Injury%20Epidemiology

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Injury Epidemiology
An Introduction
Thomas Songer, PhD University of Pittsburgh
readings
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What are Injuries?
3
Causes of Injuries

• Abnormal Energy Transfer
• Mechanical Energy (moving objects)
• Thermal
• Electric
• Chemical
• Radiation

4
Energy Transfer and Injuries

• Penetrating
• Non-Penetrating
• Compression
• Burn

5
Percentage of all Injury Deaths Caused by
Mechanical Energy, 1986
26
Motor Vehicle
Firearms
Falls
13
Other Mech. E.
Not Mechanical
31
8
United States Baker, 1992
22
6

• Motor Vehicle Crashes
• Homicide
• Suicide
• Sports and Recreation
• Drownings
• Poisonings
• Falls
• Occupational Injuries
• Burns
• Asphyxiation

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Where does epidemiology tie in?
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Leading Causes of Death in Developed Regions, 1990
(Based on number of deaths)
1. Ischemic Heart Disease
2. Cerebrovascular Disease
3. Lung Cancer
4. Lower Respiratory Infections
5. COPD
6. Colon and Rectum Cancer
7. Stomach Cancer
8. Road Traffic Accidents
9. Self-Inflicted Injuries
10. Diabetes Mellitus
Global Burden of Disease
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Leading Causes of Death Worldwide, 2000
(Based on number of global deaths)
1. Ischemic Heart Disease
2.
Cerebrovascular Disease
3.
Lower Respiratory Infections
4. HIV/AIDS
5. COPD
6. Perinatal Conditions
7. Diarrhoeal Diseases
8. Tuberculosis
9. Road Traffic Injuries
10. Lung Cancers
WHR 2001
10
Leading Causes of Death in the United States, 1992
(Based on number of deaths)
1. Heart Disease
2. Malignant Neoplasms
3. Cerebrovascular Disease
4. COPD
5. Accidents/Injuries
6. Pneumonia
7. Diabetes mellitus
8. HIV infection
9. Suicide
10. Homicide
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Leading Causes of Death, USA, 2000
(number of deaths)
1. Heart Disease
2.
Neoplasms
3.
Cerebrovascular Disease
4. Chronic Pulmonary Disease
5. Accidents/Injuries
6. Diabetes mellitus
7. Influenza and pneumonia
8. Alzheimers Disease
9. Nephritis, nephrotic syndrome
10. Septicemia
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Years of Life Lost Prior to Age 70, 1987
Baker, 1992
13
Motor Vehicle Crash Death Rates among Males by
Country, 1980
Age group
14
Alcohol Involved Crashes by Time of Day
Number of Crashes
1991 GES
150
100
Number (thousands)
50
0
6-10
10-2
2-6
6-10
10-2
2-6
Afternoon
Early Morning
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Do injury patterns differ around the world?
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Mortality Rates by Cause of Death
deaths per 100,000 population
Source World Bank,Investing in Health, 1993
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Injury Mortality Rates of U.S. Male Travelers by
Region, 1975,1984
Age Group
Hargarten, 1991
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Crude Injury Mortality Rates in Males by Level of
Economic Development
GNP 400 760 810 1320 1973 2350 13,160
17,980
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Changes in Mortality in Mexico
Frenk 1991
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Adjusted Male Mortality from Homicide Selected
countries
rate per 100,000 pop.
75
1989-1991
60
45
30
15
0
Fra
Can
Chile
USSR
Japan
Switz
Israel
USA - white
USA- AA
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Injury Control
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Definitions
Prevention

• Reducing the incidence of disease
• Reducing the prevalence of disease

Control

• Ongoing programs aimed at reducing the incidence
  and/or prevalence of disease

Last, Dictionary of Epidemiology
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A Model of Injury Control
Monitor incidence
Identify risk factors
Intervene
Evaluate
social
Identify
genetic
morbidity
environmental
mortality
health care
cost
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Advances in the Epidemiology of Injuries as a
Basis for Public Policy

• William Haddon, MD, MPH

Public Health Reports 1980 95(5)411-421
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Host
Environment
Agent
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Injuries and the Epidemiology Triad
Human
Environment
Physical Social
Vehicle
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Risk factors for motor vehicle crashes
Age Gender Experience
Human
Alcohol Fatigue
Failure Design Speed
Road Conditions Traffic Weather
Vehicular
Environmental
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The Haddon Matrix
use for planning, resource allocation, strategy
identification
Human
Vehicle
Environment
Pre-event
Event
Post-event
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The Haddon Matrix
Human
Vehicle
Environment
Pre-event
alcohol
night, rain
no seat belt
no air bag
tree too close to road
Event
slow emergency response
Post-event
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Crash Injury Prevention Strategies for the
International Traveler
Traveler
Vehicle
Environment
Avoid alcohol
Avoid night driving
Choose safe cars
Pre-event
use seat belts
Event
Know local medical system
Post-event
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Ten Methods for Limiting Physical Energy Transfer

• 1. Prevent the development of energy form
• 2. Reduce the amount of energy
• 3. Prevent the energy release
• 4. Alter the rate of energy release from its
  source or its spatial distribution
• 5. Separate structures from the energy release by
  space or time

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Methods to limit energy transfer...

• 6. Place a barrier between the released energy
  and susceptible structures
• 7. Modify surfaces that can be impacted
• 8.Strengthen structures susceptible to damage
  from energy transfer
• 9. Prevent the extension of existing damage
• 10. Carry out intermediate and long-term repair
  and rehabilitation