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Injury Epidemiology

Injury Epidemiology. An Introduction. Thomas Songer, PhD University of Pittsburgh. readings. What are Injuries?. Causes of Injuries. Abnormal Energy Transfer Mechanical Energy (moving objects) Thermal Electric Chemical Radiation. Energy Transfer and Injuries. Penetrating

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Injury Epidemiology

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  1. Injury Epidemiology An Introduction Thomas Songer, PhD University of Pittsburgh readings

  2. What are Injuries?

  3. Causes of Injuries • Abnormal Energy Transfer • Mechanical Energy (moving objects) • Thermal • Electric • Chemical • Radiation

  4. Energy Transfer and Injuries • Penetrating • Non-Penetrating • Compression • Burn

  5. Percentage of all Injury Deaths Caused by Mechanical Energy, 1986 26% Motor Vehicle Firearms Falls 13% Other Mech. E. Not Mechanical 31% 8% United States Baker, 1992 22%

  6. Motor Vehicle Crashes • Homicide • Suicide • Sports and Recreation • Drownings • Poisonings • Falls • Occupational Injuries • Burns • Asphyxiation

  7. Where does epidemiology tie in?

  8. Leading Causes of Death in Developed Regions, 1990 (Based on number of deaths) 1. Ischemic Heart Disease 2. Cerebrovascular Disease 3. Lung Cancer 4. Lower Respiratory Infections 5. COPD 6. Colon and Rectum Cancer 7. Stomach Cancer 8. Road Traffic Accidents 9. Self-Inflicted Injuries 10. Diabetes Mellitus Global Burden of Disease

  9. Leading Causes of Death Worldwide, 2000 (Based on number of global deaths) 1. Ischemic Heart Disease 2. Cerebrovascular Disease 3. Lower Respiratory Infections 4. HIV/AIDS 5. COPD 6. Perinatal Conditions 7. Diarrhoeal Diseases 8. Tuberculosis 9. Road Traffic Injuries 10. Lung Cancers WHR 2001

  10. Leading Causes of Death in the United States, 1992 (Based on number of deaths) 1. Heart Disease 2. Malignant Neoplasms 3. Cerebrovascular Disease 4. COPD 5. Accidents/Injuries 6. Pneumonia 7. Diabetes mellitus 8. HIV infection 9. Suicide 10. Homicide

  11. Leading Causes of Death, USA, 2000 (number of deaths) 1. Heart Disease 2. Neoplasms 3. Cerebrovascular Disease 4. Chronic Pulmonary Disease 5. Accidents/Injuries 6. Diabetes mellitus 7. Influenza and pneumonia 8. Alzheimer’s Disease 9. Nephritis, nephrotic syndrome 10. Septicemia

  12. Years of Life Lost Prior to Age 70, 1987 Baker, 1992

  13. Motor Vehicle Crash Death Rates among Males by Country, 1980 Age group

  14. Alcohol Involved Crashes by Time of Day Number of Crashes 1991 GES 150 100 Number (thousands) 50 0 6-10 10-2 2-6 6-10 10-2 2-6 Afternoon Early Morning

  15. Do injury patterns differ around the world?

  16. Mortality Rates by Cause of Death deaths per 100,000 population Source: World Bank,Investing in Health, 1993

  17. Injury Mortality Rates of U.S. Male Travelers by Region, 1975,1984 Age Group Hargarten, 1991

  18. Crude Injury Mortality Rates in Males by Level of Economic Development GNP $ 400 760 810 1320 1973 2350 13,160 17,980

  19. Changes in Mortality in Mexico Frenk 1991

  20. Adjusted Male Mortality from Homicide: Selected countries rate per 100,000 pop. 75 1989-1991 60 45 30 15 0 Fra Can Chile USSR Japan Switz Israel USA - white USA- AA

  21. Injury Control

  22. Definitions Prevention • Reducing the incidence of disease • Reducing the prevalence of disease Control • Ongoing programs aimed at reducing the incidence and/or prevalence of disease Last, Dictionary of Epidemiology

  23. A Model of Injury Control Monitor incidence Identify risk factors Intervene Evaluate social Identify genetic morbidity environmental mortality health care cost

  24. Advances in the Epidemiology of Injuries as a Basis for Public Policy William Haddon, MD, MPH Public Health Reports 1980; 95(5):411-421

  25. Environment Host Agent

  26. Injuries and the Epidemiology Triad Human Environment Physical Social Vehicle

  27. Risk factors for motor vehicle crashes Age Gender Experience Human Alcohol Fatigue Failure Design Speed Road Conditions Traffic Weather Vehicular Environmental

  28. The Haddon Matrix use for planning, resource allocation, strategy identification Human Vehicle Environment Pre-event Event Post-event

  29. The Haddon Matrix Human Vehicle Environment Pre-event alcohol night, rain no seat belt no air bag tree too close to road Event slow emergency response Post-event

  30. Crash Injury Prevention Strategies for the International Traveler Traveler Vehicle Environment Avoid alcohol Choose safe cars Avoid night driving Pre-event use seat belts Event Know local medical system Post-event

  31. Ten Methods for Limiting Physical Energy Transfer 1. Prevent the development of energy form 2. Reduce the amount of energy 3. Prevent the energy release 4. Alter the rate of energy release from it’s source or it’s spatial distribution 5. Separate structures from the energy release by space or time

  32. Methods to limit energy transfer... 6. Place a barrier between the released energy and susceptible structures 7. Modify surfaces that can be impacted 8.Strengthen structures susceptible to damage from energy transfer 9. Prevent the extension of existing damage 10. Carry out intermediate and long-term repair and rehabilitation

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