Non-fatal Unintentional Injuries Research Articles

Unintentional non-fatal home-related injuries in Central Anatolia, Turkey: Frequencies, characteristics, and outcomes

Injuries constitute a major public health problem worldwide. Homes are an important setting for non-fatal unintentional injuries. The aim of this study is to determine the frequency, the characteristics, and the outcome of unintentional non-fatal injuries in the household, and to describe the related risk factors through a community-based survey. The study was conducted using a household-based survey design. Eight hundred inhabitants were sampled from the entire population in the city centre by a stratified sampling method in 2004. All unintentional non-fatal home-related injuries occurring in the previous year were registered and examined, making special note of the mechanism of the injuries, the time and place of the incidents and their outcomes. The frequency of unintentional non-fatal home-related injuries requiring some form of medical attention was established as 10.8%. Falls were the most common injuries among all the study groups. Injury rates were highest among the oldest (aged > or =65) and youngest (aged <15) age groups, females, adults having incomes under euro 500, individuals living alone, or the unemployed. Contact with hot objects/substances or hot liquid/gas was the leading mechanism in children 4 years of age or younger, falls ranking second. Falls are a significant problem particularly among older adults. Multiple analysis revealed that participants with low incomes, living alone and single or divorced had a high risk for injury at home. The findings related to disability highlighted a need to focus attention on the prevention of residential falls among the elderly, and the burns and falls among young children. Preventive measures should be prioritised to risk groups such as individuals with low incomes and those living alone.

Cognitive function in childhood and early adulthood and injuries later in life: the Metropolit 1953 male birth cohort

It has been suggested that cognitive function in childhood is a modifiable risk factor for adult injury. This study examines the relationship between cognitive function measured at the age of 12 and 18 years and fatal and non-fatal injuries later in adult life. A total of 11 532 males born in Copenhagen, Denmark in 1953 were followed from 1978 until 2001 with outcomes (death from and hospital admission for unintentional injury) obtained from national registers. At the age of 12 years, 7987 of these cohort members had completed a questionnaire, which included information on cognitive performance. In addition, cognitive test scores measured on most (90%) cohort members were retrieved from the conscription board records (18 years). During follow-up, 100 of the men died as a result of and 2123 had been admitted to hospital at least once for injury. Cognitive function measured at both the age of 12 and 18 years was inversely associated with any form of unintentional injury. Adjustment for educational attainment at the age of 18 years attenuated these associations but did not remove them completely. The association was most evident for falls and poisoning, while associations with other injury types were weaker and disappeared after adjustment for educational status. Cognitive function was associated with repeated hospital admissions for injuries as well as length of hospital stay. We found marked inverse associations between cognitive function measured in ages 12 and 18 years and adult risk of fatal or non-fatal unintentional injury. An overall increase in educational level may result in a reduction in adult injury risk.

A Comparison of Nonfatal Unintentional Injuries in the United States Among U.S.-Born and Foreign-Born Persons

The objective of this research was to compare the risk of nonfatal unintentional injuries between foreign-born and U.S.-born persons. Cross-sectional, nationally representative data were used from the 2000-2003 National Health Interview Survey to compare the risk of injury between 62,267 foreign-born and 322,200 U.S.-born persons. Nonfatal unintentional injuries occurring during the three months prior to the interview were compared by age, gender, education, poverty status, region of residence, family size, and health insurance coverage status. There were a total of 7,654 injured persons with U.S.-born persons having a weighted injury prevalence of 2.3% (95% confidence interval [CI]: 2.2, 2.4) and foreign-born persons having a weighted injury prevalence of 1.2% (95% CI: 1.0, 1.3). With the U.S.-born population as the reference and while controlling for sociodemographic characteristics, the odds ratio of injury risk was 0.54 (95% CI: 0.48, 0.62) for the foreign-born population. Transportation-related injuries occurred more frequently among foreign-born persons than among U.S.-born persons (23.7%, 95% CI: 19.7, 28.3 vs. 15.0%, 95% CI: 14.0, 16.2, respectively). This research is the first step in determining the morbidity from unintentional injuries among the foreign-born population in the U.S.

Psychological symptoms and nonfatal unintentional injuries among Chinese adolescents: a prospective study

Purpose To describe patterns of nonfatal unintentional injuries and investigate the association of psychological symptoms with injury risk among adolescents in Guangxi, China. Methods Adolescents were selected from middle and high school students in Baise City, Guangxi, China. Psychological symptoms at baseline were measured using SCL-90-R and nonfatal unintentional injuries that occurred among participants were recorded using a standardized injury surveillance questionnaire. Annual injury rates per 100 adolescents by adolescents’ demographic and family characteristics were calculated. Student’s t-test and the Chi-square test were used to test differences in mean raw scores of SCL-90-R subscales and injury rates. Relative risks and odds ratios of injury with 95% confidence intervals were calculated in univariate analyses and multivariate logistic models. Results A total of 1474 middle and high school students finished the study. Of them, 442 reported nonfatal unintentional injuries during the study period, resulting in an annual injury rate of 30.3 per 100 adolescents. Boys had a significantly higher injury rate than girls (32.6% vs. 27.4%). Injury rate decreased as the adolescents’ age increased. Compared with adolescents who were not injured, the injured adolescents had higher average raw scores of all subscales of SCL-90-R, with an exception of the subscale for hostility. All SCL-90-R subscales factors, except those for hostility and phobia, were associated with injury risk. After confounding effects of age, gender, and ethnicity were controlled using logistic regression models, SCL-90-R subscales for somatization (OR = 2.00, 95% CI 1.52–2.63), obsessive-compulsiveness (OR = 2.10, 95% CI 1.71–2.58), interpersonal-sensitivity (OR = 1.66, 95% CI 1.34–2.06), depression (OR = 2.00, 95% CI 1.59–2.51), anxiety (OR = 2.08, 95% CI 1.62–2.66), and psychoticism (OR = 1.60, 95% CI 1.26–2.03) were significantly associated with an elevated injury risk. Conclusion Psychological symptoms are associated with an elevated risk of nonfatal unintentional injury among middle and high school students. Mental health services, such as psychological counseling, may help reduce the risk of nonfatal unintentional injuries among Chinese adolescents.

The global burden due to occupational injury

Occupational injuries are a public health problem, estimated to kill more than 300,000 workers worldwide every year and to cause many more cases of disability. We estimate the global burden of fatal and non-fatal unintentional occupational injuries for the year 2000. The economically active population (EAP) of about 2.9 billion workers was used as a surrogate of the population at risk for occupational injuries. Occupational unintentional injury fatality rates for insured workers, by country, were used to estimate WHO regional rates. These were applied to regional EAP to estimate the number of deaths. In addition to mortality, the disability-adjusted life years (DALYs) lost, which measure both morbidity and mortality, were calculated for 14 WHO regions. Worldwide, hazardous conditions in the workplace were responsible for a minimum of 312,000 fatal unintentional occupational injuries. Together, fatal and non-fatal occupational injuries resulted in about 10.5 million DALYs; that is, about 3.5 years of healthy life are lost per 1,000 workers every year globally. Occupational risk factors are responsible for 8.8% of the global burden of mortality due to unintentional injuries and 8.1% of DALYs due to this outcome. Occupational injuries constitute a substantial global burden. However, our findings greatly underestimate the impact of occupational risk factors leading to injuries in the overall burden of disease. Our estimates could not include intentional injuries at work, or commuting injuries, due to lack of global data. Additional factors contributing to grave underestimation of occupational injuries include limited insurance coverage of workers and substantial under-reporting of fatal injuries in record-keeping systems globally. About 113,000 deaths were probably missed in our analyses due to under-reporting alone. It is clear that known prevention strategies need to be implemented widely to diminish the avoidable burden of injuries in the workplace.

Obesity and Risk of Nonfatal Unintentional Injuries

Obesity is recognized as a risk factor for multiple chronic diseases. Yet, it is unclear whether obesity is also associated with an increased risk of nonfatal unintentional injury. A population-based survey was conducted among adults aged > or = 18 years from January 1999 through October 2000. The relationship was investigated between body mass index (BMI), defined as weight in kilograms divided by the square of the height in meters (kg/m2), and risk of nonfatal unintentional injuries among 2575 respondents aged > or = 20 years by comparing percentage of adults between obese and nonobese respondents who had injuries. Multivariate logistic regression further examined this relationship by controlling for confounding demographics. A total of 370 respondents reported injuries in the previous year. We observed a linear dose-response trend among women. An estimated 7.0% of underweight individuals (BMI <18.5) reported injuries. In contrast, 26.0% of men and 21.7% of women with a BMI > or = 35.0 reported injuries. The odds ratio of injuries for individuals with a BMI > or = 35.0 was 2.00 (95% confidence interval=1.07-3.74, p<0.05) after controlling for gender, age, education level, marital status, family poverty status, and area of residence. A marginally significant association between extreme obesity and elevated risk of injuries was observed. Efforts to promote optimal body weight may reduce not only the risk of chronic diseases but also the risk of unintentional injury among overweight and obese individuals.

Non-fatal injuries among adults with activity limitations and participation restrictions

Objective: To investigate non-fatal unintentional injuries among adults with activity/participation limitations. Design: Injuries in the previous 12 months were reported by a stratified probability sample of non-institutionalized adults. Based on...

Gender differences for non-fatal unintentional fall related injuries among older adults

Objectives: To quantify gender differences for non-fatal unintentional fall related injuries among US adults age 65 years and older treated in hospital emergency departments (EDs). Methods: The authors analyzed data...

Does poverty lead to non-fatal unintentional injuries in rural Vietnam?

The aim of this study was to identify associations between poverty at the household level and unintentional injury morbidity. A cohort consisting of 24,874 person-time episodes, representing 24,776 people living in 5,801 households (classified into rich, middle income and poor by local authorities in 1999) was followed during 2000, in order to identify and assess non-fatal unintentional injuries. Incidence rate ratios were calculated using a Poisson regression model. The results showed that poverty was a risk factor for unintentional injuries generally. When looking at different types of injury, poverty was a risk for home, work and “other” injuries, protective for school injuries, while the risk of traffic injuries was not affected. The results also showed that communes in mountainous areas were at higher risk for home, work and other injuries. Overall, poverty was associated with unintentional injury morbidity. However, the relationship varied by sex, age and type of injury. Specifically, poverty increased the risk for children and elderly people being injured at home, and for adults (15 – 59 years) being affected by work injuries.

Fatal and nonfatal unintentional injuries in adult women, United States.

Although we know that injury death rates are lower for women than for men at all ages, we still have a long way to go in exploring the impact of unintentional injuries on women's lives. This paper reviews the leading causes of unintentional injury death and nonfatal injuries for adult women. It also explores selected activities of the Division of Unintentional Injury Prevention (CDC's National Center for Injury Prevention). Data come from the Web-based Injury Statistics Query and Reporting System (WISQARS). Mortality data for the system come from the National Center for Health Statistics (CDC's annual mortality data files). Nonfatal injury data for the system come from the National Electronic Injury Surveillance System (NEISS). Unintentional injuries are the leading cause of death for women ages 18-34 and the eighth leading cause of death for adult women overall. In 2001, 31,400 adult women died as a result of unintentional injuries. Incidents related to motor vehicle traffic were the leading cause of unintentional injury death for women aged 18-74 years. Falls were the leading cause of unintentional injury deaths among women aged 75 years and older. In 2002, unintentional injuries accounted for over 8.6 million emergency department visits for adult women. The leading cause of nonfatal unintentional injury for adult women aged 25 years and older was fall related. Unintentional injury creates an enormous burden on the lives of women. Moving forward in reducing the burden of unintentional injury requires assessing and understanding the impact of these injuries on the lives of women. Further work is needed to develop a strong context and framework for research and dissemination.

Incidence and seasonal variation of injury in rural Vietnam: a community-based survey

Study objective: To describe seasonal effects on injury incidence at the community level and to assess the relative merits of cross-sectional or longitudinal surveillance for injuries in such a setting. Population and methods: This study took place in Bavi district, northern Vietnam, in the context of a longitudinal community surveillance site called FilaBavi. All non-fatal unintentional injuries which occurred in a sample of 24,776 people living in 5801 households were recorded during 2000. Four interview surveys per household were conducted continuously during 2000, each covering a 3-month period of recall. Injury morbidity data were analysed according to gender, age and circumstances of injury. Statistical analyses were based on monthly, quarterly and annual incidence rates with 95% confidence intervals. Significant differences between incidence rates were noted where the 95% confidence interval of the rate ratio excluded unity. Results: There were 1917 persons who experienced a total of 2079 new non-fatal injuries during the period of observation, corresponding to an incidence of 89/1000 person-years. Seasonal variations were found in all types of injury. Overall, the highest incidence rates were observed in July and April, while the lowest monthly rates were found in May and November. Peaks were observed in February and April for traffic injuries, June for work-related injuries, July, August and October for home injuries. A significantly higher incidence rate was found in the third quarter survey (103/1000 person-years, p<0.05). Conclusion: There can be interesting and significant seasonal variations in injury incidence within a community such as seen here in rural Vietnam and these variations have important implications for the design and planning of injury surveillance activities. Seasonal effects may cause invalid assessments of an injury problem if only cross-sectional household surveys are used, demonstrating the need for longitudinal approaches to injury incidence surveillance.

Measure for measure: The quest for valid indicators of non-fatal injury incidence

In this edition of Public Health, McClure and colleagues report on research that considered the criterion validity of indicators based on serious long bone fracture and length of stay in hospital. They found that neither were sensitive or specific indicators for serious injury as defined by an Injury Severity Score (ISS) of 16 or more. They contend that their study findings ‘… strongly support a return to a measure similar in intent to that encapsulated in the original UK Green Paper…’. We contend that their analysis does not provide any empirical evidence to support their view that there should be a return to the Green Paper: Our Healthier Nation indicator. Furthermore, we consider the analyses that they carry out to validate both the Saving Lives: Our Healthier Nation and the serious long bone fracture indicators are flawed. We agree that national (or state) indicators are very influential. They encourage preventive action and resource use aimed at producing favourable changes to these indicators. However, each of the four non-fatal indicators considered in their analysis have problems. Formal validation of existing indicators is necessary and the following aspects of validity should be addressed: face; criterion; consistency; and completeness and accuracy of the source date. Taking into account the current national data systems in England, possible options for one or more national non-fatal unintentional injury indicators have been proposed in our paper. Furthermore, the International Collaborative Effort on Injury Statistics (ICE) Injury Indicators Group is about to embark on the development of a strategic framework for the development of valid indicators of non-fatal injury occurrence.

Measure for measureThe quest for valid indicators of non-fatal injury incidence

In this edition of Public Health , McClure and colleagues report on research that considered the criterion validity of indicators based on serious long bone fracture and length of stay in hospital. They found that neither were sensitive or specific indicators for serious injury as defined by an Injury Severity Score (ISS) of 16 or more. They contend that their study findings ‘… strongly support a return to a measure similar in intent to that encapsulated in the original UK Green Paper…’. We contend that their analysis does not provide any empirical evidence to support their view that there should be a return to the Green Paper: Our Healthier Nation indicator. Furthermore, we consider the analyses that they carry out to validate both the Saving Lives: Our Healthier Nation and the serious long bone fracture indicators are flawed. We agree that national (or state) indicators are very influential. They encourage preventive action and resource use aimed at producing favourable changes to these indicators. However, each of the four non-fatal indicators considered in their analysis have problems. Formal validation of existing indicators is necessary and the following aspects of validity should be addressed: face; criterion; consistency; and completeness and accuracy of the source date. Taking into account the current national data systems in England, possible options for one or more national non-fatal unintentional injury indicators have been proposed in our paper. Furthermore, the International Collaborative Effort on Injury Statistics (ICE) Injury Indicators Group is about to embark on the development of a strategic framework for the development of valid indicators of non-fatal injury occurrence.

Why are people who return from war at increased risk of injury?

In 1990, the United States and its military partners initiated a combined force against Iraq during Operation Desert Shield/Desert Storm (ODS/DS). Shortly after the war, participating soldiers began to report high rates of chronic, unexplained illnesses that they believed might have been related to their service in the Persian Gulf.1-8 There has now been more than a decade of extensive public debate, congressional hearings, clinical evaluations, and research culminating in the expenditure of about $1 billion (US) (LTC James R Riddle, US Air Force, Office of the Assistant Secretary of Defense, Clinical and Program Policy, Pentagon, oral communication, January 13, 2000). In the aftermath of this impressive effort, however, nonbattle injury remains the only documented cause of increased postwar mortality among the soldiers who fought in ODS/DS.9-11 Even during this conflict, unintentional nonbattle injuries were a more common cause of death than battle-related injuries or illnesses.12,13 However, the etiology of this increased risk for injury fatality has not been evaluated, nor have effective intervention strategies been identified. Little information has been published regarding non-fatal injury among deployed veterans of ODS/DS. We do know that nonfatal unintentional injuries and musculoskeletal conditions (which are often related to “old” injuries) comprised the single greatest category of outpatient visits during the war, caused the most days lost from duty, and was the most common reason for evacuation from the Persian Gulf.13,14 A 1996 report found a slight, nonsignificant increase in the risk of hospitalization for postwar injury among deployed veterans compared with nondeployed veterans.15 A more recent study that links active-duty records to civilian and Department of Veterans Affairs data also suggests excess injury morbidity risk following deployment.16 Given that deployed veterans are at greater risk of fatal injury, injury morbidity would also likely be greater. But because few studies have investigated injury morbidity among ODS/DS veterans, we do not know how the frequency or severity of injuries differs for deployed US veterans. Even less is known about possible increases in injury morbidity among US military allied forces. The link between deployment to war zones and subsequent increases in nonbattle injuries is not unique to ODS/DS. Symptoms and health outcomes commonly reported by veterans of ODS/DS, including injuries, are similar to those reported by veterans of other conflicts.17 For example, US veterans of the Vietnam conflict also had greater risk for injuries resulting from motor-vehicle crashes, poisonings, fires and burns, homicide, and suicide after returning home.18-26 An Australian study found that injury accounted for 74% of the postwar mortality among their soldiers who served in Vietnam.27 As with ODS/DS, attention from the media, policy-makers, and researchers on the problems of Vietnam veterans focused almost exclusively on health outcomes other than the observed increased risk of injury mortality. Indeed, many of the mortality studies among Vietnam veterans were initiated in response to concerns from veterans about a possible relationship between exposure to herbicides and increases in cancer risk, and the excess risk of injury was found serendipitously.18-21,23,28

Teenager Injury Panorama in Northern Sweden

ABSTRACTObjectives: To study non-fatal unintentional injuries among teenagers and to suggest preventive measures.Setting: The emergency care unit of the University Hospital, Umeå, Sweden.Methods: All injured teenagers (N= 1044) attending the emergency care unit during 1991 were asked to answer a questionnaire focusing on when, where and how the injury occurred. All available medical records were examined. Data were coded according to the Nordic Medico-Statistical Committees Classification for Accident Monitoring, NOMESCO, and to the Abbreviated Injury Scale, AIS.Results: 1,043 teenagers were treated with sports and transportation related injuries as the most common ones. Most injuries were minor (AIS 1), transportation related injuries had the highest proportion of non-minor injuries (AIS>2), 139 teenagers were admitted for in-patient care. Most injuries occurred during leisure/school time.Conclusions: Sports and transportation related injuries were most frequent. Body weight and length differs among teenagers, we suggest that teenagers should exercise and play together, not only by age, but also to some extent, to height and weight. Curfew laws, a compulsory bicycle helmet law are other injury reducing measures suggested. (Int J Circumpolar Health 2001; 60: 380-390)

Frequency, characteristics, and child and parent risk factors for nonfatal injury in rural children

PURPOSE: We sought to identify child and parent risk factors for nonfatal unintentional injury among rural children.METHODS: Design: cross-sectional health interview survey. Setting: a completely rural midwestern county not adjacent to a metropolitan area. Participants: stratified, random sample of farm, town, and nonfarm, nontown households, including parents of all children aged 0–17 years. Outcome measures: parent-reported injury episodes that occurred in the past 12 months in children that required professional care, restricted normal activities for at least four hours, or resulted in blacking out or losing awareness or memory. Potential risk factors included nine child factors and six parent factors.RESULTS: Of the 621 children in participating households, 137 or 22.1% were injured. Children on a sports team were 1.88 times (95% confidence interval: 1.07 to 3.31) more likely than other children to be injured. Track team members were more likely than non-members to have an injury (54.5% vs. 23.0%, chi square test, p = 0.001), and volleyball team members were more likely than non-members to have an injury (50.0% vs. 29.0%, chi square test, p = 0.009). Unrelated to injury status were the child's gender, rural stratum, emotional health, behavioral problems, impairment or medications. Also unrelated to child injury were the parent's marital status, alcohol dependence, binge drinking, antisocial personality, depression symptoms or fear of child abuse by spouse.CONCLUSIONS: Our findings illustrate the difficulty of discovering clues with potential to aid design of effective childhood unintentional injury prevention policies, programs, and practices. The instruments and processes in our study were of acceptable quality, therefore we failed to asses the true risk factors for childhood injury or our sample size was too small to detect associations with the factors that were included.

The West-Jutland Study on Prevention of Farm Accidents, Phase 1: A Study ofWork Specific Factors in 257 Hospital-treated Agricultural Injuries

The aim of the present study was to obtain detailed knowledge of fatal and nonfatalunintentional injuries and working conditions related to farming for purposes ofdesigning possible preventive interventions. The study is geographically restricted toone county in Denmark with 270,000 inhabitants, 13,835 of whom are engaged in fulltimefarming on 7,922 farms. Most farms are owned and operated by single families.Production is focused on only one of three types: swine, dairy or crop. The study isbased on injuries treated at local hospitals. A total of 257 farm injuries were reportedduring the period 1 January to 31 December 1992. The results do not indicate anysingle preventive effort, but some aspects are considered important. The majority ofinjuries occurred near or in production buildings during work with animals andmachinery. Approximately one-third of the injured persons were employed part-time infarming. A three times higher incidence was seen among 15- to 29-year-old farmersthan among older farmers. Fractures were seen more often after injuries in whichanimals were involved. Seventy-four cases (30.7%) reported unusual conditions on theday of the incident. When asked directly 73 (30.3%) stated that they had changedroutines of work or equipment as a consequence of the injury. Comparisons with otherstudies indicate the necessity of careful data collection on both etiology and injurystatistics.

Association of Smoking and Alcohol Drinking with Residential Fire Injuries

To investigate whether tobacco, alcohol, and their combined use are important risk factors for fire injuries, the authors analyzed data from a population-based case-control study in King County, Washington, between 1986 and 1987. Cases (n = 116) were households with at least one fatal or nonfatal unintentional residential fire injury reported to the Washington State Fire Incident Reporting System from 1984 through 1985. Controls were selected by random digit dialing (n = 256). After adjustment for household size, number of male household members, total household income, and education of the head of the household, the odds ratio for fire injury in households whose members collectively smoked 1-9 cigarettes per day was 1.5 (95% confidence interval (CI) 0.6-4.2) relative to households with no smokers; for 10-19 cigarettes per day, the odds ratio was 6.6 (95% CI 2.5-17.5), and for 20 or more cigarettes per day, it was 3.6 (95% CI 1.9-7.2). Although households with alcohol drinkers who consumed five or more drinks per occasion were found to be at increased risk in the crude analysis, multivariate analysis suggested that this was partly because drinkers tended to live in households with higher smoking levels. Thus, even though households with alcohol drinkers who consume five or more drinks per occasion may be at increased risk of residential fire injury, smoking appears to be the more important underlying risk factor.