Injury mortality and morbidity in Ireland

1. Injury mortality and morbidity in Ireland Anthony Staines and Mairín Boland for The Injury in Ireland group.

2. Injury in Ireland Group • Anthony Staines (UCD) • Patricia Fitzpatrick (UCD) • Elaine Scallan (FSAI) • Alan Kelly (TCD) • Conor Teljeur (TCD/SAHRU) • Marie Laffoy (ERHA)

3. Background • Major public health problem • Most injuries never come to medical notice • A minority are fatal • Very important cause of acquired long-term disability in children and younger adults

4. Data sources • Three data sources • Irish census 1981,1986,199,1996 • Hipe hospital admissions data 1993-2000 • Mortality data 1980-200

5. Geography • Not much available! • Two geographies • Hipe: city and county level only • Mortality: city, town, and rural areas as well

6. Area populations (1996) • Total 3,626,087 • Hipe geography • City 1,337,271 • Other 2,288,816 • Mortality geography • City 1,337,271 • Urban districts 355,368 • Rural areas 1,933,448

7. Admissions (1993-2000) • Injury admissions by area • No area identified 9,889 • Not in a city 350,432 • In a city 184,035 • Total 544,356

8. Restrictions (Admissions) • Remove 9,889 admissions of people with no fixed abode (537) (0.1%), or normally resident outside Ireland (9352) (1.7%). • Remove 59,181 (10.8%) admissions with no E-code, which cannot be classified as to Cause or Intent. • Exclude 3,098 (0.6%) admissions of people with E-codes indicating only the location of the injury (E8490-E8499). • 472,796 admissions left (86.5%)

9. Admissions by sex • Injury admissions by sex • Females 216,738 • Males 327,618 • Unintentional injury • 396,243 admissions • (83% of eligible cases) • (72% of all cases)

10. Deaths 1981 – 1997 • Total 24,912 • Unintentional 18,185 • Males 12,026 • Females 6,159

11. Areas (Unintentional deaths) • Two level geography • City 6,039 • Other 12,146 • Three level geography • City 6,039 • Urban 1,954 • Rural 10,192

12. Principal questions • Concentrate on unintentional injury • 396,243 admissions • 18,185 deaths • Rates of unintentional injury by area, age and sex • SMR’s/SAR’s comparing cities to the remainder of the country by cause

13. Death rates Males and Females

14. Death rates City and Other

15. Ratios of death rates

16. Death rates City;Urban;Rural

17. Admissions Males and Females

18. Admissions City and Other

19. Ratios of admission rates

20. SMR’s and SAR’s by area

21. SMR’s by cause, City and Other

22. SAR’s by cause, City and Other

23. SAR’s by selected causes, City, Urban, Rural

24. Limitations • Problems of geography • Coarse, and may be unreliable • Problems of coding • External causes often poorly documented in hospital records • May be better for mortality, because of coroners • Definitions of ‘Injury’ • For our purposes, external cause actually coded • Incomplete data • Location coding is poor, for example

25. Conclusions • Substantial differences between injury experience in major cities, and other parts of the country • Observed for deaths and admissions • Fairly consistent ordering for all causes by sex and age • City < Urban < Rural

26. Cause specific variations • Some have obvious explanations • Natural • Machinery • Some not so obvious • Firearm deaths higher in country, but admissions higher in city • ?Suicide vs. Crime • Poisoning • ?Agrochemicals

27. Implications • Need to target injury prevention measures to different areas as well as different age groups • Need to address transport hazards in rural areas • Improve geography on HIPE system! • More systematic training for coders on injury coding