Injury Epidemiology最新文献

Background: Motor vehicle crashes are the second leading cause of injury death among adults aged 65 and older in the U.S., second only to falls. A common state-level approach to mitigating older adult crash risk is the implementation of driver license renewal policies which vary largely between states and data on their effectiveness in preventing crashes and injuries are limited. To fill this gap, the aim of this study is to examine the association between state driver license renewal policies and older driver crash and injury rates.

Methods: Historical crash data, license renewal policy data, and other relevant policy and demographic data were gathered from 13 U.S. states (CO, IL, IA, KS, MN, MO, NE, ND, OH, SD, UT, WI, WY) for years 2000 through 2019, inclusive. Main exposures included six license renewal policies: renewal period, in-person renewal frequency, vision testing, knowledge testing, on-road drive testing, and mandatory physician reporting. The primary outcomes were crash and injury rates per 100,000 population.

Results: The study population included 19,010,179 crash-involved drivers aged 40 and older. State policies became less restrictive in many states over the study period, even for drivers aged 75 and older, resulting in longer times between renewals and fewer in-person renewal requirements. Loosening of in-person renewal from every time to less than every time was associated with increased crash rates, among drivers aged 65 to 74 (RR_crash = 1.08, 95% CI: 1.01-1.16). A longer duration between in-person renewals was associated with increased injury rates among drivers 75 and older (RR_injury = 1.18, 95% CI: 1.00-1.39).

Conclusions: Generally, state policies became less restrictive and resulted in longer required intervals between license renewal. Loosening of driver license renewal policies was associated with increased crash and injury rates. However, safety benefits of restrictive older driver licensing policies should be carefully weighed against costs to older adult well-being and quality of life following licensure loss. Additional methods to assess fitness to drive are necessary to identify the mechanisms behind the increased rates.

Background: The increasing adoption of individual urban mobility in European cities is contributing to a rise in the number of bicycle and e-scooter users. Consequently, a corresponding increase in accidents, along with an additional burden on emergency departments, is anticipated, particularly in metropolitan areas. The objective of this prospective cross-sectional study was to gather detailed information regarding the patient demographics, accident mechanisms, and injury patterns of e-scooter riders in comparison to cyclists. Identifying any differences between these groups will provide a foundation for developing targeted prevention strategies and safety measures aimed at reducing the incidence of accidents and injuries.

Methods: All patients who presented to the emergency department of our level I university trauma center after an accident involving a traditional bicycle without electric assistance or an e-scooter in 2022 were recorded. Demographic data as well as information regarding the trauma mechanism, injury pattern, alcohol influence, treatment requirements and helmet use were analyzed and compared between the two groups.

Results: In 2022, a total of 626 patients were identified after a bicycle accident and 98 patients after an e-scooter accident. E-scooter riders were with a mean age of 31.0 years (standard deviation (SD) 10.7) significantly younger compared to bicycle riders at 43.2 years (SD 16.5; p < 0.001). More than half of the patients in both groups were male (e-scooter 69.4% versus bicycle 60.7%). E-scooter riders were more likely to be intoxicated (31.6% vs. 5.4%; p < 0.001), not wearing a helmet (93.9% vs. 78.4%; p < 0.001) and to have had accidents at nighttime (39.8% vs. 11.5%; p < 0.001). There was no significant difference between the distribution of minor (e-scooter 75.2% vs. bicycle 70.3%) and major (24.8% vs. 29.7%) injuries. In terms of body regions, e-scooter riders suffered from major injuries to the skull, facial cranium, cervical spine (43.8% e-scooter vs. 22.4% bicycle; p = 0.008) and less frequently to the trunk, thoracic and lumbar spine and pelvis (0.0% vs. 13.6%).

Conclusion: Compared to cyclists, injured e-scooter riders are younger, mostly do not wear a helmet and more often ride under the influence of alcohol. E-scooter accidents occur more frequently at night and the riders are more likely to suffer serious head injuries.

Background: Injury causes significant burden on Australian Aboriginal and Torres Strait Islander communities. However, a considerable portion of the research conducted in this area has been carried out by Western researchers. It has been acknowledged that historical research methodologies and discourses around Aboriginal and Torres Strait Islander research may not be suitable or beneficial. Co-production methodologies offer opportunities for research to be developed collaboratively ensuring meaningfulness of results and appropriate protection for participants. A scoping review was undertaken to investigate the use of co-production methodologies in research within the unintentional injuries space for Australian Aboriginal and Torres Strait Islander communities over time.

Main body: A systematic search was conducted using PubMed, ProQuest, Embase and Indigenous Health Infonet databases. Study characteristics, remoteness, injury topic, co-production methods and elements were extracted from eligible studies. The search revealed 4175 papers, from which 39 studies were included in this scoping review. It was found that 69% of studies were fully co-produced with community. Studies predominately focused on general injury, falls prevention or brain injury rehabilitation. The most heavily utilised co-production strategy was the inclusion of Aboriginal and Torres Strait Islander researchers into the writing and research team. This helped the collection of culturally safe data and appropriate interpretation of results.

Conclusion: There is growing diversity among co-production methodologies, better enabling meaningful engagement between community and research. This co-production helps decolonise the research process to privilege Aboriginal voices, however, more work is needed to appropriately capture Indigenous perspectives.

Background: Firearm secure storage is an important public health practice due to its potential impact on reducing the incidence of accidental injuries, suicides, and thefts. Yet, there is limited research on how economic conditions might shape firearm storage patterns.

Methods: This study explores the relationship between material hardship and firearm secure storage among firearm-owning households. Data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) were analyzed, including responses from 7,197 firearm-owning adults in California, Minnesota, Nevada, and New Mexico. Multinomial logistic regression models assessed the relationship between levels of material hardship and storage practices, adjusting for demographic and socioeconomic factors.

Results: Among respondents, 14.3% reported firearms were stored, loaded and unlocked. Compared to respondents experiencing no hardships, those experiencing three or more material hardships incurred a 183% higher risk of storing firearms in an unsecured manner (Relative Risk Ratio = 2.828, 95% CI = 1.286, 6.220).

Conclusion: This study highlights an association between greater material hardship and unsecured firearm storage. These findings emphasize the need for public health interventions that address economic barriers to safe firearm storage, potentially reducing firearm-related injuries and deaths among individuals experiencing material hardship.

Background: Understanding the nature and circumstances around the use of weapons to perpetrate an offense among individuals with mental illness is crucial for evidence-informed policies and actions. However, little is known about the prevalence and factors associated with weapon use during index offenses among patients in the forensic system. Therefore, the present study was designed to address this gap and determine the prevalence and the patient and victim characteristics associated with weapon use during the index offense in a Canadian province.

Methods: This retrospective exploratory study utilized data extracted from the Ontario Review Board reports of 2014/15. Data was analyzed using Stata, and logistic regression was employed to determine the factors associated with weapon use.

Results: Approximately half (48.11%) of the individuals included in this analysis (n = 819) used weapons during their index offense as an instrument of violence. Both patient-related and victim-related factors had a statistically significant association with weapon use during index offenses. Specifically, two patient-related factors (including a history of hospitalization prior to the index offense and diagnosis of personality disorder) were associated with lower odds of weapon use during the index offense. However, only prior hospitalization remained statistically significant after adjusting for victims' factors. Victim-related factors were associated with both lower and higher odds of weapon use during the index offense. The highest odds of weapon use were found if the victim was an extended family member of the patient, followed by sibling, lover/partner/spouse, parent, and then adult acquaintance. The odds of weapon use during the index offense were lower if victims were healthcare workers, law enforcement professionals, and females when compared to adult strangers.

Conclusion: The study highlights the significant role of both patients' and victims' characteristics as important factors associated with weapon use during index offenses among forensic patients. Notably, prior hospitalization emerged as a crucial factor with a reduced likelihood of weapon use. Implicitly, this underscores the importance of risk mitigation strategies.

Objectives: Functional limitations may be associated with firearm ownership among veterans by amplifying perceptions of vulnerability and the need for security, yet their role remains underexplored despite emerging research on health-related factors influencing firearm acquisition in this group. This study examines the relationship between the number of functional limitations and recent firearm purchasing among a sample of low-income US military veterans.

Methods: Data are from the National Veteran Homeless and Other Poverty Experiences (NV-HOPE) study, which surveyed US veterans in households under 300% of the US federal poverty level. The survey was conducted in December 2022 and January 2023 (n = 1,008). Functional limitations were assessed based on self-reported assistance needed in daily tasks. Multiple logistic regression was used to analyze the association between functional limitations and firearm purchases in the past year, adjusting for demographic and socioeconomic factors. Analyses were conducted in Stata v. 18, and statistical significance was determined at the p < 0.05 threshold.

Results: 5.5% of respondents reported purchasing a firearm in the past year. Increased functional limitations were positively associated with recent firearm purchases (Adjusted Odds Ratio [aOR] = 1.14, 95% Confidence Interval [CI] = 1.03, 1.26). Sensitivity using Firth Logit for rare events confirmed the robustness of this finding.

Discussion: Veterans experiencing a greater number of functional limitations are more likely to report recently purchasing a firearm. These findings underscore the importance of addressing health needs among firearm-owning veterans through VA programs that support disabled veterans and their caregivers.

Background: A prerequisite for understanding temporal changes in road crash severity is an unbiased description of this phenomenon. The aim of this study was to estimate the independent association trends of age, period and cohort with severity, encompassing the risk of death (RD) and the risk of death or hospitalisation (RDH) within 24 h, for drivers of passenger cars involved in road crashes with casualties in Spain from 1993 to 2020.

Methods: The study population comprised 2,453,911 drivers of passenger cars aged 18 to 98 years involved in road crashes included in the registers of the General Directorate of Traffic. Crash- and driver-related variables with sufficient continuity over time were included, establishing RD and RDH as study outcomes. Temporal trends of both outcomes were analysed using multivariable Poisson regression and multivariable age-period-cohort intrinsic estimator models. An additional sensitivity analysis was performed for the subset of single crashes.

Results: Severity estimates showed some variation across strategies. The APC model identified: (1) a J-shaped pattern for the effect of age on severity, (2) a decline in severity between 2001 and 2004 and 2013-2016, and (3) a birth cohort effect for both RD and RDH. In particular, the 1952-1958 cohort had the highest risk (RD = 1.17; 95%CI = 1.11-1.24 and RDH = 1.16; 95%CI = 1.13-1.19), followed by a decreasing trend in subsequent cohorts. Restricting the analysis to single crashes yielded similar results, with the exception of the age effect (severity increased with age). Furthermore, sex differences were observed-female sex was inversely associated with severity, especially for RD.

Conclusions: RD and RDH decreased during the first decade of the 21st century, but seemed to stabilise from 2013 onwards. Evidence from this study support that birth cohort is associated with road crash severity, independent of age and period. This cohort effect might be due, at least partially, to improvements in general and road safety education. Further studies are needed to elucidate the causes of our findings and to identify factors accounting for sex differences.

Background: Overdose mortality increased substantially during the COVID-19 pandemic, but it is unclear to what extent the COVID-19 mortality had contributed to this increase at the neighborhood level.

Methods: This was an ecological study based on New York City United Hospital Fund (NYC UHF) neighborhood-level data from 2019 to 2021, split into two time-windows: pre-COVID (2019) and during-COVID (2020 and 2021). Linear regression models were used to estimate the effect of cumulative COVID-19 mortality on the increase in drug overdose mortality from the pre-COVD to during-COVID periods at the neighborhood level, with and without adjusting for neighborhood characteristics.

Results: Drug overdose mortality rate increased from 21.3 to 33.4 deaths per 100,000 person-years across NYC UHF neighborhoods from pre-COVID to during-COVID. For each additional COVID-19 death per 1,000 person-years at the neighborhood level, the increase in drug overdose mortality rose 2.4 (95% CI: 1.7, 3.3) times. Furthermore, neighborhoods with a higher percentage of Hispanic residents, a higher percentage of single-person households, and a higher percentage of residents with health insurance experienced significantly larger increases in drug overdose mortality. In contrast, neighborhoods with a higher percentage of residents aged 75 and older had a smaller increase in drug overdose mortality.

Conclusions: NYC neighborhoods with higher cumulative COVID-19 mortality experienced a greater increase in drug overdose mortality during the first two years of the COVID-19 pandemic.

Background: Firearm injuries are the leading cause of death for U.S. adolescents. Given the prevalence of firearm ownership in the U.S., particularly among parental figures in homes with children and teens, and the relationship between firearm access and injury outcomes, it is vital to shed light on potential parental motivations for keeping firearms in their homes. The purpose of this analysis was to examine whether exposure to community violence is associated with parental firearm ownership.

Methods: Data from the Firearm Safety Among Children and Teens Consortium's National Survey (6/24/2020-7/24/2020) was examined. The survey sample comprised parents/caregivers of high-school-age teens (age 14-18). The survey examined various measures, including firearm ownership, storage, community violence exposure, and sociodemographic characteristics. Stepwise logistic regression was used to examine the association between community violence exposure and parental firearm ownership.

Results: The study included 2,924 participants, with 45.1% identifying as male, 12.9% identifying as Hispanic, and 25.3% identifying as non-White. Among these participants, 43.1% reported firearm ownership, and 49.9% reported exposure to community violence. Regression models demonstrate that community violence exposure is associated with an increased likelihood of firearm ownership among parents/caregivers of high-school age teens (OR = 1.08, p < 0.05). Other significant predictors of firearm ownership among parents/caregivers included parent/caregiver age (OR = 0.99, p < 0.01), marital status (OR = 1.29, p < 0.05), and educational attainment (OR = 0.60, p < 0.001).

Conclusions: The findings supported the hypothesis that community violence exposure was associated with an increased likelihood of parental firearm ownership, even after adjusting for potential confounders. These findings contribute to the existing literature by shedding light on the possible contributing factors for firearm ownership among parents/caregivers of teens. Public health interventions focused on raising awareness about the risks of firearm access in households with youths, providing counseling on locked storage practices, and offering resources for accessing secure firearm storage options, such as rapid access storage, may contribute to reducing firearm access among youth. Additionally, community-based initiatives focused on violence prevention and addressing the root causes of community violence can help create safer environments, thereby reducing the perceived need for accessible firearms in the home by parents and caregivers.

Background: Suicide-related presentations to pediatric emergency departments (PED) have increased in recent years. PED providers have the opportunity to reduce suicide risk by counseling on restricting access to lethal means. Supplementing lethal means counseling (LMC) with safety device distribution is effective in improving home safety practices. Data on PED-based LMC in high-risk patient populations is limited. The objective of this study was to determine if caregivers of children presenting to PED for mental health evaluation were more likely to secure all household firearms if given cable-style gun locks in addition to LMC.

Methods: In this randomized controlled trial, caregivers completed a survey regarding storage practices of firearms and medication in the home. Participants were randomized to receive LMC (control) or LMC plus 2 cable-style gun locks (intervention). Follow-up survey was distributed 1 month after encounter. Primary outcome was proportion of households reporting all household firearms secured at follow-up. Secondary outcomes included: removal of lethal means from the home, purchase of additional safety devices, use of PED-provided locks (intervention only), and acceptability of PED-based LMC.

Results: Two hundred participants were enrolled and randomized. Comparable portions of study groups completed follow-up surveys. Control and intervention arms had similar proportions of households reporting all firearms secured at baseline (89.9% vs. 82.2%, p = 0.209) and follow-up (97.1% vs. 98.5%, p = 0.96), respectively. Other safety behaviors such as removal of firearms (17.6% vs. 11.8%, p = 0.732), removal of medication (19.1% vs. 13.2%, p = 0.361), and purchase of additional safety devices (66.2% vs. 61.8%, p = 0.721) were also alike between the two groups. Both groups held favorable views of PED-based counseling. Within the intervention group, 70% reported use of provided locks. Preference for a different style of securement device was the most cited reason among those not using PED-provided locks.

Conclusions: PED-based LMC is a favorably-viewed, effective tool for improving home safety practices in families of high-risk children. Provision of cable-style gun locks did not improve rate of firearm securement compared LMC alone-likely due to high baseline rates of firearm securement and preference for different style of lock among non-utilizers.

Clinical trial registration: ID: NCT05568901 .

Clinicaltrials: gov. https://clinicaltrials.gov/ . Retrospectively registered October 6, 2022. First participant enrollment: June 28, 2021.