Injury Epidemiology最新文献

Background: Endemic levels of community firearm violence in United States cities disproportionately burden certain sociodemographic groups. Nonfatal injuries are an understudied aspect of firearm violence. Police data in a large and heterogenous place like New York City (NYC) provide the unique opportunity to use a single data source to measure fatal and nonfatal community firearm violence.

Methods: The study analyzed epidemiologic trends in fatal and nonfatal community firearm violence using the publicly available New York Police Department (NYPD) Shooting Incident Dataset from 2019 to 2023. The analyses tabulated shooting victims by sociodemographic variables (age group, race and ethnicity, and sex) and case fatality rates, mapped shootings by census tract, and described social determinants of health (SDOH)-poverty, educational attainment, unemployment-in the census tracts where shootings occurred.

Results: From 2019 to 2023, the annual average number of shooting victims in NYC was 1,578. Shootings doubled from 2019 to 2020 though trended downward from 2021 to 2022 to 2023. Four out of five shootings were nonfatal. Males, people ages 18-24, and non-Hispanic Black people in NYC experienced the greatest proportion of shootings. Shootings coincided with census tracts also experiencing above median percentages of adverse SDOH (i.e., highest levels of unemployment, poverty, and low educational attainment).

Discussion: Nonfatal injuries are an important component of community firearm violence to monitor. The findings identify inequities in community firearm violence by sex, age group, and race and ethnicity in NYC. One contributor to racial inequities in violence is the impact of place-based SDOH in certain NYC neighborhoods.

Conclusions: This study leverages NYPD data to estimate the full magnitude of violence by tracking nonfatal in addition to fatal injuries. The study emphasizes the need for researchers to go beyond individual demography and better understand the place-based social determinants of firearm violence.

Background: Gun violence exposure (GVE) is associated with a range of cognitive and behavioral outcomes. However, few studies have assessed how different forms of GVE relate to perceptions of safety, threat sensitivity, and views about the utility of firearms, and how these factors together influence firearm-related behavior. Moreover, studies have not explored whether these effects may differ by political orientation. This study examines how GVE is associated with perceptions of safety, threat sensitivity, and firearm utility, and how these perceptions relate to firearm carrying and storage practices across political groups.

Methods: The data for this study come from a subset of adults with firearm access (n = 3,042) drawn from a nationally representative sample of 8,010 U.S. adults. Structural equation modeling (SEM) was used to assess the relationships between GVE, threat sensitivity, perceptions about the utility of firearms, perceived neighborhood safety, and firearm-related outcomes. Multiple-group SEM assessed how political orientation affects those relationships.

Results: Liberals were more cognitively responsive to GVE (i.e., increased threat sensitivity and decreased neighborhood safety), while conservatives were more behaviorally responsive (i.e., increased carrying). Additionally, perceived utility of firearms was the most robust predictor of carrying and unsecure storage, consistently predicting firearm-related behavior in the general sample and within each group.

Conclusions: GVE can occur through multiple means, direct and indirect, each with distinct effects on perceptions of safety, threat, and firearm utility, as well as on firearm-related behavior. The perceived utility of firearms seems to play a central role in the relationship between GVE and firearm-related behavior. Political affiliation influences how individuals interpret and respond to such exposure. Future research should investigate the reasons for group differences in response to GVE.

Background: Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by persistent challenges in communication and social interaction and, often accompanied by restricted and repetitive patterns of behavior and interests. The reported prevalence of ASD in the United States has tripled in the past two decades. Recent studies indicate that ASD is associated with increased self-injurious behaviors. The purpose of this study is to assess the excess risk of intentional self-harm associated with ASD.

Methods: Using a repeated cross-sectional study design, we analyzed data from the 2016-2020 Nationwide Emergency Department Samples (NEDS), the largest all-payer emergency department (ED) database in the United States. ED visits for intentional self-harm were identified using the ICD-10-CM external cause-of-injury matrix. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of ED-treated intentional self-harm associated with ASD in the presence or absence of co-occurring attention-deficit hyperactivity disorder (ADHD) and/or intellectual disability (ID) were estimated through multivariable logistic regression.

Results: The 2016-2020 NEDS recorded an unweighted total of 159,590,866 ED visits, of which 2,570,446 (1.6%) were related to intentional self-harm. Using weighted data, intentional self-injury accounted for 2.3% of ED visits made by patients with a diagnosis of ASD, 3.9% of ED visits by patients with a diagnosis of ADHD, and 3.3% of ED visits by patients with a diagnosis of ID. Compared to patients without ASD or ADHD/ID, patients with ASD alone had a 65% increased odds of intentional self-harm (aOR = 1.65; 95% CI: 1.60, 1.70); in addition, patients with ADHD/ID but no ASD a 186% increased odds (aOR = 2.86; 95% CI: 2.83, 2.88), and patients with both ASD and ADHD/ ID a 170% increased odds (aOR = 2.70; 95% CI: 2.58, 2.82) of intentional self-harm. Poisoning accounted for 82.3% of the intentional self-harm-related ED visits among patients without ASD and 61.0% of intentional self-harm-related ED visits among patients with ASD.

Conclusions: ASD is associated with a significantly increased risk of ED-treated intentional self-harm, particularly in patients with co-occurring ADHD or ID. Poisoning from psychotropic and other pharmaceutical drugs is the leading mechanism of intentional self-harm.

Background: Utility task vehicles (UTVs) are increasing in popularity and have outsold all-terrain vehicles (ATVs) in recent years. However, there are few publications related to UTV crashes and injuries. Our objective was to describe UTV crash and injury epidemiology in the state of Iowa.

Methods: A comprehensive database of off-highway vehicle events from the Iowa Department of Transportation, State Trauma Registry and Department of Natural Resources, as well as from newspaper articles was created and used to evaluate Iowa UTV crashes and injuries from 2002 to 2019. Frequencies and contingency table analysis was performed with IBM SPSS Statistics (Version 27).

Results: UTV crashes involving 448 injured individuals of all ages were identified with increasing numbers over time. Children < 16 years were 31% and those 16-17 years were 8.3%. Among all victims, 69% were male and one-third were passengers. Only 10% and 32% were wearing helmets and seatbelts, respectively. Of those tested, 13% were positive for alcohol. One-fifth involved a collision with another motor vehicle, 11% were collisions with an object, and most (70%) were non-collision events (e.g., rollovers). In nearly two-thirds of cases, the victim was ejected. In a quarter, the person was hit/pinned by the vehicle. Of those with known location, 61% occurred on public roadways. In 6% of cases, the individual died. Children < 16 years had higher proportions than those older of being a passenger (52% vs. 24%, p < 0.001), having been in a non-collision event (77% vs. 66%, p = 0.035), and of being hit/pinned by the vehicle (41% vs. 19%, p < 0.001). Passengers had lower proportions that were wearing seatbelts (23% vs. 36%, p = 0.029) and higher proportions involved in non-collision events (90% vs. 59%, p < 0.001). Higher proportions in off-road crashes (55% vs. 9%, p < 0.001) and in non-collision events (33% vs. 8%, p < 0.001) were hit/pinned by the vehicle. Roadway crashes and ejected victims both had greater percentages with abnormal Glasgow Coma Scale (head injury) scores and intensive care unit admission.

Conclusions: UTV crashes and injuries are increasing in frequency and often associated with severe injuries. Driving on public roads and being ejected were both associated with more severe outcomes/injuries.

Background: Prevention efforts for mass shooting fatalities often focus on public events, overlooking where most fatalities occur. This study analyzes a comprehensive database to better inform prevention strategies.

Methods: Using data from the Gun Violence Archive (GVA), we identified 252 mass shooting events (2014-2023) with four or more deaths, excluding the perpetrator, resulting in 1,464 fatalities. A media analysis determined location and links to domestic violence. Mortality burden by location, age, gender, and domestic violence was calculated, with tests of association performed.

Results: We found that half (50%) of mass shooting fatalities occurred in homes-five times more than in businesses/workplaces (10%). Among children (0-9), 89% of fatalities occurred in homes, compared to 62% among older children and teens (10-17) and 44% among adults (18+). Women were more likely to be killed in mass shootings at home (50%) than men (40%). Fatalities were disproportionately concentrated in homes across all age groups (p < 0.001). Domestic violence-related mass shootings accounted for 46% of all fatalities, with 70% of fatalities from domestic violence-related events occurring in homes.

Conclusions: Public discourse neglects home-based mass shootings, which disproportionately affect women and children. Targeted interventions, especially addressing domestic violence, are critical for reducing fatalities.

Introduction: The effects of the COVID-19 pandemic and subsequent public health measures on trends of homicide and suicide in various settings remain unclear. There has been little attention paid to the effects of the COVID-19 pandemic on trends of homicide and suicide in African countries.

Methods: We conducted an interrupted time-series analysis (ITSA) to evaluate the impact of the COVID-19 pandemic on monthly homicide and suicide trends in Botswana. Using forensic registers from the Forensic Pathology Unit of the Botswana Police Service, we compared mean incidence and trends before, during, and after the State of Emergency (SoE), stratifying by age and sex.

Results: Our study analyzed 2,225 autopsies from January 1, 2018, to September 30, 2022, comprising of 1,479 homicides and 746 suicides. Monthly autopsy rates were lower during the SoE (median 32, IQR: 11.5) compared to pre-SoE (40, IQR: 15.8) and post-SoE (46, IQR: 11.5) periods. Homicide rates were 28 (IQR: 7.5), 19 (IQR: 7), and 29.5 (IQR: 10) for pre-SoE, SoE, and post-SoE, respectively, while suicide rates were 12.5 (IQR: 4), 13 (IQR: 6), and 16.5 (IQR: 4.75).

Conclusions: Our findings indicate a reduction in homicide and suicide incidence during the SoE, with a return to pre-pandemic levels thereafter. Public health professionals can leverage these insights to identify actionable factors for reducing suicide and homicide risks in future crises.

Background: Injury and illness surveillance is essential for understanding the relative risks of sports participation to develop effective strategies to optimize athlete health, wellness, and performance. Epidemiological studies examining injuries and illnesses among Team USA youth athletes are limited, particularly among athletes competing in Winter sports. The purpose of this study was to characterize the injury and illness incidence rate among Team USA athletes participating in the 2024 Winter Youth Olympic Games (YOG).

Methods: Injuries and illnesses among 101 Team USA youth athletes (40.6% female; age, 17 ± 1 years) were prospectively documented. Injury and illness prevalence, and incidence rate (IR) per 1,000 athlete-days (AD), and incidence rate ratios (IRR) were calculated with accompanying 95% confidence intervals ([95% CI]).

Results: Nineteen (18.8%) Team USA athletes reported at least one injury during the 2024 Winter YOG (38.0 [26.1, 53.3] injuries per 1,000 AD). Injury IR was highest among athletes competing in bobsled (166.7 [54.1, 388.9] injuries per 1,000 AD), and overuse was the most common mechanism of injury (17.3 [9.7, 28.5] injuries per 1,000 AD) among all athletes. There were no differences in injury IRs between male and female athletes (IRR [95%CI], 1.6 [0.7, 3.3]), but female athletes reported all time-loss injuries. Ten (9.9%) athletes reported at least one illness (15.0 [8.0, 26.5] per 1,000 AD), with respiratory illness (6%) being the most common type (6.9 [2.5, 15.0] per 1,000 AD).

Conclusion: This study highlights the need for focused efforts for injury and illness prevention for youth female athletes and athletes participating in high-risk sliding sports. Additionally, consideration for implementation of respiratory illness mitigation measures and load management strategies at and leading up to future competitions for youth athletes is key.

Background: Helmet use significantly decreases head injuries, the most common cause of bicycle-related fatalities in youth. Our objective was to determine bicycle helmet use by rural adolescents, their attitudes regarding helmets, and associated demographic factors.

Methods: A convenience sample of 2022 Iowa FFA (formerly Future Farmers of America) Leadership Conference attendees completed an anonymous electronic or paper survey. After compilation in Qualtrics, descriptive, bivariate and multivariable logistic regression analyses were performed using statistical program, R.

Results: 1,331 adolescents 13-18 years participated. Almost three-fifths (58%) were female; 56% were 16-18 years. One-half lived on a farm, 21% lived in the country/not on a farm and 28% lived in town. 90% of subject households had at least one bicycle. Overall, 78% had ridden a bicycle in the past year. Those from farms had lower proportions that had ridden a bicycle in the past year (73%) than those living elsewhere (83%), p < 0.001, and also rode them less frequently. The mean importance (rated 1-10) of wearing a bike helmet was 4.7 (median 4). Males, older teens, non-Hispanic White individuals, and those from farms all ascribed lower bicycle helmet importance than their corresponding peers. Only 15% supported laws requiring bicycle helmet use. Three-quarters (74%) rarely or never wore a helmet; only 13% said they always or mostly wore a helmet. A direct relationship was noted between helmet use and those who rode more frequently, and to those ascribing higher importance to helmet use. Only 12% stated their parents had a strict "no helmet, no riding" rule. However, those with a rule had 18 times greater odds of supporting bicycle helmet laws and had a higher median ascribed bicycle helmet importance as compared to those without a rule (9 vs. 4). Moreover, participants with a strict rule had 32 times higher odds of wearing a bicycle helmet always/most of the time versus those without a rule.

Conclusions: Bicycle helmet use is infrequent among rural adolescents. Youth whose parents had a strict "no helmet, no riding" rule placed greater importance on using helmets, were more supportive of bicycle helmet laws, and had significantly greater helmet use.

Background: Rural Australians have a higher age adjusted rate of both hospitalisation and death from injury, and this rate increases with increasing remoteness. However, it is uncertain if this is due to an increased incidence of injury or less access to treatment. The aim of this study is to examine the association of remoteness and in-hospital mortality in Major Trauma patients admitted to the Royal Melbourne Hospital.

Methods: This study was a retrospective cohort study of all persons aged 15 + years diagnosed with 'major trauma', (defined as Injury Severity Score, ISS > 12) from a Motor Vehicle Collision admitted to the Royal Melbourne Hospital from 2010 to 2021. The exposure of interest was remoteness as measured by the Accessibility/Remoteness Index of Australia (ARIA), the outcome of interest was in-hospital mortality. Logistic regression models were constructed looking at the odds of death by increasing remoteness adjusting for age, ISS, and comorbidity. Missing data were imputed using chained equations. A sensitivity analysis was performed for ARIA+ category, and a quantitative bias analysis performed for potential selection bias. All analyses were performed using Stata v17. Ethical approval was obtained from the Melbourne Health Human Research Ethics Committee (HREC2022_044).

Results: Eligibility was met for 2324 cases, of whom 53.3% were classified as major city, 36.1% inner regional, and 10.6% outer regional/remote. In-hospital mortality was 6.0% for those injured in major cities, 5.4% in inner regional and 4.1% for outer regional/remote. The median ISS was 19 and 18.3% had at least one limiting comorbidity. The adjusted odds of death were reduced by half for those injured in outer regional and remote compared with major city (OR = 0.51, 95%CI = 0.25-1.03). This result did not alter with the sensitivity analysis for postcode of injury. Quantitative bias analysis suggested the presence of severe selection bias, with the odds ratio showing an increased odds of death (OR = 1.83) for more remotely injured persons.

Conclusion: Persons injured remotely are not more likely to die in-hospital after major trauma once they arrive at hospital. Unexpectedly, there was some evidence to suggest that those injured most remotely had a survival advantage, despite similar injury severity Quantitative bias analysis suggested selection bias could be responsible for this apparent survival advantage for more remotely injured persons.

Background: Unintentional injuries, including traumatic brain injuries (TBI) during activities where helmet usage is recommended (AWHUR), are a leading cause of pediatric morbidity and mortality in the U.S. While advocacy and education are proven measures to address safety, community resources in a child's neighborhood are known to have a large impact on their health.

Methods: We utilized the trauma registry at two pediatric trauma centers, in a major metropolitan area from 2018 to 2022, to perform a retrospective chart review and Geographical Information System (GIS) mapping on all AWHUR injuries that were included in the trauma registry. Data extracted from the trauma registry included: mechanism, demographics, insurance status, and injury characteristics. AWHUR data was then overlaid with the Childhood Opportunity Index (COI) to assess community resources in relation to injury characteristics.

Results: Our sample size included 1425 children throughout the 5-year time period. The most common injury mechanisms included: bicycle 34.0%, ATV 18.2%, skateboard 13.3%, scooter 9.2%, and dirt-bike 7.4%. Most patients in very low and low COI were publicly insured, respectively 81.9% and 63.2%; while 65.8% of high COI injured patients were privately insured children. There was a statistically significant difference in helmet usage across different levels of COI (p < 0.001). The rates of helmet usage by COI ranking from very low to very high were as follows: 21.6%, 25.2%, 37.8%, 40.2%, and 51.6% utilization. Among those injured while wearing a helmet, the odds of sustaining a higher ISS were 34% lower (OR = 0.66, 95% CI: 0.50-0.89) compared to those who were not wearing a helmet at the time of injury. Additionally, GIS mapping identified low and very low COI communities with higher injury rates and lower helmet use.

Conclusion: Children with lower COI were more likely to be publicly insured with a lower percentage of helmet usage. Overlapping injury data and COI identified high-risk communities where low resources can contribute to growing injury severity. This data can then be used to inform injury prevention and highlight the importance of community factors.