Risk Of Fatal Injury Research Articles

Increasing the safety of children's vehicle travel: From effective risk communication to behavior change

Introduction: When installed and used correctly, child safety seats reduce the risk of fatal injury by 71% for infants and 54% for toddlers. However, four out of five safety seats are unintentionally misused. Yet, parents fail to participate in safety-seat checks and other child seat interventions aimed at correcting misuse. Method: Such lack of participation is the focus of this article, which argues that most caregivers are naı̈ve to their own vulnerability for misusing their child's seat. Research on risk perception is discussed as a guide to understanding both the high misuse rate and the lack of participation in interventions designed to correct this public safety problem. Results and Impact: A comprehensive intervention plan that incorporates risk communication techniques for maximum parental participation is proposed that includes three essential components: (a) establishing community locations for parents to turn for safety seat advice, (b) making these locations well known to the public, and (c) increasing caregivers' perceptions of risk of misusing their children's seats.

Association between side air bags and risk of injury in motor vehicle collisions with near-side impact.

Side air bags (SABs) have been introduced in an attempt to reduce the risk of injury in near-side-impact motor vehicle collisions (MVCs). The impact of SABs on MVC-related mortality and morbidity has yet to be evaluated with a large population-based study. The objective of this study was to assess the effectiveness of SABs in reducing the risk of injury or death in near-side-impact MVCs. A retrospective study investigated outboard front seat occupants involved in police-reported, near-side-impact MVCs using data from the General Estimates System (1997-2000). The risk of MVC-related nonfatal and fatal injury for occupants of vehicles with and without SABs was compared. Front seat occupants of vehicles with SABs had a risk of injury similar to that of occupants of vehicles without SABs (risk ratio [RR], 0.96; 95% CI confidence interval [CI], 0.79-1.15). Adjustment for the potentially confounding effects of age, gender, seat belt use, seating position, damage severity and location, and vehicle body type did not meaningfully affect the association (RR, 0.90; 95% CICI, 0.76-1.08). There is no association between the availability of SABs and overall injury risk in near-side-impact MVCs. Future research is necessary to determine the effectiveness of SABs in preventing the injuries for which they were specifically designed.

Vieillissement et gravité des atteintes lésionnelles des victimes d’accident de la circulation routière

This study uses the road traffic accident casualty register for the Rhône Département to investigate how the risk of severe or fatal injury varies according to age and to describe the injuries that explain the severity. Two groups of road users are investigated, car occupants and pedestrians. A NISS score of nine or over is taken to indicate a severe injury. Data analysis reveals that, for both groups, the risk of severe or fatal injury increases with age. The nature and location of the injuries depend on the age and sex of the victims. With regard to severe injuries, elderly female pedestrians are susceptible to fractures of the femur (and the femoral neck) and all parts of the upper limbs. Elderly male pedestrians are mainly exposed to fractures of the femoral neck. The greater vulnerability of severely injured elderly drivers results in thoracic injuries, which are partly explained by seat–belt wearing. The main cause of death, for pedestrians of all ages and young drivers is severe head injuries. Car occupants over the age of fifty more frequently suffer from severe thoracic injuries. These findings should not, however, be allowed to conceal the differences observed in the general population for the two severity criteria we have analyzed (severe injury or death). Mortality (in relation to the general population) is highest for young car occupants, while lethality (the fatality rate amongst those injured) is highest among the elderly. For pedestrians, both mortality and lethality increase with age. These findings are also applicable to the risk of severe injury. They justify the continuation of passive safety research in order to develop protection systems that are appropriate for the characteristics of car occupants. Furthermore, they should help to increase everybody’s awareness of the vulnerability of pedestrians and stimulate the introduction of preventive measures, particularly for seniors.

Unintentional fatal injuries arising from unpaid work at home

Objective: Unpaid work in and around the home is a common and potentially high risk activity, yet there is limited information about the circumstances surrounding resulting injuries. This study aimed...

The influence of alcohol, age and number of passengers on the night-time risk of driver fatal injury in New Zealand

Breath alcohol measurements and other data collected at randomly selected roadside sites were combined with data on fatally injured drivers in crashes occurring on the same weekdays and times (Friday and Saturday nights) at locations matched by the size of the nearest town. A logistic model was fitted to these data for the years 1995–2000 to estimate the effects of alcohol, driver’s age and the influence of passengers carried on the risk of driver fatal injury in New Zealand. The estimated risks increased steeply with increasing blood alcohol concentration (BAC), closely following an exponential curve at levels below about 200 mg/dl (i.e. 0.2%) and increasing less than exponentially thereon. The model fitted to data for drivers under 200 mg/dl showed that risks at all BAC levels were statistically significantly higher for drivers aged under 20 (over five times) and for drivers aged 20–29 (three times) than for drivers aged 30 and over. Further, controlling for age and BAC level, driving with a single passenger was associated with approximately half the night-time risk of driver fatal injury relative to driving either solo or with two or more passengers. According to a recent travel survey, the types of passengers carried at the times of night and days of week studied appear to differ significantly from the types of passengers carried generally, which may lead to different passenger effects on driver behaviour. The high relative risk of teenage drivers means that they reach high risk levels commonly regarded as unacceptable in the field of road safety even at their current legal limit of 30 mg/dl, particularly when more than one passenger is carried in the car.

Compensating Wage Differentials for Fatal and Nonfatal Injury Risk by Gender and Race

Our research examines risk compensation by gender and race using occupation, gender, and race specific fatal and nonfatal injury rates and a data set sufficiently large to produce accurate estimates across fairly narrow groups. The data provide strong evidence that men earn compensating differentials for both fatal and nonfatal injury risk and women earn compensating differentials for nonfatal injury risk. Female wage premiums for nonfatal injury risk exceed male wage premiums by a factor of more than three. Nonfatal injury risk compensation is widespread among the various demographic groups although largest for white women. Fatal injury risk compensation is more isolated with only white and Hispanic males earning significantly higher pay for greater amounts of fatal injury risk.

Restraint Use and Age and Sex Characteristics of Persons Involved in Fatal Motor Vehicle Crashes

The lap and shoulder belt combination can reduce the risk of fatal motor vehicle crash injuries to front-seat occupants by 45% and the risk of moderate-to-critical injuries by 50%. The significant life- and cost-saving potentials of these restraining devices, installed in virtually every vehicle in the United States, are well recognized, but the benefits come only from their actual use. Identified are two demographic characteristics of unrestrained persons involved in fatal crashes, age and sex, to provide a basis for targeting educational and promotional efforts to encourage restraint use among the most vulnerable groups. Analyses are based on 1996 to 2000 crash data from the Fatality Analysis Reporting System, compared with exposure data from the 1995 Nationwide Personal Transportation Survey. This study found that the risk of sustaining fatal injuries in a vehicle crash is reduced by 54% when occupant restraints are used. A much higher proportion of young males in the 16 to 19 and 20 to 24 age groups involved in fatal crashes do not use restraints, about 1.72 and 1.69 times greater, respectively, than those who do use restraints. While females in these age groups are also overrepre-sented, the extent of this excess is less than that of males. This underscores the need to find ways to educate young people, especially young males, about the benefits of restraint use.

On the Measurement of Job Risk in Hedonic Wage Models

We examine the incidence, form, and research consequences of measurement error in measures of fatal injury risk in U.S. workplaces using both Bureau of Labor Statistics and National Intitute of Occupational Safety and Health data. Of the various measures examined the NIOSH industry risk measure produces implicit value of life estimates most in line with both economic theory and the mode result for the existing literature. Because we find non-classical measurement error that differs across risk measures and is not independent of other regressors, innovative statistical procedures need be applied to obtain statistically improved estimates of wage-fatality risk tradeoffs.

An alternate characterization of hazard in occupational epidemiology: years of life lost per years worked.

Standardized mortality ratios (SMRs) and other measures of relative risk by themselves may not suffice as descriptors of occupational hazards for many audiences including decision-makers and those at direct risk from hazardous work. To explore other approaches, we calculated excess years of potential life lost and excess lifetime risk for both lung diseases and fatal injuries in a cohort of uranium miners with historical records of exposure to radon gas. We used relatively simple life table (SMR) methods and also analyzed lung cancer mortality with Poisson regression methods permitting control for smoking. Among uranium miners hired after 1950, whose all-cause SMR was 1.5, 28 percent would experience premature death from lung diseases or injury in a lifetime of uranium mining. On average, each miner lost 1.5 yr of potential life due to mining-related lung cancer, or almost 3 months of life for each year employed in uranium mining. As a consequence of all excess lung disease and injury risks combined, a year of mining was associated with 5.9 months loss of potential life. For each year actually working underground, miners lost more than 8 months of potential life. When controlled for smoking (and healthy worker effect) with Poisson regression, the estimates for radon-related lung cancer effects were slightly larger. Although chronic disease deaths dominated in excess years of life lost (due to radon, silica and possibly other exposures), more years were lost on average per individual injury death (38 yr), than per excess lung cancer (20 yr) or other lung disease death (18 yr). Fatal-injury dominated the potential years of life lost up to about age 40. Years of life lost per years employed provides another, more intuitive summary of occupational mortality risk.

Life dissatisfaction as a predictor of fatal injury in a 20-year follow-up.

To investigate the role of life satisfaction (LS) in fatal injuries with special references to unintentional injuries and whether health status modifies this relationship. A sample of adult Finns unselected for health status (n=29 173) responded in 1975 to a LS scale. Nationwide registry for deaths was used. The dissatisfied were compared with the satisfied by Cox regression. During 1976-1995, 469 fatal injuries occurred, of which 235 were unintentional. Dissatisfaction predicted fatal unintentional [hazard ratio (HR)=2.83; 95% confidence interval (CI) 1.77-4.51] and intentional injury (HR=3.26; 2.01-5.30). The risk of fatal unintentional injury was 7.8-fold (women) and 4.0-fold (men) increased in the sick and dissatisfied compared with the healthy and satisfied. A repeatedly reported dissatisfaction (1975, 1981) provided a HR of 5.17 (1.48-18.0) for unintentional injury death during 1981-1995. The found effect was partly mediated through health behavior and social situation. Life dissatisfaction predicts both unintentional and intentional injury death.

Evaluation of a child safety program based on the WHO Safe Community model

Objectives: To evaluate the outcome of the World Health Organization (WHO) Safe Community model with respect to child injuries. Study design: A population based quasiexperimental design was used. Cross sectional...

Are the self-employed at higher risk of fatal work-related injury?

Objectives. The aim of this paper was to determine if the rates of work-related fatal injury differed between employees and self-employed persons, allowing for differences in their industry and occupation. Methods. The analysis was part of a much larger study of all work-related fatalities that occurred in Australia during the 4-year period 1989–1992 inclusive and which was based on information from coroners’ files. Analysis was based on both practical and legal definitions of self-employment. Unadjusted rates, rates for specific industry and occupation groups, and rates adjusted for differences in industry and occupation distribution were calculated. Results. The unadjusted rate for self-employed persons per 100,000 persons per year (95% CI) was 8.4 (7.5–9.2), which was 70% higher than the employee rate of 5.0 (4.7–5.2). However, after adjustment for industry, the rates were almost identical (self-employed: 5.8; employee: 6.0). Adjustment for occupation still left a 40% higher rate for self-employed persons, but this was probably due to inability to fully adjust for differences at the specific occupation level. Conclusions. There was no strong evidence of an increased fatality rate in self-employed persons compared with employees, once differences in industry and occupation are taken into account. More detailed analysis of specific industry and occupation sub-groups would provide greater insight into this issue.

Socioeconomic inequalities in injury: critical issues in design and analysis.

Injuries continue to place a tremendous burden on the public's health and rates vary widely among different groups in the population. Increasing attention has recently been given to the effects of socioeconomic status (SES) as a determinant of health among both individuals and communities. However, relatively few studies have focused on the influence of SES and injuries. Furthermore, those that have, and the other injury studies that have included measures of SES in their analysis, have varying degrees of conceptual and methodological rigor in their use of this measure. Recent advances in data linkage and analytic techniques have, however, provided new and improved methods to assess the relationship between SES and injuries. This review summarizes the relevant literature on SES and injuries, with particular attention to study design, and the measurement and interpretation of SES. We found that increasing SES has a strong inverse association with the risk of both homicide and fatal unintentional injuries, although the results for suicide were mixed. However, the relationship between SES and nonfatal injuries was less consistent than for fatal injuries. We offer potential explanatory mechanisms for the relationship between SES and injuries and make recommendations for future research in this area.

Risk factors for fatal road traffic accidents in Udine, Italy

In the Province of Udine, Northeast Italy, mortality from road accidents is 37% higher than in the country as a whole. To identify the major risk factors for fatal crashes in this area, we analyzed the Police reports of 10 320 road traffic accidents that occurred from 1991 to 1996. Logistic regression was used to evaluate the association of characteristics of drivers and accidents with accident severity. The risk of involvement in fatal rather than non-fatal accidents was lower among females than among males (odds ratio (OR)=0.65; 95%confidence interval (95%CI), 0.53–0.80). Compared with subjects <30 years of age, subjects aged ≥65 had a significantly increased risk of fatal injury as pedestrians (OR=10.87; 95%CI, 4.45–26.54), car drivers (OR=1.85; 95%CI, 1.08–3.18), moped riders (OR=3.53; 95%CI, 1.42–8.78), and bicycle riders (OR=7.72; 95%CI, 2.56–23.29). In accidents that occurred from 1:00 to 5:00 h the risk of death was higher than from 6:00 to 11:00 h among pedestrians (OR=8.88; 95%CI, 2.58–30.52), car drivers (OR=4.95; 95%CI, 3.09–7.95), motorcycle riders (OR=13.44; 95%CI, 2.54–71.05) and moped riders (OR=8.76; 95%CI, 2.42–31.69). Risk of death among pedestrians, car drivers, moped, and bicycle riders was also significantly increased on roads outside the urban center. Driver's injury was strongly associated with lack of use of seat belts (OR=13.27; 95%CI, 9.39–18.74, for fatal injury; OR=2.49; 95%CI, 2.17–2.86, for non-fatal injury). Simple interventions focused on protecting the weakest road users and based on law enforcement, behavioral change and environmental modification might result in reducing the significant excess of road traffic accident mortality found in the study area.

Evaluation of an inter-organizational prevention program against injuries among the elderly in a WHO Safe Community

The aim of the study was to evaluate the outcome of a participatory community-based prevention program against injuries among the elderly. A population-based quasi-experimental design was used with pre- and post-implementation measurements in an intervention and a control area. The program was based on cross-sectoral participation in detecting and taking action against injuries among the elderly. Change in the relative risk of injury was estimated by the odds ratio. Morbidity in moderately (AIS 2) severe injury in the study area was reduced from 46 per 1000 population years to 25 per 1000 population years (odds ratio 0.55; 95% confidence interval 0.46–0.65), while the minor (AIS 1) injuries increased (odds ratio 1.55; 95% confidence interval 1.21–1.91). The risk of severe or fatal (AIS 3–6) injuries remained constant. In the study area, only a slight decrease in the total morbidity rate was observed (odds ratio 0.87; 95% confidence interval 0.77–0.99). In the control area, there was no evident change in the total morbidity rates. Falls decreased or showed a tendency to decrease in the age groups 65 to 79-y-old in the study area, while they increased in the older age group. The results indicate that no sharp boundaries should be drawn between safety education, physical conditioning, environmental adjustments and secondary prevention measures when planning safety promotion among the elderly. Future studies should address these issues along with the methodological complexity associated with assessment of participatory community-based safety promotion programs. Public Health (2001) 115, 308–316.

Evaluation of an inter-organizational prevention program against injuries among the elderly in a WHO Safe Community

The aim of the study was to evaluate the outcome of a participatory community-based prevention program against injuries among the elderly. A population-based quasi-experimental design was used with pre- and post-implementation measurements in an intervention and a control area. The program was based on cross-sectoral participation in detecting and taking action against injuries among the elderly. Change in the relative risk of injury was estimated by the odds ratio. Morbidity in moderately (AIS 2) severe injury in the study area was reduced from 46 per 1000 population years to 25 per 1000 population years (odds ratio 0.55; 95% confidence interval 0.46–0.65), while the minor (AIS 1) injuries increased (odds ratio 1.55; 95% confidence interval 1.21–1.91). The risk of severe or fatal (AIS 3–6) injuries remained constant. In the study area, only a slight decrease in the total morbidity rate was observed (odds ratio 0.87; 95% confidence interval 0.77–0.99). In the control area, there was no evident change in the total morbidity rates. Falls decreased or showed a tendency to decrease in the age groups 65 to 79-y-old in the study area, while they increased in the older age group. The results indicate that no sharp boundaries should be drawn between safety education, physical conditioning, environmental adjustments and secondary prevention measures when planning safety promotion among the elderly. Future studies should address these issues along with the methodological complexity associated with assessment of participatory community-based safety promotion programs. Public Health (2001) 115, 308–316.

Fatal work related injuries in agricultural production and services to agriculture sectors of New Zealand, 1985–94

OBJECTIVESTo describe work related fatal injuries to agricultural workers in New Zealand to identify priority areas for further research and injury control measures.METHODSInjury deaths in New Zealanders aged 15–84 inclusive...

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

Evaluation of inter-organizational traffic injury prevention in a WHO safe community

The objective of the study was to examine the effect of a community-based injury prevention program on traffic injuries. A population-based quasi-experimental design was used with pre- and post-implementation measurements in an intervention and a control area. The program was based on inter-organizational participation in detecting and taking action against traffic injuries. The total relative risk for traffic injury in the study area showed only a tendency to decrease following program exposure (odds ratio 0.91; 95% confidence interval 0.81–1.02). No change in relative risk was observed in the control area. The analyses of program impact on injury severity showed that the relative risk for moderate injuries in the study area was reduced by almost half (odds ratio 0.59; 95% confidence interval 0.49–0.69), the risk for severe or fatal injuries remained constant (odds ratio 1.27; 95% confidence interval 0.80–2.02), and the risk for minor injuries increased (odds ratio 1.34; 95% confidence interval 1.13–1.59). The relative risk for moderate injuries was reduced by at least half for mopedists, cyclists, pedestrians, and those leaving or entering a motor vehicle. Community-based injury prevention can be a complement to national traffic safety programs.

The calculation of accident risks in fitness for work assessments: diseases that can cause sudden incapacity.

Risk equations have been developed to assist in determining fitness for work of people with diseases that may cause rapid loss of control. The four equations calculate the frequency of fatal injury to the person with the disease, the frequency of fatal injury to colleagues in the workplace, and the cost of fatal injury and property damage to the employer. It is suggested that the additional risk of fatal injury to the person with the disease should not exceed the fatal injury rate in high-risk industries such as forestry, fishing and mining. It is also suggested that the additional risk of fatal injury to each colleague should be no more than one-tenth of the fatal injury rate due to motor vehicle accidents in the community. Two hypothetical case examples are given, demonstrating the use of the equations. The equations highlight the need to examine the risks associated with individuals, their specific jobs and their workplaces. They also highlight significant uncertainties in the determination of fitness, which perhaps have been underestimated in the past. Wherever possible, redundant defences should be utilized to prevent accidents in the event of sudden incapacity.