Injury Epidemiology最新文献

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.

Background: In the USA, drowning is a leading cause of death for children and the leading cause of death for children 1-4 years old. Bathtubs pose the highest risk of drowning for infants. The aim of this study is to determine factors that increase the risk of drowning in a bathtub for children.

Methods: This retrospective, cross-sectional study used data retrieved from a hospital-based registry of drowning patients that includes information manually abstracted from patient medical records. This study describes patient characteristics and incident scenarios for children aged 0-17 years who sought care at one children's hospital for unintentional drowning in a bathtub over a ten-year period, 2014- 2023. Chi-square analysis was used to assess associations between whether a supervising caregiver was present during the incident and the likelihood of hospital admission or the likelihood of poor outcome.

Results: There were 50 patients 0-9 years old treated for unintentional drowning in a bathtub over the 10-year period. The majority of patients were female (62%), White (86%), or not Hispanic (53%). Most of the patients (84%) were under 2 years old and the majority (56%) were under 1 year old. For most of the patients 2-9 years old, the drowning incident was likely seizure-related. In 91% of the incidents, a caregiver was intending to supervise the child in or around the bath, yet in only 24% of the incidents was the caregiver engaged in supervising the child. The most common reasons for the lapse in supervision was that the caregiver was retrieving a towel and/or clothes (39%) or caring for other children (20%). Chi-square analysis showed that children who were admitted to the hospital for further care were more likely to have no adult caregiver present than those who were discharged after being treated in the Emergency Department only.

Conclusions: Findings indicate that lapses in supervision are a common cause of bathtub drowning for young children and are associated with the need for higher levels of care. Additionally, results highlight the need for drowning prevention messaging emphasizing gathering all bath supplies before starting a bath and avoiding distractions, such as caring for other children.

Background: Nationwide epidemiological data on non-fatal drowning are lacking. The purpose of this study was to provide and analyze data on incidence and time-trends of hospital inpatient admissions for drowning in Finland.

Materials and methods: The Finnish Hospital Discharge Register was retrospectively searched for all inpatient hospitalizations due to unintentional and intentional drowning from January 1, 2002 to December 31, 2023 and included the entire Finnish resident population. The main outcome measure was the annual number of and crude incidence rates (n/100 000 population) of hospital admissions for drowning. The Poisson regression method was used to analyze time-trends.

Results: A total of 1205 patients (mean 54.8 per year, CI₉₅: 47.4-62.2; 52.7-68.9; mean age: 40.8 years, CI₉₅: 39.2-42.3; male to female RR: 2.6) were hospitalized for drowning (1079 unintentional, 64 self-harm, 7 assault, 55 undetermined). The mean crude incidence rate of hospital admissions for drowning was 1.01 /100 000/year and decreased from 1.73 in 2002 to 0.52/ 100 000 persons in 2023. The incidence of such non-fatal drownings (0.91/100 000/year) significantly decreased during the study period (-4.9% / year; p < 0.0001). The age distribution showed two peaks with a first peak in children 0 to 4 years old and a second one among individuals 45 to 64 years old. The most frequent setting was a natural body of water, followed, in adults, by ice-covered bodies of water and leisure boating and, in children, by swimming pool/ bathtub. The rate ratio between non-fatal accidental drowning requiring hospitalization, and fatal drowning was exceedingly low (0.3).

Conclusions: Non-fatal drownings are crucial for assessing the overall burden of drowning although, in Finland, hospital admissions for drowning have significantly declined, and fatal drownings outnumber non-fatal drownings, at least those requiring inpatient hospital care. The epidemiological profile of non-fatal drowning may substantially vary, even among high-income countries.

Background: In 2023, Wave 2 of an annual, nationally representative longitudinal survey found a concerning level of agreement that civil war was likely in the USA and, among those who agreed, widespread belief that civil war was needed. This study updates those findings to 2024 and explores respondents' predicted involvement in such a conflict.

Methods: Findings are from Wave 3, conducted May 23-June 14, 2024; participants were members of Ipsos KnowledgePanel. All respondents to prior waves who remained in KnowledgePanel were invited to participate; to facilitate comparison with 2023 findings, this analysis is restricted to Wave 3 respondents who had responded to both Waves 1 and 2. Outcomes are expressed as weighted proportions and adjusted prevalence differences.

Results: The Wave 3 completion rate was 88.4% overall and 91.6% for respondents to Waves 1 and 2; there were 8185 respondents in the analytic sample. After weighting, half the sample was female (50.6%, 95% CI 49.1%, 52.1%); the weighted mean (SD) age was 50.8 (16.4) years. Few respondents agreed strongly or very strongly that "in the next few years, there will be civil war in the United States" (6.5%, 95% CI 5.7%, 7.3%) or that "the United States needs a civil war to set things right" (3.6%, 95% CI 3.0%, 4.2%). These prevalences were higher among subsets of respondents previously associated with increased support for and willingness to commit political violence. Of the small minority (3.7%, 95% CI 3.1%, 4.3%) who thought it very or extremely likely that they would be combatants, 44.5% (95% CI 36.5%, 52.6%) reported that they would convert to not likely if this were urged by family members; 23-31% were open to persuasion by friends, respected religious leaders, elected officials, and the media.

Conclusions: In mid-2024, the expectation that civil war was likely and the belief that it was needed were uncommon and were unchanged from 2023. Those expecting to participate as combatants reported openness to change in response to input from many sources. These findings can help guide prevention efforts.

Background: Individuals living in high crime neighborhoods are more likely to carry a firearm. Members of these communities are also more likely to experience a traumatic brain injury (TBI) in their lifetime, which is a common correlate of hypervigilance and aggression. The current study evaluates the independent and interactive effects of TBI on perceived levels of neighborhood crime and gun carrying.

Methods: Data from 2015 to 2017 from a longitudinal ethnically diverse sample of adolescents and young adults are analyzed (Ns = 600-734). Multivariate logistic regression models are estimated to evaluate associations between perceived levels of neighborhood crime, TBI, gun carrying, and threatening another person with a gun.

Results: Perceived neighborhood crime is associated with higher odds of carrying a gun (AOR = 1.07; 95% CI = 1.03-1.12). Participants with a history of TBI due specifically to physical violence are twice as likely to report carrying (AOR = 2.94; 95% CI = 1.51-6.47), while participants with a history of TBI due to a nearby explosion are over seven times as likely (AOR = 7.38; 95% CI = 2.23-21.93). TBI due to a nearby explosion is associated with a six-fold increase in the odds of threatening another person with a gun (AOR = 6.60; 95% CI = 1.47-29.64).

Conclusions: TBI should be considered in gun violence prevention/intervention programming efforts. Information gleaned from the cause of TBI can help to tailor intervention strategies to individuals growing up in neighborhoods where they feel unsafe.

Background: Safe firearm storage may reduce suicide and unintentional firearm injuries. However, little is known about safe storage practices in rural US populations. We aimed to examine the association between living in a rural US area and firearm storage practices.

Methods: We used data from the Behavioral Risk Factor Surveillance System (BRFSS), 2021-2023 to compare firearm storage practices between rural and urban populations. The primary outcomes were whether firearms were stored loaded, and among loaded firearms, whether they were stored unlocked. Those living in a rural residence were compared to those living in an urban residence. Descriptive statistics for firearm storage practices were compared between living in rural or urban areas. Unadjusted and adjusted relative risks (with 95% confidence intervals) were calculated using Poisson regression models with robust standard errors.

Results: One third of rural (34.71%) and urban (34.33%) firearm-owning households stored at least one firearm loaded. Of these households with loaded firearm(s), 58.55% of rural respondents stored their firearms unlocked compared to 50.66% of urban respondents. Compared to the urban sample, rural respondents were older adults (51.41% vs. 43.91% ≥ the age of 55), non-Hispanic White (83.12% vs. 72.45%), and were high school graduates or less (48.33% vs. 34.77%). While rural respondents were equally likely as urban respondents to store firearms loaded (ARR = 1.00, CI = [0.93-1.06]), they were more likely to store loaded firearms unlocked (ARR = 1.11, CI = [1.03-1.19]).

Conclusions: Additional support for providing firearm storage options, such as firearm safety locks, may promote safer firearm storage practices in rural populations. Future research should explore culturally appropriate interventions tailored to the specific needs of individuals living in the rural US.

Background: Veteran suicide remains a major public health concern; rates increased 64.3% from 2001 to 2022 and substantial geospatial variation exists, with state-level rates ranging from 15.4/100,000 (Maryland) to 87.1/100,000 (Montana). Surveillance of suicidal ideation (SI) and suicide attempts (SA) can provide insights to reduce suicide risk within communities.

Methods: A population-based, cross-sectional survey of 17,949 Veterans residing in all 50 U.S. states, the District of Columbia, Puerto Rico, and U.S. Pacific Island (PI) Territories, was conducted in 2022 to assess SI and SA prevalence. Lifetime and post-military SI and SA and past-year SI prevalence were estimated by Census region, division, and state. Prevalence ratios were calculated for post-military SI and SA to assess differences by division, accounting for demographic covariates (i.e., age, race, gender, rurality, and time since military separation). Methods used in lifetime SA and considered in past-year SI were also examined by region.

Results: The West had the highest prevalence of lifetime (36.94%; 95%CI = 34.65-39.23) and post-military SI (28.73%; 95%CI = 26.51-30.96), significantly higher than all other regions except for PI Territories and Puerto Rico. PI Territories had the highest prevalence of past-year SI (15.68%; 95%CI = 10.91-20.44) and lifetime (9.86%; 95%CI = 6.36-13.37) and post-military SA (5.67%; 95%CI = 3.21-8.14). At the divisional level, the Pacific West (29.12%; 95%CI = 26.01-32.23) and West South Central (29.09%; 95%CI = 26.18-32.00) divisions had the highest prevalence of post-military SI, while West South Central had the highest prevalence of post-military SA (6.89%; 95%CI = 5.07-8.70), and the PI Territories remained highest for lifetime SA. After adjusting for covariates, numerous significant differences across divisions were observed. Differences in suicide methods considered and used were also observed across regions.

Conclusions: Variability in SI and SA prevalence among Veterans at state, divisional and regional levels supports the need for nuanced surveillance efforts, along with targeted prevention efforts in areas at greatest risk.

Background: The injury rate is a common measure of injury occurrence in epidemiological surveillance and is used to express the incidence of injuries as a function of both the population at risk as well as at-risk exposure time. Traditional approaches to surveillance-based injury rates use a frequentist perspective; here, we discuss the Bayesian perspective and present a practical framework on how to apply a Bayesian analysis to estimate injury rates. We estimated finescale injury rates across a broad range of categories for men's and women's soccer, applying a Bayesian methodology and using injury surveillance data captured within the National Collegiate Athletic Association Injury Surveillance Program from 2014/15-2018/19.

Results: Through an iterative process of assessing model fidelity, we found that a negative binomial model was an effective choice for modeling surveillance-based injury rates. We also found differences between schools to be a key driver of variation in injury rates.

Conclusions: Our findings indicate that the Bayesian framework naturally characterizes injury rates by modeling injury counts as outcomes of an underlying data-generation process that explicitly incorporates inherent uncertainty, complementing traditional frequentist approaches. Key benefits of the Bayesian approach in this context are the ability to test model suitability in a variety of methods, and to be able to generate plausible estimates with sparse data.