Injury Epidemiology最新文献

Background: Too little is known about the distribution of risk for committing political violence, a serious concern for the United States. This study explores the association between affiliation with the "Make America Great Again" (MAGA) movement and support for and willingness to engage in political violence.

Methods: Findings are from Wave 3 of a nationally representative annual longitudinal survey of members of the Ipsos KnowledgePanel, conducted May 23-June 14, 2024. All KnowledgePanel members who responded to prior waves were invited to participate. Political party and MAGA affiliations were reported by respondents; the principal comparison is between MAGA Republicans and non-MAGA non-Republicans. Outcomes are expressed as weighted proportions and adjusted prevalence differences (aPDs, reported as percentage point (pp) differences), with p-values adjusted for the false discovery rate.

Results: The completion rate was 88.4%; there were 8896 respondents. MAGA Republicans were more likely than non-MAGA non-Republicans to endorse violence to effect sociopolitical change and to consider violence usually or always justified to advance at least 1 of 21 specific political objectives (MAGA Republicans, 55.9% (95% CI 52.3%, 59.4%); non-MAGA non-Republicans, 25.5% (95% CI 23.7%, 27.2%); aPD 30.1pp (95% CI 26.0pp, 34.2pp), q < 0.001). They were not more willing to commit political violence. Similarly, while MAGA Republicans more frequently predicted that they would be armed in a setting where they considered political violence justified, they were not more likely to shoot someone (very or extremely likely: MAGA Republicans, 2.1% (95% CI 0.8%, 3.4%); non-MAGA non-Republicans, 1.6% (95% CI 1.0%, 2.1%); aPD 1.5pp (95% CI -0.1pp, 3.0pp), q = 0.43). Prevalences for other Republicans generally fell between those for MAGA Republicans and non-MAGA non-Republicans. In secondary analyses, MAGA Republicans endorsed attributes associated with political violence-racism, hostile sexism, homonegativity, transphobia, xenophobia, and Islamophobia; support for the QAnon movement and Christian nationalism; conspiracism; trait aggression; and authoritarianism-more frequently than did non-MAGA non-Republicans.

Conclusions: In 2024, MAGA Republicans were more likely than others to endorse political violence and attributes associated with political violence. They were not more willing to commit political violence themselves; their endorsement may increase the risk that political violence will occur.

Objective: This study evaluated the excess out-of-hospital healthcare costs associated with unintentional childhood injuries in Australia. This relationship was investigated within a longitudinal biennially surveyed cohort of 8,852 children aged 0-19 years. We assessed whether costs increased over age and with the duration of injury prevalence. Results were compared against cost estimates from similar studies in Australia and analogous developed nations.

Data sources and study setting: The nationally representative Longitudinal Study of Australian Children provided linked Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) cost data for the Birth and Kindergarten cohorts, followed for 15 years.

Study design: We used a mixed effects generalized linear model (GLM) with a gamma distribution and log link to estimate outpatient healthcare costs and assess the effect of injury status, controlling for sociodemographic characteristics. This model accounted for repeated measures over time and variability both within and between individuals.

Results: Annual excess outpatient and pharmaceutical costs for injuries among 0-19 year-olds were A$39.1 million for those who were hospitalised and A$104.8 million for those only requiring community-based treatment. These estimates do not include inpatient hospital costs, which are not captured in the Medicare dataset.

Conclusions: Unintentional childhood injuries in Australia incur significant financial burden on the public healthcare system, with costs per capita higher than other childhood conditions. Our figures are likely an underestimate. These excess healthcare costs support preventive efforts to reduce injury incidence among children.

Background: Fall injuries on ice and snow are a major public health problem in cold climates, placing a substantial seasonal burden on healthcare systems and affected individuals. To prevent such injuries, many Swedish municipalities have implemented programs that distribute ice cleats, typically restricted to adults aged ≥ 65. Evidence suggests these programs increase cleat use, reduce injuries, and are cost-effective. However, it remains unclear whether restricting distribution to older adults is more effective than broader or universal strategies. This study is the first to formally evaluate this question.

Methods: We developed a cohort simulation model combining elements of the local average treatment effects framework and the health belief model to evaluate the cost-effectiveness of alternative ice cleat distribution strategies across age thresholds. The model incorporates age-specific injury risks, compliance, costs, and quality-adjusted life year losses, using input from behavioral surveys, register data on ice-related fall injuries, and published literature. It is calibrated to outcomes from real-world distribution programs. Cost-effectiveness was assessed from a societal perspective, defining optimal thresholds as those maximizing net monetary benefit and acceptable thresholds as those with > 50% probability of being cost-effective compared to no distribution in probabilistic sensitivity analyses.

Results: Our primary analysis identified ≥ 55 years as the optimal eligibility threshold (acceptable range: 42-72). Sensitivity analyses indicated that universal distribution may be acceptable if cleats are purchased restrictively and targeted to non-users, but it is unlikely to be optimal. When assuming short-lived behavior change (≤ 2 years) or valuing costs from a healthcare perspective only, no distribution was preferable.

Conclusion: Age-targeted ice cleat distribution appears more cost-effective than universal provision and preferable to no distribution, but current programs limited to older adults may be suboptimal. Extending eligibility to middle-aged adults could further improve cost-effectiveness from a societal perspective.

Background: Violence is a leading cause of death and disparity in the United States. Individuals' physical and social environments can prevent or foster violence, but these complex milieus are challenging to model. In this study, we used machine learning to identify features of the local environment that are most predictive of violence in two Midwestern cities struggling with disinvestment and crime.

Methods: This was a serial cross-sectional study of census tracts in Cleveland, Ohio and Detroit, Michigan, 2011-2019. We took a machine learning approach-extreme gradient boosting-that enabled us to model 55 neighborhood features simultaneously and without making assumptions about their relationships or functional form. These features included building quality and type, public goods and services, residential stability, socioeconomic features, historical features, and demographic features. Primary outcomes were police-reported counts per square mile of violent crime and violent crime involving a firearm in Cleveland. Secondary outcomes were homicide and firearm homicide in Cleveland and Detroit. Variable importance was assessed with Shapley values.

Results: The primary models performed well, with a correlation between observed and predicted counts of 0.89 for violent crime and 0.65 for firearm-involved violent crime. For both outcomes, the variables with the highest importance tended to be in the domains of building quality and type or socioeconomic features. Several variables had high importance for both outcomes, including multifamily homes per square mile, road network density, commercial buildings per square mile, and percentage of the population that was white.

Conclusions: These findings underscore the fundamental importance of place in preventing and generating violence. Future studies should explore modifiable, highly important variables as potential points of intervention.

Introduction: Firearm access and associated risk behaviors (i.e., firearm storage and carriage) are established factors that increase the risk of firearm-related injuries. While extant research has demonstrated associations between singular substance use and these risks, little is known regarding the impact of polysubstance use on these outcomes. The present study aims to investigate the relationships between polysubstance use in adolescence and four specific firearm-related risks manifesting in emerging adulthood.

Methods: Ten years of annual data from a cohort of 1,042 adolescents initially aged 13-18 years were analyzed to identify polysubstance use trajectories and their associations with firearm-related behaviors in emerging adulthood. Using group-based multi-trajectory modeling, polysubstance use patterns from adolescence to emerging adulthood were identified. Associations between membership in these trajectory groups and four firearm-related risk factors in emerging adulthood-firearm access, improper storage of firearms and ammunition, and frequent carriage-were assessed using multivariable logistic regression.

Results: Five distinct polysubstance risk trajectories were identified. The highest rates of firearm access were observed among Chronic Illicit and Non-Illicit Polysubstance Users. The greatest prevalence of improper firearm storage was exhibited by Alcohol Ascenders and Chronic Non-Illicit Users. Additionally, significantly higher odds of engaging in frequent firearm carrying were found for all polysubstance use groups compared to Mild Alcohol Users, with the exception of Chronic Illicit Users. No significant associations were observed for improper ammunition storage across groups.

Conclusion: This study is among the first to identify specific associations between firearm-related risk behaviors and distinct polysubstance use trajectories. The findings provide novel insights for developing targeted interventions to mitigate firearm risks in polysubstance-using individuals transitioning from adolescence to young adulthood.

Background: Access to firearms is associated with elevated risk for suicide; however, knowledge of firearm ownership and characteristics among rural residing women Veterans remains limited. Given increasing rates of firearm suicide among women Veterans, we examined if rurality was associated with firearm ownership and firearm characteristics (type, number, reasons for ownership, perceived safety, storage) among women Veterans.

Methods: In 2020, 525 post-9/11 era women Veterans completed a survey assessing firearm ownership and characteristics. Prevalence ratios (PR) and 95% confidence intervals (CI) were estimated to compare differences in firearm ownership and related characteristics between rural and urban residing women Veterans, using Poisson regression with robust standard errors.

Results: Rural, relative to urban, residing women Veterans were significantly more likely to report personal firearm ownership (PR = 1.30; 95%CI: 1.07, 1.57) and household firearm ownership (PR = 1.22; 95%CI: 1.05, 1.41). Significant differences were not detected regarding types of firearms, number of firearms, firearm storage methods, reasons for owning, or perceived sense of safety from the presence of a firearm in the home. In a post-hoc sensitivity analysis with an alternative conceptualization of rurality, rural residing, compared to urban residing, women Veterans were more likely to own only a long gun or both long guns and handguns.

Conclusions: Assessing for personal ownership and household firearm access is an important component of suicide prevention for both rural and urban residing women Veterans and may be especially relevant to post-9/11 women Veterans residing in rural areas.

Background: Firearm thefts from motor vehicles are currently the leading source of stolen firearms in the United States. Yet little is known about the temporal, spatial, and contextual characteristics of these thefts. This study aims to advance understanding of firearm theft from vehicles by analyzing all reported incidents that occurred in San Antonio, Texas, in 2024.

Methods: Data are extracted from police reports from all reported incidents of firearm theft from vehicles reported to the San Antonio Police Department between January 1 and December 31, 2024. Information on the number and type of firearms stolen, vehicle make and model, date, and location of the incident was analyzed.

Results: In 2024, 2,465 firearms were reported stolen across 2,210 separate incidents. Most incidents (91.7%) involved the theft of a single firearm. Handguns represented 92.1% of all stolen firearms. Firearm thefts were most common on weekends, particularly Saturdays, and were more prevalent in April, July, and October. Pickup trucks were the most frequent type of vehicle with a firearm theft reported (68.9%). The most common locations of thefts included vehicles parked at hotels (24.6%), shopping centers (19.8%), and private residences (16.0%).

Conclusions: The results reveal distinct patterns in the timing, location, and types of vehicles associated with firearm thefts. The findings hold potential implications for strategies to reduce firearm thefts from vehicles, such as targeted public awareness campaigns, promoting vehicle secure storage, and place-based policing strategies.

Background: Cyclists are vulnerable road users, with preventable deaths increasing by 48% over the past decade. This study aimed to review the epidemiology of cyclist fatalities to identify risk factors for targeted interventions through a safe system approach, with a focus on urban and rural environments.

Methods: Data on fatal cyclist and motor vehicle collisions (CMVC) and injuries were collected from the Office of the Chief Coroner (2013-19), including selected crash investigations and expert reviews by a multidisciplinary team. Descriptive analyses were conducted, and urban vs. rural CMVC were compared using Pearson chi-square and Mann-Whitney U tests.

Results: There were 83 fatal cyclist collisions (81% male), with 6% children, 13% youth, 69% adults, and 12% seniors (median age = 48, ISS = 75). The head was the most severely injured body region across all age groups (median AIS = 5), except for children, whose thoracic injuries were more severe. Overall, 62% of cyclists were not wearing helmets, and 24% were impaired. Expert review found that 60% of child cyclist fatalities were run over, all of whom were ≤ 6 years. Distractions from cell phones (1%) or headphones (8%) may have contributed to CMVC. Urban collisions (49 cyclists; 59%) accounted for all child deaths and had significantly more collisions involving intersections (57% vs. 6%; p < 0.001), low-speed crashes (33% vs. 0%; p < 0.001), bike lanes (29% vs. 0%; p < 0.001), and heavy vehicles (31% vs. 6%; p = 0.006). Rural collisions were associated with higher speeds (> 50 km/h, 94% vs. 49%; p < 0.001), dark lighting (44% vs. 4%; p < 0.001), and riding on the roadway with traffic (56% vs. 16%; p < 0.001). No rural CMVCs had sidewalks or bike lanes (0% vs. 84%; 0% vs. 33%; p < 0.001).

Conclusion: Cyclists face severe injury and death risks in both urban and rural settings. A safe system approach recognizes human vulnerability and the inevitability of mistakes. Engineering countermeasures, such as road separation, better lighting in rural areas, traffic calming, and vehicle safety features (i.e., guard rails, advanced headlights, and cyclist detection), support CMVC prevention. Public health campaigns and legislative action, along with equitable implementation across urban and rural areas, facilitate improving cyclists' safety.

Background: Urban design sets the conditions under which individuals encounter one another. It is modifiable and can be an important intervention point for firearm assault prevention. Higher vehicle traffic, a previously under-studied exposure in firearm injury research, may contribute to firearm violence by fostering spaces that create interpersonal encounters while hindering positive social processes. We aimed to examine the association between vehicle traffic and firearm injury risk within the city of Portland, OR.

Methods: In response to local community concerns, we investigated the relationship between vehicle traffic volume and firearm assault risk in Portland, OR using novel traffic estimates from Streetlight, Inc, and firearm injuries from Portland Police, 2019-2021. We examined this association using (1) cross-sectional logistic regression with clustered standard errors and time strata covariates, and (2) an ecological case-crossover with conditional logistic regression comparing injury months to matched control periods at the same location in both the previous and subsequent months at the same type and time of day. Analyses were repeated at tracts and street segments in a high-risk neighborhood.

Results: Portland experienced 585 firearm assault injuries from 2019 to 2021. Tract-level average daily traffic volumes ranged from 9,584 to 230,804 trips. Tracts with 10,000 higher vehicle trips were associated with 27% increased risk (RR: 1.27, 95% CI: 1.12-1.45) of firearm assault, controlling for time variables and clustering standard errors at the census tract. In the case-crossover analysis a one standard deviation increase in traffic was associated with 59% (OR: 1.59, 95% CI: 1.17-2.17) and 85% (OR: 1.59, 95% CI: 1.35-2.55) higher odds of firearm assault at the same type and time of day in the prior month and subsequent month respectively. Street-segment analyses were in the hypothesized direction but not statistically significant.

Conclusions: Innovative strategies to curb firearm violence are necessary today more than ever. Future research should investigate whether traffic control could be a new avenue for community firearm violence prevention.

Background: Socioeconomic status (SES) is correlated with gunshot violence. This study examined the associations between SES and the severity of gunshot injuries in Israel.

Methods: The Israel National Trauma Registry was reviewed for all violence-related gunshot wound patients who were admitted to all public hospitals in Israel from 2019 to 2022. Self-inflicted injuries were excluded. This time frame preceded the regional military conflict that began in October 2023 and did not include any military-related activity. The registry records patient demographics including ethnicity. Severity was assessed on the Injury Severity Score (ISS), and SES was categorized into 10 clusters based on the patients' home addresses using the Israel Central Bureau of Statistics index.

Results: A total of 1,848 patients who sustained a gunshot injury were extracted from the database for the period in question, and their SES was identified. Patients from lower SES areas (1-5) were typically young (mean age 30.87 vs. 31.33 in the higher SES group; p = 0.4059) and were almost all from the Arab sector (94.53% vs. 46.94% in the higher SES group; p < 0.0001). Males were injured more frequently, regardless of SES (1825 vs. 82 females). While most patients came from lower SES backgrounds (92% SES levels 1-5), severe injuries were more prevalent in those with higher SES levels (6-10), and had higher ISS scores (p < 0.0001), more admissions to the intensive care unit (p = 0.04), injuries to internal organs (p = 0.0026), and referrals to rehabilitation facilities (p = 0.04). No differences were found for mode of transport to the hospital or likelihood to undergo surgery as a function of SES.

Conclusions: The rate of gunshot-related injuries in Israel is significantly affected by socioeconomic status and ethnicity. The lower SES cohorts, with an ethnic majority of Arabs, experienced more frequent gunshot injuries, but these tended to be less severe. This discrepancy suggests a potential difference in the underlying injury mechanism between social and ethnic groups. Local authorities as well as community leaders would benefit from a clearer understanding of these differences in injury mechanisms, which can contribute to better management of this growing societal issue.