Gender disparities in injury mortality: consistent, persistent, and larger than you'd think

Trends and Disparities in Firearm Injuries Among Emerging Adults: A 15-Year Analysis of Emergency Department Admissions in the U.S

Introduction

Firearm injuries in the U.S. are rising, with emerging adults (aged 18-24 years) experiencing disproportionately high rates of fatal and nonfatal incidents. This study examines trends, intent-specific patterns, and disparities in fatal and nonfatal firearm injuries among this high-risk age group.

Methods

Data were from the Healthcare Cost and Utilization Project's Nationwide Emergency Department Sample (2006-2020), analyzing emergency department admissions for firearm injuries among participants aged 18-24 years. Firearm injuries were classified by intent (assault, unintentional, intentional self-injury, undetermined, other) using International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification diagnosis codes. Trend analyses, descriptive statistics, and logistic regression models were employed to identify patterns and associations by intent and key socioeconomic and geographic indicators. Analysis was conducted in April 2024.

Results

Firearm injuries increased annually during Quarter 3 and spiked during the COVID-19 pandemic, particularly for unintentional injuries and assaults. Males had significantly higher odds of firearm injury admissions across all intents than females. Intentional self-injury was more prevalent in rural areas, whereas assault and unintentional injuries were higher in urban areas and among those with Medicaid/Medicare insurance or uninsured. Firearm injury admissions were more likely among individuals from ZIP codes with lower median household incomes, except for intentional self-injury, which showed unique patterns across most indicators. The Northeast had substantially lower firearm-related emergency department admissions across all intents than other U.S. regions.

Conclusions

Findings underscore the need for comprehensive strategies to mitigate firearm injuries among emerging adults in the U.S. The significant increase in unintentional firearm injuries and assaults during COVID-19, coupled with the decline in nonfirearm injuries during this time, underscores the complex interplay of social isolation, increased firearm exposure, and broader societal disruptions. Disparities based on sex, insurance status, and geography further emphasize the necessity for public health interventions. Addressing these multifactorial influences and disparities is essential to developing effective, evidence-based policies. Future research should prioritize enhancing data collection on nonfatal firearm injuries and standardizing reporting systems to support these efforts.

Injury recidivism in women with personality disorders reflects an increased risk for both natural and unnatural death

BACKGROUND

A small proportion of patients account for a disproportionate use of emergency healthcare services and exhibit an increased mortality. This group includes individuals with different conditions and risk-taking behaviors. Among them are persons diagnosed with personality disorders, who are particularly susceptible to injuries and intoxications-factors that contribute to an increased risk of premature death, especially from unnatural causes.. In this study in women with a personality disorder diagnosis, we hypothesized that the number of inpatient episodes due to injuries or intoxications would be independently related to the mortality risk for both natural and unnatural causes.

METHODS

A cohort of all women who received a personality disorder diagnosis in the Swedish National Patient Register during the years 1997-2015 (n = 44,221) was followed up until December 31, 2015. All inpatient treatment periods with diagnoses of injuries or intoxications were documented. Information on all deaths was obtained from The Swedish Cause of Death Register.

RESULTS

Multivariable Cox proportional hazards regressions, adjusted for relevant confounders revealed that the number of inpatient care episodes due to injuries or intoxications was independently related to later all-cause mortality, as well as mortality from unnatural and natural causes, and suicidal actions.

CONCLUSIONS

The results motivate particular attention to women with recurrent injuries or intoxications with an assessment of the need for non-emergent measures to decrease the risk of early death, including suicide.

Floods and cause-specific mortality in the United States applying a triply robust approach

The health impact of floods has not been well characterized. This study evaluated long-term associations between cause-specific mortality rates and county-level monthly flood days (excluding coastal floods caused by tropical storms) in the post-flood year in the contiguous U.S., using a triply robust approach incorporating propensity score, counterfactual estimation, and confounder adjustment. Death records came from the CDC National Center for Health Statistics (2001-2020) and floods came from the NOAA Storm Events Database (2000-2020). We found that one flood day was associated with 8.3 (95% CI: 2.5 to 14.1) excess all-cause deaths per 10 million individuals, 3.1 due to myocardial infarction, 2.4 due to respiratory diseases, and 5.9 due to external causes. From 2001 to 2020, 22,376 (95% CI: 6,758 to 37,993) all-cause deaths were attributable to floods. Our findings highlight the long-term health risks after floods, and a need for measures to reduce these risks.

At Home and at Risk: A Study on Pediatric Unintentional Firearm Injuries in the USA

AIM OF THE STUDY

Firearm injury is the leading cause of death among pediatric patients in the United States. Unintentional firearm injury remains underexplored compared to intentional firearm injury. This study aims to characterize risk factors and demographics associated with pediatric unintentional firearm injury.

METHODS

Retrospective analysis of pediatric patients (≤18 years) with firearm injuries from 2017-2022 using the ACS National Trauma Databank. Firearm injuries were identified via ICD-10 codes, classified by intent, and place of injury. Analysis involved univariate, multivariate, and regression models to identify factors associated with unintentional injury.

RESULTS

Of the 42,152 pediatric firearm injuries, 17.6% (n = 8043) were unintentional. Predominantly occurring at home (56.2%), these injuries mostly involved Black (45.7%) or White (42.0%) males (82.3%) aged 12-18 (74.1%). Children aged 2-5 experienced a higher number of unintentional injuries than intentional (1,064 vs. 770). Unintentional injuries were less severe (ISS >16: 10.9% vs. 17.3%, p<0.001) and less fatal (6.7% vs. 12.6%, p<0.001) compared to intentional injuries. Children aged 2-5 had higher odds of unintentional injury (OR 1.98, p<0.001), while adolescents aged 12-18 had lower odds (OR 0.32, p<0.001). Injuries at home were associated with higher odds of being unintentional (OR 1.61, p<0.001), while those on streets or roads were more likely intentional (OR 0.34, p<0.001).

CONCLUSIONS

Unintentional firearm injuries, while less severe and fatal, represent a substantial proportion of pediatric firearm trauma in the U.S. These injuries pose significant risks to younger children, often in domestic settings.

LEVELS OF EVIDENCE

III.

Sex-, age- and season-specific variations in accidental deaths from stumbling falls, bathtub drowning, food choking and traffic injuries among older adults in Japan

AIM

The aim of this study was to identify opportunities for more effective measures. We analyzed sex-, age- and season-specific trends in unintentional accidental deaths from stumbling falls, bathtub drowning, food choking and traffic injuries among older adults in Japan.

METHODS

Death rates from major unintentional accidents were analyzed by sex, month and 5-year age groups (aged ≥50 years) based on a custom-made aggregation of data from the Vital Statistics survey (2008-2022) in compliance with the Statistics Act.

RESULTS

From 2008 to 2022, death rates from the 4 major unintentional accidental causes (11 354 and 11 374 deaths in 19 408 000 men and 24 272 000 women aged ≥60 in 2022) were obviously higher among older men than older women, except for notably high death rates from bathtub drowning among women aged 75-84 years. Significant increases in death rates from stumbling falls were observed in men and women aged ≥85 years, with significant decreases among men aged 60-74 years and women aged 65-74 years. Significant increases in bathtub drowning death rates were observed among men aged 90-94 and ≥100 years, as well as among women aged 90-99 years. Bathtub drowning death rates rose with age but peaked in women aged 85-89 years. Both bathtub drowning and food choking deaths were more frequent during the winter season.

CONCLUSIONS

Accidental deaths from stumbling falls and bathtub drowning continue to rise among older Japanese adults in some age groups. Notably, deaths from bathtub drowning were distinctively higher among women aged in their 70s and 80s, possibly including apparently healthy women, during the winter season. Geriatr Gerontol Int 2025; 25: 287-293.

Clinical Outcomes and Patterns of Traumatic Injuries Associated with Subway Incidents at a Level 1 Trauma Center

OBJECTIVES

Subway-related accidents have risen with advancements in the system. We aim to study the injury patterns from these incidents.

METHODS

This is a retrospective study from a single center, covering patients from 1 January 2016 to 31 December 2023. Patients were identified using International Classification of Diseases (ICD) injury descriptions and Abbreviated Injury Scale (AIS) body regions.

RESULTS

Out of 360 patients (total), 23.5% presented with head injuries with an AIS score ≥ 3. Patients with blunt trauma (93.99%) were in higher numbers than penetrating (5.74%) and burn trauma (0.3%). Overall, the mean Injury Severity Score (ISS) was 10.69, suggesting a broad range of traumatic injuries. ISSs for severe injuries (17-24) comprised 9.2%, moderate injuries (10-16) comprised 17.5%, and minor injuries (1-9) comprised 60.8%. Falls had the highest percentage of traumatic brain injuries (TBI) (65.60%) and fractures (67.50%). Assaults showed a significant occurrence of traumatic thoracic injuries (28.90%). Suicide attempts demonstrated a high percentage of traumatic amputations (30.80%). In the emergency department (ED), most patients (69.4%) were admitted for further care, such as trauma, neurosurgery, or other care. Of these patients, 0.5% died in the ED, 0.5% died on arrival, and 1.04% died within 15 min of arrival. The mortality rate among serious fall patients was 17.20% compared to the suicide and train-struck groups at 37.90% each.

CONCLUSIONS

There were high occurrences of TBIs, and fractures, thoracic injuries, and amputations. Numbers of patients with blunt trauma were a lot higher than those with penetrating and burn trauma. The mortality rates observed in the suicide and train-struck groups were higher than those in patients with severe falls.

Unintentional drowning fatalities in Sweden between 2002 and 2021

BACKGROUND

Despite declining over the past three decades, unintentional drownings still account for an estimated 236 000 annual deaths worldwide. Susceptibility persists amongst demographic groups and is influenced by sex, age, and socio-economic status, emphasizing the need for targeted interventions. Due to rapidly evolving population dynamics, particularly within Europe, there is a further responsibility to understand the impact of ethnicity on the risks of drowning to guide prevention.

METHODS

We conducted a national population-based retrospective study using data from the Swedish National Board of Forensic Medicine and Statistics Sweden for the years 2002 to 2021. The analysis includes variables such as age, sex, presence of alcohol and narcotics as well as activity undertaken at the time of drowning and type of water body. Furthermore, we considered ethnicity to identify subpopulations at greater risks.

RESULTS

Results revealed a plateau in unintentional drowning rates in Sweden since 2012, despite an overall decrease from 2002 to 2021. Findings confirm the trend that males are overrepresented within drowning statistics across all age groups, and that individuals aged > 50 constitute over half of all unintentional drownings. Men aged between 40-69 years boating, and individuals of non-Swedish origin, particularly those < 20 years of age, face a notably greater risk of drowning, underscoring the need for subpopulation-targeted prevention strategies.

CONCLUSION

The ten-year plateau in unintentional drowning signals the need for an official national prevention strategy with annual evaluations. Suggestions also include improved parental supervision of children, further avoidance of alcohol while swimming and boating, as well as targeted swimming lessons and water competency training for individuals of non-Swedish origin.

Short-Term and Long-Term Mortality Risk After Preterm Birth

Importance

Preterm birth (PTB) is a leading cause of neonatal mortality. However, evidence on mortality beyond the neonatal period is limited, especially in North America.

Objective

To examine associations of PTB with all-cause and cause-specific mortality from birth through 23 to 36 years of age.

Design, Setting, and Participants

This population-based matched cohort study of live births in Canada included individuals born between January 1, 1983, and December 31, 1996, and followed up until December 31, 2019. Data were analyzed from June 1, 2023, to April 30, 2024.

Exposure

PTBs, between 24 and 37 weeks' gestation (with gestational age [GA]-specific subcategories of 24 to 27 weeks, 28 to 31 weeks, 32 to 33 weeks, and 34 to 36 weeks) compared with term births (37-41 weeks' gestation).

Main Outcomes and Measures

All-cause mortality and cause-specific mortality were the main outcomes. Risk differences (RDs) and risk ratios (RRs) were estimated for all-cause mortality using log-binomial regressions and hazard ratios were estimated for cause-specific mortality using Cox proportional hazards regression models (censoring individuals who died from other causes) within prespecified age intervals (ages 0-11 months and ages 1-5, 6-12, 13-17, 18-28, and 29-36 years). Observed confounding was accounted for using coarsened exact matching on baseline characteristics.

Results

Of 4 998 560 births (54.2% male), 6.9% were born preterm (with GA-specific subcategories of 0.3% born at 24-27 weeks, 0.6% at 28-31 weeks, 0.8% at 32-33 weeks, and 5.1% at 34-36 weeks). During a median of 29 years of follow-up, 72 662 individuals died (14 312 born preterm and 58 350 at term). PTB was associated with an increased risk of death in all age intervals, with the highest RDs and RRs from birth through infancy (ages 0-11 months) (RD, 2.29% [95% CI, 2.23%-2.35%]; RR, 11.61 [95% CI, 11.09-12.15]) and in early childhood (ages 1-5 years) (RD, 0.34% [95% CI, 0.31%-0.36%]; RR, 2.79 [95% CI, 2.61-2.98]) and the lowest RDs and RRs among those between ages 18 and 28 years (RD, 0.07% [95% CI, 0.04%-0.10%]; RR, 1.13 [95% CI, 1.07-1.19]). We identified increased risks of mortality associated with several causes, including respiratory, circulatory, and digestive system disorders; nervous system, endocrine, and infectious diseases; cancers; congenital malformations; and conditions originating in the perinatal period. No associations were found for external causes of deaths. Associations by GA categories suggested lower risks with higher GA.

Conclusions and Relevance

The findings of this population-based matched cohort study suggest that individuals born preterm were at an increased risk of death from birth until their third and fourth decades of life, with higher risks as GA decreased. Some of these associations may have been partly due to underlying health determinants that affected PTB and mortality. These findings suggest that PTB should be recognized as a risk factor for mortality and could inform preventive strategies.

Contributions of injury deaths to the changes in sex gaps in life expectancy and life disparity in the Nordic countries in the 21st century

OBJECTIVE

The objective of this study was to provide novel comparative insights on the contributions of injury deaths to the changes in sex gaps in life expectancy (SGLE) and sex gaps in life disparity (SGLD) across Nordic countries.

STUDY DESIGN

Retrospective demographic analysis of aggregated mortality data.

METHODS

To compute life expectancy (LE)/life disparity (LD), annual data on age- and sex-specific causes of death from the World Health Organization mortality database were used to construct abridged life tables for two periods: 2000-2002 and 2016-2018 (2014-2016 for Norway). The contributions of injury deaths to the changes in the SGLE and SGLD between these two periods were decomposed by age and cause using a continuous-change model.

RESULTS

Females' LE and LD advantages due to injury deaths narrowed by 0.16-0.44 (0.06-0.35) years for LE (LD) over time. While self-inflicted injuries consistently played a predominant role in contributing to the SGLE/SGLD in all countries in both periods, in all countries but Finland, transport accidents had the greatest contributions to the narrowing SGLE/SGLD. Widening SGLE due to self-inflicted injuries in Iceland and due to falls in Sweden were unique to these countries. Accounting for >20% of total contributions of injury deaths, the age group of 20-24 years had the greatest contributions to the narrowing SGLE/SGLD. Deaths due to falls in older ages and assault in younger ages generally contributed to the widening SGLE/SGLD.

CONCLUSIONS

Injury deaths, particularly transport accidents, contributed significantly to the narrowing SGLE and SGLD across Nordic countries, with cross-country variations in age- and cause-specific patterns. The results suggest the need for injury prevention policies targeting self-inflicted injuries in younger and falls in older males.

Characterizing emergency department surgical airway placement in the setting of trauma

INTRODUCTION

Airway management is a key intervention during the resuscitation of critically ill trauma patients. Emergency surgical airway (ESA) placement is taught as a backup option when endotracheal intubation (ETI) fails. We sought to (1) describe the incidence of the emergency department (ED) ESA, (2) compare ESA versus ETI-only recipients, and (3) determine which factors were associated with receipt of an ESA.

METHODS

We searched within the Trauma Quality Improvement Program datasets from 2017 to 2022 for all emergency department surgical airway placement and/or endotracheal intubations recipients. We compared ESA versus ETI-only recipients.

RESULTS

From 2017 to 2022, there were 6,477,759 within the datasets, of which 238,128 met inclusion for this analysis. Within that, there were 236,292 ETIs, 2264 ESAs, with 428 (<1 %) having documentation of both. Of the ESAs performed, there were 82 documented in children <15 years of age with the youngest being 1 year of age. The ETI-only group had a lower proportion serious injuries to the head/neck (52 % versus 59 %), face (2 % versus 8 %), and skin (3 % versus 6 %). However, the ETI-only group had a higher proportion of serious injuries to the abdomen (15 % versus 9 %) and the extremities (19 % versus 12 %). Survival at 24-h was higher in the ETI-only group (83 % versus 76 %) as well as survival to discharge (70 % versus 67 %). In the subanaysis of children <15 years (n = 82), 34 % occurred in the 1-4 years age group, 35 % in the 5-9 years age group, and 30 % in the 10-14 years age group. In our multivariable logistic regression analysis, serious injuries to the head/neck (odds ratio [OR] 1.37, 95 % CI 1.23-1.54), face (OR 3.41, 2.83-4.11), thorax (OR 1.19, 1.06-1.33), and skin (OR 1.53, 1.15-2.05) were all associated with receipt of cricothyrotomy. Firearm (OR 3.62, 3.18-4.12), stabbing (2.85, 2.09-3.89), and other (OR 2.85, 2.09-3.89) were associated with receipt of ESA when using collision as the reference variable.

CONCLUSIONS

ESA placement is a rarely performed procedure but frequently used as a primary airway intervention in this dataset. Penetrating mechanisms, and injuries to face were most associated with ESA placement. Our findings reinforce the need to maintain this critical airway skill for trauma management.

A public health campaign to increase awareness of the risk of dog bites in South Australia

Dog bites are a serious public health problem. A campaign by the Dog and Cat Management Board of South Australia was launched to increase awareness that any dog can bite as a first step in reducing the incidence of dog bites. The aims of this study were to 1) evaluate changes in attitudes to dog bites following the media campaign, and 2) provide baseline data on dog bites and attitudes to interactions with dogs to help target future campaigns. The media campaign 'Good Dogs Have Bad Days' was run from July to October, 2023, using TV, radio, billboards and social media. A cross-sectional survey was conducted pre- and post-campaign, including demographics and questions relating to interactions and attitudes to dogs. A total of n = 402 to the pre- and n = 404 responses to the post-campaign surveys were received, with most having owned a dog, living in metropolitan areas, and an equal split of males and females. Over one third (36-37 %) of dog owners and 25-29 % of non-dog owners had been previously bitten by a dog, although most did not require medical attention. Respondents were more likely to agree that any dog can bite if they recalled seeing the campaign, and less likely if they were male and had poor knowledge of the scenarios in which a dog might bite. Older respondents and those from lower socioeconomic areas believed dog bites were a more serious community issue than younger respondents from higher socioeconomic areas. Approximately 70 % of dog owners believed it was safe for strangers to approach their dog, 34-37 % allowed children or other people to pat their dog without permission and less than half separated their dog from visitors or delivery people. In contrast few of the non-dog owners allowed their children to pat a dog without the owner's permission and only 2 % allowed them to play with dogs without supervision. The results demonstrate a relatively short campaign was associated with increased agreement any dog can bite. The proportion of respondents who had been bitten by a dog affirms the importance of public health campaigns targeting dog attacks. Some behaviours, such as supervising dogs around children and keeping dogs separate from delivery people, had relatively low agreement from dog owners and may be targeted in future campaigns. Public awareness campaigns and ongoing education will help to increase safer interactions with dogs, but it will take time and commitment to achieve a result.

Return-to-Work After Attempted Digit Replantation: A Systematic Review of 31 Studies

BACKGROUND

Traumatic digit amputation is a common injury with life-altering consequences for thousands of patients each year. In this study, we aim to update and expand the reported outcomes of return-to-work (RTW) and functional recovery in patients treated with digit replant after traumatic amputation.

METHODS

A PRISMA-guided systematic review was performed to identify all published articles related to digit replantation following amputation. We queried the following 4 databases: Scopus, Embase, Web of Science, and PubMed-MEDLINE. A total of 31 studies were included in the analysis of return-to-work data.

RESULTS

Of the 31 included studies, 26 studies reported that 1976 digits were successfully replanted, while 27 studies reported that 300 replants failed (86.8% success rate). Among 1087 patients in these studies, 82.9% who underwent replantation returned to work. The mean RTW time in 16 studies was 4.7 months (weighted average). Return-to-work time ranged from 0 to 26 months in 12 studies. Of 352 patients who returned to work in 17 studies, 90.9% resumed their previous occupation, while 29 (8.2%) changed occupations. The RTW for finger-only replantations was significantly lower compared to thumb-only, distal digit-only, and any digit replantations (66.0% vs 82.8%; 66.0% vs 87.6%; 66.0% vs 82.9%).

CONCLUSION

Despite a declining prevalence of digit replantation surgery in recent years, this study illustrates that replantation provides beneficial outcomes for patients with a high return-to-work rate.

Excess Risk of Injury in Individuals With Type 1 or Type 2 Diabetes Compared With the General Population

OBJECTIVE

To estimate the relative risk (RR) and excess hospitalization rate for injury in individuals with diabetes compared with the general population.

RESEARCH DESIGN AND METHODS

Data were obtained from the Australian National Diabetes Services Scheme, hospitalization data sets, the Australian Pharmaceutical Benefits Scheme, the National Death Index, and the census spanning from 2011 to 2017. Hospitalizations for injury were coded as head and neck, lower-extremity, upper-extremity, or abdominal and thoracic injury; burns; or other injury. Poisson regression was used to estimate the age- and sex-adjusted RR of hospitalization for injury.

RESULTS

The total number of hospitalizations for any injury was 117,705 in people with diabetes and 3,463,173 in the general population. Compared with that in the general population, an elevated adjusted risk of admission was observed for any injury (RR 1.22; 95% CI 1.21, 1.22), head and neck (1.28; 1.26, 1.30), lower extremity (1.24; 1.23, 1.26), abdominal and thoracic (1.29; 1.27, 1.30), upper extremity (1.03; 1.02, 1.05), burns (1.52; 1.44, 1.61), and other injury (1.37; 1.33, 1.40). The adjusted RR of any injury was 1.62 (1.58, 1.66) in individuals with type 1 diabetes, 1.65 (1.63, 1.66) in those with type 2 diabetes who were taking insulin, and 1.07 (1.06, 1.08) in individuals with type 2 diabetes not using insulin. Falls were the primary cause of injury in individuals with diabetes.

CONCLUSIONS

Individuals with diabetes, especially those using insulin, had a higher risk of hospitalization for injury compared with the general population.

What was the impact of COVID-19 restrictions on unintentional injuries, in Canada and globally? A scoping review investigating how lockdown measures impacted the global burden of unintentional injury

Background

Injuries are among the leading causes for hospitalizations and emergency department (ED) visits. COVID-19 restrictions ensured safety to Canadians, but also negatively impacted health outcomes, including increasing rates of certain injuries. These differences in trends have been reported internationally however the evidence is scattered and needs to be better understood to identify opportunities for public education and to prepare for future outbreaks.

Objective

A scoping review was conducted to synthesize evidence regarding the impact of COVID-19 restrictions on unintentional injuries in Canada, compared to other countries.

Methods

Studies investigating unintentional injuries among all ages during COVID-19 from any country, published in English between December 2019 and July 2021, were included. Intentional injuries and/or previous pandemics were excluded. Four databases were searched (MEDLINE, Embase, Web of Science, SPORTDiscus), and a gray literature search was also conducted.

Results

The search yielded 3,041 results, and 189 articles were selected for extraction. A total of 41 reports were included from the gray literature search. Final studies included research from: Europe (n = 85); North America (n = 44); Asia (n = 32); Oceania (n = 12); Africa (n = 8); South America (n = 4); and multi-country (n = 4). Most studies reported higher occurrence of injuries/trauma among males, and the average age across studies was 46 years. The following mechanisms of injury were reported on most frequently: motor vehicle collisions (MVCs; n = 134), falls (n = 104), sports/recreation (n = 65), non-motorized vehicle (n = 31), and occupational (n = 24). Injuries occurring at home (e.g., gardening, home improvement projects) increased, and injuries occurring at schools, workplaces, and public spaces decreased. Overall, decreases were observed in occupational injuries and those resulting from sport/recreation, pedestrian-related, and crush/trap incidents. Decreases were also seen in MVCs and burns, however the severity of injury from these causes increased during the pandemic period. Increases were observed in poisonings, non-motorized vehicle collisions, lacerations, drownings, trampoline injuries; and, foreign body ingestions.

Implications

Findings from this review can inform interventions and policies to identify gaps in public education, promote safety within the home, and decrease the negative impact of future stay-at-home measures on unintentional injury among Canadians and populations worldwide.

Editorial Commentary: Women Do Not Return to Sport at the Same Level After Anterior Cruciate Ligament Reconstruction as Often as Men: This May Be Associated With Lower Risk Tolerance-and Not Necessarily a Bad Thing!

It has been established that women do not return to preinjury sports (RTS) at the same level after anterior cruciate ligament reconstruction at the same rate as men. Normalization of strength parameters does influence the return to sports in men, but not women. Lower RTS rates may be associated with lower risk tolerance, and this is not necessarily a bad thing. Neither lower RTS rates nor lower risk tolerance is maladaptive or in need of correction. Awareness of the psychological diversity between the sexes does help in understanding this difference. Appreciation of this perspective will improve the relationship with the female athlete during her recovery.

Clarifying the relationship between physical injuries and risk for suicide attempt in a Swedish national sample

INTRODUCTION

The Interpersonal-Psychological Theory of Suicide proposes that capability for suicide is acquired through exposure to painful and provocative events (PPEs). Although there is robust evidence for a positive association between aggregate measures of PPEs and risk for suicidal behavior, little is known about the contributions of physical injuries. The present study investigated the relationship between injuries and risk of subsequent suicide attempt (SA).

METHODS

Data were from Swedish population-based registers. All individuals born in Sweden between 1970 and 1990 were included (N = 1,011,725 females and 1,067,709 males). We used Cox regression models to test associations between 10 types of injuries (eye injury; fracture; dislocation/sprain/strain; injury to nerves and spinal cord; injury to blood vessels; intracranial injury; crushing injury; internal injury; traumatic amputation; and other or unspecified injuries) and risk for later SA. Analyses were stratified by sex and adjusted for year of birth and parental education. Additional models tested for differences in the pattern of associations based on age group and genetic liability for SA. In co-relative models, we tested the association between each injury type and risk for SA in relative pairs of varying genetic relatedness to control for unmeasured familial confounders.

RESULTS

All 10 injury types were associated with elevated risk for SA (hazard ratios [HRs] = 1.2-7.0). Associations were stronger in the first year following an injury (HRs = 1.8-7.0), but HRs remained above 1 more than 1 year after injury exposure (HRs = 1.2-2.6). The strength of associations varied across injury type, sex, age, and genetic liability for SA. For example, the magnitude of the association between crushing injury and risk for SA was larger in females than males, whereas other injuries showed a similar pattern of associations across sex. Moreover, there was evidence to support positive additive interaction effects between several injury types and aggregate genetic liability for SA (relative excess risk due to interaction [RERI] = 0.1-0.3), but the majority of these interactions became non-significant or changed direction after accounting for comorbid psychiatric and substance use disorders. In co-relative models, the pattern of associations differed by injury type, such that there was evidence to support a potential causal effect of eye injury, fracture, dislocation/sprain/strain, intracranial injury, and other and unspecified injuries on risk for SA. For the remaining injury types, HRs were not significantly different from 1 in monozygotic twins, which is consistent with confounding by familial factors.

CONCLUSIONS

Injuries are associated with increased risk for subsequent SA, particularly in the first year following an injury. While genetic and familial environmental factors may partly explain these associations, there is also evidence to support a potential causal effect of several injury types on future risk for SA.

Access to quality care after injury in Northern Malawi: results of a household survey

BACKGROUND

Most injury care research in low-income contexts such as Malawi is facility centric. Community-derived data is needed to better understand actual injury incidence, health system utilisation and barriers to seeking care following injury.

METHODS

We administered a household survey to 2200 households in Karonga, Malawi. The primary outcome was injury incidence, with non-fatal injuries classified as major or minor (> 30 or 1-29 disability days respectively). Those seeking medical treatment were asked about time delays to seeking, reaching and receiving care at a facility, where they sought care, and whether they attended a second facility. We performed analysis for associations between injury severity and whether the patient sought care, stayed overnight in a facility, attended a second facility, or received care within 1 or 2 h. The reason for those not seeking care was asked.

RESULTS

Most households (82.7%) completed the survey, with 29.2% reporting an injury. Overall, 611 non-fatal and four fatal injuries were reported from 531 households: an incidence of 6900 per 100,000. Major injuries accounted for 26.6%. Three quarters, 76.1% (465/611), sought medical attention. Almost all, 96.3% (448/465), seeking care attended a primary facility first. Only 29.7% (138/465), attended a second place of care. Only 32.0% (142/444), received care within one hour. A further 19.1% (85/444) received care within 2 h. Major injury was associated with being more likely to have; sought care (94.4% vs 69.8% p < 0.001), stayed overnight at a facility (22.9% vs 15.4% P = 0.047), attended a second place of care (50.3% vs 19.9%, P < 0.001). For those not seeking care the most important reason was the injury not being serious enough for 52.1% (74/142), followed by transport difficulties 13.4% (19/142) and financial costs 5.6% (8/142).

CONCLUSION

Injuries in Northern Malawi are substantial. Community-derived details are necessary to fully understand injury burden and barriers to seeking and reaching care.

Individual characteristics associated with road traffic collisions and healthcare seeking in low- and middle-income countries and territories

Incidence of road traffic collisions (RTCs), types of users involved, and healthcare requirement afterwards are essential information for efficient policy making. We analysed individual-level data from nationally representative surveys conducted in low- or middle-income countries (LMICs) between 2008-2019. We describe the weighted incidence of non-fatal RTC in the past 12 months, type of road user involved, and incidence of traffic injuries requiring medical attention. Multivariable logistic regressions were done to evaluate associated sociodemographic and economic characteristics, and alcohol use. Data were included from 90,790 individuals from 15 countries or territories. The non-fatal RTC incidence in participants aged 24-65 years was 5.2% (95% CI: 4.6-5.9), with significant differences dependent on country income status. Drivers, passengers, pedestrians and cyclists composed 37.2%, 40.3%, 11.3% and 11.2% of RTCs, respectively. The distribution of road user type varied with country income status, with divers increasing and cyclists decreasing with increasing country income status. Type of road users involved in RTCs also varied by the age and sex of the person involved, with a greater proportion of males than females involved as drivers, and a reverse pattern for pedestrians. In multivariable analysis, RTC incidence was associated with younger age, male sex, being single, and having achieved higher levels of education; there was no association with alcohol use. In a sensitivity analysis including respondents aged 18-64 years, results were similar, however, there was an association of RTC incidence with alcohol use. The incidence of injuries requiring medical attention was 1.8% (1.6-2.1). In multivariable analyses, requiring medical attention was associated with younger age, male sex, and higher wealth quintile. We found remarkable heterogeneity in RTC incidence, the type of road users involved, and the requirement for medical attention after injuries depending on country income status and socio-demographic characteristics. Targeted data-informed approaches are needed to prevent and manage RTCs.

Sex differences in frailty among older adults

By definition, aging is a natural, gradual and continuous process. On the other hand, frailty reflects the increase in vulnerability to stressors and shortens the time without disease (health span) while longevity refers to the length of life (lifespan). The average life expectancy has significantly increased during the last few decades. A longer lifespan has been accompanied by an increase in frailty and decreased independence in older adults, with major differences existing between men and women. For example, women tend to live longer than men but also experience higher rates of frailty and disability. Sex differences prevent optimization of lifestyle interventions and therapies to effectively prevent frailty. Sex differences in frailty and aging are rooted in a complex interplay between uncontrollable (genetic, epigenetic, physiological), and controllable factors (psychosocial and lifestyle factors). Thus, understanding the underlying causes of sex differences in frailty and aging is essential for developing personalized interventions to promote healthy aging and improve quality of life in older men and women. In this review, we have discussed the key contributors and knowledge gaps related to sex differences in aging and frailty.

Contributions of avoidable mortality to the sex gap in life expectancy and life disparity in Iran

BACKGROUND

Public health policies and healthcare quality play a pivotal role on the health outcome level and disparities across sociodemographic groups. However, there is little evidence on their role on disparities in life expectancy (LE) and life disparity (LD) in low and middle income countries. The present study aimed to assess the contributions of avoidable mortality, as a measure of inter-sectoral public health policies and healthcare quality, into the sex gap in LE (SGLE) and LD (SGLD) in Iran.

METHODS

Latest available data of death causes, according to the ICD codes, for Iran was obtained from the WHO mortality database for the period 2015-2016. An upper age limit of 75 years was applied to define avoidable causes of death. LD was measured as the average years of life lost at birth. The SGLE and SGLD (both females minus males) were decomposed by age and cause of death using a continuous-change model.

RESULTS

Females, on average, outlived males for 3.8 years (80.0 vs. 76.2 years) with 1.9 lower life years lost (12.6 vs. 14.4 years). Avoidable causes accounted for 2.5 (67%) and 1.5 (79%) years of the SGLE and SGLD, respectively. Among avoidable causes, injury-related deaths followed by ischaemic heart disease had the greatest contributions to both SGLE and SGLD. Across age groups, the age groups 55-59 and 60-64 accounted for the greatest contributions of avoidable causes to SGLE (0.3 years each), while age groups 20-24 and 55-59 had the greatest contributions to SGLD (0.15 years each). Lower mortality rates for females than males in age groups 50-74 years accounted for about half of the SGLE, while age groups 20-29 and 50-64 years accounted for around half of SGLD.

CONCLUSION

More than two third of the SGLE and SGLD in Iran were attributed to the avoidable mortality, particularly preventable causes. Our results suggest the need for public health policies targeting injuries in young males as well as lifestyle risk factors including smoking in middle aged males in Iran.

Sociodemographic distribution and correlates of nonfatal unintentional non-traffic-related injuries in Kenya: Results from the 2014 demographic and health survey

Background and Aim

Injuries are among the leading causes of mortality worldwide. There exists a paucity of nationally representative injury data from the sub-Saharan African region on the nature of injuries outside of road traffic contexts. The aim of this study was to estimate the prevalence of nonfatal unintentional injuries that occurred outside of the traffic environment among persons aged 15-54 years in Kenya.

Methods

We used the 2014 Kenyan Demographic Health Survey data to estimate the prevalence of nonfatal unintentional injuries and their injury mechanisms. Binary logistic regression was used to estimate the odds of unintentional injuries and associated factors.

Results

Injury prevalence was three times higher among males (27.56%) compared to females (8.25%). The highest prevalence for females and males respectively was among those aged 15-19 years (9.80%) and (31.18%), rural residents (8.45%) and (30.05%) and those who consumed alcohol (18.13%), and (31.39%). For both females and males, the most frequent injuries were cuts (4.95%; 18.15%) and as result of falls (3.29%; 8.92%) respectively. Burns were more prevalent among females (1.65%) compared to males (0.76%). Among males, the demographic and contextual factors associated with nontraffic unintentional injuries were residing in a rural area (OR 1.33, 95% CI 1.14, 1.56), primary education (OR 2.02, 95% CI 1.48, 2.76), a higher wealth index (second quintile OR 1.41, 95% CI 1.19, 1.67) and consuming alcohol (OR 1.49, 95% CI 1.32, 1.69). Females who had completed primary, secondary (OR 2.43, 95% CI 1.92, 3.08) or higher education had higher odds of unintentional injuries.

Conclusion

The findings mirror prior literature highlighting the clustering of demographic and behavioral factors which underlie predisposition to injuries outside of the traffic environment. Future nationally representative studies would benefit from deeper inquiry into and measurement of injury severity and health care utilization to inform strategic policy-relevant research.

Neglected burden of injuries in Ethiopia, from 1990 to 2019: a systematic analysis of the global burden of diseases study 2019

Background

The 2030 agenda for sustainable development goals has given injury prevention new attention, including halving road traffic injuries. This study compiled the best available evidence on injury from the global burden of diseases study for Ethiopia from 1990 to 2019.

Methods

Injury data on incidence, prevalence, mortality, disability-adjusted life years lost, years lived with disability, and years of life lost were extracted from the 2019 global burden of diseases study for regions and chartered cities in Ethiopia from 1990 to 2019. Rates were estimated per 100,000 population.

Results

In 2019, the age-standardized rate of incidence was 7,118 (95% UI: 6,621-7,678), prevalence was 21,735 (95% UI: 19,251-26,302), death was 72 (95% UI: 61-83), disability-adjusted life years lost was 3,265 (95% UI: 2,826-3,783), years of live lost was 2,417 (95% UI: 2,043-2,860), and years lived with disability was 848 [95% UI: (620-1,153)]. Since 1990, there has been a reduction in the age-standardized rate of incidence by 76% (95% UI: 74-78), death by 70% (95% UI: 65-75), and prevalence by 13% (95% UI: 3-18), with noticeable inter-regional variations. Transport injuries, conflict and terrorism, interpersonal violence, self-harm, falls, poisoning, and exposure to mechanical forces were the leading causes of injury-related deaths and long-term disabilities. Since 1990, there has been a decline in the prevalence of transport injuries by 32% (95% UI: 31-33), exposure to mechanical forces by 12% (95% UI: 10-14), and interpersonal violence by 7.4% (95% UI: 5-10). However, there was an increment in falls by 8.4% (95% UI: 7-11) and conflict and terrorism by 1.5% (95% UI: 38-27).

Conclusion

Even though the burden of injuries has steadily decreased at national and sub-national levels in Ethiopia over the past 30 years, it still remains to be an area of public health priority. Therefore, injury prevention and control strategies should consider regional disparities in the burden of injuries, promoting transportation safety, developing democratic culture and negotiation skills to solve disputes, using early security-interventions when conflict arises, ensuring workplace safety and improving psychological wellbeing of citizens.

The burden of mortality due to injury in Cabo Verde, 2018

External causes continue to be one of the main causes of mortality in the world and Cabo Verde is no exception. Economic evaluations can be used to demonstrate the disease burden of public health problems such as injuries and external causes and support prioritization of interventions aimed at improving the health of the population. The objective of this study was to estimate the indirect costs of premature mortality in 2018 due to injuries and other consequences of external causes in Cabo Verde. Years of potential life lost, years of potential productive life lost and human capital approach were used to estimate the burden and indirect costs of premature mortality. In 2018, 244 deaths were registered due to injury and other consequences of external causes. Males were responsible for 85.4% and 87.73% of years of potential life lost and years of potential productive life lost, respectively. The cost of productivity lost due to premature death caused by injury was 4,580,225.91 USD. The social and economic burden due to trauma was substantial. There is a need for more evidence on the burden of disease due to injuries and their consequences, to support the implementation of targeted multi-sectoral strategies and policies for the prevention, management, and reduction of costs due to injuries in Cabo Verde.

Modelling Determinants of Deaths Attributable to External Causes Among Adults in India

The study aimed at finding the risk factors associated with adult mortality (15-59 years) due to external causes (accidents, suicide, poisoning, homicide, and violence). Using National Family Health Survey data-4 consisting of 1,756,867 sample, we applied a Robust Poisson Regression Model to determine the potential risk factors. Findings suggest that the highest proportion of deaths due to external causes was in the age group 20-24 years. The prevalence of these deaths was higher among older adults (age 50 years and above). The risk was more among males (Incident Rate Ratio (IRR) for females is: 0.29, p < 0.001), rural residents (IRR: 1.16, p < 0.001), exposed to mass-media (IRR: 1.08, p < 0.05), residing in female-headed households, in households having a member with higher education. This risk decreased for large families (IRR: 0.89, p < .001). A need to strengthen awareness and mentorship programs for young-adults and middle-aged people to control such avoidable deaths is recommended.

Prevalence, pattern and determinants of disabilities in India: Insights from NFHS-5 (2019-21)

There is a need to provide an overview of the disability burden in India as there are limited studies. The present study aimed to estimate the prevalence and assess the pattern and determinants of disability in India. We analyzed National Family Health Survey-5 data using the "svyset" command in STATA software. We assessed the correlates by multivariable regression and reported an adjusted prevalence ratio (aPR) with a 95% confidence interval (CI). QGIS 3.2.1 software was used for spatial analysis of distributions of different disabilities. The mean (SD) age of 28,43,917 respondents was 30.82 (20.62) years, with 75.83% (n = 21,56,633) and 44.44% (n = 12,63,086) of them being from a rural area and were not educated, respectively. The overall prevalence of disability was 4.52% [(95% CI: 4.48-4.55), n = 1,28,528]. Locomotor disabilities accounted for 44.70% of all disabilities (n = 51,659), followed by mental disabilities (20.28%, n = 23,436). Age 75 years and above (vs. 0-14 years) [aPR: 2.65 (2.50-2.81)], male (vs. female) [aPR: 1.02 (1.0-1.04)], no education (vs. higher education) [aPR 1.62 (1.56-1.68)], unmarried (vs married) [aPR: 1.76 (1.70-1.82)], seeking the care of non-governmental organization (NGO) (vs. other) [aPR: 1.32 (1.13-1.55)] were significant independent determinants. The highest overall prevalence of locomotor was in Lakshadweep/UTs (8.88%) and Delhi (57.03%), respectively. Out of every hundred individuals in India, four have a disability. More intervention strategies should be planned, considering factors like education, residence, health promotion and caste so that the services provided by the government can be available and accessible to everyone in need.

The contributions of injury deaths to the gender gap in life expectancy and life disparity in Eastern Mediterranean Region

BACKGROUND

Injury deaths constitute a major avoidable cause of death affecting life expectancy to a different degree in men and women. This study quantified the contributions of injury deaths to the gender gap in life expectancy (GGLE) and life disparity (GGLD) in nine Eastern Mediterranean Region (EMR) countries.

METHODS

We retrieved annual data on age-sex specific causes of death from the World Health Organization mortality database for EMR countries with at least 2-year consecutive data during 2010-2019. The injury-related deaths were categorized into five groups: transport accidents, other accidental injuries, intentional self-harm, assault and events of undetermined intent. Considering women as the reference, the GGLE and GGLD were decomposed by age and causes of death, using a continuous-change model.

RESULTS

The largest and smallest GGLE were observed in Kuwait (5.2 years) and Qatar (- 1.2 years), respectively. Qatar (- 2.2 years) and Oman (0.2 years) had the highest and lowest GGLD. The highest contributions of injury deaths to the GGLE/GGLD were seen in Libya (1.8/- 1.2 years), followed by Iran (1.2/- 0.8 years). Among injury causes, transport accidents were the leading cause of GGLE in all countries but Libya and Morocco, with Iran having the greatest contributions (0.6 years). Injury deaths in men aged 15-29 years accounted for 33% [41%] (Kuwait) to 55% [65%] (Oman) of total GGLE [GGLD] attributable to injury deaths.

CONCLUSIONS

High injury deaths, particularly transport accidents, among young men contributed substantially to the GGLE and GGLD across nine EMR countries in this study. This highlights the need for implementing preventing policies to reduce the burden of injury deaths specifically in young men.

The Epidemiology of Moderate and Severe Traumatic Brain Injury in Central Norway

INTRODUCTION

Few studies account for prehospital deaths when estimating incidence and mortality rates of moderate and severe traumatic brain injury (msTBI). In a population-based study, covering both urban and rural areas, including also prehospital deaths, the aim was to estimate incidence and mortality rates of msTBI. Further, we studied the 30-day and 6-month case-fatality proportion of severe TBI in relation to age.

METHODS

All patients aged ≥17 years who sustained an msTBI in Central Norway were identified by three sources: (1) the regional trauma center, (2) the general hospitals, and (3) the Norwegian Cause of Death Registry. Incidence and mortality rates were standardized according to the World Health Organization's world standard population. Case-fatality proportions were calculated by the number of deaths from severe TBI at 30 days and 6 months, divided by all patients with severe TBI.

RESULTS

The overall incidence rates of moderate and severe TBI were 4.9 and 6.7 per 100,000 person-years, respectively, increasing from age 70 years. The overall mortality rate was 3.4 per 100,000 person-years, also increasing from age 70 years. Incidence and mortality rates were highest in men. The case-fatality proportion in people with severe TBI was 49% in people aged 60-69 years and 81% in people aged 70-79 years.

CONCLUSION

The overall incidence and mortality rates for msTBI in Central Norway were low but increased from age 70 years, and among those ≥80 years of age with severe TBI, nearly all died. Overall estimates are strongly influenced by high incidence and mortality rates in the elderly, and studies should therefore report age-specific estimates, for better comparison of incidence and mortality rates.

Temperature-related mortality in China from specific injury

Injury poses heavy burden on public health, accounting for nearly 8% of all deaths globally, but little evidence on the role of climate change on injury exists. We collect data during 2013-2019 in six provinces of China to examine the effects of temperature on injury mortality, and to project future mortality burden attributable to temperature change driven by climate change based on the assumption of constant injury mortality and population scenario. The results show that a 0.50% (95% confident interval (CI): 0.13%-0.88%) increase of injury mortality risk for each 1 °C rise in daily temperature, with higher risk for intentional injury (1.13%, 0.55%-1.71%) than that for unintentional injury (0.40%, 0.04%-0.77%). Compared to the 2010s, total injury deaths attributable to temperature change in China would increase 156,586 (37,654-272,316) in the 2090 s under representative concentration pathways 8.5 scenario with the highest for transport injury (64,764, 8,517-115,743). Populations living in Western China, people aged 15-69 years, and male may suffer more injury mortality burden from increased temperature caused by climate change. Our findings may be informative for public health policy development to effectively adapt to climate change.

Rates of injury according to a single or comorbid mental illness identified in a large employee database

OBJECTIVE

To identify associations between specific types of mental illness (occurring alone or in combination with other mental illness) and (specific and all types) of injury.

METHODS

Analyses involve 21 027 employees aged 18-64 insured by Deseret Mutual Benefit Administrator (DMBA), 2020. Nine classifications of mental illness and 12 classifications of injury are considered. Rate ratios are adjusted for age, sex, and marital status.

RESULTS

The rate of injuries is 13.6%. A positive association exists between any mental illness and injury (rate ratio [RR] = 1.74, 95% CI 1.62-1.87). The positive association is consistent across all types of injury, except burns. While having a mental illness tends to positively associate with having an injury (vs. none), it more strongly associates with having two or more types of injury (vs. none). Injury rates are significantly greater when comorbid mental illness is involved (vs. one type of mental illness), more so for multiple types of injuries. Specifically, there is a positive association between having a mental illness (vs. none) and a single type of injury (vs. none) (RR = 1.58, 95% CI 1.42-1.75) or two or more types of injuries (vs. none) (RR = 1.94, 95% CI 1.70-2.23). Corresponding estimates where comorbid mental illnesses exist (vs. none) are (RR = 2.07, 95% CI 1.70-2.51) and (RR = 3.32, 95% CI 2.64-4.17), respectively. The most common combinations of mental illness that positively associate with injury tend to involve comorbid mental illness.

CONCLUSIONS

Several types of mental illness positively associate with injury and are more strongly associated when there is comorbid mental illness.

Lower testosterone levels are associated with higher risk of death in men

Background and Objectives

Testosterone plays an important role in regulating male development, reproduction and health. Declining levels across the lifespan may reflect, or even contribute to, chronic disease and mortality in men.

Methodology

Relationships between testosterone levels and male mortality were analyzed using data from multiple samples of the cross-sectional National Health and Nutrition Examination Survey (n = 10 225). Target outcomes included known deaths from heart disease, malignant neoplasms, chronic lower respiratory diseases, cerebrovascular diseases, Alzheimer's disease, diabetes mellitus, influenza and pneumonia, kidney diseases, and accidents or unintentional injuries.

Results

Results of discrete-time hazard models revealed that lower levels of testosterone were related to higher mortality for the majority of disease categories in either an age-dependent or age-independent fashion. Analysis of all-cause mortality-which included deaths from any known disease-also revealed greater general risk for those with lower testosterone levels. For most disease categories, the hazard associated with low testosterone was especially evident at older ages when mortality from that particular ailment was already elevated. Notably, testosterone levels were not related to mortality risk for deaths unrelated to chronic disease (i.e. accidents and injuries).

Conclusions and Implications

While the causal direction of relationships between testosterone and mortality risk remains unclear, these results may reflect the decline in testosterone that accompanies many disease states. Accordingly, the relationship between testosterone and male mortality may be indirect; ill individuals are expected to have both lower testosterone and higher mortality risk.

US racial and sex-based disparities in firearm-related death trends from 1981-2020

BACKGROUND

Firearms cause the most suicides (60%) and homicides (36%) in the US. The high lethality and availability of firearms make them a particularly dangerous method of attempted violence. The aim of this study was to study US trends in firearm suicide and homicide mortality and years of potential life lost before age 75 (YPLL-75) between 1981 and 2020.

METHODS

Data in this cross-sectional study were collected between 1981 and 2020 from the Centers for Disease Control and Prevention (CDC)'s WISQARS database for fatal injury and violence. Data from the US population were considered for all age groups and were divided by racial groups and sex for analysis.

RESULTS

Those most heavily impacted by firearm homicide were Black, with homicide age-adjusted death rates almost seven times higher than White people. A spike in firearm homicide deaths occurred between 2019 and 2020, with Black people having the largest increase (39%). White people had the highest rates of firearm suicide, and suicide death rates increased between 2019 and 2020. Increases in homicide and suicide YPLL-75 between 2011 and 2020 had most heavily impacted minority populations. Men had a firearm suicide rate that was seven times higher than women, and a firearm homicide rate that was five times higher than women.

CONCLUSION

This study demonstrated that Black and White men were most impacted by firearm deaths, and that firearm homicide and suicide rates increased between 2019 and 2020 for all racial groups except Asian/Pacific Islander. Our results suggest that prevention efforts should focus on specific demographic factors and articulate the urgency to mitigate firearm-related deaths in the US.

Trend analysis and prediction of injury death in Xi’an city, China, 2005-2020

Background

Injury is an important cause of death in China. In the present study, we systematically analyzed the epidemiological characteristics and trends of injury death in Xi’an residents from 2005 to 2020.

Methods

Data on injury deaths from 2005 to 2020 were obtained from the “Xi’an Center for Disease Control and Prevention”, injury deaths were classified according to the International Classification Disease-10th Revision (ICD-10). The data were stratified by gender, age groups, injury types, and then overall and type-specific injury mortality rates were estimated. Joinpoint regression analysis was conducted to estimate annual percent change (APC). The grey interval predicting method was used to predict the future characteristics of injury deaths in Xi’an city.

Results

From 2005 to 2020, injury caused 32,596 deaths (5.79% of all deaths; 35.71/100000 population). Injury mortality rates were higher among males than females. Motor vehicle traffic accidents were the commonest injury type. The highest injury mortality rates were in those aged 85 years or older. Overall, Joinpoint regression analysis revealed that injury mortality had significantly (p < 0.05) decreasing trends. GM (1,1) model estimated that injury mortality will be on a declining curve.

Conclusions

Motor vehicle traffic accidents, transport accidents other than motor vehicles, unintentional falls, suicide, and accidental poisoning are the main causes of injury. The injury death rate is projected to decline over the next decade.

A cohort study of differences in trauma outcomes between females and males at four Indian Urban Trauma Centers

Background Studies from high income countries suggest improved survival for females as compared to males following trauma. However, data regarding differences in trauma outcomes between females and males is severely lacking from low- and middle-income countries. The objective of this study was to determine the association between sex and clinical outcomes amongst Indian trauma patients using the Australia-India Trauma Systems Collaboration database. Methods A prospective multicentre cohort study was performed across four urban public hospitals in India April 2016 through February 2018. Bivariate analyses compared admission physiological parameters and mechanism of injury. Logistic regression assessed association of sex with the primary outcomes of 30-day and 24-hour in-hospital mortality. Secondary outcomes included ICU admission, ICU length of stay, ventilator requirement, and time on a ventilator. Results Of 8,605 patients, 1,574 (18.3%) were females. The most common mechanism of injury was falls for females (52.0%) and road traffic injury for males (49.5%). On unadjusted analysis, there was no difference in 30-day in-hospital mortality between females (11.6%) and males (12.6%, p = 0.323). However, females demonstrated a lower mortality at 24-hours (1.1% vs males 2.1%, p = 0.011) on unadjusted analysis. Females were also less likely to require a ventilator (17.3% vs 21.0% males, p = 0.001) or ICU admission (34.4% vs 37.5%, p = 0.028). Stratification by age or by ISS demonstrated no difference in 30-day in-hospital mortality for males vs females across age and ISS categories. On multivariable regression analysis, sex was not associated significantly with 30-day or 24-hour in-hospital mortality. Conclusion This study did not demonstrate a significant difference in the 30-day trauma mortality or 24-hour trauma mortality between female and male trauma patients in India on adjusted analyses. A more granular data is needed to understand the interplay of injury severity, immediate post-traumatic hormonal and immunological alterations, and the impact of gender-based disparities in acute care settings.

Males with low income and catastrophic illnesses are important risk factors for in-hospital homicide-related deaths in Taiwan from 1998 to 2015: A cross-sectional study

This study aimed to investigate not only the differences in in-hospital deaths between male and female homicides in Taiwan from 1998 to 2015, but also the epidemiological characteristics and long-term trend analysis. We collected data on 76,125 hospitalized patients injured in attempted homicides from January 1, 1998, to December 31, 2015, from the National Health Insurance Research Database (NHIRD), identifying 59,161 male and 16,694 female patients. Age, gender, and index date match. Multiple logistic regression was used to analyze the risks of gender differences in terms of homicide. The death risk of male patients was 1.673 times that of female patients and the mortality risk of low-income male patients was 3.447 times greater than that of non-low-income male patients. Moreover, the in-hospital death risk was 23.584 and 5.064 times higher for male and female patients with catastrophic illness, respectively, compared to patients with noncritical diseases. There is a higher trend of male than female patients hospitalized after an attempted homicide. Gender differences are significantly related to homicide, with males having a higher risk of death risk from homicide than females, especially in terms of low-income and catastrophic illness.

Weather and prehospital predictors of trauma patient mortality in a rural American state

Introduction

In rural settings, factors like weather and location can significantly impact total prehospital time and survival after injury. We sought to determine what prehospital conditions affect mortality and morbidity in severely injured patients.

Materials and methods

We retrospectively evaluated adult trauma patients that were admitted to our level 1 trauma center with Glasgow Coma Score (GCS≤ 9), hypotension (SBP≤ 90 mmHg), or both. Weather and prehospital conditions on patient outcomes were evaluated. Weather data was extracted from the National Oceanographic and Atmospheric Administration public database. Prediction models were done using bivariate and multivariate logistic regression analysis.

Results

A total of 442 subjects were captured, Median time on the scene was 15 min  [IQR =10, 20.5], with median time to definitive care 129 min  [IQR= 61, 247]. Hypotension in the field was the greatest predictor of ED mortality (OR=11, P = 0.004), and field hypoxia (OR=3, P = 0.007) was a predictor of in-hospital mortality. Patients with field GCS ≤ 9 had higher odds of ICU admission (OR=2, P = 0.029). Among transfers, increasing prehospital time correlated with ED mortality while injury during warmer weather showed lower odds (OR =0.94, P = 0.019) of mortality. No weather condition predicted mortality for patients that presented directly from the field.

Conclusion

Among severely injured patients being injured during cold weather was associated with higher in-hospital mortality among trauma transfer patients. Prehospital hypotension, hypoxia, and GCS≤9 are also independent predictors of mortality. Future analysis will explore factors impacting transport and field time in order to improve outcomes.

Adrenal crises in adolescents and young adults

PURPOSE

Review the literature concerning adrenal insufficiency (AI) and adrenal crisis (AC) in adolescents and young adults.

METHODS

Searches of PubMed identifying relevant reports up to March 2022.

RESULTS

AI is rare disorder that requires lifelong glucocorticoid replacement therapy and is associated with substantial morbidity and occasional mortality among adolescents and young adults. Aetiologies in this age group are more commonly congenital, with acquired causes, resulting from tumours in the hypothalamic-pituitary area and autoimmune adrenalitis among others, increasing with age. All patients with AI are at risk of AC, which have an estimated incidence of 6 to 8 ACs/100 patient years. Prevention of ACs includes use of educational interventions to achieve competency in dose escalation and parenteral glucocorticoid administration during times of physiological stress, such as an intercurrent infection. While the incidence of AI/AC in young children and adults has been documented, there are few studies focussed on the AC occurrence in adolescents and young adults with AI. This is despite the range of developmental, psychosocial, and structural changes that can interfere with chronic disease management during this important period of growth and development.

CONCLUSION

In this review, we examine the current state of knowledge of AC epidemiology in emerging adults; examine the causes of ACs in this age group; and suggest areas for further investigation that are aimed at reducing the incidence and health impact of ACs in these patients.

Long-term effect of chronic hepatitis B on mortality in HIV-infected persons in a differential HBV transmission setting

BACKGROUND

There remain gaps in quantifying mortality risk among individuals co-infected with chronic hepatitis B (HBV) and human immunodeficiency virus (HIV) in sub-Saharan African contexts. Among a cohort of HIV-positive individuals in Rwanda, we estimate the difference in time-to mortality between HBV-positive (HIV/HBV co-infected) and HBV-negative (HIV mono-infected) individuals.

METHODS

Using a dataset of HIV-infected adults screened for hepatitis B surface antigen (HBsAg) from January to June 2016 in Rwanda, we performed time-to-event analysis from the date of HBsAg results until death or end of study (31 December 2019). We used the Kaplan-Meier method to estimate probability of survival over time and Cox proportional hazard models to adjust for other factors associated with mortality.

RESULTS

Of 21,105 available entries, 18,459 (87.5%) met the inclusion criteria. Mean age was 42.3 years (SD = 11.4) and 394 (2.1%) died during follow-up (mortality rate = 45.7 per 100,000 person-months, 95% confidence interval (CI) 41.4-50.4) Mortality rate ratio for co-infection was 1.7, 95% CI 1.1-2.6, however, Cox regression analysis did not show any association with mortality between compared groups. The adjusted analysis of covariates stratified by co-infection status showed that males, residing outside of the capital Kigali, drinking alcohol, WHO-HIV-clinical stage 3 and 4 were associated with increased mortality in this HIV cohort.

CONCLUSIONS

HBV infection does not significantly influence mortality among HIV-infected individuals in Rwanda. The current cohort is likely to have survived a period of high-risk exposure to HBV and HIV mortality and limited health care until their diagnosis.

Mechanisms, Pattern and Outcome of Pediatrics Trauma At Agaro General Hospital, Southwest Ethiopia, 2021

Introduction

Over 80% of trauma related deaths in children occur in low income and middle-income countries including Ethiopia. Trauma affects several aspects of child life and is still a major concern. Despite the Ethiopian federal ministry of health (FMoH) conducting away different trials, there was an increased burden and high projection of pediatric trauma. In Ethiopia, There is insufficient evidence about the mechanisms, patterns and outcomes of pediatric trauma including this study area, Therefore this study aimed to assess the mechanisms, patterns, and outcomes of pediatric trauma in Agaro General Hospital, Southwest Ethiopia, 2021.

Methods and Materials

This cross-sectional study was study conducted on randomly selected 405pediatric patients who visited the Agaro General Hospital between 1/1/2018 and 30/8/2021. Data were extracted from each medical chart using a structured checklist. Data were entered into Epi-data 4.4.2.1for cleaning and analyzed using SPSS version 24. Tables, charts, and text are used to report the results.

Results

A total of 405 patients were included in the study. This study revealed that majority 271 (66.9%) of injured children were males. Most 188 (46.4%) of the traumas were occurred on the street. Fall down injury were the most common 151(37.3%) cause of trauma, followed by road traffic accidents 98 (24.2%). Trauma caused by falls accounted for 43.7% and 34.4% % of all traumas in the 5–12 year and the <5 year age groups respectively. Most 126 (31.1%) of the subjects were exposed to head and face trauma. Majority 256 (63.2%) of children were discharged with improvement, while12 (3.0%) of them have died.

Conclusions

Pediatric trauma remains a major public health concern. Most of trauma occurred among boys and falldown injury was the most frequent trauma, and the majority of the subjects were exposed to head and face trauma. Therefore, children should receive safety precautions, more supervision, and identification of specific risk factors for these injuries, and should be prohibited from risky practices by concerned bodies including families and traffic officers.

Biological mortality bias in diaphyseal growth of contemporary children: Implications for paleoauxology

Objectives

Biological mortality bias is the idea that individuals who comprise skeletal samples (non‐survivors) are a specific subset of the overall population, who may have been exposed to greater stress during life. Because of this, it is possible that studying growth in a skeletal population misrepresents the growth and health of survivors in that population. Using a modern sample, this study investigates whether biological mortality bias in growth may be present in archaeological skeletal samples.

Materials and methods

Postmortem computed tomography scans of 206 children aged under 13 years were collected from two institutions in the United States and Australia. The sample was separated into children who died from natural causes as proxies for non‐survivors and from accidental causes as proxies for survivors. Differences in long bone length for age were assessed through analysis of covariance (ANCOVA) and z‐score analysis, and these results were compared with studies linking anthropometrics and mortality risk in nonindustrialized societies.

Results

Differences in growth favoring survivors were greater for girls than for boys and seemed to increase over age. The effect in nonindustrialized societies was 1.5 to 5 times the magnitude of that in our contemporary sample.

Conclusions

A greater growth delay in girls than in boys has been documented in historical identified collections, and skeletal samples consistently become more stunted relative to modern standards over the course of growth. Our findings on biological mortality bias could explain part of these growth delays and impact interpretations of past ontogenetic environments.

Mobile telephone follow-up assessment of postdischarge death and disability due to trauma in Cameroon: a prospective cohort study

OBJECTIVES

In Cameroon, long-term outcomes after discharge from trauma are largely unknown, limiting our ability to identify opportunities to reduce the burden of injury. In this study, we evaluated injury-related death and disability in Cameroonian trauma patients over a 6-month period after hospital discharge.

DESIGN

Prospective cohort study.

SETTING

Four hospitals in the Littoral and Southwest regions of Cameroon.

PARTICIPANTS

A total of 1914 patients entered the study, 1304 were successfully contacted. Inclusion criteria were patients discharged after being treated for traumatic injury at each of four participating hospitals during a 20-month period. Those who did not possess a cellular phone or were unable to provide a phone number were excluded.

PRIMARY AND SECONDARY OUTCOME MEASURES

The Glasgow Outcome Scale-Extended (GOSE) was administered to trauma patients at 2 weeks, 1 month, 3 months and 6 months post discharge. Median GOSE scores for each timepoint were compared and regression analyses were performed to determine associations with death and disability.

RESULTS

Of 71 deaths recorded, 90% occurred by 2 weeks post discharge. At 6 months, 22% of patients still experienced severe disability. Median (IQR) GOSE scores at the four timepoints were 4 (3-7), 5 (4-8), 7 (4-8) and 7 (5-8), respectively, (p<0.01). Older age was associated with greater odds of postdischarge disability (OR: 1.23, 95% CI: 1.07 to 1.41) and mortality (OR: 2.15, 95% CI: 1.52 to 3.04), while higher education was associated with decreased odds of disability (OR: 0.65, 95% CI: 0.58 to 0.73) and mortality (OR: 0.38, 95% CI: 0.31 to 0.47). Open fractures (OR: 1.73, 95% CI: 1.38 to 2.18) and closed fractures (OR: 1.83, 95% CI: 1.42 to 2.36) were associated with greater postdischarge disability, while higher Injury Severity Score (OR: 2.44, 95% CI: 2.13 to 2.79) and neurological injuries (OR: 4.40, 95% CI: 3.25 to 5.96) were associated with greater odds of postdischarge mortality.

CONCLUSION

Mobile follow-up data show significant morbidity and mortality, particularly for orthopaedic and neurologic injuries, up to 6 months following trauma discharge. These results highlight the need for reliable follow-up systems in Cameroon.

Trends in Homicide Hospitalization and Mortality in Taiwan, 1998-2015

In Taiwan, the national research on homicide is rare, mostly discussing the issue of child abuse. We sought to better understand the characteristics and risk factors of homicide through a retrospective cohort study from 1998 to 2015. “Child battering and other maltreatment” ranked first for the 0–4 age group and second for the 5–14 age group. The hospital mortality was 511 deaths. We found that the 25–44 age group had the highest risk and accounted for 44.76% of hospitalization. The most common causes were “fight, brawl, and rape” (49.12%), “cutting and piercing instruments,” (13.16%) and “child battering and other forms of maltreatment” (4.72%). Additionally, the percentages of “fight, brawl, and rape,” “firearms and explosives,” and “cutting and piercing instruments” were significantly higher among males than among females. The percentages of “hanging and strangulation,” “corrosive or caustic substance,” “child battering and other maltreatment,” “submersion,” and “poisoning” were significantly higher among females than males. Factors associated with homicide in-hospital mortality included gender, age, low income, catastrophic disease, Charlson comorbidity index score, urbanization level, hospital level, classification of hospitalization, and surgery. Overall, the trend of hospitalization rates due to homicide decreased both by gender and age group, except for the 0–4 age group: cause of homicide first, hanging and strangulation second, firearms and explosives third; type of injury, hospitalized patients with “vascular injuries” first, joint and muscle sprain, and intracranial, chest, and abdominal pelvic injuries second, and “burns” third with a higher risk of death. Homicide reduction requires a comprehensive strategy beyond specific victim groups. Interagency collaboration should be strengthened, especially between law enforcement/criminal justice and public health.

Gender Differences in the Epidemiological Characteristics and Long-Term Trends of Injuries in Taiwan from 1998 to 2015: A Cross-Sectional Study

Objective: This study used a long-term trend analysis to investigate whether gender differences were related to the risk of injury and epidemiological characteristics in Taiwan from 1998 to 2015. Materials and methods: Data on 4,647,259 hospitalized patients that were injured from 1 January 1998, to 31 December 2015 were collected from the National Health Insurance Research Database (NHIRD). Among the injured patients, 2,721,612 males and 1,925,446 females were identified. Patients were age-, gender-, and index date-matched. Multiple logistic regression was used to analyze the risks of injury via gender differences. A p-value < 0.05 was considered significant. Results: The injury risk of the male patients was 1.4 times higher than that of female patients (AOR = 1.427, 95% CI = 1.40−1.44). The rising trend of male injured hospitalized patients was also greater than that of female injured hospitalized patients. Conclusion: Males were more at risk of injury than females. Gender differences were related to the increased risk of epidemiological characteristics of injury.

Analysis of deaths and injuries related to road traffic crashes in al-najaf governorate of iraq from 2017 to 2019

BACKGROUND

This study aimed to determine the rates of road traffic injuries and deaths as well as the factors affecting their levels in the Al-Najaf governorate for 3 years (2017-2019).

MATERIALS AND METHODS

Data were collected and analysed from the annual report of traffic crashes statistics of the Iraqi Ministry of Planning/Central Statistical Organisation. Al-Najaf governorate was selected as the study model for the period between 2017 and 2019. This selection was based on its urban growth, important location and standing for religious tourism.

RESULTS

Of the 8824, 9852 and 10,753 crashes reported in Iraq in 2017, 2018, and 2019, Al-Najaf governorate recorded 1057 (12%), 1041 (10.6%) and 1148 (10.7%), respectively. The percentage of injuries in Al-Najaf governorate to the total of injuries in Iraq decreased as follows: (11.9%), (10.2%) and (9.9%) for 2017, 2018 and 2019 respectively, while the mortality rate decreased as follows: (8.4%), (7.7%) and (7.1%), respectively. The number of deaths and injuries on main roads and highways was higher. Besides, the rates of injuries and deaths among males were higher than in females. Driving at excessive speed was the most statistically significant factor leading to a high proportion of deaths and injuries.

CONCLUSION

This study showed a decrease in the deaths and injuries caused by road traffic crashes during the 3 years 2017-2019 in the Al-Najaf Governorate, Iraq. It seems that driving rules and regulations need to be revised so that they can have more deterrent power in preventing injuries and deaths from driving accidents.

Trends in hospital admissions for adrenal insufficiency in adolescents and young adults in the 21st century

BACKGROUND

Very little is known about the epidemiology of adrenal crises (AC) and adrenal insufficiency (AI) in adolescents and young adults.

METHODS

Data on all admissions to Australian hospitals between 2000/1 to 2019/20 for a principal diagnosis of AI (including AC) in 10-24 year olds were extracted from a national repository. Age and sex-specific rates and age-adjusted rates were compared.

FINDINGS

Over the study, there were 3386 admissions for a principal diagnosis of AI; 24.0% (n=812) were for an AC and 50·7% (n=1718) were for secondary AI. Age-adjusted AI admissions increased from 31·70/million in 2000/1 to 54·68/million in 2019/20 (p<0·0001). Age-adjusted AC admissions also increased, most notably in the second decade (from 5·80/million in 2010/11 to 15·75/million in 2019/20) (p<0·00001). Average AI and AC admission rates were comparable between the sexes, but rates increased significantly in females, especially in those aged 20 to 24 years, whose AC rate in 2019/20 (39·65/million) was significantly higher than the corresponding rate in 2000/1 (3·15/million) (p<0·00001). Average age-adjusted SAI admission rates were higher in males (23·92/million) than females (15·47/million) (p<0·00001). However, SAI admission rates increased only among females (from 11·81/million to 22·12/million in 2019/20), with an increase in 20-24 year old females in the second decade from 5·07/million in 2010 to 20·42/million (p<0·00001). Age adjusted admissions for congenital adrenal hyperplasia, primary AI (PAI) and drug-induced AI did not change significantly over the study.

INTERPRETATION

AC/AI admissions increased over the first two decades of this century in the emerging adult population, particularly among females who also experienced a marked increase in AC admission rates, most evident in the second decade. Although uncertain, possible explanations include: dose of glucocorticoid replacement; non-adherence to therapy; psychosocial factors; and difficulty in transition to adult services. Admissions for SAI also increased, while rates of PAI and CAH remained constant.

The study of simultaneous bilateral ocular trauma in Northern India: clinical presentation, epidemiology and patterns of injury

PURPOSE

This study is aimed to determine the frequency, sociodemographic profile, clinical presentation, patterns of injury, treatment and outcomes of cases of simultaneous bilateral ocular trauma treated in a teaching hospital of Northern India.

METHODS

This retrospective study was conducted from May 2015 to April 2019. The medical records of patients presenting with bilateral ocular injuries were reviewed.

RESULTS

Among the 402 patients presenting with ocular injuries, 34 (8.5%) had simultaneous bilateral ocular trauma. The majority were male (70.6%), and the mean age was 26.82 ± 15.86 years (range: 2-70 years). The most frequently affected age group has been 16-25 years (35.3%). Most injuries occurred away from home (64.7%), mainly on roads (32.4%) or playgrounds (14.7%), and the vast majority (91.2%) were non-occupational in nature. Mechanical injuries were most frequent (47.1%), followed by cracker (17.7%), chemical (17.7%) and thermal (11.8%) injuries. Most cases occurred due to assault (26.5%), road traffic injury (20.6%) or sports/recreational activities (17.7%). The majority of victims were not using protective devices at the time of injury (82.4%) and had associated polytrauma (58.8%). Closed and open globe injuries accounted for 29.4% and 14.7% of cases, respectively, mostly involving zones I (55.0%) and II (40.0%). Orbital fractures occurred in 27.9% of eyes. Category I and II ocular trauma scores were noted in 5.9% and 7.4% of eyes, respectively. Overall, 13.2% were blinded as a result of the trauma.

CONCLUSION

Simultaneous bilateral ocular trauma is rare and occurs mostly following road traffic accidents, assault or recreational activities. In particular, young-adult males are more prone to bilateral ocular injuries, the majority of which are severe and associated with poor outcomes. The study also highlights that poor initial visual acuity, multiple ocular structure involvement, large open globe injury, presence of intraocular hemorrhage, posterior segment injury, multiple orbital fractures and lower OTS were the poor prognostic factors.

Epidemiology of childhood injuries in Saudi Arabia: a scoping review

BACKGROUND

Injury is the leading cause of death among Saudi children. Despite that, much remains unknown on the epidemiology and the extent of burden. This scoping review aims to describe previous literature on injury burden, including types, causes, and outcomes.

METHODS

We conducted a scoping literature search of English published articles on injuries among Saudi children between 0 to 18 years old using Scopus, MEDLINE, and Web of Science between January 2000 and December 2020. The primary outcome was the type and the cause of childhood injuries. Data extraction was based on specified data elements that included study characteristics and epidemiological parameters. The STROBE checklist was used to assess the quality of publications.

RESULTS

The initial review identified 3,384 studies. Of which, 36 studies met the inclusion criteria. A total of 20,136 children were included; of them, 69% were males. Among studies that examined overall injuries, falls represented 31.9%, while 25.1% were due to Motor Vehicle Collision (MVC). The leading cause of fractures was falls (37.9%), followed by MVC (21.5%). The leading cause was flames (52.1%) followed by scald (36.4%) for burns. While for poisoning, medications were the leading cause of (39.9%), followed by toxic household products (25.7%). Weighted mortality rates were 5.2% for overall injuries, 8.3% for fractures of the skull and spine, and 17.4% for burns.

CONCLUSIONS

MVC and falls are associated with the highest share of injuries in the kingdom. These findings can guide prevention efforts to reduce injury burden and improve population health. Further population-based research is warranted to explore the determinants of childhood injuries across all regions of Saudi Arabia.

Are there sex differences in crash and crash-related injury between men and women? A 13-year cohort study of young drivers in Australia

BACKGROUND

Young men have long been known to be disproportionately impacted by road crash and crash-related injury compared to young women and older drivers. However, there is limited insight into how sex differences in crash and crash-related injury changes over time as men and women get older and gain more driving experience. To explore sex differences in crash and crash-related injury, we undertook a sex disaggregated analysis in a large longitudinal cohort of over 20,000 young drivers in New South Wales, Australia, for up to 13 years after they first attained their independent car driver licence.

METHODS

DRIVE Study survey data from 2003-04 were linked with police, hospital and deaths data up to 2016. Sex differences were analysed using cumulative incidence curves investigating time to first crash and in negative binominal regression models adjusted for driver demographics and crash risk factors.

RESULTS

After adjusting for demographics and driving exposure, compared with women, men had 1.25 (95% CI 1.18-1.33), 2.07 (1.75-2.45), 1.28 (95% CI 1.13-1.46), 1.32 (95% CI 1.17-1.50) and 1.59 (95% CI 1.43-1.78) times higher rates of any crash, single vehicle crash, crash on streets with a speed limit of 80 km/h or above, crash in wet conditions and crash in the dark, respectively. By contrast, men were less likely to be involved in crashes that resulted in hospitalisation compared to women 0.73 (95% CI 0.55-0.96).

CONCLUSIONS

Young men are at increased risk of crash, and this risk persists as they get older and gain more driving experience. Despite lower risk of crash, women are at higher risk of crash related injury requiring hospitalisation. These differences in men's and women's risk of crash and injury signal the need for better understanding of how sex and/or gender may contribute to risk of crash and injury across the life-course.

Non-fatal injuries in rural Burkina Faso amongst older adults, disease burden and health system responsiveness: a cross-sectional household survey

OBJECTIVES

This study aimed to evaluate the epidemiology of injury as well as patient-reported health system responsiveness following injury and how this compares with non-injured patient experience, in older individuals in rural Burkina Faso.

DESIGN

Cross-sectional household survey. Secondary analysis of the CRSN Heidelberg Ageing Study dataset.

SETTING

Rural Burkina Faso.

PARTICIPANTS

3028 adults, over 40, from multiple ethnic groups, were randomly sampled from the 2015 Nouna Health and Demographic Surveillance Site census.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcome was incidence of injury. Secondary outcomes were incidence of injury related disability and patient-reported health system responsiveness following injury.

RESULTS

7.7% (232/3028) of the population reported injury in the preceding 12 months. In multivariable analyses, younger age, male sex, highest wealth quintile, an abnormal Generalised Anxiety Disorder score and lower Quality of Life score were all associated with injury. The most common mechanism of injury was being struck or hit by an object, 32.8%. In multivariable analysis, only education was significantly negatively associated with odds of disability (OR 0.407, 95% CI 0.17 to 0.997). Across all survey participants, 3.9% (119/3028) reported their most recent care seeking episode was following injury, rather than for another condition. Positive experience and satisfaction with care were reported following injury, with shorter median wait times (10 vs 20 min, p=0.002) and longer consultation times (20 vs 15 min, p=0.002) than care for another reason. Injured patients were also asked to return to health facilities more often than those seeking care for another reason, 81.4% (95% CI 73.1% to 87.9%) vs 54.8% (95% CI 49.9% to 53.6%).

CONCLUSIONS

Injury is an important disease burden in this older adult rural low-income and middle-income country population. Further research could inform preventative strategies, including safer rural farming methods, explore the association between adverse mental health and injury, and strengthen health system readiness to provide quality care.