Crash costs by body part injured, fracture involvement, and threat-to-life severity. United States, 2000

Global, regional, and national burden of bone fractures in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019

BACKGROUND

Bone fractures are a global public health issue; however, to date, no comprehensive study of their incidence and burden has been done. We aimed to measure the global, regional, and national incidence, prevalence, and years lived with disability (YLDs) of fractures from 1990 to 2019.

METHODS

Using the framework of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we compared numbers and age-standardised rates of global incidence, prevalence, and YLDs of fractures across the 21 GBD regions and 204 countries and territories, by age, sex, and year, from 1990 to 2019. We report estimates with 95% uncertainty intervals (UIs).

FINDINGS

Globally, in 2019, there were 178 million (95% UI 162-196) new fractures (an increase of 33·4% [30·1-37·0] since 1990), 455 million (428-484) prevalent cases of acute or long-term symptoms of a fracture (an increase of 70·1% [67·5-72·5] since 1990), and 25·8 million (17·8-35·8) YLDs (an increase of 65·3% [62·4-68·0] since 1990). The age-standardised rates of fractures in 2019 were 2296·2 incident cases (2091·1-2529·5) per 100 000 population (a decrease of 9·6% [8·1-11·1] since 1990), 5614·3 prevalent cases (5286·1-5977·5) per 100 000 population (a decrease of 6·7% [5·7-7·6] since 1990), and 319·0 YLDs (220·1-442·5) per 100 000 population (a decrease of 8·4% [7·2-9·5] since 1990). Lower leg fractures of the patella, tibia or fibula, or ankle were the most common and burdensome fracture in 2019, with an age-standardised incidence rate of 419·9 cases (345·8-512·0) per 100 000 population and an age-standardised rate of YLDs of 190·4 (125·0-276·9) per 100 000 population. In 2019, age-specific rates of fracture incidence were highest in the oldest age groups, with, for instance, 15 381·5 incident cases (11 245·3-20 651·9) per 100 000 population in those aged 95 years and older.

INTERPRETATION

The global age-standardised rates of incidence, prevalence, and YLDs for fractures decreased slightly from 1990 to 2019, but the absolute counts increased substantially. Older people have a particularly high risk of fractures, and more widespread injury-prevention efforts and access to screening and treatment of osteoporosis for older individuals should help to reduce the overall burden.

FUNDING

Bill & Melinda Gates Foundation.

Using a novel data linkage approach to investigate potential reductions in motor vehicle crash severity - An evaluation of strategic highway safety plan emphasis areas

INTRODUCTION

With the significant number of motor-vehicle fatalities occurring on the nation's roadways in recent years, there exists a need to integrate a more complete range of data sources, available at a regional or statewide level, to effectively evaluate existing safety concerns and quantify their impacts. Crash data alone does not provide ample crash-associated citation, injury, and roadway characteristics; therefore, a more cohesive dataset is required to accurately and completely analyze the true impacts of motor-vehicle crashes. Previously developed strategies linked crash data with citation and roadway inventory data to enhance the identification and optimization of highway safety strategies.

METHOD

The main objective of this research focused on developing a new deterministic linkage between crash and Emergency Medical Services (EMS) data, by utilizing the Massachusetts Crash Data System (CDS) and the Massachusetts Ambulance Trip Record Information System (MATRIS).

RESULTS

After several iterations of match criterion, the validated linkage successfully matched 58.3% of MATRIS records (containing an Injury Cause of Motor Vehicle Crash) to a CDS person record (55011 linked pairs, between 2014 and 2016). The data linkage provided significant insight into injury trends in several highway safety emphasis areas such as roadway departure, speeding-related, and distraction-affected crashes. The findings from this research are twofold: (1) an established process for linking previously separate data sets, and (2) a mechanism for analysis that provides decision-makers and safety professionals with a better measure of crash outcomes.

Entrapment of the urinary bladder: A rare mechanism of bladder injury in pelvic trauma

A pelvic fracture with entrapment of the urinary bladder in the fracture site is a rare pattern of injury. As the “team captains” in the trauma bay and in the care of polytraumatized patients, trauma surgeons must be aware of this entity and its implications. We report a case of acute bladder entrapment in the fracture site of a lateral compression pelvic fracture. A review of the English literature yielded four previous reports, including two patients with delayed diagnosis (Ghuman et al., 2014; Kumar et al., 1980; Wright and Taitsman, 1996; Min et al., 2010 [1–4]).

Kumar and colleagues first documented bladder entrapment by a pelvic fracture in 1980 (Kumar et al., 1980 [2]). Ghuman et al. described a similar case treated with fixation of the pelvic fracture (Ghuman et al., 2014 [1]). Wright and colleagues treated a patient with bladder perforation due to entrapment diagnosed two weeks after a pelvic ring fracture (Wright and Taitsman, 1996 [3]). In this case the bladder injury was repaired, but internal fixation of the pelvis fracture was avoided due to fear of contamination. Finally, Min et al. documented a case of bladder entrapment and perforation presenting six months after non-operative management of a pelvic ring fracture. The female patient developed recurrent UTIs and dyspareunia, and imaging revealed fracture malunion with the bladder entrapped in the fracture site (Min et al., 2010 [4]).

This collection of case reports demonstrates the potential for acute or delayed bladder injury even in seemingly benign pelvic fractures. A high index of suspicion is required to intervene and prevent morbidity from bladder injuries in pelvic trauma. Entrapment of the bladder may require surgical intervention even when the injury pattern would not normally dictate surgery for the pelvis or bladder alone (Bryk and Zhao, 2016 [5]). We describe the diagnosis and surgical management of bladder entrapment and present a brief review of bladder injuries associated with pelvic fractures.

Accident analysis to support the development of strategies for the prevention of brain injuries in car crashes

This study estimated the frequency and risk of Moderate-to-Maximal traumatic brain injuries sustained by occupants in motor vehicle crashes in the US. National Automotive Sampling System - Crashworthiness Data System crashes that occurred in years 2001-2015 with light vehicles produced 2001 or later were incorporated in the study. Crash type, crash severity, car model year, belt usage and occupant age and sex were controlled for in the analysis. The results showed that Moderate concussions account for 79% of all MAIS_brain2+ injuries. Belted occupants were at lower risks than unbelted occupants for most brain injury categories, including concussions. After controlling for the effects of age and crash severity, belted female occupants involved in frontal crashes were estimated to be 1.5 times more likely to sustain a concussion than male occupants in similar conditions. Belted elderly occupants were found to be at 10.5 and 8 times higher risks for sub-dural haemorrhages than non-elderly belted occupants in frontal and side crashes, respectively. Adopted occupant protection strategies appear to be insufficient to achieve significant decreases in risk of both life-threatening brain injuries and concussions for all car occupants. Further effort to develop occupant and injury specific strategies for the prevention of brain injuries are needed. This study suggests that these strategies may consider prioritization of life-threatening brain vasculature injuries, particularly in elderly occupants, and concussion injuries, particularly in female occupants.

Risk of serious injury of occupants involved in frontal crashes of cab-over-type trucks

OBJECTIVES

Truck vehicles (TVs) have a different structure and stiffness than non-TVs and are used commercially for transporting goods. This study aimed to analyze whether truck occupants have a greater risk of serious injury than those of other types of vehicles.

METHODS

Crash data were obtained from the Korean In-Depth Data Analysis Study (KIDAS) for calendar years 2011-2016. Vehicles involved in frontal crash were included and classified into TVs and non-TVs (passenger cars and sports utility vehicles). We compared the demographic characteristics and serious injuries by body region between the 2 groups and analyzed factors that contributed to the serious injury severity from frontal crashes.

RESULTS

The analysis was based on 884 occupants; 177 (20.0%) were in TVs and 707 (80.0%) were in non-TVs. Non-TVs had more frontal airbags deployments than TVs (50.9% vs. 3.4%, P <.01). TV occupants were 4.8 times more likely to have a serious lower extremity (LE) injury (adjusted odds ratio [AOR] = 4.820; 95% confidence interval [CI], 2.407-9.653) and 2.5 times to have a serious abdominal injury (AOR = 2.465; 95% CI, 1.108-5.487) compared to non-TV occupants.

CONCLUSIONS

Truck occupants had more serious LE and abdominal injuries than those of other types of vehicles in frontal crashes. Structural improvement and legislative efforts to develop safety systems are necessary to improve the safety of truck occupants.

Cost analysis of facial injury treatment in two university hospitals in Malaysia: a prospective study

Objective

Facial injury (FI) may occur in isolation or in association with injuries to other parts of the body (facial and other injury [FOI]). The objective of this study was to determine the direct treatment costs incurred during the management of facial trauma.

Materials and methods

A prospective cohort study on treatment cost for FIs and FOIs due to road-traffic crashes in two university hospitals in Malaysia was conducted from July 2010 to June 2011. The patients were recruited from emergency departments and reviewed after 6 months from the date of initial treatment. Direct cost analysis, comparison of cost and length of hospital stay, and Injury Severity Score (ISS) were performed.

Results

A total of 190 patients were enrolled in the study, of whom 83 (43.7%) had FI only, and 107 (56.3%) had FOI. The mean ISS was 5.4. The mean length of stay and costs for patients with FI only were 5.8 days with a total cost of US$1,261.96, whereas patients with FOI were admitted for 7.8 days with a total cost of US$1,716.47. Costs doubled if the treatment was performed under general anesthesia compared to local anesthesia.

Conclusion

Treatment of FI and FOI imposes a financial burden on the health care system in Malaysia.

Incidence and lifetime costs of injuries in the United States

BACKGROUND

Standardized methodologies for assessing economic burden of injury at the national or international level do not exist.

OBJECTIVE

To measure national incidence, medical costs, and productivity losses of medically treated injuries using the most recent data available in the United States, as a case study for similarly developed countries undertaking economic burden analyses.

METHOD

The authors combined several data sets to estimate the incidence of fatal and non-fatal injuries in 2000. They computed unit medical and productivity costs and multiplied these costs by corresponding incidence estimates to yield total lifetime costs of injuries occurring in 2000.

MAIN OUTCOME MEASURES

Incidence, medical costs, productivity losses, and total costs for injuries stratified by age group, sex, and mechanism.

RESULTS

More than 50 million Americans experienced a medically treated injury in 2000, resulting in lifetime costs of $406 billion; $80 billion for medical treatment and $326 billion for lost productivity. Males had a 20% higher rate of injury than females. Injuries resulting from falls or being struck by/against an object accounted for more than 44% of injuries. The rate of medically treated injuries declined by 15% from 1985 to 2000 in the US. For those aged 0-44, the incidence rate of injuries declined by more than 20%; while persons aged 75 and older experienced a 20% increase.

CONCLUSIONS

These national burden estimates provide unequivocal evidence of the large health and financial burden of injuries. This study can serve as a template for other countries or be used in intercountry comparisons.

Assessment of Integrated Pedestrian Protection Systems with Autonomous Emergency Braking (AEB) and Passive Safety Components

OBJECTIVE

Autonomous emergency braking (AEB) systems fitted to cars for pedestrians have been predicted to offer substantial benefit. On this basis, consumer rating programs-for example, the European New Car Assessment Programme (Euro NCAP)-are developing rating schemes to encourage fitment of these systems. One of the questions that needs to be answered to do this fully is how the assessment of the speed reduction offered by the AEB is integrated with the current assessment of the passive safety for mitigation of pedestrian injury. Ideally, this should be done on a benefit-related basis. The objective of this research was to develop a benefit-based methodology for assessment of integrated pedestrian protection systems with AEB and passive safety components. The method should include weighting procedures to ensure that it represents injury patterns from accident data and replicates an independently estimated benefit of AEB.

METHODS

A methodology has been developed to calculate the expected societal cost of pedestrian injuries, assuming that all pedestrians in the target population (i.e., pedestrians impacted by the front of a passenger car) are impacted by the car being assessed, taking into account the impact speed reduction offered by the car's AEB (if fitted) and the passive safety protection offered by the car's frontal structure. For rating purposes, the cost for the assessed car is normalized by comparing it to the cost calculated for a reference car. The speed reductions measured in AEB tests are used to determine the speed at which each pedestrian in the target population will be impacted. Injury probabilities for each impact are then calculated using the results from Euro NCAP pedestrian impactor tests and injury risk curves. These injury probabilities are converted into cost using "harm"-type costs for the body regions tested. These costs are weighted and summed. Weighting factors were determined using accident data from Germany and Great Britain and an independently estimated AEB benefit. German and Great Britain versions of the methodology are available. The methodology was used to assess cars with good, average, and poor Euro NCAP pedestrian ratings, in combination with a current AEB system. The fitment of a hypothetical A-pillar airbag was also investigated.

RESULTS

It was found that the decrease in casualty injury cost achieved by fitting an AEB system was approximately equivalent to that achieved by increasing the passive safety rating from poor to average. Because the assessment was influenced strongly by the level of head protection offered in the scuttle and windscreen area, a hypothetical A-pillar airbag showed high potential to reduce overall casualty cost.

CONCLUSIONS

A benefit-based methodology for assessment of integrated pedestrian protection systems with AEB has been developed and tested. It uses input from AEB tests and Euro NCAP passive safety tests to give an integrated assessment of the system performance, which includes consideration of effects such as the change in head impact location caused by the impact speed reduction given by the AEB.

Crash test rating and likelihood of major thoracoabdominal injury in motor vehicle crashes: the new car assessment program side-impact crash test, 1998-2010

BACKGROUND

The National Highway Traffic Safety Administration's New Car Assessment Program (NCAP) implemented side-impact crash testing on all new vehicles since 1998 to assess the likelihood of major thoracoabdominal injuries during a side-impact crash. Higher crash test rating is intended to indicate a safer car, but the real-world applicability of these ratings is unknown. Our objective was to determine the relationship between a vehicle's NCAP side-impact crash test rating and the risk of major thoracoabdominal injury among the vehicle's occupants in real-world side-impact motor vehicle crashes.

METHODS

The National Automotive Sampling System Crashworthiness Data System contains detailed crash and injury data in a sample of major crashes in the United States. For model years 1998 to 2010 and crash years 1999 to 2010, 68,124 occupants were identified in the Crashworthiness Data System database. Because 47% of cases were missing crash severity (ΔV), multiple imputation was used to estimate the missing values. The primary predictor of interest was the occupant vehicle's NCAP side-impact crash test rating, and the outcome of interest was the presence of major (Abbreviated Injury Scale [AIS] score ≥ 3) thoracoabdominal injury.

RESULTS

In multivariate analysis, increasing NCAP crash test rating was associated with lower likelihood of major thoracoabdominal injury at high (odds ratio [OR], 0.8; 95% confidence interval [CI], 0.7-0.9; p < 0.01) and medium (OR, 0.9; 95% CI, 0.8-1.0; p < 0.05) crash severity (ΔV), but not at low ΔV (OR, 0.95; 95% CI, 0.8-1.2; p = 0.55). In our model, older age and absence of seat belt use were associated with greater likelihood of major thoracoabdominal injury at low and medium ΔV (p < 0.001), but not at high ΔV (p ≥ 0.09).

CONCLUSION

Among adults in model year 1998 to 2010 vehicles involved in medium and high severity motor vehicle crashes, a higher NCAP side-impact crash test rating is associated with a lower likelihood of major thoracoabdominal trauma.

LEVEL OF EVIDENCE

Epidemiologic study, level III.

Variations in car crash-related hospitalization costs amongst young adults in New South Wales, Australia

BACKGROUND

This study aims to examine factors associated with variation in crash-related hospitalization costs for young adults in New South Wales (NSW), Australia with a particular focus on types of vehicle occupant, rurality of residence and socioeconomic status (SES).

METHODS

Data on patients aged 17-25 years, admitted to public hospitals due to a crash during July 2000-June 2007 were extracted from the NSW Health Admission Collection database. The hospitalization cost of each admission was calculated based on published charges for specific Australian Refined-Diagnosis Related Groups (AR-DRG). Multivariable analyses using generalized estimating equations were used to estimate costs by vehicle occupant type (driver, passenger and other occupants), rurality of residence (urban, regional and rural areas) and SES (low, moderate and high SES areas).

RESULTS

During 2000-2007, there were 11,892 crash-related hospitalizations involving young adults, aged 17-25 years, in NSW. These cost the health sector about A$87.6 million or on average, A$7363 per hospitalization (mean length of stay (LOS) 5.3 days). Compared to drivers, passengers had significantly longer LOS (<0.01) as well as higher hospitalization costs (p = 0.04). Regional and rural young adults had significantly longer LOS and higher hospitalization costs compared to urban young adults (p<0.05). Compared with young adults from high SES areas, young adults from moderate SES areas had significantly higher costs (p = 0.02), whilst the higher costs for young adults of low SES areas was borderline significant (p = 0.06), although differences in LOS by SES were not significant.

CONCLUSION

Annually, young adults' crashes in NSW were estimated to cost the health sector at least A$14.6 million between 2001 and 2007. The higher hospitalization costs and LOS for young adults living in regional and rural vs. urban areas, and those living in moderate and low SES vs. high SES areas partly reflects the severity of these crashes and challenges for treatment. Based on these findings, a strong economic argument can be made for targeting prevention strategies to young people living in rural and low SES areas. The area variations in costs also suggest some scope for policy makers to consider potentially more efficient ways of targeting both treatment and preventative programmes.

Multi-disciplinary update on pelvic fracture associated bladder and urethral injuries

Pelvic ring fractures often result in severely injured patients with multiple organ injuries. The most common associated injuries are intraabdominal or urogenital, and urogenital injuries are the most common associated injuries in those with severe pelvic fractures. Prompt and effective diagnosis and management of these injuries is essential to successful outcomes, but this is potentially complicated by poor communication and coordination among the many specialists involved. To address this, we present a multi-disciplinary review of pelvic fracture-associated bladder and urethral injuries that is specifically geared towards orthopaedic, urology, and trauma surgeons caring for these patients.

The relationship between serious injury and blood alcohol concentration (BAC) in fatal motor vehicle accidents: BAC = 0.01% is associated with significantly more dangerous accidents than BAC = 0.00%

AIM

To analyze the severity of automotive injuries associated with blood alcohol concentration (BAC) in increments of 0.01%.

DESIGN/SETTING

Epidemiological study using the Fatality Analysis Reporting System.

PARTICIPANTS

All people in US fatal automotive accidents, 1994-2008 (n = 1 495 667).

MEASUREMENTS

The ratio of serious: non-serious injuries for drivers, by BAC.

FINDINGS

Accident severity increases significantly even when the driver is merely 'buzzed', a finding that persists after standardization for various confounding factors. Three mechanisms mediate between buzzed driving and high accident severity: compared to sober drivers, buzzed drivers are significantly more likely to speed, to be improperly seatbelted and to drive the striking vehicle. In addition, there is a strong 'dose-response' relationship for all three factors in relation to accident severity (e.g. the greater the BAC, the greater the average speed of the driver and the greater the severity of the accident).

CONCLUSIONS

The severity of life-threatening motor vehicle accidents increases significantly at blood alcohol concentrations (BACs) far lower than the current US limit of 0.08%. Lowering the legal limit could save lives, prevent serious injuries and reduce financial and social costs associated with motor vehicle accidents.

Injury outcomes and costs for cross-median and median barrier crashes

INTRODUCTION

The objective of this research was to quantify the injury outcomes and develop reliable and comprehensive injury costs for cross-median crashes (CMC) and median barrier crashes (MBC).

METHOD

A three-step methodology was developed to quantify the crash costs for each crash severity and type. All CMC and MBC between 2001 and 2007 in Wisconsin were identified and used in this analysis. The Wisconsin CODES database provided comprehensive injury costs based on the injury types and severities suffered by participants in study crashes.

RESULTS

As expected, multi-vehicle CMC result in more total injuries and more severe injuries than single-vehicle CMC. Injury costs for the same injury level on KABCO scale are different for different crash types. Injury costs for concrete MBC are 33% to 50% less than those of multi-vehicle CMC, while the injury costs of concrete MBC for lower severities (B and C) are similar to those of single-vehicle CMC for the same severities; but for incapacitating injuries the costs are 30% less. As expected, concrete MBC result in lower severities than CMC. The costs, by crash severity, vary significantly between different crash types. Concrete median barrier injury crashes are roughly 20% of multi-vehicle CMC costs and 50% of single-vehicle CMC costs.

CONCLUSIONS

Results indicate that using one set of crash costs for all crash types biases any evaluation. Therefore, it is recommended that crash-type-specific costs be used in applications such as development of median barrier warrant where specific types of crashes are considered (CMC and MBC).

IMPACT ON INDUSTRY

Using crash specific costs can lead to a more realistic benefit-cost analysis and enable better decision-making.

Commuting by bike in Belgium, the costs of minor accidents

Minor bicycle accidents are defined as "bicycle accidents not involving death or heavily injured persons, implying that possible hospital visits last less than 24 hours". Statistics about these accidents and related injuries are very poor, because they are mostly not reported to police, hospitals or insurance companies. Yet, they form a major share of all bicycle accidents. Official registrations underestimate the number of minor accidents and do not provide cost data, nor the distance cycled. Therefore related policies are hampered by a lack of accurate data. This paper provides more insight into the importance of minor bicycle accidents and reports the frequency, risk and resulting costs of minor bicycle accidents. Direct costs, including the damage to bike and clothes as well as medical costs and indirect costs such as productivity loss and leisure time lost are calculated. We also estimate intangible costs of pain and psychological suffering and costs for other parties involved in the accident. Data were collected during the SHAPES project using several electronic surveys. The weekly prospective registration that lasted a year, covered 1187 persons that cycled 1,474,978 km. 219 minor bicycle accidents were reported. Resulting in a frequency of 148 minor bicycle accidents per million kilometres. We analyzed the economic costs related to 118 minor bicycle accidents in detail. The average total cost of these accidents is estimated at 841 euro (95% CI: 579-1205) per accident or 0.125 euro per kilometre cycled. Overall, productivity loss is the most important component accounting for 48% of the total cost. Intangible costs, which in past research were mostly neglected, are an important burden related to minor bicycle accidents (27% of the total cost). Even among minor accidents there are important differences in the total cost depending on the severity of the injury.

Influence of pre-collision occupant parameters on injury outcome in a frontal collision

Optimal performance of adaptive restraint systems in the vehicle requires an accurate assessment of occupant characteristics including physical properties and pre-collision response of the occupant. To provide a feasible framework for incorporating occupant characteristics into adaptive restraint schemes, this study evaluates the sensitivity of injury risk in frontal collisions to four occupant parameters: mass, stature, posture and bracing level. The numerical approach includes using commercial multi-body software to develop occupant models that span a range of occupant parameters representative of the real-world driver population. Coupled with a multi-body model of the vehicle interior and standard restraint system, risk of occupant injuries within specific body regions are predicted through numerical simulations in conjunction with established injury risk functions. The results show occupant posture to be the most significant parameter affecting the overall risk of injury in frontal collisions. The causal relationship as predicted using the numerical model has been compared to the traffic injury epidemiology findings, and the feasibility of an analytical methodology to provide real-time estimates of injury severity has been discussed. Preliminary estimates from the study indicate that the proposed methodology will provide a framework to optimize restraint performance and potentially reduce the risk of injuries up to 35% (based on parameter-specific optimization), using accurate information regarding the pre-collision occupant characteristics.

Integrated model of simulated occupant injury risk and real medical costs

INTRODUCTION

The purpose of this study was to develop an integrated methodology that links occupant injury risk functions, estimated in the laboratory, with real world medical treatment costs by using the abbreviated injury score (AIS). Using our model, the expected medical treatment costs for crash injuries to various body regions and of different severities can be investigated.

METHODS

First, the simulation results are compared with NHTSA crash data. We used a modified kinematics simulation model that incorporates an F=E(b) function as a supplement to the previous Steffan's model to obtain a more accurate acceleration history a(t). Second, head injury criteria HIC(36) can be calculated from a(t), and we use the injury probability P as a function of HIC(36,) as proposed by Kuppa, to obtain the injury risk function for various AIS values. Third, medical treatment cost models for various AIS values can be calculated by using a regression cost model with real world data. Finally, the injury risk function and medical treatment cost models are linked through AIS values. We establish an integrated methodology and predict medical costs and car safety data using real world police reports, medical treatment costs, and laboratory simulation results.

RESULTS

Using head injuries in frontal crashes as an example, we focus on simulation parameters for different vehicle models, with and without airbags. We specifically examine impact closing speed, Delta-V, and impact directions.

CONCLUSION

Simulation results can be used to supplement insufficient real crash data, in particular DeltaV, and injury risk results from police crash reports.

IMPACT ON INDUSTRY

The proposed integrated methodology may provide the vehicle industry with a new safety assessment method. Real crash data coupling provides consumers with more realistic and applicable information.

The cost of alcohol in California

BACKGROUND

California is the largest alcohol market in the United States. In 2005 alone, Californians consumed almost 14 billion alcoholic drinks, which contributed to many severe and potentially fatal alcohol-related illnesses and conditions. Alcohol use also causes violent and nonviolent crimes, as well as injuries and traffic collisions. While several studies have estimated the magnitude and cost of these problems nationally and others have analyzed underage drinking costs, no overall cost estimate at the state level currently exists for California. We present the first comprehensive estimate of the cost of alcohol consumption in California.

METHODS

For each category of alcohol-related problems, we estimated fatal and nonfatal cases attributable to alcohol use. We multiplied alcohol-attributable cases by estimated costs per case to obtain total costs for each problem. Our estimates are presented in 2 sections, the economic costs, estimated using a human capital approach, and quality-of-life costs estimated using a quality adjusted life year framework.

RESULTS

Alcohol consumption in California led to an estimated 9,439 deaths and 921,929 alcohol-related problems, such as crime and injury in 2005. The economic cost of these problems is estimated at between $35.4 billion and $42.2 billion. Our main estimate is $38.5 billion, of which $5.4 billion was for medical and mental health spending, $25.3 billion in work losses, and $7.8 billion in criminal justice spending, property damage and public program costs. In addition, alcohol is responsible for severe reductions in individuals' quality of life in California. We estimate that the disability caused by injury, the personal anguish of violent crime victims, and the life years lost to fatality are the largest costs imposed by alcohol. The total value for this reduced quality of life in California is between $30.3 billion and $60.0 billion. Our main estimate for quality-of-life costs is $48.8 billion.

CONCLUSIONS

In light of the associated substantial illness, injuries, death, and high cost to society, alcohol consumption in California needs serious attention. In addition, the methods developed in this paper can be expanded to estimate the cost of alcohol in other states.

Medicaid-based child restraint system disbursement and education and the vaccines for children program: comparative cost-effectiveness

OBJECTIVE

Low-income children are disproportionately at risk for preventable motor-vehicle injury. Many of these children are covered by Medicaid programs placing substantial economic burden on states. Child restraint systems (CRSs) have demonstrated efficacy in preventing death and injury among children in crashes but remain underutilized because of poor access and education. The objective of this study was to evaluate the cost-effectiveness of Medicaid-based reimbursement for CRS disbursement and education for low-income children and compare it with vaccinations covered under the Vaccines For Children (VFC) program.

METHODS

A cost-effectiveness analysis was performed of Medicaid reimbursement for CRS disbursement/education for low-income children based on data from public and private databases. Primary outcomes measured include cost per life-year saved, death, serious injury, and minor injury averted, as well as medical, parental work loss, and future productivity loss costs averted. Cost-effectiveness calculations were compared with published cost-effectiveness data for vaccinations covered under the VFC program.

RESULTS

The adoption of a CRS disbursement/education program could prevent up to 2 deaths, 12 serious injuries, and 51 minor injuries per 100,000 low-income children annually. When fully implemented, the program could save Medicaid over $1 million per 100,000 children in direct medical costs while costing $13 per child per year after all 8 years of benefit. From the perspective of Medicaid, the program would cost $17,000 per life-year saved, $60,000 per serious injury prevented, and $560,000 per death averted. The program would be cost saving from a societal perspective. These data are similar to published vaccination cost-effectiveness data.

CONCLUSION

Implementation of a Medicaid-funded CRS disbursement/education program was comparable in cost-effectiveness with federal vaccination programs targeted toward similar populations and represents an important potential strategy for addressing injury disparities among low-income children.

Total costs of bicycle injuries in Norway: correcting injury figures and indicating data needs

Bicycle injuries and fatalities are reported by the police to Statistics Norway. Fatality records from the police are then corrected with Vital Statistics records. However, there is no complete hospital recording that could provide more correct data for bicycle injuries. Bicycle injuries are underreported in official data. There is a nearly complete omission of single bicycle accidents. This disguises societal accident costs and curtails the identification of black spots and effective infrastructure improvements. This paper provides an estimate of total bicycle injuries in Norway and the total costs of these injuries. Application of case study hospital data from Norwegian towns enabled an estimation of the relationship between these data and the official data, including the distribution of injuries by severity. Costs were then assessed by applying official monetary values for given levels of injury severity. Total annual bicycle injury costs are huge, but these costs must be balanced against the benefits of bicycling, related to health and environment. Accident reporting and data should be enhanced to enable a reduction of bicycle injuries.

[Knee injuries of vulnerable road users in road traffic]

BACKGROUND

The purpose of this study was to assess the risk of knee injuries among vulnerable road users, such as pedestrians, bicyclists and motorcyclists.

METHODS

Two different periods (years 1985-1993 and 1995-2003) were compared. Inclusion criteria were furthermore Abbreviated Injury Scale knee 2-3 (AIS(knee)). Technical analysis assessed the type of collision, direction and speed as well as the injury pattern, and different injury scores (AIS, ISS) were examined documented by the accident research unit, which analyses technical and medical data collected shortly after the accident at the scene. This study included 2,580 pedestrians, 2,279 motorcyclists and 4,322 bicyclists from a total number of 22,794 victims in 17,382 accidents.

RESULTS

Among vulnerable road users, 2% (196/9181 patients) had serious ligamentous or bony injuries of the knee. The risk of injury was higher for motorcyclists and bicyclists than for pedestrians. Knee injury severity was higher for pedestrians. Over the course of 18 years, the knee injury risk was significantly reduced in more recent times (35%>28%, p<0.0001). Improved aerodynamic design of car fronts reduced the risk for severe knee injuries significantly (p=0.0015).

CONCLUSIONS

The highest risk for knee injuries among vulnerable road users is encountered by motorcyclists followed by bicyclists and pedestrians. Over time, the knee injury risk for pedestrians could be significantly reduced due to aerodynamic changes of current car fronts. Further modification of the exterior car design might decrease the risk for knee injuries among vulnerable road users.

The health economics of the treatment of long-bone non-unions

A review of the existing evidence on economic costs of treatment of long-bone fracture non-unions has retrieved 9 papers. Mostly the tibial shaft non-unions have been utilised as models for these economic analyses. Novel treatment strategies like BMP-7 grafting, Ilizarov ring external fixation or supplementary use of therapeutic ultrasound devices have been compared with standard methods of treatment focusing on direct and indirect costs and expenses. A cost-identification query was conducted and revealed costs of pound 15,566, pound 17,200 and pound 16,330 for humeral, femoral, and tibial non-unions respectively on a "best-case scenario". The existing scientific evidence can only imply the extent of the economic burden of long-bone non-unions. Further systematic studies are needed to assess the direct medical, direct non-medical, indirect, and monetised quality of life and psychosocial costs of non-unions.

Incidence and lifetime costs of injuries in the United States

BACKGROUND

Standardized methodologies for assessing economic burden of injury at the national or international level do not exist.

OBJECTIVE

To measure national incidence, medical costs, and productivity losses of medically treated injuries using the most recent data available in the United States, as a case study for similarly developed countries undertaking economic burden analyses.

METHOD

The authors combined several data sets to estimate the incidence of fatal and non-fatal injuries in 2000. They computed unit medical and productivity costs and multiplied these costs by corresponding incidence estimates to yield total lifetime costs of injuries occurring in 2000.

MAIN OUTCOME MEASURES

Incidence, medical costs, productivity losses, and total costs for injuries stratified by age group, sex, and mechanism.

RESULTS

More than 50 million Americans experienced a medically treated injury in 2000, resulting in lifetime costs of 406 billion dollars; 80 billion dollars for medical treatment and 326 billion dollars for lost productivity. Males had a 20% higher rate of injury than females. Injuries resulting from falls or being struck by/against an object accounted for more than 44% of injuries. The rate of medically treated injuries declined by 15% from 1985 to 2000 in the US. For those aged 0-44, the incidence rate of injuries declined by more than 20%; while persons aged 75 and older experienced a 20% increase.

CONCLUSIONS

These national burden estimates provide unequivocal evidence of the large health and financial burden of injuries. This study can serve as a template for other countries or be used in intercountry comparisons.

Employer costs of alcohol-involved injuries

BACKGROUND

This study estimates the annual cost of alcohol-related injuries to employers in 1998-2000.

METHODS

Incidence was estimated with occupational injury data, motor vehicle crash data and health care data for 1998-2000. Employer costs were estimated from federal estimates of injury costs by source of payment using data on the percentage of varied payment streams (e.g., health insurance, sick leave) paid by employers.

RESULTS

The annual employer cost of alcohol-related injuries to employees and their dependents exceed US dollars 28.6 billion. Out of this, US dollars 13.2 billion comes from job-related, alcohol-involved injuries. The annual employer cost of motor vehicle crashes in which at least one driver was alcohol-impaired is over US dollars 9.2 billion. Out of this, only US dollars 3.4 billion comes from job-related alcohol involvement.

CONCLUSION

Safety programs can reduce the fringe benefit bill without reducing the benefits offered to employees.

Cost-outcome analysis of booster seats for auto occupants aged 4 to 7 years

OBJECTIVES

The purpose of this work was to analyze the societal return on investment in booster seats and in laws requiring their use in the United States. Booster seats reduce crash-related injury. Their use is mandatory for vehicle occupants aged 4 to 7 years in most of the United States. This study estimates the injury cost savings attributable to booster seat use.

METHODS

Seat cost came from pricing on the Web and at retailers. Costs of passing and enforcing a legal mandate were estimated as a percentage of the costs of seat use. Injury risk when belted absent a seat was computed from national probability samples of crashes in the last years before booster seats entered into general use (1993-1999). Published estimates were used of the percentage of reduction in injuries achieved with booster seats, the mix of diagnoses reduced, and injury cost by diagnosis. The computations used a 3% discount rate. We studied the net cost per quality-adjusted life year saved, benefit-cost ratio, and net savings per seat.

RESULTS

A booster seat costs 30 dollars plus 167 dollars for maintenance and time spent on installation and use. This investment saves 1854 dollars per seat, a return on investment of 9.4 to 1. Even lower bound estimates in sensitivity analysis indicated that society would benefit from the use of booster seats. Seat laws offer a return of 8.6 to 1.

CONCLUSIONS

Belt-positioning booster seats offer a sound return on investment. Booster seat use laws should be passed, publicized, and enforced nationwide.

The employer costs of motor vehicle crashes

The latest published estimate of the cost of US motor vehicle crashes to employers is for 1989. This study estimates annual employer costs in 1998-2000. Incidence was estimated with occupational injury data and motor vehicle crash data for 1998-2000. Employer costs were estimated from Federal estimates of crash costs by source of payment using data on the percentage of varied payment streams (e.g. health insurance, sick leave) paid by employers. Motor vehicle crash injuries on and off the job cost employers almost $60 billion annually, including $16.3 billion in fringe benefit costs; $25.2 billion in property damage, workplace disruption and other non-fringe costs; and $18.4 billion in wage-risk premiums. Traffic safety programmes can reduce the fringe benefit bill without reducing the benefits offered to employees. Eliminating alcohol-impaired and unrestrained driving would save employers $15.2 billion annually.

Crash costs in the United States by crash geometry

MAIN OBJECTIVES

This study was conducted to estimate the costs per crash for three police-coded crash severity groupings within 16 selected crash geometry types and within two speed limit categories (<or=45 and >or=50 mph).

METHODS

We merged previously developed costs per victim by abbreviated injury scale (AIS) score into U.S. crash data files that scored injuries in both the AIS and police-coded severity scales to estimate injury costs, then aggregated the estimates into costs per crash by maximum injury severity.

RESULTS

The most costly crashes were non-intersection fatal/disabling injury crashes on a road with a speed limit of 50 miles per hour or higher where multiple vehicles crashed head-on or a single vehicle struck a human (over 1.69 US dollars and 1.16 million US dollars per crash, respectively). The annual cost of police-reported run-off-road collisions, which include both rollovers and object impacts, represented 34% of total costs.

CONCLUSIONS

This paper provides cost estimates useful for evaluating roadway countermeasures and for designing vehicles to minimize crash harm. It gives unit costs of crashes by type in the coding system used by the police. The costs are in an appropriate form for economic analysis of countermeasures addressing locally defined problems identified by analyzing police crash reports.

Long term medical costs of motor vehicle casualties in Alberta (1999): a population-based, incidence approach

The purpose of this paper is to estimate the long term medical costs attributable to motor vehicle accidents (MVAs) for all persons in Alberta, Canada in 1999, primarily using observational data. Injury claims with personal identifiers for 1999 were reported by the automobile insurance companies. These records were linked to the provincial health registry which covers the entire population. The registry is linked to databases which identify all inpatient and outpatient (including emergency room) visits, physician services, and other health records. Utilization and costs were derived for all casualties who were admitted to hospital or seen in an emergency room, and for a large sample of other (low severity) cases; a sample of matched controls was derived and their costs were also estimated. Actual costs were obtained for 3 years, and longer term costs were projected for subsequent years. Total costs attributable to MVAs were estimated at over $117 million for 1999. Average net costs per casualty, reported by severity group, were: $22.9 thousand for hospital cases; $3.6 thousand for emergency room-only cases; and $157 for other cases. Long term costs were 65% of first year costs for hospitalized cases and 250% for emergency room cases. Overall, aggregate costs for all non-hospital cases exceeded those for hospitalized cases.

Costs of large truck-involved crashes in the United States

This study provides the estimates of the costs of highway crashes involving large trucks by type of truck involved. These costs represent the present value of all costs over the victims' expected life span that result from a crash. They include medically related costs, emergency services costs, property damage costs, lost productivity, and the monetized value of the pain, suffering, and lost quality of life that a family experiences because of death or injury. Based on the latest data available, the estimated cost of police-reported crashes involving trucks with a gross weight rating of more than 10,000 pounds averaged US$ 59,153 (in 2000 dollars). Multiple combination trucks had the highest cost per crash (US$ 88,483). The crash costs per 1000 truck miles however, were US$ 157 for single unit trucks, US$ 131 for single combination trucks, and US$ 63 for multiple combinations.