injury epidemiology an introduction readings thomas songer, phd university of pittsburgh
TRANSCRIPT
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Injury EpidemiologyInjury Epidemiology
An Introduction
readings
Thomas Songer, PhDUniversity of Pittsburgh
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What are Injuries?
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Causes of Injuries
• Abnormal Energy Transfer–Mechanical Energy (moving objects)–Thermal–Electric–Chemical
–Radiation
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Energy Transfer and Injuries
• Penetrating• Non-Penetrating• Compression• Burn
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Percentage of all Injury Deaths Caused by Mechanical Energy, 1986
31%
22%
8%
13%
26%
Motor VehicleFirearmsFallsOther Mech. E.Not Mechanical
United StatesBaker, 1992
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• 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 Disease2. Cerebrovascular Disease3. Lung Cancer4. Lower Respiratory Infections5. COPD6. Colon and Rectum Cancer7. Stomach Cancer8. Road Traffic Accidents9. Self-Inflicted Injuries
10. Diabetes Mellitus GlobalBurden of Disease
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Leading Causes of Death Worldwide, 2000(Based on number of global deaths)
1. Ischemic Heart Disease2. Cerebrovascular Disease3. Lower Respiratory Infections4. HIV/AIDS5. COPD
6. Perinatal Conditions7. Diarrhoeal Diseases8. Tuberculosis9. Road Traffic Injuries10. Lung Cancers
WHR 2001
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Leading Causes of Death in the United States, 1992
(Based on number of deaths)1. Heart Disease2. Malignant Neoplasms3. Cerebrovascular Disease4. COPD5. Accidents/Injuries6. Pneumonia7. Diabetes mellitus8. HIV infection9. Suicide
10. Homicide
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Leading Causes of Death, USA, 2000(number of deaths)
1. Heart Disease2. Neoplasms3. Cerebrovascular Disease
4. Chronic Pulmonary Disease5. Accidents/Injuries6. Diabetes mellitus
7. Influenza and pneumonia8. Alzheimer’s Disease
9. Nephritis, nephrotic syndrome10. Septicemia
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Years of Life Lost Prior to Age 70, 1987
0
1000
2000
3000
4000
5000
Injury Cancer CHD AIDS Stroke
Baker, 1992
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Motor Vehicle Crash Death Rates among Males by Country, 1980
0
20
40
60
80
Rat
e pe
r 10
0,00
0 po
p.
USA France Japan GER UK
Age group
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Alcohol Involved Crashes by Time of Day
1991 GES
Number of Crashes
0
50
100
150
Num
ber
(tho
usan
ds)
6-10 10-2 2-6 6-10 10-2 2-6Afternoon Early Morning
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Do injury patterns differ around the
world?
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Mortality Rates by Cause of Death
1
10
100
1000
India China DevelopingCountries
OECDCountries
Comm. NCD Injury
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
0
100
200
300
400
25-34 35-44 45-54 55-64 65+
rate
per
100
,000
Developing Developed
Age Group Hargarten, 1991
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Crude Injury Mortality Rates in Males by Level of Economic Development
0
20
40
60
80
100
120
140
SriLan Egypt Thai Chile Mex Arg Swe USA
pe
r 1
00
,00
0 p
op
ula
tion
GNP $ 400 760 810 1320 1973 2350 13,160 17,980
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Changes in Mortality in Mexico
0
20
40
60
80
100
120
1950 1955 1960 1965 1970 1975 1980
Rat
e p
er 1
00,0
00 p
op.
Injuries Malaria Heart Dis. Diabetes
Frenk 1991
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Adjusted Male Mortality from Homicide: Selected countries
0
15
30
45
60
75
Japan Switz Israel USA - white
USA- AA
rate per 100,000 pop.
Fra Can Chile USSR
1989-1991
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Injury Control
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DefinitionsDefinitions
• Reducing the incidence of disease• Reducing the prevalence of disease
• Ongoing programs aimed at reducing the incidence and/or prevalence of disease
PreventionPrevention
ControlControl
Last, Dictionary of Epidemiology
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A Model of Injury Control
Monitorincidence
Identifyrisk factors
Intervene Evaluate
Identifymorbiditymortality
cost
socialgenetic
environmentalhealth care
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Advances in the Epidemiology of Injuries as a Basis for Public PolicyAdvances in the Epidemiology of
Injuries as a Basis for Public Policy
William Haddon, MD, MPHWilliam Haddon, MD, MPH
Public Health Reports 1980; 95(5):411-421
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HostEnvironment
Agent
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Human
Environment
Vehicle
Injuries and the Epidemiology Triad
PhysicalSocial
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Risk factors for motor vehicle crashes
Human
Environmental
Vehicular
FailureDesignSpeed
AgeGenderExperience
AlcoholFatigue
Road ConditionsTrafficWeather
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The Haddon Matrixuse 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
Event
Post-event
alcohol
no seatbelt
no air bag
night, rain
tree too close to road
slow emergencyresponse
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Crash Injury Prevention Strategies for the International Traveler
Traveler Vehicle Environment
Pre-event
Event
Post-event
Avoidalcohol
use seatbelts
Avoid nightdriving
Know localmedical system
Choosesafe cars
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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 it’s source or it’s 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