Proportion Of Fatalities Research Articles

Antibacterial Drug Discovery in the Age of Resistance

The lack of new antibacterials for the treatment of serious infections has been broadly recognized as a major unmet medical need for at least a decade. A recent survey of 96 intensive care doctors across Europe showed that 50% have treated at least one patient with a gram-negative pathogen that was totally or almost totally resistant to all antibiotics during the previous six months. This is a dire predicament, as it is expected that no entirely novel mechanism agent for the treatment of gram-negative infections will be launched before 2015. Furthermore, recent experience with H1N1 pandemic influenza emphasizes the urgency of the situation, as bacterial coinfection with MRSA was implicated in a surprising proportion of fatalities. This phenomenon is especially worrying, since few oral treatment options exist for MRSA pneumonia.

Driver-Related Risk Factors in Commercial Motorcycle (Okada) Crashes in Benin City, Nigeria

There has been global concern regarding road traffic injuries. Motorcyclists constitute a high proportion of fatalities in road traffic crashes. Commercial motorcyclists (Okadas) constitute a unique group in this regard. The purpose of this study was to evaluate driver-related risk factors in Okada accidents in Benin City, Nigeria. This was a prospective study. Interviewers administered questionnaires which were used to assess Okada drivers during a two-month period (November-December 2006). A total of 996 Okada drivers were interviewed, 995 males and one female. Their ages ranged from 16-80 years with a mean age of 36.4 +/-2.4 years. In the majority of cases, the maximum educational level achieved was primary or secondary. The majority of Okada drivers (82.8%) took to the Okada business as a last resort. Driver's licenses for Okada operation were possessed by 73.5% of drivers, but only 27.2% had taken a road test before being given a license. No form of training on the use of Okadas was received by 45% of drivers before they commenced operations. Crash helmets were owned by 56.4%, but they did not use them on a regular basis. Inconvenience was the reason provided for poor compliance by 52.7% of drivers. Regular intake of alcohol was present in 39.8% of drivers. Okada drivers are mainly young males with a low level of education who are ill-prepared and ill-equipped for the road. This is a recipe for traffic crash-related injuries and fatal motorcycle crashes. There is an urgent need for job creation, better licensing procedures, road safety education, national legislation, and enforcement of crash helmet laws as well as alcohol breath tests for Okada drivers in Nigeria.

Proposal for territorial distribution of the 2010 EU road safety target

European Union (EU) road safety policies include reduction in road fatalities by 50% during 2000–2010. The original territorial distribution of this target is uniform, as all the territories have to halve the number of fatalities regardless of their previous record. We propose a simple method of distributing the total effort required to reach the EU target of halving fatalities in a territory in such a way that those areas with a higher proportion of fatalities (relative to their populations) have the highest targets and the sum of all of the areas is the 50% reduction. The distribution function we use here is based on an inverse logarithmic function selected from among several alternative functions analyzed in an initial study. This use of weighted distribution functions has been applied since 2000 by the EU in other policies, such as the use of renewable energies. We applied the proposed distribution function to two territorial aggregation levels in the EUROSTAT Nomenclature of Territorial Units for Statistics (NUTS): NUTS0 for EU-15 and EU-25 Member States, and NUTS3 for the 50 Spanish provinces, comparing the new and old targets with the real achievements for the 2000–2006 period, and new and old targets for the 2000–2010 period. This is a simple proposal for modification of target distribution that can be further improved using other parameters, such as road or weather conditions.

Imaging Occult Lesions in the Cervical Spine Facet Joints

Discrete injuries in the lower cervical spine facet joints have been reported in studies of motor vehicle crash victims. We conducted a detailed investigation of these joints from 20 motor vehicle crash fatalities and 22 decedents due to nontraumatic causes, using conventional radiology, computed tomography, and magnetic resonance imaging to examine whether the diagnostic imaging procedures could identify injuries in the facet joints. The diagnostic imaging procedures identified facet joint fractures in 4 of the 19 trauma cases with computed tomography having the highest sensitivity and obtaining good correlation with findings from the microscopical evaluation. No diagnostic imaging procedure could reliably evaluate the integrity of the synovial folds or the joint spaces for bleeding despite microscopical evidence of such findings in these structures in a large proportion of the motor vehicle crash fatalities. This study emphasizes the need for scientific evidence of validity and reliability of advanced diagnostic imaging procedures in forensic settings, in particular, with regard to occult soft tissue lesions, and cautions uncritical use of negative results from these procedures until such evidence has been produced.

A community-based study of case fatality proportion among those who carry out suicide acts

To investigate the case fatality proportion and associated factors in those carrying out suicide acts in Nantou, Taiwan. Data from 1,171 suicide acts (including 973 with deliberate self harm and 198 completed suicides), identified between July 2000 and February 2003, were collected from a population suicide register in Nantou County, Taiwan. Case fatality proportion and the independent effects of demographic factors and suicide method on case fatality were investigated. The overall case fatality proportion was 16.9%, with higher proportions in men (26.3%) and in those aged 65 and over (37.9%). Hanging was the most lethal method (fatality proportion = 81.5%); pesticide was both commonly used and associated with a high case fatality (fatality proportion = 26.3%). Only age (increased with age) and suicide method were found to be independently associated with the risk of fatality. Suicide method and older age are independent predictors of the fatality of suicide acts. Suicide prevention strategy and clinical assessment ought to take into account of these two factors. Diminution of pesticide toxicity and control of access to pesticides are important considerations for suicide prevention in rural Taiwan.

Surgical quality improvement: a simplified method to apply national standards to pediatric trauma care

Background The emerging “pay for performance” national initiative mandates the development of valid metrics for risk stratification and performance assessment. The International Classification Injury Severity Score (ICISS) predicts survival from injury and is calculated as the product of survival risk ratios (SRRs) for a patient's 3 worst injuries. Survival risk ratios are derived as the proportion of fatalities for every International Classification of Diseases, Ninth Edition, Clinical Modification, diagnosis in a “benchmark” population. We hypothesized that the ICISS prediction model derived from the National Pediatric Trauma Registry (NPTR) would accurately predict mortality in an independent sample from a single pediatric trauma center (PTC) and could be applied to the NSQIP methodology to analyze performance. Methods The ICISS survival probabilities (Ps) were calculated for PTC patients using SRRs computed from 102,608 NPTR records. Records with a single diagnosis and Ps of 1 were excluded from the analysis. Receiver operator characteristics analysis (ROC) was used to evaluate the accuracy of Ps to predict mortality. The Hosmer-Lemeshow statistic was used to determine the degree that the NPTR-derived expected probabilities matched the observed mortality profile at the PTC. Program performance from 2000 to 2004 was then evaluated using Ps adjusted by logit transformation to predict expected mortality (E) for each year cohort. Observed mortality divided by expected mortality (O/E) was calculated for each year group to compare PTC performance to the NSQIP standard of one. The influence of injury severity on these results was determined by evaluating the correlation between O/E and mean Ps of each year cohort. Results A total of 1523 records were analyzed. The ROC area under the curve (AUC ) for Ps was .947 (confidence interval, .934-.957). The Hosmer-Lemeshow statistic ( χ 2 = 5.102; df = 8; P = .747, not significant) indicated the model fit the data well. Adjusted O/E ratio after logit transformation of Ps for the PTC demonstrated initial performance slightly below standard (1.000778) followed by performance better than expected for the subsequent 4 years (range, .6466-.9784). The ratio of observed (O) to expected (E) demonstrated no correlation to mean Ps ( r 2 = .378; P = .208). Conclusion These data validate the application of injury diagnosis derived survival probabilities as objective metrics for determining performance using the NSQIP methodology. Incorporation of these objective predictors of expected outcome to calculation of the risk adjusted O/E ratio enables trend analysis of program performance over time. The lack of significant correlation between O/E and mean Ps demonstrates that NSQIP does indeed reflect process of care while adjusting for severity of patient pathologic condition.

Risk Stratification Simplified: The Worst Injury Predicts Mortality for the Injured Children

The International Classification Injury Severity Score (ICISS) uses anatomic injury diagnoses to predict probability of survival (Ps) computed as the product of the survival risk ratios (SRR) of the three most severe injuries. SRRs are derived as the proportion of fatalities for every International Classification of Diseases-9th Revision-Clinical Modification diagnosis in a "benchmark" population. Pediatric-specific SRRs were computed from 103,434 entries in the National Pediatric Trauma Registry. We hypothesized that ICISS was a valid pediatric outcome predictor, and that the child's most severe injury; i.e., the lowest SRR, is the major driver of outcome, which can be used alone to predict survival. Receiver operator characteristic analysis was used to assess the predictive validity of ICISS. SRRs derived from 53,235 phase II patients were used as the training set to calculate the Ps for 50,199 phase III children comprising the test set. The survival probability (Ps) computed from the standard three diagnoses was compared with that computed from only the worst injury (lowest SRR). Records with a single diagnosis or Ps of 1, indicating no mortality potential, were excluded from the analysis. Nagelkerke pseudo R2 defined what proportion of the predicted Ps was the effect of the worst injury alone versus the traditional Ps. A total of 25,239 records with at least two diagnoses with SRRs indicating risk of mortality were analyzed. The area under the receiver operator characteristic curve for traditional Ps was 0.935, compared with 0.932 for that calculated using only the lowest SRR. The difference of 0.003 was not significant (z = 1.061, p = 0.2888, NS). Nagelkerke pseudo R2 for the lowest SRR was 0.455 compared with 0.462 for the traditional three diagnosis Ps, which shows that the majority of Ps predictive power is related to the single injury with the lowest SRR. Further analysis demonstrated that this effect was related to frequency of coexistent injuries with no mortality risk rather than definable difference in severity. These data validate ICISS as predictive of pediatric injury survival. The dominant effect of the worst injury reflects an epidemiologic characteristic of pediatric trauma that will identify specific injuries for best practice analysis and focused injury prevention.

Lessons from the past: Familial aggregation analysis of fatal pandemic influenza (Spanish flu) in Iceland in 1918

The pandemic influenza of 1918 (Spanish flu) killed 21-50 million people globally, including in Iceland, where the characteristics and spread of the epidemic were well documented. It has been postulated that genetic host factors may have contributed to this high mortality. We identified 455 individuals who died of the Spanish flu in Iceland during a 6-week period during the winter of 1918, representing >92% of all fatal domestic cases mentioned by historical accounts. The highest case fatality proportion was 2.8%, and peak excess mortality was 162/100,000/week. Fatality proportions were highest among infants, young adults, and the elderly. A genealogical database was used to study relatedness and relative risk (RR) of the fatal influenza victims and relatives of their unaffected mates. The significance of these RR computations was assessed by drawing samples randomly from the genealogical database matched for age, sex, and geographical distribution. Familial aggregation of fatalities was seen, with RRs for death ranging from 3.75 for first-degree relatives (P < 0.0001) to 1.82 (P = 0.005), 1.12 (P = 0.252), and 1.47 (P = 0.0001) for second- to fourth-degree relatives of fatal influenza victims, respectively. The RRs within the families of unaffected mates of fatal influenza victims were 2.95 (P < 0.0001), 1.27 (P = 0.267), 1.35 (P = 0.04), and 1.42 (P = 0.001), for first- to fourth-degree relatives, respectively. In conclusion, the risk of death from the Spanish flu was similar within families of patients who succumbed to the illness and within families of their mates who survived. Our data do not provide conclusive evidence for the role of genetic factors in susceptibility to the Spanish flu.

Occupational fatalities due to electrocutions in the construction industry

Introduction Occupational fatalities due to contact with electricity account for approximately 9% of all deaths in the construction industry and is the fourth leading cause of death in this industry. Method Differences in the proportions of electrocutions in the construction industry are significantly different from other industries based upon the age of the worker and the source of the electricity. Results This study found that, in the construction industry, the proportion of occupational fatalities due to contact with electric current is significantly higher for workers in the 16 to 19 years old age group. Contact with overhead power lines occurred more frequently with younger workers, while contact with electric wiring, transformers, and related equipment was found to occur more frequently with older workers. The proportion of fatalities due to this event was also found to account for a significantly greater proportion of fatalities in the construction industry overall. Impact on industry The proportions of electrocution fatalities in the construction industry were found to be significantly higher for younger workers when compared to all other industries. Focusing prevention measures toward younger workers who work near overhead power lines could have a significant impact upon death rates. For older workers, the focus should be on those who work on or near transformers, electrical wiring, and components. Across the construction industry, implementation of effective lockout-tagout programs, and verification of energy isolation, can prevent approximately 125 fatalities per year in the construction industry.

Case Fatality Proportion

A precise definition of case fatality proportion for compartmental disease transmission models with disease induced mortality rate is given. This is applied in classical epidemic modeling frameworks to models with multiple infectious stages, with multi-groups, with spatial patches, and with age of infection. It is shown that the case fatality proportion is the sum over all stages of the product of the probability of dying from the disease at a given stage and the probability of surviving to that stage. The derived expressions for case fatality can be used to estimate the disease induced death rates from more readily available data.

Defining the Population-Based Burden of Nosocomial Pneumococcal Bacteremia

The characteristics, risk factors, and outcome of patients with nosocomial pneumococcal bacteremia (NPB) have not been described in large, population-based studies. All episodes of invasive pneumococcal infections reported by Finnish clinical microbiology laboratories (positive blood or cerebrospinal fluid culture) from January 1, 1995, through December 31, 2002, were linked to data in national health care registries and vital statistics to obtain information on the patient's preceding hospitalizations, comorbidities, and outcome of illness. Pneumococcal bacteremia was defined as nosocomial if the first positive blood culture was obtained more than 2 days after hospital admission, or if the patient had been hospitalized for more than 2 days within 7 days of the first positive blood culture. Information on hospital admission was available for 4217 of 4357 persons (96.8%) with invasive pneumococcal infections. We identified 387 NPBs (9.7%) among 3973 pneumococcal bacteremias. Patients with NPB were older (median age, 67 years vs 52 years; P < .001) and were more likely to have at least 1 high-risk condition (other than age > or = 65 years), for which 23-valent pneumococcal polysaccharide vaccine is recommended (59.2% vs 34.6%; P < .001), compared with patients who had community-associated pneumococcal bacteremias. The case fatality proportion at 28 days was higher in patients with NPB than in those with community-associated pneumococcal bacteremias (23.8% vs 10.8%; P < .001). Pneumococcal serotypes included in 23-valent polysaccharide vaccine and 7-valent conjugate vaccine caused 71.5% and 46.1% of NPBs, respectively. A substantial proportion of pneumococcal bacteremias are health care associated. The high prevalence of conditions for which pneumococcal polysaccharide vaccine is recommended provides opportunities for strengthening prevention efforts in these patients at high risk of illness and death.

An analysis of equipment-related fatal accidents in U.S. mining operations: 1995–2005

Despite significant reductions in mining fatalities, the number of these accidents remains high. Based on the number of fatalities per year, a persistent area of concern in mine safety continues to be equipment-related. The study was undertaken in order to more thoroughly characterize equipment-related mining fatalities and to perform an analysis of those that occurred over the last 11-years, from 1995 through 2005. Equipment-related fatalities obtained from the Mine Safety and Health Administration (MSHA) reports are used in this study. Results show that the proportion of total mine fatalities attributable to the equipment ranged from 37% to 88% per year. Among the MSHA equipment subcategories, the greatest proportion of fatalities is related to haul trucks (22.3%), belt conveyors (9.3%), front-end loaders (8.5%), and miscellaneous equipment (36.6%). The relationship between number of equipment-related fatalities and mining experience of the workforce was also examined. Study shows that workers with less than five years of appropriate mining experience constitute 44% of all fatalities that occurred during the period of 1995–2005.

The Epidemiology of Haemophilus influenzae Type b Meningitis in Burkina Faso

Haemophilus influenzae type b (Hib) disease burden studies are important to conduct in African countries that plan to introduce vaccine so that vaccine impact can be documented. We implemented population-based meningitis surveillance in 3 districts of Burkina Faso for 12 months each during 2002-2003 and 2004-2005 using polymerase chain reaction, culture and antigen detection. Lumbar puncture was performed on 1686 patients and 112 had Hib identified. Persons <1, <5, 5-14 and 15+ years of age had annual Hib meningitis incidences of 97, 34, 2.1 and 0.55 per 100,000, respectively; overall case fatality proportion was 25%. During the historic meningitis epidemic season months of December through April, the proportion of purulent cerebrospinal fluid among children aged <5 years that yielded Hib was 27% compared with 30% during other months. Twenty-five of 98 persons with information available were treated with only one or 2 doses of oily chloramphenicol. Among children age <5 years with Hib meningitis, 28% were pretreated with antimalarials and antimalarial pretreatment was associated with delay in hospitalization. In Burkina Faso, Hib meningitis incidence and case fatality proportion are high and thus vaccine could have a substantial impact. While awaiting well-implemented routine infant Hib vaccination, empiric case management for pediatric meningitis in sub-Saharan Africa must recognize that Hib is likely even during the epidemic season. In malaria-endemic areas, pediatric Hib meningitis case management may be adversely affected by the similar presentation of these 2 diseases.

Transmission dynamics of the great influenza pandemic of 1918 in Geneva, Switzerland: Assessing the effects of hypothetical interventions

Recurrent outbreaks of the avian H5N1 influenza virus in Asia represent a constant global pandemic threat. We characterize and evaluate hypothetical public health measures during the 1918 influenza pandemic in the Canton of Geneva, Switzerland. The transmission rate, the recovery rate, the diagnostic rate, the relative infectiousness of asymptomatic cases, and the proportion of clinical cases are estimated through least-squares fitting of the model to epidemic curve data of the cumulative number of hospital notifications. The latent period and the case fatality proportion are taken from published literature. We determine the variance and identifiability of model parameters via a simulation study. Our epidemic model agrees well with the observed epidemic data. We estimate the basic reproductive number for the spring wave R 1 ^ = 1.49 ( 95 % CI: 1.45 – 1.53 ) and the reproductive number for the fall wave R 2 ^ = 3.75 ( 95 % CI: 3.57 – 3.93 ). In addition, we estimate the clinical reporting for these two waves to be 59.7 % ( 95 % CI: 55.7 – 63.7 ) and 83 % ( 95 % CI: 79 – 87 ). We surmise that the lower reporting in the first wave can be explained by a lack of initial awareness of the epidemic and the relative higher severity of the symptoms experienced during the fall wave. We found that effective isolation measures in hospital clinics at best would only ensure control with probability 0.87 while reducing the transmission rate by > 76.5 % guarantees stopping an epidemic.

Causes of casualties and the regulation of occupational health and safety in the shipping industry

The aim of this paper is to investigate maritime safety from an occupational hazards perspective as opposed to a maritime casualty perspective. It is recognised that safety in shipping should encompass casualties arising from accidents occurring in the course of performing normal seafaring duties, not just those arising from technical defects or maritime disasters. The paper discusses an investigation involving a survey of 19 flag states and two detailed studies of records kept at the Hong Kong and Singapore maritime administrations. The results indicate that occupational accidents account for a significant proportion of fatalities at sea. The statistics presented specify the ship types that are most at risk, as well as the types of occupational hazards that can most frequently lead to accidents and fatalities. The results of this study indicate voids in the process of investigating fatalities that relate to occupational accidents. These results also indicate inadequate investigation of events and causes. The creation of a database of such information could potentially be used for the development of appropriate regulations that could prevent fatal and non-fatal occupational accidents through regulatory processes.

Is the number of traffic fatalities in American hospitals decreasing?

Fatality Analysis Reporting System (FARS) data from 1977 to 2002 record a decreasing number of traffic fatalities taken to a hospital compared with traffic fatalities not taken to a hospital. In this study, we calculated the proportions of decedents reportedly taken to a hospital each year in each state, and the proportions surviving at least 1 h. We also used death certificate data from the National Center for Health Statistics (NCHS) for 1979–1999 to categorize the proportion of motor vehicle fatalities in each state by hospital patient status. The annual number of traffic fatalities decreased slightly over the period of observation. The proportion of decedents recorded in FARS as transported to a hospital fell from about 73 to 43%. However, this proportion decreased abruptly at certain times in some states, suggesting previous misclassification. The proportion surviving at least 1 h remained relatively constant. NCHS data showed a decline in the proportion declared dead in hospitals from 62 to 51%, including a decline in the proportion declared dead on arrival (DOA) from 20 to 8%. Along with occasional misclassification in some states, the decrease in cases transported only to be pronounced DOA could explain why FARS data show a decrease in deaths after hospital transport.

Trends in Arkansas Motorcycle Trauma After Helmet Law Repeal

This study aimed to assess the impact of the 1997 Arkansas helmet law repeal on motorcycle registrations, crash and fatality risks, and alcohol involvement in motorcycle crashes. Annual motorcycle registration data for the years 1990 through 2001 were obtained from the Arkansas Department of Finance and Administration. These motorcycle registration data were complemented by the motorcycle crash data from the Arkansas State Police Highway Safety Office and motorcycle fatality data for the state of Arkansas from the Fatality Analysis Reporting System. The impact of the repeal on crash rates, helmet usage, and alcohol involvement was assessed through comparisons of data from before (1993 to 1996) and after (1998 to 2001) the repeal. After the repeal, an increase in motorcycle registrations correlated with a marked rise in the total number of crashes and fatalities; however, fatalities per crash remained virtually the same. The proportion of motorcycle fatalities that were not wearing a helmet increased from 47.0% (47/100) before the repeal to 78.2% (104/133) after the repeal (P = 0.001). The overall percentage of fatal motorcycle crashes involving alcohol use remained unchanged after the repeal (37.6% [29/77] to 38.5% [40/104], P = 0.91), but the percentage of fatal crashes involving drinking nonhelmeted drivers increased from 14.2% (11/77) to 33.6% (35/104) (P = 0.003). Inebriated motorcyclists killed in crashes were overwhelmingly non-helmeted (87.5%, 35/40) after the repeal, up from 37.9% (11/29) before the repeal (P < 0.001). These findings suggest that the repeal of the mandatory helmet law in Arkansas has had a significant adverse effect on road safety.

Pre-hospital coronary care and coronary fatality in the Belfast and Glasgow MONICA populations

The aim of this study was to describe and compare coronary event case fatality and care pathways in two defined populations with access to different models of pre-hospital care provision. Secondary analysis of MONItoring of Trends and Determinants in CArdiovascular Disease (MONICA) population coronary event registers (1988, 1989, 1990, 1992 and 1993). Case fatality at 28 days following an acute coronary event was 6.5% greater in the Glasgow MONICA Project (GMP) population (46.7%) than in the Belfast MONICA Project (BMP) population (40.2%). Pre-hospital case fatality was 33.9% in the GMP population and 28.3% in the BMP population. These differences could not be fully explained by mobile coronary care unit (MCCU) responses in the BMP area. Initial care was provided in hospital for 28.3% of the BMP events and only 7.7% of the GMP events. Additional data collected by the Belfast and Glasgow MONICA investigators support a large difference between the median delay to main medical care in the BMP events (120 min) and the median delay to ward admission in the GMP area (220 min) at this time. Our findings suggest that the delay between coronary event onset and access to specialist coronary care was the most likely critical difference, irrespective of hospital-based MCCU provision in the BMP area. An established 'culture of early intervention' in Belfast may have been an important factor. As a large proportion of coronary event fatalities continue to occur outside hospital, there is a need to strengthen the evidence base underpinning the provision of appropriate skilled care and treatment at the earliest possible opportunity.

Psychobiological Aspects of Panic in SCBA AND SCUBA

ABSTRACTThis review focuses on a series of survey and experimental investigations, led by Professor William P. Morgan, designed to examine the role of panic and anxiety in the etiology of diving-related accidents and deaths. A significant proportion of scuba fatalities have been attributed to panicking while submerged, but these estimates should be considered conservative at best. Morgan's work has demonstrated that most divers report experiencing panic or near-panic incidents at some point in their diving careers and that the phenomenon is not limited to novice or inexperienced divers. Trait anxiety has proven to be a reliable predictor of those individuals prone to panic behavior while wearing a self-contained breathing apparatus, both above and underneath water. Additional investigations have suggested that environmental influences, such as water temperature and thermal apparel, could also be critical factors in the development of panic while diving. Employing a psychobiological perspective, Morgan's research has made an impressive and indelible contribution to the future safety of scuba divers and to the field of sport psychology.

A prospective cohort study to investigate risk factors for horse falls in UK hurdle and steeplechase racing

Equine fatalities during racing continue to be a major welfare concern and falls at fences are responsible for a proportion of all equine fatalities recorded on racecourses. To identify and quantify risk factors for horse falls in National Hunt (NH) racing and to report the frequency of falling and falling-associated fatalities. A prospective cohort study was conducted on 2879 horse starts in hurdle and steeplechase races on 6 UK racecourses. Any horse that suffered a fall at a steeplechase or hurdle fence during the race was defined as a case. Data were obtained by interview and observations in the parade ring and from commercial databases. Multivariable logistic regression models, allowing for clustering at the level of the track, were used to identify the relationship between variables and the risk of falling. There were 124 falling cases (32 in hurdling and 92 in steeplechasing) identified. The injury risk of fallers was 8.9% and fatality risk 6.5%. Duration of journey to the racecourse, behaviour in the parade ring and weather at the time of the race were associated with falling in both hurdle and steeplechase racing. Age, amount of rainfall and going were also associated with falling in steeplechase racing. Falls at fences are significant contributors to equine fatalities during NH racing. Potentially modifiable risk factors identified were the condition of track surfaces and journey time to the racecourse. It is hoped that information from this study may be used in future interventions to improve horse and jockey safety in racing. The study has also identified areas requiring further research, such as equine behaviour and its effect on racing performance, and the effect of light conditions on jumping ability.