Gender differences in the occurrence of farm related injuries

Aims: To use national surveillance data in Canada to describe gender differences in the pattern of farm fatalities and severe injuries (those requiring hospitalisation). Methods: Data from the Canadian Agricultural Injury Surveillance Program (CAISP) included farm work related fatalities from 1990 to 1996 for all Canadian provinces and abstracted information from hospital discharge records from eight provinces for the five fiscal years of 1990 to 1994. Gender differences in fatalities and injuries were examined by comparison of proportions and stratified by sex, injury class (machinery, non-machinery), and age group. Results: Over the six year period of 1990 to 1996 there were approximately 11 times as many agriculture related fatalities for males compared to females (655 and 61, respectively). The most common machinery mechanisms of fatal injuries were roll-over (32%) for males and run-over (45%) for females. Agricultural machinery injuries requiring hospitalisation showed similar patterns, with proportionally more males over age 60 injured. The male:female ratio for non-machinery hospitalisations averaged 3:1. A greater percentage of males were struck by or caught against an object, whereas for females, animal related injuries predominated. Conclusions: Gender is an important factor to consider in the interpretation of fatal and non-fatal farm injuries. A greater number of males were injured, regardless of how the occurrence of injury was categorised, particularly when farm machinery was involved. As women increasingly participate in all aspects of agricultural production, there is a need to collect, interpret, and disseminate information on agricultural injury that is relevant for both sexes.     

The impact of geographical location on trends in hospitalisation rates and outcomes for fall‐related injuries in older people

Objective : This population‐based study investigates the influence of geographical location on hospital admissions, utilisation and outcomes for fall‐related injury in older adults, adjusting for age, sex and comorbidities. Methods : A linked dataset of all admissions of NSW residents aged 65 and older, hospitalised at least once for a fall‐related injury between 2003 and 2012, was used to estimate rates of hospitalisations, total lengths‐of‐stay, 28‐day readmissions, and 30‐day mortalities. These were standardised for age, sex, comorbidity, and remoteness. Results : Compared to urban residents, rural residents were hospitalised less (p<0.0001) and hospitalisation rates increased at a lower rate (0.8% vs 2.6% per year) from 2003 to 2012. Rural residents had a shorter median total length of stay (5 vs 7 days, p<0.0001), a higher 28‐day readmission rate (18.9% vs 17.0%, p<0.0001) and higher 30‐day mortality (5.0% vs 4.9%, p=0.0046). Conclusions : Over the study period, rural residents of NSW had lower rates of fall‐related injury hospitalisation and a lower annual increase in hospitalisation rates compared to urban residents. When hospitalised, rural residents had a shorter length‐of‐stay, but higher rates of readmission and mortality. These differences existed following standardisation. Implications : This study highlights the need for further research to characterise and explain this variability.     

Epidemiology of hospitalised traumatic brain injury in the state of New South Wales,Australia: a population‐based study

Objective: To describe the population‐based incidence and epidemiological characteristics of hospitalised traumatic brain injury (TBI) in New South Wales (NSW), Australia. Methods: One‐year statewide hospital admission data from the NSW Department of Health were analysed. TBI cases were identified using a combination of TBI‐related diagnostic and external cause codes from the International Classification of Diseases (ICD‐10^th Revision). Sociodemographics, causes, associated factors, severity and medical details of hospitalisation were examined. Results: There were 6,827 hospitalised TBI cases that met review criteria. Incidence rate was 99.1/100,000 population. Incidence in persons older than 75 years of age and residents in remote areas was three times higher. Aboriginal and Torres Strait Islander peoples were 1.7 times more likely to sustain a TBI than the general population, and risk was greater for all NSW residents from areas that were remote and disadvantaged‐socioeconomically. Older adults and those with severe injuries showed prolonged hospitalisation, higher morbidity and mortality. Conclusions: Overall TBI incidence in NSW is lower than international estimates. Nevertheless, groups with higher incidence rates and/or poor in‐hospital outcomes were identified, highlighting directions for prevention and future research. Implications for public health: There is a need for identifying risk factors/barriers and assessing the impact of recent policies on these population groups.     

Baseline indicators for measuring progress in preventing falls injury in older people

Objective: Over recent years, there has been increasing attention given to preventing falls and falls injury in older people through policy and other initiatives. This paper presents a baseline set of fall injury outcome indicators against which these preventive efforts can be assessed in terms of monitoring the rate of fall-related deaths and hospitalisations.
Methods: ICD-10-AM coded hospital separations, Australian Bureau of Statistics (ABS) mortality and ABS population data were used to determine the rate of fall-related injury mortality and hospitalisations occurring in people aged 65+ years in New South Wales (NSW), Australia, over the six-year period from 1998/99 to 2003/04, inclusive.
Results: Baseline trends for one fatality and five separations-based metrics are presented. Overall, fall mortality rates increased over the six years, with higher rates in males. Falls hospitalisation rates also increased slightly, with higher rates in females. The rates of hip fracture and pelvic fracture hospital separations generally declined over the six years and were highest in females. The level of unspecified and missing information about the place where falls occur increased by 1.5%.
Conclusion: Baseline trends in fall injury outcome metrics highlight the severity and frequency of fall injuries before wide scale implementation of the Management Policy to Reduce Fall Injury Among Older People in NSW.
Implications: Future use of these metrics will help to evaluate and monitor the progress of falls prevention in older people in NSW. They could also be adopted in other jurisdictions.     

The burden of hospitalised fall‐related injury in community‐dwelling older people in Victoria: a database study

Objective : To estimate the burden of hospitalised fall‐related injury in community‐dwelling older people in Victoria. Methods : We analysed fall‐related, person‐identifying hospital discharge data and patient‐level hospital treatment costs for community‐dwelling older people aged 65+ years from Victoria between 1 July 2005 and 30 June 2008, inclusive. Key outcomes of interest were length of stay (LOS)/episode, cumulative LOS (CLOS)/patient and inpatient costs. Results : The burden of hospitalised fall‐related injury in community‐dwelling older people aged 65+ years in Victoria was 284,781 hospital bed days in 2005–06, rising to 310,031 hospital bed days in 2007–08. Seventy‐one per cent of episodes were multiday. One in 15 acute care episodes was a high LOS outlier and 14% of patients had ≥1 episode classified as high LOS outlier. The median CLOS/patient was nine days (interquartile range 2–27). The annual costs of inpatient care, in June 2009 prices, for fall‐related injury in community‐dwelling people aged 65+ years in Victoria rose from $213 million in 2005–06 to $237 million in 2007–08. The burden of hospitalised fall‐related injury in community‐dwelling older women, people aged 85+ years and those with comorbidity was considerable. Conclusions : The burden of hospitalised fall‐related injury in community‐dwelling older people aged 65+ years in Victoria is significantly more than previously projected. Importantly, this study identifies that women, patients with comorbidity and those aged 85+ years account for a considerable proportion of this burden. Implications : A corresponding increase in falls prevention effort is required to ensure that the burden is properly addressed.     

Statistical methods to enhance reporting of Aboriginal Australians in routine hospital records using data linkage affect estimates of health disparities

Objective: To investigate under‐recording of Aboriginal people in hospital data from New South Wales (NSW), Australia, define algorithms for enhanced reporting, and examine the impact of these algorithms on estimated disparities in cardiovascular and injury outcomes. Methods: NSW Admitted Patient Data were linked with NSW mortality data (2001–2007). Associations with recording of Aboriginal status were investigated using multilevel logistic regression. The number of admissions reported as Aboriginal according to six algorithms was compared with the original (unenhanced) Aboriginal status variable. Age‐standardised admission, and 30‐ and 365‐day mortality ratios were estimated for cardiovascular disease and injury. Results: Sixty per cent of the variation in recording of Aboriginal status was due to the hospital of admission, with poorer recording in private and major city hospitals. All enhancement algorithms increased the number of admissions reported as Aboriginal, from between 4.1% and 37.8%. Admission and mortality ratios varied markedly between algorithms, with less strict algorithms resulting in higher admission rate ratios, but generally lower mortality rate ratios, particularly for cardiovascular disease. Conclusions: The choice of enhancement algorithm has an impact on the number of people reported as Aboriginal and on estimated outcome ratios. The influence of the hospital on recording of Aboriginal status highlights the importance of continued efforts to improve data collection. Implications: Estimates of Aboriginal health disparity can change depending on how Aboriginal status is reported. Sensitivity analyses using a number of algorithms are recommended.     

Work-related injury in NSW hospitalisation and workers' compensation datasets: a comparative analysis

OBJECTIVE: To undertake a comparative analysis of the New South Wales (NSW) Inpatient Statistics Collection (ISC) and Workers' Compensation Scheme Statistics (WCSS) for the 1999/2000 financial year in an attempt to evaluate their respective roles in the surveillance and monitoring of work-related injuries in NSW. METHODS: Work-related injuries in ISC were identified mainly by using the ICD-10 activity code and payment status and were compared with injury-related claims reported in WCSS. RESULTS: In 1990/2000, the majority of hospital separations for work-related injury involved males (86.2%) who came into contact with various objects, including machinery and tools, representing the most common mechanisms of injury, and open wounds and fractures of the upper and lower limbs as the most common injury nature/location. Injuries reported in the WCSS were also dominated by males (70%), with muscular stress while handling objects as the most common mechanism of injury and sprain and strain of the lower back as the leading nature/location of injury. The proportion of workers aged 15-19 years in the WCSS (1.2%) was over five times lower than the proportion of the same age group recorded in the ISC. CONCLUSIONS AND IMPLICATIONS: The analysis indicates that the ISC and WCSS complement each other in characterising the burden of work-related injuries in NSW. Linking compensation and outcomes data, including hospital admissions and emergency presentations, will provide a more comprehensive picture of the nature and the factors contributing to work-related injuries. Such data will inform policy and program development aimed at reducing the burden of this type of injury in the community.     

Falls from ladders in Australia: comparing occupational and non‐occupational injuries across age groups

Objective : To examine national ladder‐related fall injury patterns and trends, and compare the changes over time in occupational and non‐occupational falls across age groups. Methods : Analysis of national hospital morbidity data to examine trends over time and differences between groups. Results : There were 41,092 hospitalised falls from ladders in Australia over the ten year period from July 2002 to June 2012, rising from 3,374 hospitalisations in 2002/03 to 4,945 hospitalisations in 2011/12. The age standardised rate of ladder‐related fall hospitalisations rose significantly for males, and a higher increase was evident in people aged over 60 years. Occupational falls accounted for 20% of hospitalisations, and the hospitalisation rate for both occupational and non‐occupational falls increased significantly over the ten year period. Conclusions : With almost 5,000 hospital admissions per year in recent years and a significant rise in the rate of hospitalisations over the past decade, this paper highlights the importance of focusing injury prevention efforts to reduce the growing number of ladder‐related falls. Implications : This study demonstrates the significant burden that ladder‐related falls are continuing to have on the community, both in the occupational and domestic setting.     

The impact of shift work on the risk and severity of injuries for hospital employees: an analysis using Oregon workers' compensation data

BACKGROUND: While past research on health care workers has found that shift work can lead to negative physiological and psychological consequences, few studies have assessed the extent to which it increases the risk of specific work-related injuries, nor quantified and compared associated types, severity and costs. AIMS: This study aimed to derive and compare the rates, typologies, costs and disability time of injuries for various hospital worker occupations by day, evening and night shift. METHODS: This study used Oregon workers' compensation claim data from 1990 to 1997 to examine the differences in hospital employee claims (n = 7717) by shift and occupation. Oregon hospital employee claim data, hospital employment data from Oregon's Labor Market Information System and shift proportion estimates derived from the Current Population Survey (CPS) were used to calculate injury rate estimates. RESULTS: The injury rate for day shift per 10,000 employees was estimated to be 176 (95% CI 172-180), as compared with injury rate estimates of 324 (95% CI 311-337) for evening shift and 279 (95% CI 257-302), night shift workers. The average number of days taken off for injury disability was longer for injured night shift workers (46) than for day (38) or evening (39) shift workers. CONCLUSION: Evening and night shift hospital employees were found to be at greater risk of sustaining an occupational injury than day shift workers, with those on the night shift reporting injuries of the greatest severity as measured by disability leave. Staffing levels and task differences between shifts may also affect injury risk.     

The burden of fall-related injury among older persons in New South Wales

Objective: To develop a comprehensive estimate of the burden of fall‐related injury among older people in New South Wales. Methods: Fall injuries in 2006/07 were estimated using information from several datasets and the literature. Healthcare costs were calculated using Australia‐Refined – Diagnostic‐Related Group costs for hospital episodes of care and average costs for Emergency Department presentations, ambulance transport and residential aged care (RAC). Ratios of the cost of inpatient care relative to other health services, derived from the literature, were used to estimate the costs associated with these services. Results: In 2006/07, in NSW, there were almost 143,000 falls, among older people, resulting in injuries requiring medical treatment. The total cost of healthcare associated with these falls was estimated at $558.5 million. Although accounting for only 6% of the NSW population aged 65 years and older, persons in RAC accounted for 15% of the total cost of falls injury and 21% of hospital inpatient costs. Conclusion and implications: This study demonstrates the extremely high economic cost of falls in older persons and highlights the disproportionate impact of falls in RAC. The study underscores the urgent need for significant investment in fall‐injury prevention efforts in both the community and RAC settings.     

The cost of fall-related injuries among older people in NSW, 2006-07

This study aimed to establish comprehensive estimates of the cost of fall-related injury among older people in NSW. A health service utilisation approach was used to estimate the cost of hospital treatment, residential care and ambulance transport. Other costs were estimated by deriving ratios of inpatient costs to other services from the literature. In the 2006-07 financial year, 251,000 (27%) of older people fell at least once and suffered, in total, an estimated 507,000 falls. An estimated 143000 medically treated fall-related injuries among older people resulted in lifetime treatment costs of $558.5 million. Although only 18% of these injuries resulted in hospital admission, the cost of care associated with these cases accounted for 84.5% of the total cost. The cost of fall-related injury among older people in NSW in 2006-07 is a significant increase over earlier estimates and underscores the urgent need for effective preventive efforts across the state.     

Coronary artery bypass graft surgery: socioeconomic inequalities in access and in 30 day mortality. A population-based study in Rome, Italy

OBJECTIVES: To evaluate whether coronary artery bypass graft (CABG) surgery is equally provided among different socioeconomic status (SES) groups in accordance with need. To estimate the association between SES and mortality occurring 30 days after CABG surgery. DESIGN: Individual socioeconomic index assigned with respect to the characteristics of the census tract of residence (level I = highest SES; level IV = lowest SES). Comparison of age adjusted hospital admission rates of ischaemic heart disease (IHD) and CABG surgery among four SES groups. Retrospective cohort study of all patients who underwent CABG surgery during 1996-97. SETTING: Rome (2 685 890 inhabitants) and the seven cardiac surgery units in the city. PARTICIPANTS: All residents in Rome aged 35 years or more. A cohort of 1875 CABG patients aged 35 years or more. MAIN OUTCOME MEASURES: Age adjusted hospitalisation rates for CABG and IHD and rate of CABG per 100 IHD hospitalisations by SES group, taking level I as the reference group. Odds ratios of 30 day mortality after CABG surgery, adjusted for age, gender, illness severity at admission, and type of hospital where CABG was performed. RESULTS: People in the lowest SES level experienced an excess in the age adjusted IHD hospitalisation rates compared with the highest SES level (an excess of 57% among men, and of 94% among women), but the rate of CABG per 100 IHD hospitalisations was lower, among men, in the most socially disadvantaged level (8.9 CABG procedures per 100 IHD hospital admissions in level IV versus 14.1 in level I rate ratio= 0.63; 95% CI 0.44, 0.89). The most socially disadvantaged SES group experienced a higher risk of 30 day mortality after CABG surgery (8. 1%) than those in the highest SES group (4.8%); this excess in mortality was confirmed even when initial illness severity was taken into account (odds ratio= 2.89; 95% CI 1.44, 5.80). CONCLUSIONS: The universal coverage of the National Health Service in Italy does not guarantee equitable access to CABG surgery for IHD patients. Factors related to SES are likely to influence poor prognosis after CABG surgery.     

Injury from assault in New Zealand: an increasing public health problem

Abstract: Injury purposely inflicted by other persons is a significant public health problem accounting for approximately 4 per cent of all injury hospitalisations in New Zealand. National injury morbidity data for the years 1979–1988 were examined. These data were used to identify the characteristics of victims of assault who were hospitalised, the nature of the injuries they sustained, and the circumstances in which the injuries were inflicted. The incidence of hospitalisations in 1988 was 73.7 per 100 000 persons per year. A significant increase in the rate of hospitalisations over the decade 1979–1988 was identified. The rates for males were higher than those for females, with males 20–24 years of age most at risk. Maori had higher rates than non-Maori. Fights or brawls were the leading cause of hospitalisation. The most common place of occurrence was private homes, followed by streets and highways, and licensed premises. The findings with regard to age, sex, employment status and use of weapons were consistent with earlier studies. A higher proportion of incidents occurring in the home was attributed to differences in selection of cases between studies. An indication of underreporting by women was attributed to concealment of intentionality, possible owing to fear of reprisal. Standard hospital reporting procedures were proposed as a means of improving identification.     

The impact of migration on deaths and hospital admissions from work‐related injuries in Australia

Objective: The shift from an industrial to a service‐based economy has seen a decline in work‐related injuries (WRIs) and mortality. How this relates to migrant workers, who traditionally held high‐risk jobs is unknown. This study examined deaths and hospital admissions from WRI, among foreign and Australian‐born workers. Methods: Tabulated population data from the 1991 to 2011 censuses, national deaths 1991–2002 and hospital admission for 2001–10. Direct age standardised mortality and hospital admission rates (DSRs) and rate ratios (RRs) were derived to examine differences in work‐related mortality/hospital admissions by gender, country of birth, employment skill level and years of residence in Australia. Results: DSRs and RRs were generally lower or no different between Australian and foreign‐born workers. Among men, mortality DSRs were lower for nine of 16 country of birth groups, and hospital admissions DSRs for 14 groups. An exception was New Zealand‐born men, with 9% (95%CI 9–13) excess mortality and 24% (95%CI 22–26) excess hospital admissions. Conclusions: Four decades ago, foreign‐born workers were generally at higher risk of WRI than Australian‐born. This pattern has reversed. The local‐born comprise 75% of the population and a pro‐active approach to health and safety regulation could achieve large benefits.     

Hospitalisations,admission costs and re‐fracture risk related to osteoporosis in Western Australia are substantial: a 10‐year review

Objective: To quantify hospitalisation costs to Western Australia (WA) for osteoporosis‐related fractures and estimate risk of readmission after incident fracture. Methods: All hospitalisation records for WA residents aged ≥50 years admitted to a WA hospital between 2002 and 2011 due to osteoporotic fractures were extracted from the WA Hospital Morbidity Data System. Data linkage enabled identification of the first (index) fracture admission, determination of subsequent osteoporotic fracture‐related readmissions, and quantification of total admission costs and bed days. Cox proportional hazard models assessed factors influencing first readmission. Results: A total of 5,326 patients were admitted to WA hospitals for an index fracture. Of the 2,037 (38.2%) patients who sustained a re‐fracture requiring readmission, 1,223 (23.0%) had one re‐fracture episode, 453 (8.5%) has two, and 361 (6.8%) has three or more re‐fracture episodes requiring readmission. Cost of index admissions was $57,007,262 while $48,948,623 was associated with readmissions (CPI‐adjusted to 2011/12). Cumulative probability of readmission within six months of the index admission was 20% (males) and 17% (females). Conclusions: Osteoporotic fracture‐related hospitalisations impose a substantial financial impact on WA, exceeding $100 million in a decade. Implications: Considering the large system costs, policy and programs to improve identification of index fractures and initiation of osteoporosis treatments and primary prevention initiatives are justified.     

Closing the Aboriginal child injury gap: targets for injury prevention

Objective : To describe the leading mechanisms of hospitalised unintentional injury in Australian Aboriginal children and identify the injury mechanisms with the largest inequalities between Aboriginal and non‐Aboriginal children. Methods : We used linked hospital and mortality data to construct a whole of population birth cohort including 1,124,717 children (1,088,645 non‐Aboriginal and 35,749 Aboriginal) born in the state of New South Wales (NSW), Australia, between 1 July 2000 and 31 December 2012. Injury hospitalisation rates were calculated per person years at risk for injury mechanisms coded according to the ICD10‐AM classification. Results : The leading injury mechanisms in both groups of children were falls from playground equipment. For 66 of the 69 injury mechanisms studied, Aboriginal children had a higher rate of hospitalisation compared with non‐Aboriginal children. The largest relative inequalities were observed for injuries due to exposure to fire and flame, and the largest absolute inequalities for injuries due to falls from playground equipment. Conclusion : Aboriginal children in NSW experience a significant higher burden of unintentional injury compared with their non‐Aboriginal counterparts. Implications for Public Health : We suggest the implementation of targeted injury prevention measures aimed at injury mechanism and age groups identified in this study.     

Letter: Children's bicycle safety education does not reduce injuries

Learning to ride a bicycle is a common and joyful experience of childhood (up to 68% of children reported riding a bicycle in a two‐week period) that has many health benefits. However, children have the highest bicycle‐related injury rates compared to other age groups. In NSW, bicycle injury‐related hospitalisations in people aged 5–14 years account for approximately half of all bicycle injury‐related hospitalisations. A typical bicycle education program for children will involve a one‐session program focusing on safe cycling information, with some time allocated to practising safe cycling skills. However, these programs have not been well documented or evaluated. We conducted a pilot study investigating the effectiveness of a bicycle education program in increasing safe cycling knowledge and behaviour in the Macarthur area of south‐west Sydney.     

Hospital inpatient costs resulting from road crashes in Western Australia

Abstract: The purpose of this study was to estimate the inpatient costs of road crashes in Western Australia, and to investigate factors relating to casualties and their injuries that affect the hospital costs resulting from road crashes. All road crash casualties who were injured severely enough to be hospitalised in Western Australia in 1988 were included. A casemix classification system was used to classify patients into diagnostic related groups. Hospital costs were assigned to individual patients on the basis of their diagnostic related group and length of hospital stay. The annual cost of hospital treatment for road crash casualties was estimated as $13.9 million, and 33 per cent of this was incurred by those with lower extremity injuries and 27 per cent by those with head injuries. Hospital costs per casualty ranged from an average of $1388 for those sustaining minor (Abbreviated Injury Scale severity score of 1 or 2) spinal injuries to $16 580 and $33 424, respectively, for those sustaining severe (Abbreviated Injury Scale severity score of 4 or 5) head and spinal injuries. A multivariate analysis of variance revealed the following factors as having a significant independent effect on the hospital inpatient costs of road crash casualties: type of hospital (teaching or nonteaching), body region of injury, injury severity level and road user group. There were also significant interaction effects between different factors. Since hospital inpatient costs vary considerably across factors, using average cost data in the specific economic evaluation of road safety interventions for groups of road users is inappropriate.     

Combined Antifungals Produce Less Toxicity,Better Results

Abstract

Background:Intensivists have been associated with decreased mortality in several studies, but in one major study, centers with intensivist-staffed units reported increased mortality compared with controls. We hypothesized that a closed unit, in which a unit-based intensivist directly provides and coordinates care on all cases, has improved mortality and utilization compared with an open unit, in which individual attendings and consultants provide care, while intensivists serve as supervising consultants. Methods: We undertook the retrospective study of outcomes in 2 intensive care units (ICUs)—a traditional open unit managed by faculty intensivists and a second closed unit overseen by the same faculty intensivists who coordinated the care on all patients in a large community hospital. Primary Outcome: In-hospital mortality. Secondary Outcomes: Hospital length of stay (LOS), ICU LOS, and relative costs of hospitalization. Results: From January 2006 to December 2007, we identified 2602 consecutive admissions to the 2 medical ICUs. Of all patients admitted to the closed and open units, 19.2% and 24.7%, respectively, did not survive (P < 0.001, adjusted for severity). Median hospital LOS was 10 days for the closed unit and 12 days for the open unit (P < 0.001). Median ICU LOS was 2.2 days for the closed unit and 2.4 days for the open unit (P = NS). The unadjusted cost index for the open unit was 1.11 relative to the closed unit (1.0) (P < 0.001). However, after adjusting for disease severity, cost differences were not significantly different. Conclusions: We observed significant reductions in mortality and hospital LOS for patients initially admitted to a closed ICU versus an open unit. We did not observe a significant difference in ICU LOS or total cost after adjustment for severity.