Injury Epidemiology最新文献

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.

Objective: Because of limitations to government data on police-related violence, researchers commonly use open-source data as the best approximation for studying the prevalence, causes, and prevention of police killings and other police-related violence in the United States. However, the comprehensiveness and accuracy of these open sources are not well known.

Methods: We compared fatal police shootings in three commonly used open sources to self-reports from a national sample of 573 U.S. police agencies from 2015 to 2019. Using ANOVA and regression methods, we assessed patterns of agreement and discrepancy by open source, year, and agency characteristics. We also examined media reports to assess factors contributing to overcounts in open sources.

Results: Annual open-source counts were higher or lower than self-reports for 5%-9% of agencies depending on year and open source. Discrepancies varied between open sources but not consistently across years. Discrepancies were more likely and greater in magnitude for large agencies and state police, with less consistent evidence of regional variation. Overcounts in open sources appear linked to incidents involving multiple police agencies, multiple shooters, officer deaths, unclear causes of death, and agency misidentification.

Conclusions: Open-source data on fatal police shootings are largely accurate but should be used cautiously, particularly in agency-level analyses. Coordinated efforts by police agencies, open-source compilers, and other researchers could potentially improve the accuracy of data on fatal police shootings.

Background: It is difficult to study the epidemiology of drowning at the regional level because of multiple data sources, many of which have a high degree of unstandardized and missing data. We aimed to link multiple datasets to identify demographics and geographic locations of unintentional fatal drowning in a metropolitan region and compare linked data with vital statistic data.

Methods: This cross-sectional study included unintentional drowning fatalities among persons of all ages in metropolitan Houston between 2016 and 2022. Probabilistic linking was used to link multiple datasets and geographical mapping to identify drowning locations. The effectiveness of data linkage was assessed by the recall, precision, and F1-score (harmonic mean of precision and recall). Geographic location of drownings by aquatic body was studied. Drowning burden by demographics, county and aquatic body were compared between linked data and vital statistic data using Chi-square tests.

Results: Data from 8 datasets were linked. The linkage metrics were Recall (0.88-1.00), Precision (0.91-1.00), and F1-score (0.91-1.00) for datasets. There were 790 drowning fatalities. The median age was 40 years (IQR: 18.5,60); 71% were males. Children aged 0-17 years constituted 24% of drowning fatalities. Drownings occurred in swimming pools (27%), bathtubs (19%) natural water (27%), flood control structures (20%), and during flooding events (6%). Adults commonly drowned in natural water, flood control structures, bathtubs, and during flooding events whereas most toddlers drowned in swimming pools and hot tubs. No significant differences in counts by age group, sex, county of drowning and body of water were observed between linked and vital statistic data. Drowning locations were geocoded in 769 of 790 records (97%).

Conclusion: Probabilistic data linkage can accurately determine the epidemiology of fatal drowning in a metropolitan region. Identification of high-risk drowning subpopulations and locations can inform drowning countermeasures at the regional level.

Background: With the global rise in the aging population, ensuring safe mobility for older adults is an urgent public health concern. In Taiwan, scooters are widely used by older individuals, yet the impact of air pollution, particularly fine particulate matter (PM_2.5), on their traffic safety remains poorly understood. This study investigated the short-term association between PM_2.5 exposure and the risk of scooter collisions among older adults.

Methods: We conducted a nationwide time-series analysis using Taiwan's Police-Reported Traffic Accident Registry and air quality monitoring data from 2023. The study included 58,181 scooter riders aged ≥ 65 years involved in collisions. Daily PM_2.5 concentrations were derived from over 70 monitoring stations. We applied distributed lag non-linear models (DLNM) with a negative binomial distribution to estimate the association between PM_2.5 exposure and daily scooter collision counts, adjusting for meteorological variables, co-pollutants (NO₂ and SO₂), and temporal variables. The models accounted for both same-day exposure and cumulative effect of exposure across lag periods of up to 14 days.

Results: We found that 159 older adults were involved in scooter collisions per day on average, with a mean PM_2.5 level of 13.4 µg/m³. A non-linear exposure-response relationship was observed, with rate ratios increased at PM_2.5 levels ≥ 20 µg/m³, particularly over longer lag periods. The highest risk estimate was observed for 15-day cumulative exposure at 31 µg/m³ (rate ratio = 2.357; 95% CI: 1.419-3.914). In contrast, same-day exposure showed a limited association with collision risk.

Conclusions: These findings suggest that prolonged exposure to elevated PM_2.5 may increase the risk of scooter collisions among older adults, highlighting the need to integrate air quality considerations into traffic safety strategies for aging populations.

Background: Low income has been associated with a higher risk of transportation-related injury however, previous studies have largely relied on area-level income, due to the limited availability of individual-level data.

Methods: To examine the independent and combined roles of individual- and area-level income, this prospective cohort study followed ~ 6,557,000 Canadians from the Canadian Census Health and Environment Cohorts (2006, 2011, 2016), for pedestrian, bicycling, or motor vehicle hospitalizations. Income was measured (1) individually by the low-income cut-off and (2) at the area level using neighbourhood income quintiles. Poisson regression estimated the incidence rate ratios (IRR) and 95% confidence intervals (CI) for transportation-related hospitalizations.

Results: After adjusting for covariates, low-income individuals had higher risks of hospitalizations for pedestrian (IRR = 1.93, 95%CI (1.62, 2.29)), bicycling (IRR = 1.16, 95%CI (1.01, 1.34)) and motor vehicle injuries (IRR = 1.18, 95%CI (1.06, 1.31)). When both individual and neighbourhood income were assessed together we estimated, that those who lived in the lowest income neighbourhoods (compared to the highest) had a higher risk of pedestrian (IRR = 1.80, 95%CI (1.51, 2.14)) and motor vehicle injury (IRR = 1.33, 95%CI (1.22, 1.42)) but lower risk of bicycling injury (IRR = 0.73, 95%CI (0.65, 0.81)).

Conclusions: The interaction between individual and neighbourhood income revealed an increased injury risk for low-income individuals in all neighbourhoods, with large inequities in pedestrian and motor vehicle injury risk persisting even in the highest-income neighbourhoods. These findings demonstrate individual income independently contributes to transportation injury risk, underscoring the importance of considering both individual- and area-level income.

Motor vehicle collisions (MVCs) are the most common etiology of trauma and non-obstetric fetal death among pregnant individuals. Seat belts prevent MVC-related injuries; however, some pregnant individuals do not wear a seat belt due to discomfort and concerns about belt-related safety for their fetus. Highlighted by stagnating seat belt use rates over time and potential for incorrect usage, seat belt effectiveness among pregnant occupants requires further study. Here, crash data 1998-2021 for pregnant occupants from National Automotive Sampling System - Crashworthiness Data System (NASS-CDS) and the Crash Investigation Sampling System (CISS) were analyzed to: 1) evaluate the effectiveness of seat belts on preventing whole-body injury outcomes; 2) evaluate the effectiveness of seat belts on preventing body region-specific injuries; and 3) investigate vehicle- and occupant-specific factors that modify the risk of injuries. Adjusted for occupant and vehicle factors, seat belts prevented whole-body injuries as well as injuries to critical body regions such as the brain, thorax, and pelvis. Although three-point seat belts are effective in improving injury outcomes for pregnant occupants overall, there is room to improve their effectiveness for specific body regions (e.g., abdomen, uterus/placenta). Importantly, no elevated injury risk to pregnant occupants from wearing a seat belt during an MVC was found.

Background: Ingestion of delta-8 tetrahydrocannabinol (Δ8THC) by young children is recognized as a public health concern and is commonly encountered by healthcare providers; however, a better understanding of Δ8THC toxicity in this age group is needed. The objective of this study is to investigate the relationship between body weight-based doses of ingested Δ8THC and clinical outcomes among children < 6 years old.

Methods: Using data from the National Poison Data System, we analyzed single-substance Δ8THC ingestions reported to United States poison centers to investigate the dose-response relationship between Δ8THC dose and clinical outcomes, including severe and prolonged toxicity, followed by receiver operator characteristic (ROC) curve analyses.

Results: There were 232 cases (median age: 3.0 years, 51.7% female) and the median ingested Δ8THC dose was 6.7 mg/kg. CNS depression (75.5%) was the most common related clinical effect. There was a dose-response relationship between dose and CNS depression severity. Children who ingested a dose in the top quartile (> 17.0 mg/kg) had 3.43 times (95% CI: 1.44-8.14) greater odds of experiencing severe toxicity and 5.02 times (95% CI: 2.05-12.29) greater odds of prolonged toxicity than those who ingested a dose in the lowest quartile (< 2.4 mg/kg), with prolonged toxicity demonstrating a similar dose-response relationship. During ROC curve analyses, a dose cutoff of 2.3 mg/kg yielded a sensitivity of 91% with a specificity of 31% for identifying severe toxicity (area under the curve [AUC] = 0.64) and a sensitivity of 91% with a 37% specificity for identifying prolonged toxicity (AUC = 0.62). A dose cutoff of 1.7 mg/kg yielded a sensitivity of 98% with a specificity of 28% for identifying severe toxicity and a sensitivity of 93% with a 30% specificity for identifying prolonged toxicity.

Conclusions: Despite limitations of NPDS data and inconsistent quality control and labeling of Δ8THC products, the findings of our study are similar to those previously described for delta-9 tetrahydrocannabinol ingestions among young children. We found that a 1.7 mg/kg dose cutoff value for Δ8THC had a high sensitivity for identifying severe or prolonged toxicity associated with Δ8THC ingestions among children < 6 years old; however, it was associated with a high number of false positives.

Background: Accurate information on where suicides occur; especially in domestic settings, is essential for designing prevention programs. In practice, place of death from death certificates is used as a proxy, though its accuracy is unclear. This study assessed the validity of using death certificate data to determine place of suicide, using linked records from the Suicide Surveillance System in Taiwan.

Methods: We linked mortality data with the Suicide Surveillance System in Kaohsiung City, Taiwan, from 2021 to 2023. Using the place of suicide recorded in the surveillance system as the reference standard, we estimated the proportion of suicide deaths in each place-of-death category (home, hospital, and other) that actually occurred at home.

Results: Among 1465 suicide deaths, 965 were successfully linked to the Suicide Surveillance System. The positive predictive value for death at home was high: 99.3% for hanging, 97.8% for charcoal burning, and 100.0% for other poisoning. Many suicides recorded as hospital deaths actually occurred at home, including 79.3% of hanging, 66.7% of charcoal burning, 85.5% of other poisoning, and 71.6% of jumping cases. After adjustment, the estimated proportion of suicides occurring at home was 80.4% for hanging, 68.2% for charcoal burning, 77.9% for other poisoning, 75.0% for jumping from a height, and 60.2% for other methods.

Conclusions: Using death certificates alone underestimates suicides at home. Improved data integration is needed to support more accurate surveillance and better-targeted suicide prevention efforts.

Background: Motorcyclists are the fastest growing road user group in Latin America, and account for 25% of all road traffic collision deaths. This study examines the relationship between motorcyclist mortality and the built and social urban environment in Latin American cities.

Methods: We studied 337 cities with ≥ 100,000 inhabitants in seven Latin American countries. Mortality data from 2010 to 2019 were obtained from civil registries and linked to cities defined by the SALURBAL project. Motorcyclist deaths were identified using ICD-10 codes, with redistribution of ill-defined codes. City-level measures included population, urban development, street design, public transportation, and social environment. Associations were estimated using multilevel negative binomial models. A subanalysis of 300 cities with motorcycle registration data was conducted.

Results: The crude city-level motorcyclist mortality rate was 4.16 per 100,000 population. Age-standardized rates varied from 0.51 to 22.60. Males had higher mortality rates, with the highest rates in 20-24-year-olds. After adjustment, cities with higher population density (RR 0.92 [95% CI 0.85-1.00]), intersection density (RR 0.91 [95% CI 0.83-0.99]), and social environment index (RR 0.88 [95% CI 0.83-0.93]) had lower motorcyclist mortality. More curvilinear street layout (RR 0.97 [95% CI 0.90,1.03]) and the presence of public transportation (RR 0.94 [95% CI 0.87,1.03]) showed a non-significant association with mortality. Higher urban development isolation (RR 1.07 [95% CI 1.00-1.14]) was associated with higher mortality, but the association weakened after adjustment. In cities with motorcycle registration data, higher rates of registered motorcycles were associated with higher motorcyclist mortality.

Conclusion: Motorcyclist road traffic deaths in Latin American cities are associated with specific city-level characteristics. In fully adjusted models, higher intersection density and a stronger social environment index were linked to lower mortality rates. City-level interventions that improve street connectivity, promote safer and more cohesive urban environments, and address social inequities in infrastructure and services may help reduce motorcycle deaths and enhance road safety in the region.