Injury Epidemiology最新文献

Background: Puerto Rico (PR) endures numerous natural and human-caused disasters with significant impacts on community health and infrastructure each year. The Centers for Disease Control's Social Vulnerability Index (CDC-SVI) quantifies a community's capacity to prepare, respond, and recover from disasters. The SVI has been linked to all-cause mortality in the continental US, however, its relevance to suicide mortality, particularly in PR, remains understudied.

Methods: This cross-sectional study analyzed data from 1,471 suicide decedents recorded in the PR site of the National Violent Death Reporting System (NVDRS) from 2017 to 2022. Using Bayesian Poisson hierarchical models, we examined the associations between the county-level CDC-SVI with age- and sex-standardized suicide mortality. We explored whether contributing circumstances (i.e., mental health history, financial loss) varied by measure of SVI among these decedents.

Results: During 2017-2022, there were 1,471 suicides (Mean age: 51 years, 84% male, 68% lower education) across PR's 78 municipalities. Overall, there was no association between county CDC-SVI and suicide mortality (Relative Risk: 1.05, 95% CI: 0.88-1.25). The most common contributing circumstances (available for 93% of decedents) were mental health problems (45%), depressed mood (44%), history of mental health treatment (29%), and prior suicide attempt (28%) or suicidal thoughts (26%). Our geospatial analyses revealed a clustering of suicide and vulnerability in central counties and island-municipalities, areas marked by long-standing economic disadvantage and limited access to healthcare.

Conclusions: Social vulnerability was unrelated to suicide mortality, contrasting with prior studies in the continental US. While the CDC-SVI is a useful tool for disaster response planning, its utility for suicide prevention in PR depends on the local validity and relevance of its components. These results suggest that the contextual determinants of suicide in PR operate through different structural pathways, shaped by the island's distinct socioeconomic, demographic and disaster-exposed setting, where most communities already experience high vulnerability.

Background: Road traffic injury (RTI) is a major threat to children and adolescents worldwide. RTIs account for 25.7 deaths per 100,000 people in the general population. Unlike in other western countries where road fatalities are declining, deaths in Ghana continue to rise. This study examined the injury characteristics and spatiotemporal patterns of pediatric RTI cases and inpatient fatalities across three zones in Ghana.

Methods: This study employed a retrospective cross-sectional design, analyzing pediatric RTI data from three teaching hospitals in Ghana, with each hospital located in one of Ghana's three geographic zones: northern, middle, and coastal/southern. The study included all pediatric RTI cases captured between 2021 and 2024. Data on sociodemographic, spatial-temporal information, type of injury, injury severity, and admission outcome were analyzed. Descriptive statistics and Chi-square tests were used to compare groups at p < 0.05. Quantum Geographic Information System (QGIS) was used to develop choropleth maps.

Results: A total of 1,485 pediatric RTI cases were included. Boys constituted 72.3%. Adolescents aged 13-18 years (45.6%) and school children aged 6-12 years (32.4%) were the most affected age groups. The leading causes of RTI were pedestrian knockdown (51.1%) and motorcycle crash (33.2%). While pedestrian knockdowns were widespread across the country, motorcycle crashes were dominant in the northern zone. Head injury was commonly reported among patients seen in the middle (60.4%) and northern (59.5%) zones, while lower limb injuries (54.3%) were most frequently seen in the southern zone. Mortality rates differed among the zones: 6.9% northern, 2.8% southern, and 0% middle (p < 0.001).

Conclusion: The differences in injury patterns, mortality rates, and crash types underscore regional disparities in risk exposure and point to the limited effectiveness of road safety interventions across the country. The local road safety authorities should intensify road safety education and law enforcement, with clear outcome indicators to monitor impacts. Improvements in road infrastructure are also necessary, which provide separate routes for pedestrians with strict adherence.

Background: Motor vehicle crashes and resultant fatalities remain disproportionately high among young drivers, with crash risk peaking immediately after licensure. Although graduated driver licensing laws (GDL) for young novice drivers have reduced such fatalities, driver error remains a leading cause; thus, prevention efforts that target improving skills in novice teen drivers before licensure are a strong candidate for reducing crash risk early in licensure. States with more comprehensive driver licensing laws that include mandated driver training before licensure in addition to GDL show lower crash rates post-licensure, but these effects were not determined through rigorous controlled studies of driver training. This paper describes the DRIVER study, a phase III randomized trial that tests the effectiveness of two different driver training programs in reducing young driver crash risk early in licensure in Pennsylvania, a state like many others that does not require formal training for young drivers.

Methods: Learner drivers age 16 and 17 years will be recruited and followed through the GDL learner phase and for six months post-licensure. Participants will be randomly assigned to one of three interventions: professional behind-the-wheel training (n = 333), online hazard training (n = 333), or an active control online vehicle and driver safety course, unrelated to hazard skills training (n = 333). The primary outcomes are on-road crash risk post-licensure (via kinematic hard braking events tracked through a smartphone-based app) and state license examination performance. Secondary outcomes include change in simulated driving performance from baseline to the time of license examination, self-reported and kinematically tracked risky driving behavior (e.g. cell phone use, speeding) and self-reported crashes. Participants will complete baseline surveys and cognitive assessments to determine potential moderating effects of cognitive maturation and risk-taking tendencies.

Discussion: Findings from the DRIVER study will provide insights into training effectiveness generally, and an evidence base for recommendations to policy makers, while also revealing for whom these interventions are less effective.

Trial registration: The study was registered on ClinicalTrials.gov Registry (NCT06413927) in May 2024, https://clinicaltrials.gov/study/NCT06413927 and last updated on August 11th, 2025. This protocol was developed per the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) Checklist.

Background: In the US, federal law prohibits firearm possession and purchasing for individuals with convictions for a felony or domestic violence misdemeanor. If a prohibiting conviction occurred in a state court, then state law dictates how/when a prohibited person can later have their firearm rights reinstated. To our knowledge, there is limited empirical research documenting the frequency and characteristics of individuals who receive firearm rights restoration (FRR). Research is needed to guide policy, balancing the need to prioritize public safety while also fairly re-instating rights for formerly convicted individuals. We sought to address this research gap by examining FRR data from Washington state (2017-2022). During this time period, FRR granting was largely procedural (i.e., non-discretionary).

Methods: We used data from Washington State Patrol to identify who received FRR statewide. We linked these data to prior criminal convictions, arrests, and protection orders to understand the person's characteristics and violent behaviors prior to FRR.

Results: We identified n = 11,516 individuals in the state of Washington who received FRR over the six-year study period (~ 1,900 people annually). FRR recipients were mostly male (88.4%, n = 10,182) and majority White (84.2%, n = 9697). Half (51.4%, n = 5921) had a prior conviction for a violent crime. On average, 15.3 years (sd: 6.1, median: 15.0) had elapsed between the last prohibiting conviction and FRR. In the 5 years prior to FRR, 710 individuals had been arrested, and 200 had been restrained in a protection order.

Conclusions: By understanding who receives FRR and how often, this research helps lay the foundation to improve our understanding of FRR legal practices. Our findings suggest that variability within the population of prohibited individuals could help inform FRR eligibility considerations to meet the goals of both preventing firearm violence and equitably re-instating rights to formerly convicted individuals.

Background: Social media challenges (SMC) are activities individuals perform as content for social media, sometimes being "challenged" by others to join. Some of these challenges can cause injuries and even death. While SMC are frequently reported in media, peer-reviewed literature on SMC is limited and varied. Our objective was to conduct a scoping review of risky SMC to map the research area.

Methods: We conducted a comprehensive search of MEDLINE and PsycInfo® from 2000 through 2024, for articles about risky SMC, defined as SMC that have a reasonable likelihood of causing injury. The articles were excluded if the SMC involved intentional injury (e.g., cutting or suicide). Articles were screened and data were extracted. Descriptive statistics summarized article characteristics.

Results: A total of 1651 articles were identified; 54 met inclusion criteria. All articles were categorized as observational studies including reviews (26%), case reports or series (24%), or descriptive studies (22%). The first article about a risky SMC was from 2010 and article numbers increased annually since, with an increase from 1 article in 2010 to 12 in 2024. The most common social media platforms discussed were YouTube (52%) followed by TikTok (31%), both video-based platforms. The top risky SMC were the Cinnamon Challenge (33%) and Fire Challenge (24%). Injuries were mentioned in 89% of the articles including burns, poisoning, lung injury, and strangulation. Of the articles that discuss a specific injury case, reported outcomes include emergent medical evaluation (67%), permanent morbidity (29%), and death (33%). The majority (67.3%) of articles mention possible interventions including parent, school or provider education (57%), platform changes (17%), and legislation (13%). There were no descriptions of employed interventions.

Conclusions: Injuries from risky SMC have been reported in peer-reviewed literature and have increased annually over time. There is a need for more research and interventions to mitigate the harmful effects.

Background: Political violence constitutes an increasing threat to individual and population-level health in the United States, with military service identified as a potential risk factor. The current study examines the association between military service, combat experience, and support for and willingness to engage in political violence and approval of extremist organizations and movements.

Methods: A nationally representative sample of 12,947 US adult members of the Ipsos KnowledgePanel completed the 2022 Life in America Survey. Outcomes are presented as weighted proportions and adjusted prevalence differences. The analytic sample comprised 2,255 respondents with military backgrounds; 1,105, including an augment of 415 respondents, reported combat experience.

Results: Military respondents were less likely than others to perceive the use of political violence "to keep our borders open" as usually or always justified (adjusted prevalence difference (aPD) -3.1%, 95% confidence interval (CI) -5.6, -0.7, q = 0.049). By contrast, they demonstrated a greater willingness to "use force or violence on your own as an individual" (aPD 5.0%, 95% CI 2.5%, 7.5%, q = .001) and to "organize a group of people who share your beliefs to use force or violence" (aPD 2.8%, 95% CI 0.7%, 4.8%, q = .029) to advance a political objective. They were also more likely to report that it would be very or extremely likely that they would be armed with a gun (aPD 6.3%, 95% CI 3.5%, 9.2%, q = .001) or carry a gun openly (aPD 6.5%, 95% CI 3.1%, 10.0%, q = .001) in a situation where they thought force or violence was justified to advance an important political objective; however, there were no differences with respect to threatening or shooting someone with a gun. Additionally, military respondents were more likely to strongly or very strongly approve of the Oath Keepers (aPD 4.1%, 95% CI 0.7%, 7.6%, q = .037). There were no significant differences by combat experience.

Conclusions: Given the modest number of differences among numerous comparisons, and the relatively small size of prevalence differences, it does not appear that military service and combat experience act as risk factors for support for and willingness to engage in political violence, or approval of extremist organizations and movements.

Background: The objective of this study was to analyze the characteristics and trends of consumer product-related fractures among children < 18 years old treated in United States (US) emergency departments (EDs).

Methods: National Electronic Injury Surveillance System data for 1990-2023 were analyzed and national fracture estimates were calculated. US Census Bureau data were used to calculate annual fracture rates.

Results: An estimated 24,071,446 children < 18 years old were treated for nonfatal consumer product-related fractures in US EDs during 1990-2023, and 7.8% were admitted to the hospital. The average annual rate of pediatric fractures was 983.8 per 100,000 US children < 18 years old, and overall, the rate decreased by 26.8% during the study. Males accounted for 65.0% of fractures and were more likely than females to be admitted (OR: 1.094, 95% CI: 1.091-1.098). However, the difference in the rate of fractures between males and females narrowed during the study. The number of fractures peaked at age 11 years among females compared with 13 years among males. Fractures occurred most frequently in the home (38.7%), followed by a place of sports or recreation (32.7%) and school (19.5%). The most common injury mechanism was fell off/rolled off (36.4%), followed by play and/or sport (25.0%). Most (71.4%) fractures involved the upper extremity. Children < 6 years old had the highest hospital admission rate from 2009 to 2023 and were twice as likely to be admitted (OR: 1.986, 95% CI: 1.979-1.992) than older children during the study. Most (70.6%) fractures were associated with sports and recreation activities and equipment. Fractures involving home furnishings, fixtures, and accessories (OR: 1.221, 95% CI: 1.215-1.227) or the injury mechanism of fell off/rolled off (OR: 1.435, 95% CI: 1.430-1.439) were more likely to be associated with hospital admission than fractures associated with other products and activities or injury mechanisms, respectively.

Conclusions: To our knowledge, this is the first study to investigate secular trends of consumer product-related fractures among US children, locations where fractures occurred, injury mechanisms, and associated consumer products and activities. The characteristics and trends of pediatric fractures identified in this study can help inform future research and prevention of these common injuries.

Background: Firearms are a leading cause of death among Black adults in the U.S., accounting for more than 300,000 years of potential life lost in each of the past five years. Firearms are particularly challenging for suicide prevention in Black American communities. Few recent studies have been dedicated to investigating firearm ownership and safety challenges among Black adults. Without this understanding, promising interventions such as safe storage programs and lethal means counseling may inadequately address the specific challenges and motivations relevant to Black firearm owners. Our objective was to gather feedback from Black adults with access to firearms in their homes on their (1) experience with firearms (2), rationale for firearms being in their homes, and (3) perceived challenges or barriers to safely storing firearms in their homes.

Methods: This study involved semi-structured interviews and rapid qualitative analysis. 15 Black adults ages 18 years and older in the U.S. who had access to firearms in their homes participated. We developed a Transcript Summary Template to deductively condense all relevant information for three topics. Matrix analysis techniques were used to identify emerging key concepts in the responses to each topic.

Results: The participants' relationships with firearms appeared to be shaped by family traditions, vulnerability, and safety concerns that sometimes extended across generations. Participants described various pathways to firearm access, from childhood introductions through parents who viewed firearms as necessary protection against racial threats, to adult acquisition motivated by experiences of violence, discrimination, or a hobby. Key challenges to household firearm storage safety emerged: limited access to firearm safety knowledge and training in Black communities, the financial and time costs associated with safe firearm storage, and concerns about children gaining access to firearms and the importance of communicating with children about firearms in the home.

Conclusions: This study provides new insights into factors shaping firearm ownership and perceived challenges to safe firearm storage among a sample of Black adults in the U.S. Our findings may help inform community-driven and clinician-focused initiatives that acknowledge the context of Black firearm ownership while promoting evidence-based safety practices.

Background: Self-harm is a risk factor for suicide completion, and repeated self-harm carries an even greater risk. This study aimed to assess the characteristics of patients who repeatedly presented to the emergency department (ED) for self-harm.

Methods: We conducted a retrospective analysis of data from the ED‑Based Injury In‑Depth Surveillance registry in South Korea from January 2017 to December 2022. Patients aged 19-65 years with recorded information on prior self-harm episodes were included. Data regarding their demographic, pre-hospital, and clinical characteristics, as well as in-hospital mortality, were compared based on the number of prior self-harm episodes (0, 1, or ≥ 2). Univariate logistic regression analyses were performed within each self-harm episode group to evaluate the associations between demographic and pre-hospital characteristics and in-hospital mortality.

Results: In total, 6,488 patients who self-harmed were included, of whom 3,650 reported one prior episode and 2,838 reported two or more prior episodes. Most patients were female, with the proportion increasing alongside the number of prior self-harm episodes (0: 57.5%, 1: 66.8%, and ≥ 2: 77.2%). Those presenting with repeated attempts were younger, more likely to be Medical-aid insured, and more likely to use cutting or stabbing as methods of self-harm, but fewer arrived by emergency medical services. Injury severity, hospital admission, and in-hospital mortality decreased as the episode frequency increased. Univariate logistic regression analyses showed that demographic and pre-hospital factors consistently influenced in-hospital mortality across the three groups.

Conclusions: Patients with repetitive self-harm were more likely to be female, to use cutting or stabbing as methods, and to have psychiatric issues, and they showed a lower in-hospital mortality rate than those without prior episodes.

Background: People with disabilities (PwD) are at an increased risk of experiencing nonfatal violence; however, the risk of fatal violence victimization (i.e., homicide) among this population is less well established.

Methods: We used National Violent Death Reporting System (NVDRS) data for homicide victims with disabilities for 2003 to 2022 in 50 states, the District of Columbia, and Puerto Rico. NVDRS is a surveillance system that collects data on violent deaths, linking information from death certificates, coroner or medical examiner records, and law enforcement reports. NVDRS does not currently include standard variables on disability status or disability type; these decedent characteristics were identified using a literal text search of textual data. Descriptive statistics were used to characterize homicides among PwD.

Results: From 2003 to 2022, NVDRS collected 1,498 homicides among people with disabilities. The largest proportion of victims had a neurological disability (36.7%), followed by cognitive disability (35.5%), physical disability (22.4%), or unspecified disability type (5.4%); 18.2% had multiple disability types. Those aged ≥ 65 years accounted for 45.1% of all victims; the largest proportion of victims were ≥ 75 years old (29.7%). A firearm was used in 38.5% of these homicides. The top three precipitating circumstances of these homicides were: caregiver abuse and neglect (27.0%), argument (26.0%), and intimate partner violence (IPV; 24.0%). Caregiver abuse or neglect precipitated 38.1% of homicides among female victims, versus 19.1% of male victims. IPV precipitated 43.7% of female homicides, versus 9.1% of male homicides. Half (49.5%) of all victims had a mental health problem at the time of death; 23.3% had a history of ever being treated for a mental health problem; 17.8% were receiving mental health treatment at the time of death.

Conclusion: This study characterized homicides among PwD. Older adults accounted for nearly half of all victims, and mental health conditions such as dementia and Alzheimer's disease were frequently present among decedents, especially female victims. Among older adults and child victims, caregiver abuse/neglect was common. Our results underscore the importance of supporting caregivers of PwD, creating protective environments for PwD, systematically collecting data on violence against PwD, and tailoring prevention strategies to address the needs of PwD.