Corinne Peek-Asa

The Global Burden of Unintentional Injuries and an Agenda for Progress

According to the World Health Organization, unintentional injuries were responsible for over 3.9 million deaths and over 138 million disability-adjusted life-years in 2004, with over 90% of those occurring in low- and middle-income countries (LMIC). This paper utilizes the year 2004 World Health Organization Global Burden of Disease Study estimates to illustrate the global and regional burden of unintentional injuries and injury rates, stratified by cause, region, age, and gender. The worldwide rate of unintentional injuries is 61 per 100,000 population per year. Overall, road traffic injuries make up the largest proportion of unintentional injury deaths (33%). When standardized per 100,000 population, the death rate is nearly double in LMIC versus high-income countries (65 vs. 35 per 100,000), and the rate of disability-adjusted life-years is more than triple in LMIC (2,398 vs. 774 per 100,000). This paper calls for more action around 5 core areas that need research investments and capacity development, particularly in LMIC: 1) improving injury data collection, 2) defining the epidemiology of unintentional injuries, 3) estimating the costs of injuries, 4) understanding public perceptions about injury causation, and 5) engaging with policy makers to improve injury prevention and control.

Fatal motor vehicle crashes in rural and urban areas: decomposing rates into contributing factors

Objectives: Motor vehicle crash fatality rates have been consistently higher in rural areas than in urban areas. However, the explanations for these differences are less clear. In this study the decomposition method was used to explore the factors associated with increased fatal crash involvement rates in rural communities. Design: Using national databases, the fatal crash incidence density was decomposed into the product of three factors: the injury fatality rate, the crash injury rate, and the crash incidence density. Results: As expected, the fatal crash incidence density was more than two times higher in rural than in urban areas. This was driven primarily by the injury fatality rate, which was almost three times higher in rural areas. Conclusions: Further research should examine the relative roles of crash severity and the timely receipt of definitive medical care after a crash.

Acute Traumatic Injuries in Rural Populations

In the United States, injuries are the leading cause of death among individuals aged 1 to 45 years and the fourth leading cause of death overall. Rural populations exhibit disproportionately high injury mortality rates. Deaths resulting from motor vehicle crashes, traumatic occupational injuries, drowning, residential fires, and suicide all increase with increasing rurality. We describe differences in rates and patterns of injury among rural and urban populations and discuss factors that contribute to these differences.

Violence Against Women in Mexico: A Study of Abuse Before and During Pregnancy

OBJECTIVE We identified the prevalence and types of violence experienced by pregnant women, the ways victimization changed during pregnancy from the year prior to pregnancy, and factors associated with violence during pregnancy. METHODS We interviewed 914 pregnant women treated in health clinics in Mexico about violence during and prior to pregnancy, violence during childhood and against their own children, and other socioeconomic indicators. RESULTS Approximately one quarter of the women experienced violence during pregnancy. The severity of emotional violence increased during pregnancy, whereas physical and sexual violence decreased. The strongest predictors of abuse were violence prior to pregnancy, low socioeconomic status, parental violence witnessed by women in childhood, and violence in the abusive partners childhood. The probability of violence during pregnancy for women experiencing all of these factors was 61%. CONCLUSIONS Violence is common among pregnant women, but pregnancy does not appear to be an initiating factor. Intergenerational violence is highly predictive of violence during pregnancy.

Nighttime driving, passenger transport, and injury crash rates of young drivers.

Objective: This study examines the association of nighttime driving and the carrying of passengers with the rate of motor vehicle crashes that resulted in severe or fatal injury to young drivers in California before the implementation of a graduated licensing system. Method: Passenger vehicle drivers aged 16 or 17 involved in injury crashes in California from 1 January 1993 to 30 June 1998 were identified through a police crash database. An induced exposure method was used to estimate driving exposure. Odds ratios for driver injury crashes were estimated with logistic regression. Results: Driving at night, driving without adult supervision, driving with passengers, using alcohol, being 16, and being male were associated with high rates of driver injury crash. Conclusions: The injury crash rate for drivers aged 16 or 17 increases during nighttime hours and in the absence of adult supervision, with or without other passengers. Driving between 10 pm and midnight is particularly dangerous for young drivers. Nighttime driving restrictions that begin at 10 pm or earlier and restrictions on carrying passengers at any hour may increase the effectiveness of graduated licensing systems.

Seismic, structural, and individual factors associated with earthquake related injury

Background: Earthquakes cause thousands of deaths worldwide every year, and systematic study of the causes of these deaths can lead to their prevention. Few studies have examined how multiple types of risk factors are related to physical injury during an earthquake. Methods: A population based case-control study was conducted to examine how individual characteristics, building characteristics, and seismic features of the 1994 Northridge, California, earthquake contributed to physical injury. Cases included fatal and hospital-admitted injuries caused by the earthquake. Controls were drawn from a population based phone survey of county residents. Cases were individually matched to two sets of controls: one matched by age and gender and one matched by location at the time of the earthquake. Results: Individuals over age 65 had 2.9 times the risk of injury as younger people (95% confidence interval (CI) 1.2 to 7.4) and women had a 2.4 times greater risk than men (95% CI 1.2 to 5.1). Location in multiple unit residential and commercial structures each led to increased injury risk compared with single unit residential structures, but the exact estimate varied depending on the control group used. With every increase in ground motion of 10%g, injury risk increased 2.2 times (95% CI 1.6 to 3.3). Conclusions: Controlling for other factors, it was found that individual, building, and seismic characteristics were independently predictive of increased injury risk. Prevention and preparedness efforts should focus on each of these as potential points of intervention.

A geographic analysis of motor vehicle collisions with child pedestrians in Long Beach, California: comparing intersection and midblock incident locations

Objectives—The purpose of this study was to use geographic information system (GIS) software to locate areas of high risk for child pedestrian-motor vehicle collisions in the city of Long Beach and to compare risk factors between midblock and intersection collisions. Methods—Children 0–14 years of age involved in a motor vehicle versus pedestrian collision that occurred on public roadways in Long Beach, CA, between 1 January 1992 and 30 June 1995, were identified retrospectively from police reports. The GIS software program, ArcView, was used for spatial analysis and distance calculations. χ2 Tests were used to compare the distribution of the characteristics between intersection and midblock collisions. Results—The average annual incident and fatality rate was 183.3/100 000 children/year and 2.4/100 000 children/year, respectively. Children less than 5 years of age were significantly more likely to be hit at a midblock location while those aged 5–9 and 10–14 were more often hit at an intersection. Intersection collisions were more likely to occur on major arterials and local streets, and the driver to be the primary party at fault (p<0.001). While intersection incidents tended to occur further from the childs home (64.4%) the majority of midblock incidents (61.5%) occurred within 0.1 miles of the childs residence. For both midblock and intersection locations, pedestrian collisions tended to occur more frequently in those census tracts with a larger number of families per census tract—a measure of household crowding and density. Conclusions—Future studies taking into consideration traffic volume and vehicle speed would be useful to focus prevention efforts such as environmental modifications, improving police enforcement, and educational efforts targeted at parents of younger children. As GIS illustrative spatial relationships continue to improve, relationships between pedestrian collision sites and other city landmarks can advance the study of pedestrian incidents.

Alcohol use, driver, and crash characteristics among injured motorcycle drivers

BACKGROUND Motorcycle drivers have the highest frequency of alcohol use among all road users. This study examines alcohol use among a large sample of injured motorcycle drivers and examines how crash characteristics differ with the use of alcohol. METHODS Over 3000 motorcycle drivers who crashed between January 1, 1991, and December 31, 1992, were studied. All fatally injured drivers in 11 California counties and a sample of nonfatally injured drivers treated in 28 hospitals were included in the study if a crash report and medical record were available. RESULTS Among drivers tested for alcohol use, 42% tested positive for the presence of alcohol. Drinking drivers were more likely to be speeding and less likely to wear a helmet, and more frequently had single motorcycle crashes than nondrinking drivers. Crash characteristics, but not alcohol use, were predictive of increased injury severity. CONCLUSIONS Alcohol use remains a significant factor in motorcycle crashes and is an important area for injury prevention efforts.

Epidemiologic Features of Facial Injuries Among Motorcyclists

STUDY OBJECTIVE To describe the extent, nature, and severity of facial injuries among motorcyclists injured in a crash requiring hospital treatment. METHODS The study population consisted of 5,790 motorcycle riders who sustained a nonfatal crash injury during 1991, 1992, or 1993 in 10 California counties. The injured riders were identified in 28 hospitals during 1991 and 1992 and in 18 of these 28 hospitals in 1993. Information was collected from crash reports and hospital records. All injuries were coded according to the 1990 Abbreviated Injury Scale. RESULTS Facial injury was present in 24.3% of injured riders, a high proportion of them young men. Among riders wearing helmets, 36.8% had facial injuries, compared with 53.8% of those not wearing helmets. Soft tissue injuries and facial fractures were present in 72% and 22% of the injured, respectively. The maxilla (22%), orbit (16%), and nasal (16%) bones were the most frequently fractured facial bones. The frequency of multiple facial injuries, severity of facial injuries, and incidence of high-severity facial fractures was greater among nonhelmeted riders compared with helmeted riders. Upper facial fractures were more common among riders without helmets compared with those wearing helmets. CONCLUSION This study provides evidence of the protective value of helmets to reduce risk of facial injury. Information on the positive effect of facial injury sparing provided by helmet use should be incorporated into helmet promotion programs.

Workplace violence prevention programs in hospital emergency departments

Objective: Hospital violence is a growing concern, yet little is known about existing programs. This study compared workplace violence programs in high-risk emergency departments among a representative sample of 116 hospitals in California and 50 hospitals in New Jersey. Methods: Information was collected through interviews, a facility walk-through, and review of written policies, procedures, and training material. Programs were scored on the components of training, policies and procedures, security, and environmental approaches. Results: California had significantly higher scores for training and policies and procedures, but there was no difference for security and environmental approaches. Program component scores were not highly correlated. For example, hospitals with a strong training program were not more likely to have strong policies and procedures. Conclusions: Most hospitals in California and New Jersey had implemented a workplace violence prevention program, but important gaps were found.