Injury Epidemiology最新文献

Objectives: Extreme Risk Protection Orders (ERPOs) are civil court orders that temporarily prohibit firearm purchase and possession by someone ("respondent") at imminent risk of harming themselves or others. Despite ERPOs being currently available in 21 states, DC, and U.S. V.I., little is known about the circumstances under which they are used across states.

Methods: Using a standardized protocol, we abstracted ERPO petitions and associated court documents from 6 states to examine characteristics of respondents, documented risks of harm, and court outcomes. Included cases were filed through June 30, 2020, from 2013 (Connecticut) or from when the law went into effect (California: 2016; Colorado: 2020; Florida: 2018; Maryland: 2018; and Washington: 2016).

Results: There were 6,634 ERPO petitions across included states. The median age of respondents was 40.0 years (SD: 16.4), and 10.8% were female. Almost half of petitions noted suicidal threats, plans, or ideation (43.9%) as the precipitating event, half noted interpersonal violence threats (50.8%), and one quarter (24.6%) noted threats to both self and others. Around one third (36.0%) noted unlawful or reckless firearm use. The majority of petitions (84.1%) indicated the respondent had current or recent access to a firearm. Most (77.5%) of the final orders (post-hearing) were granted. ERPO implementation varied across states, particularly with regard to how frequently they were used, for what type of threat, and by what type of petitioner.

Conclusions: This study examined ERPO law implementation in 6 states, highlighting differences and similarities. This comparison allows for a more nuanced understanding of variation in ERPO use, which can inform ERPO implementation and future studies of ERPOs' effectiveness.

Background: Compared to other sports, combat sports are typically thought to be dangerous and more prone to injury. The injury rates sustained by Muay Thai combat athletes during practice, competition, and tournaments are presented as an overall rate in the literature. However, none of the earlier studies have focused on injuries during official championship matches. Head trauma (5-66%), epistaxis, laceration, contusion (2-28%), soft tissue of the extremities (9-77%), and other conditions have been linked to high rates of disability. In addition to its distinct qualities and growing appeal, Muay Thai is an Olympic Committee and a UNESCO-recognized sport. Our primary goal was to assess the patterns, frequency, and severity of in-ring injuries and collect data for the sports authorities and the literature. The second goal was to determine the relationship between the "referee stop contest/RSC decision" and injury incidence.

Methods: The ringside doctor examined all healthy athletes twice before and after the match. The number of athletes assessed from a combat perspective, the overall number of contests, and the percentage of athletes who maintained their health during the competition were ascertained. Furthermore, following the announcement of the RSC decisions, medical diagnosis, first aid, and hospital referral status were disclosed along with the decision rates.

Results: This study included 663 athletes (445 males, and 218 women). A total of 606 athletes (91.4%) had no health issues following official bouts. It was observed that 24.58% of the contests were completed with the RSC decision. 68 athletes (10.25%) received medical treatment; 57 (8.60%) had their matches stopped by the RSC decision. The remaining 11 (1.65%) completed the competition without an RSC decision but requested a medical examination after the bout. According to our study, injuries related to the head and extremities were surprisingly low, at a rate of approximately 4%. Most of the patients required outpatient treatment. Epistaxis, concussion, rib trauma and extremity soft tissue strains were among the most frequent injury categories with percentages of 1.96%, 1.50%, 1.05%, and 1.05%, respectively. For the 17 individuals, the hospital emergency room attendance rate was 2.56%. An urgent operation was scheduled for one patient (0.15%) at the hospital.

Conclusions: Compared to published research, injury rates are comparatively low in Muay Thai in-ring official contests managed by doctors and referees. The data we obtained suggest that RSC decision may be useful in preventing athlete injury.

Background: Although there is a growing dependence on the immigrant workforce in many countries, recent trend analyses on the work-related health of immigrants are scarce. Thus, this study aims to fill this gap by comparing reported occupational injuries due to accidents (OIA) trends among native-born Swedes with first-generation immigrants arriving from different global regions now working in Sweden from 2003 to 2020.

Methods: A repeated cross-sectional registered-based study was conducted including the total working population (18 years or older) (approximately 3.5-4 million individuals annually). Information on OIA and migrant status was obtained from nationwide registers. The incidence rate (IR) of an OIA per 1000 workers with 95% confidence intervals (CI) was calculated for region of birth, the reason for immigration, and time since immigration for each year. Joinpoint analyses were employed to detect significant shifts in the trends.

Results: The IR of OIA among native-born workers demonstrated a relatively stable trend between 2003 and 2020. Immigrant workers had in general a higher IR of OIA compared to native-born workers across the study period. Among immigrant workers, a steeper downward trend in OIA was observed until 2008/2010. After 2010, the trends were relatively stable or slightly increasing, depending on the region of birth, reason for immigration, and time since immigration. The stratified analysis demonstrated varying patterns depending on sociodemographic and occupational factors.

Conclusions: Immigrant workers in Sweden have a higher incidence of occupational injuries than native Swedes. Despite a general downward trend since 2003, young immigrants from Africa and the Middle East show an upward trend, highlighting a concerning increase for an already vulnerable group and potentially worsening health inequalities.

Background: Repeat self-harm hospitalizations are associated with a greater risk of suicide and place a substantial burden on the healthcare system. In Canada, despite growing awareness of self-harm as a public heath issue, most existing research has focused on the prevalence of self-harm, with less attention given to repeat admissions. This study aims to assess the risk of repeat self-harm hospitalizations in Canada and identify population subgroups at higher risk.

Methods: We included 74,055 patients discharged between April 2016 and March 2022, with self-harm hospitalizations recorded in the Canadian Institute for Health Information's Discharge Abstract Database and the Ontario Mental Health Reporting System. After an initial self-harm hospitalization, patients were followed for repeat admissions during the study period. The risk of readmission was estimated using Kaplan-Meier survival analysis, while hazard ratios for factors such as sex, age group, method of self-harm and the presence of a mental disorder diagnosis, were calculated using Cox regression models.

Results: Among patients hospitalized for self-harm, the risk of readmission was 9.3% within one year and 13.0% within three years of the index hospitalization. Three-quarters of readmissions occurred within the first year, and 90% occurred within two years. Females had a higher risk of readmission than males (hazard ratio = 1.32), with the highest risk observed among females aged 10-14 years (19.2% within three years), while patients aged 65 years and older had the lowest risk for both males and females. Females who self-harmed by cutting and patients of both sexes who used substance-related poisoning methods, as well as patients with a mental disorder diagnosis, were also at greater risk of readmissions.

Conclusion: In Canada, approximately one in ten patients hospitalized for self-harm were readmitted, with most readmissions occurring within the subsequent first year. Certain subgroups, including females, young girls, individuals who engaged in self-harm through cutting or substance use, and those with a mental disorder, face higher risks. This study provides insights to guide targeted interventions aimed at preventing recurrence, informing resource allocation, and emphasizing the need for comprehensive mental health support to improve outcomes for at-risk individuals.

Background: Vulnerable populations at risk of injury include persons with intellectual and developmental disabilities (IDD), and persons who are deaf or hard of hearing (DHH). The purpose of this study was to describe and compare emergency department and inpatient hospitalization (ED + IP) injury rates and rate ratios by injury type among persons under age 65 with IDD or with DHH to those without IDD or DHH.

Methods: This is a descriptive population-based retrospective cross-sectional study of injuries among patients under the age of 65 with an IDD disability or a DHH disability using Kentucky ED + IP discharge datasets from 2019 to 2023. Injury rates and injury rate ratios were calculated for those under the age of 65 with an IDD or a DHH disability and without an IDD or a DHH disability, using number of persons under age 65 with or without the related disability as the denominator.

Results: The overall injury rate was lower for persons under age 65 with an IDD or DHH compared to those without those disabilities in 2023 (1 and 3 per 100,000 population, respectively). IDD or DHH disability types had significantly lower overall ED + IP injury rate ratios compared to those without those disabilities (IDD: 0.667 [95% CI: 0.640-0.694], DHH: 0.658 [95% CI: 0.633-0.683]). When ED + IP injury type rate ratios were compared, IDD or DHH persons had higher injury rate ratios for self-harm (IDD: 8.740 [95% CI: 7.783-9.815], DHH: 1.7846 [95% CI: 1.402-2.272]), assault (IDD: 1.386 [95% CI: 1.173-1.637], DHH: 1.310 [95% CI: 1.115-1.540]), unintentional falls (IDD: 1.540 [95% CI: 1.436-1.633], DHH: 1.283 [95% CI: 1.201-1.372]), and drug poisonings (IDD: 2.401 [95% CI: 2.103-2.740], DHH:1.620 [95% CI: 1.391-1.886]) compared to those without such disabilities. Those with IHH or DHH who were treated for injuries incurred triple the charges of patients without these conditions (~$17,086 IDD; $19,550 DHH; and $5,216 no IDD or DHH disabilities).

Conclusions: These findings have implications for health policy at the state and federal level. Clinical care interventions to reduce assault, self-harm, drug poisonings and unintentional injuries and healthcare utilization in persons with IDD or DHH should be publicly funded or covered by health insurance.

Background: Unintentional firearm death (UFD) rates are higher among Black children than among White and Hispanic children. Whether disparities in UFD rates among Black as compared to White and Hispanic children vary by other demographic characteristics or by circumstances is unknown.

Methods: Data come from the 32 states contributing to the National Violent Death Reporting System (NVDRS), 2015-2021. Our sample comprises children 0-17 who died from unintentional firearm injuries. Race/ethnicity- and age-specific population data at the state and county level were used to calculate rates. UFD rates were compared within and across race-ethnicity groupings by age, sex, urbanization and across four NVDRS coded circumstances. Urbanization was assigned using a six-level urban-rural classification scheme from the National Center for Health Statistics (NCHS) based on the county in which the fatal injury occured.

Findings: Of the 568 UFDs, four-fifths of victims were male (82%) and four-fifths died in a home (84%), usually the Victim's home (55%). Most deaths involved a child playing with a firearm (63%). Overall, UFD rates were 4.6-fold higher for Black children compared with White children. Black children's rates were more than 6-fold higher than those of White children for females and for children five to nine years of age, and nearly 8-fold higher for children living in large central metro counties.

Conclusions: Black children die from unintentional firearm injury at disproportionately high rates, especially young children living in urban centers. The underlying reasons for these racial disparities are unclear and should be a priority for future research.

Background: Our pediatric tertiary care hospital sees a high rate of firearm injuries. Hospital-based violence intervention programs (HVIPs) reduce violent injury recidivism rates in victims. However, significant gaps exist in the delivery of trauma-informed services to families. Our specific aim was to increase our HVIP referral rate by 20% over a 12-month time frame for children seen for interpersonal violence in the emergency department (ED).

Methods: Our quality improvement study was done at a pediatric tertiary care hospital and encompassed patients 0 to 18 years of age who presented to our ED for assault-related concerns from December 26, 2021 to June 23, 2024. The primary outcome measure was percentage of HVIP-eligible patients who received a referral from the ED. We conducted a root cause analysis by interviewing stakeholders including HVIP staff, ED providers, nurses, and social workers to understand gaps in the referral process. Key drivers included electronic medical record (EMR) trigger tools for referral placement, accessibility of HVIP staff, and staff knowledge of HVIP eligibility and services. We integrated three main EMR-based interventions on June 15, 2023 that triggered referrals to the HVIP.

Results: Our ED HVIP referral rate during the pre-intervention period (December 26, 2021 to June 15, 2023) was 53.6%. During our post-intervention phase (June 15, 2023 to June 23, 2024), the referral rate reached and sustained at 93.5%, a 74.4% increase.

Conclusions: We identified a large percentage of missed HVIP-eligible referrals and developed interventions that significantly increased our referral rate. However, this did not translate into increased enrollment, indicating the need for additional efforts.

Background: In the United States, firearm-related violence disproportionately impacts low-income, racially segregated communities more than affluent, predominantly White neighborhoods. This trend stems from historical disinvestment, discriminatory lending practices, and persistent structural inequalities. Housing policies have enforced racial segregation, limiting wealth accumulation in low-income communities. This study examines the relationship between historical and contemporary lending discrimination in mortgage originations and firearm-related violence in Chicago, Illinois. By analyzing investment and disinvestment patterns, we assess how housing discrimination continues to influence the risk of victimization in various social contexts.

Methods: Redlining scores were derived from the 1930s Homeowners' Loan Corporation (HOLC) grades, while contemporary lending indicators were obtained from the 2019 Home Mortgage Disclosure Act (HMDA). We classified neighborhoods into four lending trajectories-sustained disinvestment, disinvestment, growing investment, and high investment-based on historical redlining and contemporary mortgage lending patterns. Sustained disinvestment reflects historical redlining and ongoing lending discrimination, while growing investment targets areas that were historically redlined but are now experiencing increased lending activity. Bayesian spatial models examined firearm-related homicide risk across lending trajectories, adjusting for area deprivation index (ADI) and racial segregation.

Results: In unadjusted models, sustained disinvestment (Relative Risk [RR] = 2.230, 95% CrI: [1.352, 3.681]) was associated with increased firearm-related homicide risk, while growing investment (RR = 0.782, 95% CrI: [0.452, 1.359]) and high investment (RR = 0.146, 95% CrI: [0.054, 0.397]) were associated with lower risk. After adjusting for ADI and racial segregation, the effect of sustained disinvestment attenuated (RR = 1.714, 95% CrI: [1.054, 2.791]), suggesting partial mediation. However, growing investment increased by 155% (RR = 1.987, 95% CrI: [1.144, 3.458]), indicating suppression, indicating that ADI and segregation initially masked its association with firearm homicide risk.

Conclusion: Findings highlight the need for policies that address the long-term effects of lending discrimination. Reverse redlining-where financial institutions target minority communities with high-cost loans-further exacerbates existing inequities. Additionally, neighborhood deprivation and segregation shape firearm-related violence risk, underscoring the broader consequences of systemic housing discrimination.

Background: Suicide remains a significant cause of death in the United States. Traumatic events, such as experiences of violence, financial loss, and mental illness, significantly increase an individual's risk of suicide. Substance use, often used as a coping mechanism for trauma, frequently occurs alongside these events. Geographic patterns of trauma and substance use may reveal underlying factors that contribute to suicide rates across the nation.

Methods: Data from the National Violent Death Reporting System (NVDRS), collected between 2017 and 2021, was used to examine spatial relationships between traumatic events and substance use among suicides. Spatial autocorrelation was used to assess global spatial dependence of traumatic events among suicide deaths. Additionally, hot spot analyses were conducted to pinpoint regions with significantly elevated or reduced experiences of trauma. Colocation analyses were conducted to identify areas where traumatic events and substance use co-occur spatially.

Results: Traumatic events among suicides exhibited geographic clustering. Spatial clusters of traumatic events were identified in specific regions across the U.S. and its territories. Hot spots were predominantly observed in Western and Midwestern areas, while more cold spots were found in Southern regions. Additionally, colocation analysis revealed that Midwestern counties had a higher likelihood of experiencing traumatic events in conjunction with substance use history among suicide decedents.

Conclusion: Clustering patterns may provide insight on underlying mechanisms that have significant impacts on suicide outcomes. The colocation analysis helps reveal patterns of spatial clustering, shedding light on potential risk factors or shared characteristics in those areas. By examining both global and local spatial patterns, researchers gain insights into the distribution of trauma and substance use-related incidents and their association with suicide.

Background: Recent publications on Child Access Prevention (CAP) laws suggest substantial protective effects on adolescent firearm suicide. However, these studies have also found comparable protective effect estimates on adolescent non-firearm suicide and adult firearm suicide, which may indicate residual confounding. Here we apply bias analysis techniques to assess the effects of CAP laws while accounting for potential unmeasured sources of bias using a negative control approach.

Method: Using established bias formulas, we bias-adjust previously published point estimates and their 95% confidence intervals (CI) assuming that an arbitrary confounder biases all suicide-related effect estimates and that adolescent non-firearm suicide and adult firearm suicide are negative controls. Negative controls are outcomes or populations that prior subject matter suggests should not be meaningfully affected by the exposure and can be used to better understand and sometimes account for bias in the primary exposure-outcome relationship.

Results: After bias adjustments, effect estimates were attenuated, with many of the confidence intervals including the null. Assuming that adolescent non-firearm suicide is a negative control outcome and taking a published point estimate as the bias parameter, the bias-adjusted effect estimate for adolescent firearm suicide decreased from an incidence rate ratio of 0.87 (95% CI: 0.78, 0.97) to 0.95 (95% CI: 0.85, 1.07). When adult firearm suicide was used as the negative control, the bias-adjusted estimate was 0.92 (95% CI: 0.82, 1.03).

Conclusion: Our findings suggest that CAP laws may have had a smaller public health impact on adolescent suicide than previously estimated. Given the strong evidence that reducing access to firearms can prevent suicide deaths, and that secure storage helps reduce access for many children, our findings underscore the need to continue to identify and promote effective ways to motivate adults to make household firearms inaccessible to children.