing-home admission, and direct medical costs. In 2003, a total of 13,700 persons aged > or =65 years died from falls, and 1.8 million were treated in emergency departments (EDs) for nonfatal injuries from falls. Falls cause the majority of hip fractures, which often result in long-term functional impairments that might require admission to a nursing home for a year or more. To examine trends in fatal and nonfatal falls among older persons, CDC analyzed U.S. rates of 1) fatalities from falls (during 1993-2003), 2) hospitalizations for hip fractures (1993-2003), and 3) nonfatal injuries resulting from falls in persons treated in EDs (2001-2005). This report summarizes the results of those analyses, which indicated that, during 1993-2003, the overall rate of fatal falls among persons aged > or =65 years increased, and the rate of hospitalizations for hip fractures decreased; during 2001-2005, the change in the overall rate of nonfatal injuries from falls was not statistically significant. However, disparities by sex existed for all three measures. Certain interventions can reduce falls (e.g., exercising regularly or having medicines reviewed to reduce side effects and interactions), but implementation at the community level remains limited, and additional measures are needed to promote widespread adoption.     

Incidence and outcome of injury in Ghana: a community-based survey

Injury is an increasingly significant health problem in most low-income countries. However, strategies for preventing injury have not been well addressed. The present study was carried out to measure the incidence and outcome of various mechanisms of injury in Ghana in order to provide data for use in developing priorities for injury prevention efforts. For this purpose, using two-stage cluster sampling and household interviews, we surveyed 21,105 persons living in 431 urban and rural sites. During the preceding year, 1609 injuries resulting in one or more days of loss of normal activity were reported. Injury-related mortality was slightly higher in the urban (83 per 100,000) than in the rural area (53 per 100,000). However, the burden of disability from nonfatal injuries, as assessed by disability days, was higher in the rural (4697 disability days per 1000 person-years) than in the urban area (2671 days per 1000 person-years). Based on incidence rates and disability times, the major types of injury in the urban area were transport-related injury and falls. In the rural area, agricultural injuries predominated, followed by falls and transport-related injury. In rural and urban areas combined, 73% of motor vehicle-related injuries involved commercial vehicles. In this and other similar developing-country settings, injury prevention efforts should focus on falls and on transport safety in both urban and rural areas, with special attention being paid to commercial vehicles. In rural areas, agricultural injuries contributed the largest burden of morbidity, and should be a priority for prevention efforts.     

Utilizing United States Coast Guard data to calculate incidence rates and identify risk factors for occupational fishing injuries in New Jersey

Commercial fishing has high rates of work-related injury and death and needs preventive strategies. Work-related fatal and nonfatal injury rates for New Jersey (NJ) commercial fishermen who suffered unintentional traumatic injuries from 2001 to 2007 are calculated using data from the United States Coast Guard (USCG) Marine Safety and Pollution Database and estimated denominator data. Fatalities were compared to those ascertained by the NJ Fatality Assessment Control and Evaluation (FACE) surveillance system. For the study years, 225 nonfatal injuries and 31 fatal injuries were reported. Among nonfatal injuries, the causes by frequency were fall onto surface, crushed between objects, struck by moving object, line handling/caught in lines, collision with fixed objects, fall into water, and other noncontact injuries. The distribution of fatal injuries differed, with the most frequent cause as crushed between objects. Falls into water and several noncontact injuries accounted for most of the other fatalities. The large majority (96%) of nonfatal injuries were contact injuries, whereas only 68% of fatalities were classified as contact. The overall incidence rate of nonfatal injuries was 1188 per 100,000 full-time equivalents (FTEs) per year. The rate varied considerably by year, from a low of 286 per 100,000 FTEs in 2001 and 2007 to 3806 per 100,000 FTEs in 2003. The overall occupational fatality rate over the period 2001-2007 was 164 per 100,000 FTEs per year. These results can aid in targeting the commercial fishing industry for injury prevention strategies and interventions, especially for falls, crushing injuries, and drownings.     

北京市城市社区老年人伤害疾病负担的研究

目的 探讨北京市城市社区老年人伤害发生现状及其疾病负担。方法 以居委会为单位，采取随机整群抽样的方法，调查北京市牛街地区60岁及以上老年人在其过去一年中的受伤情况及伤后影响等。结果 被调查者在过去一年中共有311例、420人次伤害发生，涉及12种伤害。伤害总发生率（人）为13．55％，人次发生率为18．30％。因伤死亡1例。伤害的危害涉及个人、家庭、社会三个层面，包括躯体、精神、经济损失等多方面。跌倒不仅发生率最高，伤情最严重，而且经济损失最大。结论 北京市城市社区老年人群伤害发生与死亡水平位居中等水平；跌倒已经成为威胁该人群生存与健康的重要公共卫生问题。     

中国五岁以下儿童非致死性伤害发生率及影响因素研究

目的 了解中国5岁以下儿童非致死性伤害的发生率及相关影响因素.方法 数据来自于第四次国家卫生服务调查,其中5岁以下儿童10 819名,为本次研究对象.伤害相关内容:是否发生伤害以及发生次数、原因、地点、严重程度.采用两水平Poisson回归分析社会经济学变量与非致死性伤害发生次数的关联性.结果 最近12个月内5岁以下儿童非致死性伤害发生率为16.0%o.＜1岁组儿童非致死性伤害前3位原因是:跌倒、动物咬伤、烧伤/烫伤,发生率分别为3.9%o、1.8%o和1.8%o;1～4岁组儿童是:动物咬伤、跌倒、烧伤/烫伤,发生率分别为6.5‰、6.0‰和2.9‰.两年龄组儿童分别有83.0%和69.0%的最近一次伤害发生在家里.＜1岁组无残疾发生,1～4岁组伤害致残疾率为1.0%.控制其他变量后,1～4岁组中男童非致死性伤害风险是女童的1.57倍(P＜0.05);民族、家庭人均收入和地区等变量差异无统计学意义(P＞0.05);＜1岁组在全部社会经济学变量上的统计检验结果均无统计学意义(P＞0.05).结论 中国5岁以下儿童最近12个月非致死性伤害发生率为16.0%o;动物咬伤、跌倒、烧伤/烫伤是非致死性伤害的前三位原因;家庭内是非致死性伤害最常见地点;1～4岁男童非致死性伤害发生率明显高于女童.

Abstract：

Objective To determine the incidence of non-fatal injuries and related influencing factors among children under 5 years old in China. Methods Data involving 10 819 children under 5 years old was from the Fourth National Health Service Survey of China. Injury-related indicators include: history of ever having had an injury, its frequency, cause, location and severity of the injury.A two-level Poissun regression was used to examine the significance of related socio-economic variables. Results The overall incidence rate of nonfatal injuries among children under 5 years old was 16.0 per 1000 population in the prior 12 months. The first three leading causes of non-fatal injuries were falls,animal bite, fire/bum among children under 1 year old,with the rates as 3.9, 1.8 and 1.8 per 1000 population, respectively. For children aged I to 4 years old, the first three leading causes were animal bite, fall, fire/burn with rates as 6.5,6.0 and 2.9 per 1000 population, respectively. 83.0% and 69.0% of last injuries occurred at home for the above said two age groups. No disability was found among children younger than 1 year old who suffered from a nonfatal injury while for the 1-4 age group, the disability accounted for 1.0% of injury-induced outcomes. After adjusting other variables,boys had 1.57 times the risk of injury compared with girls in the 1-4 age group (P＜0.05). The differences on the effects regarding ethmicity,per capita household income, and place were insignificant (P＞0.05). None of the socio-economic variables was found that significantly related to the non-fatal injury risk among children under 1 year old (P＞0.05). Conclusion The incidence of nonfatal injuries among children under 5 years old was 16.0 per 1000 population in the prior 12 months. The three leading causes of injuries were animal bite, falls, fire/bum respectively. Home was the most common place that non-fatal injuries occurred. Boys had a higher risk of injury compared with girls among children aged 1 to 4 years old and the difference was significant.     

Pediatric Falls from Buildings: Defining the Burden of Injury in Hawai‘i

Falls from buildings, including houses, are an important cause of childhood injury in the United States; however, no study has previously examined the impact of this problem in Hawai‘i. The objective of this study is to categorize the demographics and injury circumstances of pediatric falls from buildings in Hawai‘i and compare to other US cities. Patients age 10 and under who were injured in nonfatal accidental falls from buildings in Hawai‘i between 2005 and 2011 were identified retrospectively from a statewide repository of hospital billing data. The Hawai‘i death certificate database was searched separately for deaths in children age 10 and under due to falls from buildings, with data available from 1991 through 2011. Data was reviewed for demographics, circumstances surrounding the injury, and level of hospital treatment. During the 7-year period for nonfatal injuries, 416 fall-related injuries were identified in children age 10 and younger. Of these, 86 required hospitalization. The rate of nonfatal injury in Hawai‘i County was twice that of Honolulu and Maui Counties, and three times that of Kaua‘i County. There were 9 fatal falls over a 21-year period. The population based incidence for nonfatal injuries was three-fold higher than that reported in the city of Dallas. The rate of hospitalizations following building falls was more than twice as high as the national average, and that of New York City, but similar to that of California. Strategies for education and environmental modification are reviewed, which may be helpful in reducing the incidence of pediatric falls from buildings in Hawai‘i.     

A prospective population based study of childhood injuries: the Velestino town study

BACKGROUND: Unintentional injuries in childhood constitute a significant public health problem. Our purpose is to estimate the incidence of identifiable unintentional childhood injuries of any type and severity, and to document risk factors of non-transient nature. METHODS: We have undertaken a prospective population-based investigation in a Greek town with a population of 748 children (0-14 years old). All identifiable injuries have been monitored during a twelve-month period through information provided by the health care outlets or educational institutions as well as the police station and the regional hospital. RESULTS: The overall incidence was 28.2 per 100 person-years (95% confidence interval from 24.4 to 32.0), whereas the incidence of injuries with Hopkins Injury Severity Score equal to or higher than four was 6.3 with 95% confidence interval 4.5 to 8.1. The incidence of total injuries was higher among boys than among girls (p<0.01) and the gender difference was particularly evident among older children. Almost half of the injuries were due to falls and more than 20% were due to cutting. Children of younger and less educated parents have higher risk for injury and children from families with more injuries were more likely to be injured themselves. There was no evidence that somatometric characteristics were associated with injury risk. CONCLUSION: The incidence of unintentional childhood injuries is high and represents a considerable health burden. Family related variables are important risk factors for childhood injuries, whereas somatometric characteristics play a minimal role. Key points: Incidence and risk factors of all injuries in a population-based study among children. About 28 per 100 children got injured over a period of one year. There is evidence that younger paternal age and lower education may be associated with increased injury risk. Family related variables seem to be important risk factors for childhood injuries, whereas somatometric characteristics play minimal role.     

Hospitalized nonfatal injuries in the Alaskan construction industry

BACKGROUND: Construction industry workers are exposed to many hazards leading to fatal and nonfatal injuries. Information for nonfatal work-related injury surveillance may be vague and come from a variety of sources. METHODS: The Alaska Trauma Registry (ATR) is used as an injury surveillance tool to focus on hospitalized nonfatal injuries in the Alaskan construction industry. RESULTS: During 1991-1999, 717 workers in the Alaskan construction industry were hospitalized due to occupational injuries, with an average annual injury rate of 0.39 injuries/100 workers. Leading causes of injury included falls (48%) and machinery (15%). Thirty-four percent of the falls were from a building or structure, followed by falls from a ladder (24%). A fractured bone was the most common type of injury (57%). CONCLUSIONS: Information on hospitalized patients from the ATR focuses on the more severe and debilitating injuries, and provides valuable information for prioritizing injury prevention efforts in Alaska.     

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.     

Incidence of falling injuries leading to medical treatment in the elderly

The incidence of falling injuries leading to medical treatment was described by sex, age, marital status, education, amount of daily motion, self-perceived health, mechanism of fall and severity of injury. Material was collected regarding persons aged 65 years or over seeking medical treatment due to a fall during a period of one year. Altogether 3.8% of the elderly population (men: 2.5%; women: 4.4%) sought medical treatment due to a fall at least once during this year. When repeated falls were taken into account, the total incidence rate was 5.5 per 100 persons per year. The cumulative incidence rate (percentage of persons seeking medical treatment due to a fall) of women was higher than that of the men and in both sexes it increased with age. It was also higher for unmarried, widowed or divorced persons than for married ones, and higher in less educated persons than in better educated ones. It was also higher in persons with a low amount of daily motion or poor self-perceived health than in persons with a moderate or high amount of daily motion or good health status. The multivariate analyses based on log-linear models showed two-term interactions. A low amount of daily motion, poor self-perceived health and high age were independently related to the occurrence of a fall leading to medical treatment in both sexes.     

Trends in public hospital injury admission rates, Victoria, July 1987 to June 1993

Abstract: Admissions to Victorian public hospitals because of injury for the six years from July 1987 to June 1993 were analysed to ascertain the frequencies, rates and trends over time in rates. This information is important for epidemiological purposes, to determine priorities for injury prevention and, as baseline data, to monitor the success of interventions. The major causes of injury, and their rates, did not change markedly. Falls or transport-related injuries were still the major cause of hospitalisation. The mean annual all-age frequency over the six years was 67 902, an all-age, all-cause rate of 1620 per 100 000. The highest frequencies of injury occurred in the young age groups, 15–19, 20–24 and 25–29 years, but the highest rates occurred in the over-60 age groups. The all-age, all-cause injury rate increased significantly at 39 per 100 000 per year (2.4 per cent per year), notwithstanding the decreasing rate of transport-related injury of 17 per 100 000 per year (7.5 per cent). Significant increases were also observed for injuries from falls in all age groups and intentional self-inflicted injuries. For the 15–24 years age group, transport-related injury rates declined by 35 per 100 000 per annum but intentional injury rates were increasing. In the over-65 years age group, rates of injury from falls were increasing by 3.3 per cent per annum. The benefits of investment in prevention of transport-related injury are apparent. With high rates, frequencies and increases over time for many injury causes, similar resources for prevention of other causes of injury are justified and necessary.     

Nonfatal bathroom injuries among persons aged ≥15 years--United States, 2008

In 2008, approximately 21.8 million persons aged ≥15 years sustained nonfatal, unintentional injuries, resulting in approximately $67.3 billion in lifetime medical costs. Information about where injuries occur is limited, but bathrooms commonly are believed to be a particularly hazardous location. To investigate this assumption, CDC analyzed data from a nationally representative sample of emergency departments (EDs) to describe the incidence and circumstances of nonfatal injuries in bathrooms (in any setting) among persons aged ≥15 years in the United States. This report describes the results of that investigation, which found that, based on 3,339 cases documented in the 2008 National Electronic Surveillance System All Injury Program (NEISS-AIP) database, an estimated 234,094 nonfatal bathroom injuries were treated in U.S. EDs. Injury rates increased with age, and most injuries (81.1%) were caused by falls. All persons, but especially older adults, should be aware of bathroom activities that are associated with a high risk for injury and of environmental modifications that might reduce that risk.     

Public health and aging: nonfatal injuries among older adults treated in hospital emergency departments--United States, 2001

Because injuries generally are considered a problem of the young, injuries among older adults (i.e., persons aged > or =65 years) have received little attention. However, injuries are the eighth leading cause of death among older adults in the United States. In 2001, approximately 2.7 million older adults were treated for nonfatal injuries in hospital emergency departments (EDs); the majority of these injuries were the result of falls. To characterize nonfatal injuries among older adults, CDC analyzed data from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP). This report summarizes the results of that analysis, which indicate differences in type and mechanism of injury by sex, suggesting that prevention programs should be designed and tailored differently for men and women.     

天津市2014年0~14岁儿童院内报告伤害流行特征分析

目的 了解天津市院内报告0~14岁儿童伤害监测病例的发生现状及其三间分布特征。方法 数据来源于覆盖天津市各级医疗卫生机构的发病监测体系,收集2014年1~12月全市241家哨点医院报告的首次伤害就诊病例资料。结果 0~14岁儿童伤害病例共报告34 297例,发生率为2 710.06/10万,男童发生率为3 319.66/10万,女童发生率为2 032.29/10万（χ²=1 983.329,P<0.001）。0~岁组发生率为2 613.42/10万,5~岁发生率为2 780.43/10万,10~14岁发生率为2 757.61/10万（χ²=28.242,P<0.001）。伤害发生地点最多为家中（占47.92%）。累及部位最多为头面部（9 787例,占28.5%）,其次为腕和手（8 009例,占23.4%）。76.3%为轻度伤害。在24种伤害原因中排在前5位的依次是：跌倒（42.44%）、动物伤（20.63%）、非机动车交通事故与机动车交通事故合计（9.16%）、砸伤（5.58%）、钝器伤（4.06%）。伤害发生以5月份（10.05%）和9月份（9.90%）最多;按季度来看为第二季度最高（29.23%）,且不同伤害类型在一年中的分布不同。结论 儿童伤害男童较女童发生率高,跌倒、动物伤、交通事故发生数量最高,5~岁发生率最高,5月和9月高发,应特别加强这方面的宣传教育和干预,多部门参与提高全社会安全意识。     

Fall-related injuries during the holiday season--United States, 2000-2003

Although fall-related injuries occur throughout the year, few studies have analyzed seasonal patterns, and none have examined the extent of such injuries associated with holiday decorating. To characterize nonfatal fall injuries associated with decorating or related activities, CDC analyzed data from the National Electronic Injury Surveillance System All Injury Program (NEISS-AIP) for three winter holiday seasons. This report summarizes the results of that analysis, which indicated that, during 2000-2003, an estimated 17,465 persons were treated in U.S. hospital emergency departments (EDs) for holiday-decorating-related falls. Approximately 62% of those injured were aged 20-49 years; approximately 43% of injuries were caused by falls from ladders; and males were 40% more likely than females to be injured. Prevention strategies should focus on raising awareness about falls and promoting safety practices during the holiday season.     

Incidence, causes and severity of injuries in Aquitaine, France: a community-based study of hospital admissions and deaths.

This paper reports the results of a study of injuries conducted during a one-year period within a defined geographic population of 2.7 million persons (Aquitaine, France). Cases were defined as unintentional or intentional injuries, either resulting in immediate death before reaching hospital or requiring hospital admission. During the one-year period, 1,181 deaths were registered and 8,190 hospital admissions occurred during the sample periods. The three leading causes of injury were falls (40 per cent), traffic accidents (27 per cent), and poisonings (15 per cent). The overall incidence of injuries was 136 per 10,000 person years. Incidence by sex and age was assessed for the main external causes. The ratios of nonfatal to fatal cases were calculated by sex and age and by external cause. The origin of the injury was suicide in 14 per cent of cases and assault or homicide in 3 per cent. The severity of injuries, assessed using an automatic computation of the Injury Severity Score (ISS), ranged from 1 to 66 with a mean of 6.9. Substantial variations of ISS were observed according to external cause. At the 8th day following admission, 31 per cent of hospital-treated patients were still hospitalized and 0.8 per cent had died in hospital. The outcome correlated well with the ISS.     

Interpersonal violence-related injuries in an African-American community in Philadelphia

Violence has been recognized as a significant health problem. This study describes fatal and nonfatal interpersonal violence-related injury events over 1 year in an indigent African-American community in Philadelphia. Information on injuries was collected from emergency rooms, the Office of the Medical Examiner, and death certificate files. For persons aged 15 through 49 years, violence-related injury rates surpassed any other injury type. The overall violence-related injury rate was 28.7 per thousand population. Interpersonal violence-related injuries were important for the 0- to 4-year age group (9.19 injuries per 1000 population), and continued as a major cause of morbidity through age 59 (12.08 injuries per 1000 population). For more than half of the events, information from the emergency room chart was sufficient only to categorize the incident as a "fight" or that it was intentional; no further classification was possible.     

2010-2020年上海市虹口区伤害死亡流行特征分析

目的 研究虹口区2010-2020年居民伤害死亡流行特征,为制定上海市虹口区有针对性的伤害防制措施提供依据.方法 资料来源于上海市虹口区户籍居民的死因监测系统.采用粗死亡率、标化死亡率、年均变化百分比及潜在寿命损失年(PYLL)等指标进行描述.结果 2010-2020年虹口区户籍居民伤害粗死亡率为42.50/10万,标...     

Incidence and costs of injuries in The Netherlands

BACKGROUND: Injuries are a major and persistent public health problem, but a comprehensive and detailed overview of the economic burden is missing. We therefore estimated the number of emergency department (ED) attendances and health care costs as a result of injury. METHODS: We estimated lifetime health care costs of injuries occurring in The Netherlands in the year 1999. Patient groups were defined that are homogeneous in terms of health service use. Health service use and costs per patient group was estimated with data from national databases and a prospective study among 5755 injury patients. RESULTS: Total health care costs due to injury in 1999 were euro 1.15 billion, or 3.7% of the total health care budget. Major cost peaks were observed among males between ages 15 and 44 due to a high incidence, and among females from age 65 onwards due to a high incidence and high costs per patient. For the age groups 0-14, 15-44, 45-64, and 65+ ED attendances per 1000 person years were 85, 85, 43, and 49, respectively, and costs per capita were euro 38, euro 59, euro 43, and euro 210, respectively. Costs per patient rise about linearly up to age 60 and about exponentially thereafter. From age 25 onwards, females have higher costs per patient than males. Hip fracture (20%), superficial injury (13%), open wounds (7%), and skull-brain injury (6%) had the highest total costs. Most costs were attributable to falls (44%) and traffic injuries (19%). CONCLUSION: Young adult males, elderly females, falls, hip fractures, and minor injuries without medical need for hospitalization account for a substantial share of health care costs.