Unintentional injury deaths among adult Finns in 1971-2008

Injuries are a significant public health problem and among the leading causes of death worldwide. In Finland, nearly 1.2 million accidents or assaults lead to physical injury annually. This study examined the nationwide trends in unintentional injury deaths of adults in Finland. For this purpose, we obtained from the Finnish Official Cause-of-Death Statistics (OCDS) the data for persons aged 15 years or older whose deaths occurred in 1971-2008 due to an unintentional injury.A drastic decline occurred in road traffic crashes. The age-standardized death rate (per 100 000 person-years) of men's road traffic crashes was 48 in 1971 but only 10 in 2008. Traffic caused fewer deaths in women than men, but the declining trend in women's death rates was also clear, from 17 in 1971 to 3 in 2008. During the study period, falls became the leading category of men's unintentional injury death, although their rate rose rather slowly from 19 in 1971 to 21 in 2008. Among Finnish women, the rate of fall-induced deaths declined from 32 in 1971 to 16 in 2008.There was a notable rise in men's unintentional alcohol poisoning deaths, especially since 2003. In 2008, alcohol poisonings were the second leading cause of men's injury death (rate 18). The rate of women's deaths due to alcohol poisoning was yet low during the entire study period but its rise was clear, from 1 in 1971 to 5 in 2008. Poisoning deaths caused by other substances also increased: among men their rate was 4 in 1971 and 11 in 2008, and among women 2 in 1971 to 4 in 2008. Between 1998 and 2008, psychotropic drugs, narcotics and opioid analgesics caused the majority of both men's and women's non-alcohol poisoning deaths.In conclusion, unintentional injury deaths in road traffic crashes declined steeply among adult Finns during 1971-2008. The rate of fall-induced deaths in Finnish men was rather stable during the study period while in women it clearly declined. In contrast, increase in poisoning deaths due to alcohol and other substances was alarming. Vigorous preventive actions should be initiated to control this development.     

Epidemiology of road traffic mortality and injuries in Yazd, Iran during 2003-2008

Objective: Road traffic crashes (RTCs) are considered to be the second highest cause of mortality in Iran. The purpose of this study was to describe the morbidity and mortality of RTC during 2003-2008.Methods: Data were got from national health sources of Iran. These data included population, the number of RTCs,consequent fatalities, cause and place of death from 2003 to 2008.Results: RTC incidence rate increased from 868.5 per 100 000 population in the year 2003 to 1 643.6 in 2008. A total of 2 565 deaths from RTC were recorded in Yazd from 2003 to 2008. RTC mortality rate increased from 46.1 per 100 000 population in 2003 to 46.9 in 2006, then declined to 38.8 in 2008. During this time period, overall traffic injury incidence per 100 000 population increased from 368.8 in 2003 to 647.9 in 2006, then declined to 527.9 in 2008. Head injuries were the most common cause of road traffic-related mortality from 2003 to 2008. Following road traffic accidents, most of the deaths occurred before arriving hospital.Conclusions: Road traffic crash-related mortality and morbidity in Yazd in the recent six years are increased, but decreased in the last two years. This decline is most probably the result of a variety of interventions, including laws,police enforcement, improvements in traffic and transport,health care resources and media and public education.     

The association of trauma death and alcohol use in a rural state.

This study documents the strong association of alcohol in trauma-related deaths. In a previous study alcohol was present in 62.8% of homicide victims, 48.6% of unintentional injury fatality victims, 35.3% of persons who committed suicide, and 14.4% of persons who died of natural causes. The present study uses the legal limit of 100 mg/100 mL to include patients as having an alcohol-associated trauma death. In addition the study includes patients who die up to 20 hours after injury. These features of our study result in the lower reported frequency rates. Our study confirms that alcohol is strongly associated with trauma deaths resulting from motor vehicle crashes. It also demonstrates a strong association between alcohol use and victims of all types of trauma mortality; specifically those victims of gunshot wounds, burns, stabbings, and falls all are frequently using alcohol. This information is of importance for those who treat such injured patients, since such tests as neurologic examination frequently will be compromised by the use of alcohol in the victims of major trauma. Perhaps most importantly this information can be of help in designing appropriate strategies in attacking this problem the best possible way--by prevention.     

The analysis of epidemiological characteristics of road traffic crashes in a mountain city in western China

Objective: To study the epidemiological characteristics and preventive methods of road traffic crashes in a mountain city in western China through sampling investigation of traffic crashes in different regions of Chongqing city in recent years. Methods： Two police teams of traffic management in downtown, two teams in suburb, one team in county and one freeway team were randomly selected, and road traffic crashes between 1988 and 1997 were investigated and analyzed. Results: A total of 13121 road traffic crashes with 6201 crashes with casualties were analyzed. The incidence of crashes was higher in May, June and July, and on Friday and Wednesday and at 8:00-12:00 and 14:00-18:00 within a day. Casualties were 44.0% in pedestrians and 42.5% in passengers of total casualties. The deaths and severe injuries in pedestrians were 59.1% of total deaths and 56.4% of total severe injuries. The age of drivers and passengers were mainly at 18-30 years, followed by 31-40 years. People over 60 years old accounted for 24.1% of total pedestrian casualty. Head injury was the most common reason for deaths. The main reasons for these crashes were improper driving and violating traffic laws.Violating traffic laws by pedestrian was one of the main reasons for pedestrian casualty. Conclusions: The crashes are related to the characteristics of geography, climate, society activity of people, and the sense of traffic safety, the basic traffic construction and management in Chongqing. The traffic casualty of pedestrian is a big problem in Chongqing. To prevent and decrease road traffic injuries effective methods should be worked out and propaganda on traffic safety and traffic management should be strengthened according to different characteristics of different regions. To strengthen the first aid and treatment of cranium-brain injury and chest-back injury is also helpful in decreasing traffic deaths.     

Road traffic accidents and policy interventions in Korea

The high rate of road traffic crashes, in conjunction with the absence of order on the road, has long been considered a critical social problem in Korea. The Korean public seems to agree that high priority ought to be placed on policies for improving road safety. Using data from government sources, this study describes what has happened in the area of road traffic crashes since 1970, the causes of traffic crashes, and the relative importance of traffic injuries as a cause of death in Korea. Road traffic crashes in Korea increased nearly eight-fold, from 37,000 in 1970 to 290,481 in 2000. The fatalities increased three-fold and injuries ten-fold over the same period. Road traffic injuries were the leading cause of death for people under 29. However, through multiple policy interventions, partly in response to the 2002 FIFA World Cup, about two thousand road traffic deaths and nine thousand traffic-related disabilities were averted in 2001 alone. The policy interventions included enforcement of penalties for seven risky driving behaviours, including drunk driving and speeding, installation of traffic-monitoring cameras, financial rewards for citizens who reported traffic violations, introduction of a road safety evaluation system, correction of accident black spots in existing roads, and road safety education programs. Through multiple policy interventions, road traffic crashes in Korea were reduced in a relatively short time period, along with their associated injuries and fatalities. However, road traffic crashes still pose a major public health problem, threatening the quality of life of the Korean people.     

Do some U.S. states have higher/lower injury mortality rates than others?

BACKGROUND: This article examines the hypothesis that the six U.S. states with the highest rates of road traffic deaths (group 1 states) also had above-average rates of other forms of injury such as falling, poisoning, drowning, fire, suffocation, homicide, and suicide, and also for the retail trade and construction industries. The converse, second hypothesis, for the six states with the lowest rates of road traffic deaths (group 2 states) is also examined. RESULTS: Data for these 12 states for the period 1983 to 1995 included nine categories of unintentional and four categories of intentional injury. Seventy-four percent of the group 1 states conformed to the first hypothesis, and 85% of the group 2 states conformed to the second hypothesis. CONCLUSION: Group 1 states are likely to exhibit above-average rates for most other categories of injury death, whereas group 2 states are even more likely to exhibit below-average rates for most other categories of injury death.     

Road traffic crashes in rural setting: an experience of a middle-income country

Objective： To date, there has been little information published on the death of rural road accident deaths. This study uses burden of injury method to explore a more accurate estimate of years of life lost due to road traffic crashes occurring over a four-year period in Guilan province, northern Iran. Methods： Rural road accident deaths from 2009 to 2013 were extracted from Iran＇s Forensic Medicine System, Death Registry System and Road Trauma Research center database. Results： During the study period, the average years of life lost due to motor vehicle crashes was 13.8 per 1 000 persons, ranging from 11.9 during March 2011- 2012 to 15.8 per 1 000 persons during March 2012-2013. Conclusion： Road accident deaths in 2013 remained at the same high level as in 2009. The information obtained from this study provides a new perspective on fatal road traffic crash victims in rural settings and show us that more attention is needed in this area.     

Road traffic injuries in Thailand: trends,selected underlying determinants and status of intervention

Injuries and deaths from traffic crashes have become a major public health and socio-economic problem in Thailand. Injuries, fatalities and economic losses due to traffic crashes have increased with the rising level of motorization. This study analyzes hospital-based data compiled by the Ministry of Public Health, data compiled by the National Police Office and data compiled by the traffic engineering division of the Department of Highways, Ministry of Transport and Communications. Analysis reveals that 70% of the people injured or killed in traffic crashes are aged 10-39. Men are at four to five times higher risk of death and injury due to traffic crashes than women. The number and rate of traffic injury in Thailand swung from a record low during the economic recovery in the 1980's to record a high during the bubble economy, then declined with the economic crisis in 1997. The economic costs were estimated at U.S.$1.6 billion in 1995. An urban-rural difference in traffic injuries has been recorded with a higher rural case-fatality rate. A number of known behavioral risk factors have been identified, i.e., drunk driving, speeding, substance abuse and failure to use helmets and seat belts. However, determinants of behavior need further investigation. Hazardous road locations have also been mapped. Trends of traffic injuries seem to follow trends of economic growth. Without effective policy and implementation programs to control the determinants, it is expected that traffic injuries will increase as the country recovers from economic crisis. A major pitfall to many current government programs is that they incorporate no systematic evaluation. The fragmented structure of road safety authorities further complicates collaboration and coordination. A broad coalition of stakeholders is needed to catalyze policy action.     

Road crash in China from 2003 to 2005

Objective： To analyze characteristics and causes of road crash and injuries in China from 2003 to 2005.
Methods： The data of road crash in 2003-2005 were collected to study the characteristics including total vehicle number, occurrence rates of traffic accidents and serious traffic accidents so as to discuss the causes and characteristics of road crash in China.
Results： From 2003 to 2005, the numbers of traffic accidents, injuries and deaths as well as the mortality rates per 100 000 persons and per 10 000 vehicles declined in China. Until 2005, the total number of traffic accidents decreased to 450 000 and deaths to 99 000, with the mortality rate per 10 000 vehicles being 7.6 persons. While the drivers and passengers accounted for 33.2 % and 26.6 % of death casualties respectively in 2005. Most traffic accidents were caused by drivers, especially those with driving experience less than 3 years. Traffic accidents occurred on suburban roads accounted for 60%. The mortality rate of the traffic accidents per 100 km on the first grade road ranked the highest. The mortality rate of the traffic accidents on expressways ranked the highest, with continual increase of death and injury.
Conclusions. At present, the increase trend of traffic accidents and casualties in China has been slowed down to some extent and shows a declining tendency, but the situation is far away from being optimistic. In order to cut down the number of traffic accidents and casualties, we should pay more attention to training and managing drivers with less than three driving years and those driving buses. Strict prevention measures should be laid on traffic accidents on first grade roads, expressways and suburban roads as well as the enhancement on improving first-aid system.     

Impact of acute alcohol intoxication on patterns of non-fatal trauma: cause-specific analysis of head injury effect

The impact of alcohol on injury patterns was studied by using 14,920 injured men aged 15-64 years seen in an emergency room in Helsinki, Finland. Blood alcohol was estimated by clinical evaluation and breath test, and was coded into a three-grade intoxication code. Intoxication was recorded in 19.7 per cent. Head injury was more common among the intoxicated (64.1 per cent) than among the sober (17.6 per cent). The odds of head injury, if 1.0 among the sober, was 8.3 among the intoxicated. This head injury effect (HIE) was found in every major external cause category: falls 15.4, traffic 3.0, other unintentional injury 3.4 and assault 2.6. A major difference in HIE was found by hospitalization status: 2.1 for hospitalized and 9.8 for ambulatory patients. Alcohol seems to produce mostly low-energy events (like falls) resulting usually in minor, though potentially dangerous, head injury.     

Epidemiologic study of traffic crash mortality among motorcycle users in Iran(2011e2017)

Purpose: Motorcycle accident is a major cause of road traffic injuries and the motorcyclists are considered as vulnerable road users. The present study aimed to determine the epidemiological characteristics of fatal motorcycle crashes in Iran. Methods: In this cross-sectional study, a total of 28,356 motorcycle traffic fatalities registered in the Legal Medicine Organization of Iran were analyzed during the period between March 2011 and March 2017. The examined variables included demographic characteristics, helmet use, crash mechanisms, crash location, position state, type of counterpart vehicle, cause of death and place of death. In the study, road traffic mortalities involving drivers and/or passenger of motorcycles were included. Cases or events registered without these conditions were excluded from the study. To analyse the data, SPSS statistics 25 and GraphPad Prism 8 softwares were used. Results: Of the 122,682 fatal traffic injury cases, 28,356 (23.1%) were motorcycle users, of whom 95.3% were male and 4.7% were female. Most of the motorcycle fatalities belonged to the age group of 18-24 years (29.1%). Head trauma was the major cause of death (59.0%). Also, the overall proportion of safety helmet use among motorcycle crash victims was estimated at 37.4%. Most of the road traffic crash cases (46.8%) happened out of city and half of people (49.9%) died in hospital. About 77.4% of the victims were motorcycle riders and 21.1% were pillion passengers. The highest rate of mortality belonged to the selfemployed (38.4%) and then workers (21.8%) and students (10.2%). In addition, most fatalities occurred in people with low education (77.5%) and the least occurred in university graduates (5.5%). Among 31 provinces of Iran, Fars had the highest (9.3%) occurrence rate and Kohgiluyeh and Buyer-Ahmad had the lowest (0.5%). Most of the crash mechanisms were due to motorcycle-vehicle crashes (80.2%), followed by rollover (9.8%). Conclusion: Comprehensive public education and special rules are needed to reduce the rate of deaths in motorcycle crashes.     

Pedestrian traffic injuries in Mexico: a country update

Road traffic injuries in general and pedestrian injuries in particular are a major public health problem in Mexico, especially in large urban areas. Analysis of mortality and road crashes at the national level was done using routine data recorded on death certificates. Fatality rates for different age groups were estimated by region for the year 2000. These data were supplemented by a cross-sectional study of pedestrian injuries in Mexico City based on death certificates information for pedestrians who lived and died in Mexico City between 1994 and 1997. Participant observation of physical spaces where crashes occurred was carried out. The spaces were filmed and in-depth interviews of survivors conducted. Road traffic crashes were responsible for approximately 17,500 deaths in Mexico during 2000. The mean age of the victims was 37 years. Mexico lost an average of 30 years of productive life for each individual who died in a traffic crash--525,000 years in 2000. An estimated 9500 (54.3%) of all fatalities were pedestrians, and for every pedestrian death there were 13 others who sustained nonfatal injuries requiring medical care. The overall crude mortality rate for pedestrian injuries in Mexico City was 7.14 per 100,000 (CI 6.85-7.42). A concentration of deaths was observed in 10 neighborhoods at specific types of street environments. The underlying factors included dangerous crossings and the absence or inadequacy of pedestrian bridges, as well as negative perceptions of road safety by pedestrians. In conclusion, this study demonstrates the importance of elucidating the underlying contextual determinants of pedestrian injuries.     

Effectiveness of the Chaos Falls Clinic in preventing falls and injuries of home-dwelling older adults: A randomised controlled trial

Background

Falls and related injuries are a major public health concern in elderly people. Multifactorial interventions may result in significant reduction in falls but their effectiveness in prevention of fall-induced injuries at centre-based falls clinics is unclear. This study assessed the effectiveness of the multifactorial Chaos Clinic Falls Prevention Programme on rate of falls and related injuries of home-dwelling older adults.

Methods

This study was a pragmatic, randomised controlled trial concentrating on high risk individuals and their individual risk factors of falling. Home-dwelling elderly people aged 70 years or more were recruited to the Chaos falls clinics in the cities of Lappeenranta and Tampere in Finland between January 2005 and June 2009. 1314 participants with high-risk for falling and fall-induced injuries and fractures were randomised into intervention group (n = 661) and control group (n = 653). A multifactorial, individualized 12-month falls prevention programme concentrating on strength and balance training, medical review and referrals, medication review, proper nutrition (calcium, vitamin D), and home hazard assessment and modification was carried out in the intervention group. The main outcome measures were rates of falls, fallers, and fall-induced injuries.

Results

During the one-year follow-up, 608 falls occurred in the intervention group and 825 falls in the control group. The rate of falls was significantly lower in the intervention group (95 falls per 100 person-years) than in the controls (131 falls per 100 person-years), the incidence rate ratio (IRR) being 0.72 (95% confidence interval (CI) 0.61–0.86, p < 0.001, NNT 3). In the intervention group 296 participants fell at least once. In the controls the corresponding number was 349. The hazard ratio (HR) of fallers in the intervention group compared with the control group was 0.78 (95% CI 0.67–0.91, p = 0.001, NNT 6). The number of fall-induced injuries in the intervention group was 351 with the corresponding rate (per 100 person-years) of 55. In the control group, these figures were higher, 468 and 75. The IRR of fall-induced injuries in the intervention group compared with the control group was 0.74 (95% CI 0.61–0.89, p = 0.002, NNT 5).

Conclusions

The multifactorial Chaos Clinic Falls Prevention Programme is effective in preventing falls of older adults. The programme reduces the rate of falls and related injuries by almost 30%.     

Epidemiological characteristics and relative factor of hospital death cases with road traffic trauma

Objective:To investigate the epidemiological characteristics and relative factor about hospital death in patients with road traffic trauma. Methods: The age, sex, road-use category, sites of injury, injury severity scale of 159 hospital death cases in 2436 cases with road traffic trauma were observed, and the relation between the causes of death and time elapsed after injury was also studied with likelihood ratio Chi-square test. Results: More hospital deaths happen more likely in the elderly patients and peasants with road traffic trauma. Motor vehicle was the most common culprit, and the majority of victims were pedestrians. The causes of death were related with the time elapsed after injury, and according to which the clinical course of the wounded patients could be divided into cerebral injury / shock phase, transitional phase, infection phase and multiple organ dysfunction syndrome (MODS) phase.Conclusion: There is a significant relation between the hospital deaths and types of the injury and medical care in road traffic accidents. It should be emphasized that strategy of prevention of hospital deaths during hospital care should vary in different phases of the clinical course.     

Road traffic injuries in Sri Lanka: a call to action

Road traffic injuries and associated deaths have reached epidemic proportions in Sri Lanka, resulting in 2,000 deaths and 14,000 injuries each year. Accurate information on the patterns and trends in fatal and non-fatal outcomes are essential to identify emerging issues relating to vulnerable road user groups. This information is also needed to raise community awareness, prioritize public action, mobilize and allocate resources for intervention, and monitor the impact of road safety programmes. Another important gap relating to road traffic injury in Sri Lanka is the scant data regarding the determinants and consequences of road traffic injuries. It is essential to engage with local communities to understand their concerns and attitudes as well as develop partnerships that can mobilize support and action to address this problem. At the national level, a lead government agency, for example the Ministry of Health, should be identified and empowered to guide and coordinate inter-sectoral road traffic injury prevention efforts. The response must include a systematic approach to assessing the problem and addressing research gaps. The initiatives developed must provide the necessary evidence to develop context-relevant actions that can prevent road crashes and minimize the consequences of road traffic injuries.     

Deaths (144) from road traffic accidents occurring before arrival at hospital

One hundred and forty-four deaths occurring as a result of road traffic accidents are reported, with reference to circumstance of accident, cause of death, severity of injury and blood alcohol levels. In seven cases there may have been a contribution to death from aspiration of blood or vomit. In two other cases there were lesions which might have responded to the very early provision of full medical care.     

Incidence of traumatic brain injury in the United States, 2003

Traumatic brain injury (TBI) is an important public health problem in the United States. In 2003, there were an estimated 1,565,000 TBIs in the United States: 1,224,000 emergency department visits, 290,000 hospitalizations, and 51,000 deaths. Findings were similar to those from previous years in which rates of TBI were highest for young children (aged 0-4) and men, and the leading causes of TBI were falls and motor vehicle traffic.     

Alarming rise in fall-induced severe head injuries among elderly people

This study assessed the current trend in the number and incidence (per 100,000 persons) of fall-induced severe head injuries among the very old adults in Finland, an EU-country with a well-defined white population of 5.2 million, by taking into account all persons 80 years of age or older who were admitted to our hospitals for primary treatment of such injury in 1970-2004. The number of Finns aged 80 years or older with a fall-induced severe head injury increased considerably between the years 1970 and 2004, from 60 (women) and 25 (men) in 1970 to 745 (women), and 350 (men) in 2004. The relative increases were 1142 and 1300%, respectively. Across the study period, the age-adjusted incidence of injury also showed a clear increase from 1970 to 2004, from 168 to 506 in women (201% increase), and from 172 to 609 in men (254% increase). A similar finding was observed in age-specific incidences. If the age-adjusted incidence of injury continues to rise at the same rate as in 1970-2004 and the size of the 80 year old or older population of Finland increases as predicted (approximately 2.2-fold increase during the coming 25 years), the number of fall-induced severe head injuries in this population will be about 3.4-fold higher in the year 2030 than it was in 2004. In Finnish persons 80 years of age or older, the number of fall-induced severe head injuries shows an alarming rise with a rate that cannot be explained merely by the demographic changes of the population. The finding underscores an increasing influence of falls on well-being of our elderly persons, and therefore, effective fall-prevention actions should be initiated to control this development.     

Women's empowerment and violent death among women and men in Europe: an ecological study

Background

This study examined the association between mortality due to injury and poisoning among men and women in Europe and nine indicators of women's empowerment (i.e. women's challenging of existing power structures that subordinate women).

Methods

A cross-sectional ecological design was used, with 24 countries from the European Union plus two countries within the European Economic Area and Switzerland.

Results

Most of the nine indicators of women's empowerment were unrelated to men's, as well as women's, death rates from injury and poisoning. However, multiple linear regression models showed that a few indicators of women's empowerment were significantly associated with mortality due to injury and poisoning for both women and men. When three Baltic States with considerably higher mortality rates (Latvia, Lithuania and Estonia) were excluded from the analysis, however, only one indicator (female economic activity as a percentage of male economic activity) remained a significant predictor of men's death rates.

Conclusion

These data suggest that some indicators of women's empowerment may be associated with mortality due to injury and poisoning for men, although the association was dependent on which countries were included in the analysis. This highlights the importance of examining in greater detail the influence of changing gender roles on the health behaviours of women and men.