Health and environmental data supporting injury prevention Ronan Lyons Professor of Public Health

1. Health and environmental data supporting injury preventionRonan LyonsProfessor of Public Health

2. Information for prevention Numbers injured Where injuries occur Preceding activities Exposure to hazardous and safe environments/factors The burden of injuries on individuals and society What works in preventing injuries How to get effective interventions into practice

3. Lots of data Little used Limited quality and completeness Much has been achieved with limited data Opportunities for prevention with linked and integrated data are enormous

4. The magnitude of the injury epidemic (resources) World Health Organization (WHO)publications Reports on road traffic injury prevention and violence http://www.who.int/violence_injury_prevention/en/ Contribution to the Global Burden of Disease/Injuries Centres for Disease Control – NCIPC http://www.cdc.gov/ncipc/ Collaboration for Accident Prevention and Injury Control (CAPIC) www.capic.org.uk South West Public Health Observatory http://www.swpho.nhs.uk/ Injury Observatory for Britain and Ireland (IOBI)

6. Comparison between US/100 and Wales

7. UK Burden of Injuries Research Group A Miskin Group Collaboration – www.miskin-group.org.uk Swansea: Ronan Lyons, Sinead Brophy, Steven Macey, Ceri Phillips, Adrian Evans, Ian Pallister Bristol: Elizabeth Towner, Mariana Brussoni, Jonathon Benger Surrey: Nicola Christie, Judith Sleney Nottingham: Denise Kendrick, Lindsay Groom, Carol Coupland, Frank Coffey Child Accident Prevention Trust (CAPT) – Mike Hayes

8. Data on injuries Health Services: ED data – AWISS, England ED MDS, HASS/LASS- 2002, IDB (EU), NEISS (US). inpatient data Outpatient data GP data Special systems - TARN Emergency Services… Police STATS19 – RTC Police violence datasets Fire Service FDR databases Ambulance Service – MPDS+ HSE – work related injuries RoSPA/MCA - drowning

9. Limited data …. Still useful AWISS has incomplete and some poor quality data but has led to important research studies on prevention

10. AWISS: Injury Prevention Research Identifying areas and types of premises with high injury rates Planning and evaluating interventions: Fractures in older people: Vitamin D trial Fractures in children: playground surfaces Housing and Health: home injuries - safety assessment Targeting road traffic accident prevention Evaluation of a speed reduction partnership. Evaluation of violence prevention initiatives

11. Sources of data on exposures Scientific papers: Ecological studies Cross sectional studies Case control studies Cohort studies GIS and web based sources OS Mastermap Local authority data STATS19 Government statistics Travel surveys Household surveys Web based tools – SafeHome www.safehome.org.uk/

12. Health Information Research Unit (HIRU) If lots can be achieved with datasets alone or used in parallel imagine what could be achieved with data linkage!

13. Health Information Research Unit (HIRU) Funded by Wales Office of Research and Development Part of the strategic infrastructure for research Working in partnership with multiple NHS and non NHS bodies Large scale computing and support from IBM as part of £50 Institute of Life Science development

14. The essence of HIRU’s work . . Linking anonymised data, at individual and ecological levels, across multiple datasets, drawn from operational systems in health services, national databases, clinical datasets and databases in social care, education, housing, transport, etc.

15. HIRU Research Programme Develop methodologies for accessing and combining routine data in ways which do not breech data confidentiality rules and regulations, but which still permit the use of data for a wide range of research purposes. Explore how to use routinely collected and other data to support large scale multi-site intervention and cohort studies and policy relevant research. …… ……

16. Longitudinal Tracking: Patient Journey Analysis Being able to track anonymised individuals across multiple datasets longitudinally has huge potential benefits: Effects of interventions in one sector on others More comprehensive and long term follow up Economic modelling Understanding complex NHS and SS care packages

17. Patient Journey Analysis- Health and Social Care

18. Electronic follow up produces more reliable outcome measures? Two similar large scale Vitamin D trials in similar populations from residential homes, n=3,500 Law et al, 2007 Age and Aging: 3.9/100 Lyons et al, 2007 Osteoporosis International: 7.4/100

19. Integrating health and ecological datasets The physical and built environment influences health and injury occurrence Tremendous opportunity for collaborative work and research between health and local government Development of mapping, GIS and increasing numbers of ecological datasets offers huge potential, particularly when linked to individual health datasets

22. Garmin Forerunner 205 in Car

25. Example of map of casualty locations

26. Traffic calming – Advocacy in Action Study 

27. Social equity in the provision of traffic calming

29. AWISS/HIRU: Health Services Research TRUST related: Thematic Research network for emergency and UnScheduled Treatment Research with Ambulance Service to reduce burden on ED and provide more appropriate care - trials older people who fall to falls services self harm patients to mental health services new referral pathways for patients with an isolated ankle injury.

30. Conclusions Lots can be achieved with limited data UK urgently needs to replace HASS/LASS There are many different data sources – be imaginative Linked data offers huge opportunities Same data can have multiple uses and support