Injury Epidemiology最新文献

Background: Motor vehicle crashes (MVCs) are a leading cause of injury among adults aged 65 years and older ("older adults"). As the number of older drivers grows, it is increasingly important to understand clinical factors associated with an increased risk of MVC. A major barrier, however, is the lack of data. To address this, we linked two large-scale administrative databases, the New Jersey Safety and Health Outcomes (NJ-SHO) Data Warehouse, which contains information on all police-reported crashes in New Jersey from 2004 to 2019, and Medicare Fee-for-Service (FFS) insurance claims, which contains health care encounters and prescription drug dispensings among older adults in the United States over the same period. This paper explains the linkage process, describes selected work leveraging these data to study MVCs in older drivers, and highlights features and strengths of this linkage for future research.

Methods: The NJ-SHO-Medicare linkage was performed using categories of name (first and last), sex, age (birth and death date), and residence (state and ZIP code). Matches were ranked by quality and overall confidence.

Results: After comparing different match strategies, we accepted a match when (1) the name match quality was High or Medium and the age match was High or (2) the name, sex, and residence match categories were all High. Of the 2,722,773 individuals successfully linked, we accepted 2,661,782 matches (97.76% of individuals linked and 91.59% of those submitted for linkage). All accepted matches were Strong or Fair. Among accepted matches who enrolled in Medicare FFS in 2019, 342,422 (28.57%) were 65-69 years old, 619,437 (51.69%) were female, and 955,309 (79.72%) were non-Hispanic White. Only 29,561 (2.47%) experienced an MVC and 25,478 (2.13%) received a citation. The most prevalent clinical conditions ever diagnosed were cataracts (669,044; 55.83%); chronic pain, fatigue, and fibromyalgia (367,165; 30.64%); and glaucoma (287,420; 23.98%).

Conclusions: With extensive temporal and population coverage, the NJ-SHO-Medicare linkage supports studying the relationships between clinical exposures (e.g., medications ), driving events (e.g., crashes, citations) and medical care trajectories, which can help advance the driving safety of older adults and inform future efforts to integrate administrative data.

Objectives: To compare the differences in US federal funding sources for firearm injury prevention and publications.

Methods: We extracted publications from three literature databases and grant data for five federal agencies (CDC, NIH, SAMHSA, NSF, NIJ) through federal archives from 2020 to 2022, excluding case studies, editorials, and literature reviews. Specific funding sources for publications were further extracted. We calculated funding-to-publication (F-P) ratios for federal public health, science, and criminal justice agencies and tested associations. Health agencies with grant data included the CDC, NIH, and SAMHSA and were categorized as public health agencies. The NSF was classified as science and engineering. The NIJ was classified as criminal justice.

Results: The three largest funders were the NIH, CDC, and NIJ, and were associated with the most publications, with health agencies funding most studies (86%). Health agencies had higher F-P ratios than the NSF and NIJ. Public health funders were more likely to fund experimental studies, studies related to suicide, and unintentional firearm injury prevention. NIJ and NSF were more likely to support research on mass shootings. Most studies funded by all agencies examined community violence.

Conclusions: The NIH and CDC supported most firearm-injury-related grant funding and subsequent publications from 2020 to 2022. Differences in funding existed depending on the types of firearm injury. Federal funding is imperative to advance the science of firearm injury prevention, and future funding across federal agencies should be aligned with national public health and safety needs.

Background: Drowning is the leading cause of death in US children 1-4 years old. The epidemiology of drowning at a regional level is understudied because no single data source provides complete information on persons who drown. Probabilistic data linkage is a novel way of studying the epidemiology of drowning. This study aimed to document the lessons learned during the linkage process.

Methods: This was a cross-sectional study of persons of all ages who died from unintentional drowning in metropolitan Houston from 2016 to 2022. We describe the lessons learned during the project planning and execution phases which pertained to data curation, the regulatory aspects involved with obtaining data, data security, spatial identification, and the strengths and limitations of the different datasets.

Results: Twelve datasets were reviewed; eight were successfully linked. During the planning phase, the key issues identified pertained to data ownership and governance and robustness of data which impacted the availability and quality of data, variation in the description of drowning location, and risk and protective factors which helped identify subpopulations at-risk for drowning. In the execution phase, the major issues included data security, data sharing, and dissemination of results.

Conclusion: There are a plethora of data sources for fatal drowning. The process of obtaining and analyzing data to describe the epidemiology of fatal drowning using probabilistic data linkage is complex, lengthy, and cumbersome. Documenting the process and lessons learned can support drowning research and inform regional drowning prevention strategies.

Background: News coverage of community firearm violence (CFV) can cause multilevel harm. We aimed to quantify the frequency and severity of harmful CFV news content and examine how victim, shooting event, and place-based characteristics relate to harmful CFV reporting.

Methods: We performed a quantitative media content analysis of a random sample of CFV clips aired on Philadelphia local television news in 2021 using a novel codebook. We matched clips to shooting victims in the Philadelphia Police Department dataset and used shooting event location to obtain place-based characteristics from American Community Survey data. Generalized structural equation models evaluated associations between victim demographics, shooting event, and place-based characteristics (Group I), news coverage characteristics (Group II), and either composite harmful CFV reporting scores or specific harmful reporting elements determined by a prior modified Delphi process (Group III).

Results: Among 394 individuals covered in 303 clips, the mean (SD) individual-level harmful CFV reporting score was 15.2 (4.38) out of 29. Episodic framing (i.e. reporting lacking systematic context) (93.9%) was the most common harmful content element and perpetrator mugshot (4.8%) was least common element. Graphic and/or explicit content was present in 30.3% of clips. Individuals having more than one clip and longer total focus time had higher harmful reporting scores, while individuals involved in fatal shootings, having longer total clip length, and having a follow-up story had lower scores. Black, adult, victims in non-fatal shootings and people shot in areas with a higher proportion of Black residents were more likely to have news coverage containing graphic and/or explicit content.

Conclusions: Harmful CFV reporting is pervasive, and the severity of harm is associated with news coverage characteristics. Disparities in specific harmful CFV content elements may further exacerbate existing health inequities. Journalists should modify CFV reporting practices to minimize harm.

Background: Secure firearm storage (i.e., keeping firearms locked and ammunition stored separately) is a means of reducing risks of suicide, unintentional injury, and homicide. While prior research has examined demographic and household factors associated with storage practices, less is known about how contextual factors, such as perceived neighborhood safety from crime, influence firearm storage behavior.

Methods: Data were from the 2024 Behavioral Risk Factor Surveillance System (BRFSS), a nationally coordinated, state-based survey administered by state health departments with technical and methodological support from the Centers for Disease Control and Prevention. Analyses were restricted to respondents in firearm-owning households from ten states (n = 18,443). Firearm storage was categorized as: (1) unloaded [safest], (2) loaded and locked [intermediate risk], or (3) loaded and unlocked [unsafe storage practice]. Perceived neighborhood safety from crime was classified as extremely safe, safe, or unsafe (unsafe and extremely unsafe combined). Multinomial logistic regression models were used to assess the associations between perceived neighborhood safety and firearm storage.

Results: Most respondents lived in households with firearms stored unloaded (63.2%), followed by loaded and locked (19.8%) and loaded and unlocked (17.0%). Compared with those who perceived their neighborhoods as extremely safe, respondents who perceived them as unsafe or extremely unsafe had a higher relative risk of living in a household with firearms loaded and unlocked (RRR = 1.773; 95% CI: 1.240-2.536).

Conclusions: Firearm injury prevention initiatives addressing storage practices should consider the role of community-level perceptions of safety through intervention-oriented and policy-relevant approaches, including via the integration of public health and violence prevention strategies.

Background: Firearm purchasing patterns, intentions, and behaviors change over time in response to specific events. Additionally, the nature of these changes may be evolving over time or differ depending on the nature of the event in question. Given the intensity of the rhetoric surrounding gun violence leading up to the 2024 election, we sought to examine the extent to which firearm purchasing patterns, intentions, and behaviors changed following the 2024 Presidential election and the extent to which any such changes varied by population.

Methods: A nationally representative sample was recruited to complete an online survey October 22-November 3, 2024 (n = 1,530) and assessed again January 7-January 22, 2025 (n = 1,359).

Results: Identifying as Black was associated with increases in urges to carry firearms because of the election results (β = 0.16; 95%CI = 0.07-0.61). Liberal beliefs were associated with greater increases in urges to carry firearms because of the election results (β = 0.11; 95%CI = 0.01-0.13) and greater odds of storing firearms more quickly accessible because of the election results (OR = 2.11; 95%CI = 1.29-3.44).

Conclusions: Individuals threatened by Trump administration policies appear to be experiencing urges to acquire firearms, carry them, and store them readily accessible. These results highlight that the current political environment may be fostering community-level decision making that, while motivated by the drive for protection, increases the risk for harm. Policies and programs that encourage secure storage and discourage firearm carrying may be increasingly important for the prevention of injury and death.

Background: Helmet-preventable head injuries are a common cause of snowmobiling-related injury. Our objective was to determine the demographics, helmet use, and attitudes regarding snowmobile helmet use among rural adolescents.

Methods: An anonymous survey was administered to a convenience sample of adolescents (ages 13-18) at the 2022 Iowa FFA Leadership Conference. Frequency and comparative analyses were performed.

Results: Of the 1,331 respondents, 58% were female and 96% non-Hispanic White. One-half lived on farms, 21% lived in the country/not on a farm, and 28% lived in town. One-quarter (26%) lived in households owning a snowmobile, with higher ownership among farm residents (31%) compared to those in the country/not on a farm (23%) or in town (19%), p < 0.001. Over one-third of participants had ridden in the past year. Riding was more common amongst males, Caucasians, farm residents, and those from households owning snowmobiles (all p ≤ 0.01). Frequent riding (at least weekly) was higher among older teens and snowmobile-owning households (p = 0.025 and p < 0.001, respectively). Helmet use was: 67% always/mostly, 11% sometimes, and 21% rarely/never. The importance of snowmobile helmet use (from 1 to 10) was highly rated (median, 9; mean, 8.2). Relative to their peers, females (p = 0.018), those owning snowmobiles (p < 0.001), and frequent riders (p < 0.01) had greater proportions wearing helmets always/most of the time, and rated the importance of helmet use more highly. 59% supported snowmobile helmet laws.

Conclusion: While most rural adolescents value snowmobile helmet use and support legislation, nearly half report inconsistent use. Importantly, our study identified demographic groups for targeted interventions.

Background: Firearm violence in the United States is highly concentrated within specific demographic, economic, geographic, and social population groups. Prior research indicates elevated violence exposure among gang-involved individuals, but the extent and mental health implications of firearm victimization at the national level remain poorly understood.

Methods: We analyzed data from a national online survey of 10,000 U.S. adults fielded in 2024. Respondents self-reported lifetime gang membership and lifetime exposure to five forms of firearm victimization: presence at a mass shooting, gun threats, being shot at without injury, accidental gunshot injury, and intentional gunshot injury. Weighted descriptive statistics compared prevalence by lifetime gang status. Multivariable logistic regression estimated adjusted odds ratios controlling for several covariates. Among victims of firearm violence, self-reported psychological impacts, including anxiety, fear, depression, panic attacks, and post-traumatic stress symptoms, were assessed.

Results: People with a history of gang involvement reported substantially higher lifetime exposure to all forms of firearm victimization. After adjustment, gang involvement was associated with 2-4 times greater odds of firearm exposure across outcomes. Psychological impacts following firearm victimization were prevalent in both gang and non-gang groups. Differences in reported mental health impacts by gang status were generally modest, with relatively few statistically significant differences in adjusted models.

Conclusions: Firearm victimization is highly concentrated among people with a history of gang involvement, and such exposure is associated with substantial psychological distress. Mental health impacts were broadly similar across gang-involved and non-gang victims. These findings highlight the importance of recognizing gang-involved adults as a population with disproportionate exposure to firearm violence and significant trauma-related needs within a public health framework.

Background: Reasons for gun ownership have shifted from primarily for hunting, to protection from other people, and increasingly for concerns about political violence. In 2023, these reasons differed by party affiliation. In the aftermath of the 2024 Presidential election, the objective of this study was to compare gun owners' reasons for gun ownership in January 2025 vs. 2023, overall and by political party affiliation.

Methods: We analyzed two waves of gun owning respondents to the National Survey of Gun Policy (n = 2,003). In both waves, fielded 1/4/23 - 2/6/23 and 1/6/25 - 1/24/25, respondents identified personally important reasons for gun ownership from 10 potential reasons (e.g., at-home protection, out-of-home protection, protection from police, ideological conflict, hunting or recreation). We calculated weighted proportions to generate nationally representative estimates and compared reasons for gun ownership in 2025 to 2023 overall and by political affiliation (i.e., Republican, Democrat, or Independent).

Results: In 2025 (vs. 2023), more gun owners valued gun ownership "for protection at demonstrations, rallies, or protests" (42% vs. 35%) and for hunting (81% vs. 74%), but fewer valued ownership "to advance an important political objective" (22% vs. 35%). Increases were largely driven by Republican gun owners, who also rated higher at-home protection (97% vs. 93%) and protection against police violence (34% vs. 25%). Fewer Republican, Democrat, and Independent gun owners valued ownership "to advance an important political objective."

Conclusions: As political violence escalated nationally, larger portions of gun owners rejected such violence, while also seeking to protect themselves from it. Safety and policy implications are discussed.

Globally in 2021, for the first time, the unintentional drowning fatality rate among people aged 70 years and older (8.15 per 100,000 people) surpassed the drowning rate of children under five years (7.66 per 100,000 people). While strong investment and advocacy in child drowning prevention have proven effective, we currently lack the research, consensus-based risk factors, and age-specific drowning prevention interventions for older people. Amid a globally aging population, we use this comment to highlight the need for increased evidence to reduce the persistent yet preventable fatal drowning rate for this age group.