Finn Nilson

Trends in hip fracture incidence rates among the elderly in Sweden 1987–2009

BACKGROUND Previous trend studies have shown large increases in hip fracture incidence rates among the elderly. International research, however, suggests a levelling off, or decline, of hip fracture incidence rates, although for Sweden this remains to be studied. METHODS Data were obtained regarding hip fractures among individuals 65 years and above from 1987 to 2009. Analysis was performed in three steps. First, age- and sex-specific trends in hip fracture rates per 100 000 and the mean age when sustaining a hip fracture were analysed. Secondly, the annual percentage change was used to compare time periods that helped to quantify changes in secular trends. Finally, linear and Poisson regression models were used to examine the trend data and observed rates. RESULTS The absolute number of hip fractures among the elderly in Sweden has largely remained constant between 1987 and 2009, while incidence rates have decreased for all age- and sex-specific groups, with the largest changes in the younger age groups and among women. The mean age of sustaining a hip fracture has increased for both men and women. CONCLUSIONS This study supports other international studies in showing a decrease in hip fracture incidence rates among the elderly, especially since the mid-1990s.

Investigating the fall-injury reducing effect of impact absorbing flooring among female nursing home residents: initial results

Background Fall-related injuries affect the lives of elderly to a substantial degree. This quasi-experimental study investigates the fall-injury reducing effect of impact absorbing flooring among female nursing home residents. Methods The intervention site is a nursing home in Sweden where impact absorbing flooring was installed in parts of one of six wards (six out of 10 apartments (excluding bathrooms), the communal dining-room and parts of the corridor). The impact absorbing flooring is a 12 mm thick closed cell flexible polyurethane/polyurea composite tile (500×500 mm) with an exterior surface of polyurethane/polyurea. A generalised linear model (log-binomial) was used to calculate the RR of injury from falls on impact absorbing flooring compared to falls on regular flooring, adjusted for age, body mass index, visual and cognitive impairments. Results During the study period (1 October 2011 to 31 March 2014), 254 falls occurred on regular flooring and 77 falls on impact absorbing flooring. The injury/fall rate was 30.3% for falls on regular flooring and 16.9% for falls on impact absorbing flooring. Adjusted for covariates, the impact absorbing flooring significantly reduced the RR of injury in the event of a fall by 59% (RR 0.41 (95% Cl 0.20 to 0.80)). Conclusions This is, to our knowledge, the first study evaluating the injury-reducing effect of impact absorbing flooring in a nursing home showing statistically significant effect. The results from this study are promising, indicating the considerable potential of impact absorbing flooring as a fall-related injury intervention among frail elderly.

The Effect of the Swedish Bicycle Helmet Law for Children: An Interrupted Time Series Study

BACKGROUND Previous population-based research has shown that bicycle helmet laws can reduce head injury rates among cyclists. According to deterrence theory, such laws are mainly effective if there is a high likelihood of being apprehended. In this study, we investigated the effect of the Swedish helmet law for children under the age of 15, a population that cannot be fined. METHOD An interrupted time series design was used. Monthly inpatient data on injured cyclists from 1998-2012, stratified by age (0-14, 15+), sex, and injury diagnosis, was obtained from the National Patient Register. The main outcome measure was the proportion of head injury admissions per month. Intervention effect estimates were obtained using generalized autoregressive moving average (GARMA) models. Pre-legislation trend and seasonality was adjusted for, and differences-in-differences estimation was obtained using adults as a non-equivalent control group. RESULTS There was a statistically significant intervention effect among male children, where the proportion of head injuries dropped by 7.8 percentage points. There was no evidence of an intervention effect on the proportion of head injuries among female children. CONCLUSION According to hospital admission data, the bicycle helmet law appears to have had an effect only on male children. PRACTICAL APPLICATIONS This study, while quasi-experimental and thus not strictly generalizable, can contribute to increased knowledge regarding the effects of bicycle helmet laws.

A comparison of hip fracture incidence rates among elderly in Sweden by latitude and sunlight exposure.

Background: Research has shown that hip fracture risk increases with latitude; hypothetically due to reduced sunlight exposure and its effect on bone quality. Sweden, with large differences in latitude and UV radiation, is ideal to study in order to analyse the association between latitude and UV radiation on age- and sex-specific hip fracture rates among elderly. Method: Aggregated (2006–2008) age- and sex-specific hip fracture data was obtained for each Swedish municipality as well as the municipality’s latitudinal coordinates and aggregated (2006–2008) UV radiation levels. Pearson correlations were calculated between hip fracture incidence rates, latitude and UV radiation. Independent t tests were calculated on tertile-categorized latitudinal data in order to investigate the difference in hip fracture risk between these categories. Results: Statistically significant correlations were seen in all groups between hip fracture incidence rates and latitude as well as UV radiation. The independent t tests showed that this correlation was mainly due to high incidence rates in high latitude municipalities. Conclusions: Statistically significant correlations are seen between hip fracture incidence rates and latitude as well as UV radiation in Sweden and the northern parts of Sweden have an increased risk of hip fractures compared to the middle and southern parts. To our knowledge this is the first study using a national discharge register that shows this relationship and provides a starting point for further research to investigate why populations in northern Sweden have a higher risk of hip fractures compared to other Swedish regions.

Fall-related fracture trends among elderly in Sweden – exploring transitions among hospitalized cases

PROBLEM Fall-related injuries have been a cause of worry during the end of the 20th century with increasing trends among the elderly. METHOD Using data from the Swedish National Patient Register (NPR) based on hospital admissions, this study explores the trends in fall-related fractures between 1998 and 2010. RESULTS The data shows a decreasing trend in fall-related fractures in all age- and sex-specific groups apart from men 80 years and above. While hip fracture incidence rates decreased in all age- and sex-specific groups, both central fractures and upper extremity fractures have increased in all age- and sex-specific groups apart from women 65-79 years. Lower extremity fractures have increased in the older age groups and decreased in the younger. DISCUSSION The differences found between the groups of fractures and by age- and sex-specific groups indicate a possible transition where more serious fractures are decreasing while less serious fractures increase among hospitalized cases. SUMMARY Perhaps due to a focus on hip fracture prevention, this study shows that while the incidence rate of hospitalized hip fractures has decreased, other fall-related hospitalized fractures have increased. IMPACT ON INDUSTRY Potentially, this could be indicative of a healthier younger elderly, coupled with a frailer older elderly requiring more comprehensive healthcare also for less serious injuries. Further research is needed to confirm our results.

The effect of the transition from the ninth to the tenth revision of the International Classification of Diseases on external cause registration of injury morbidity in Sweden

Background Revisions of the International Classification of Diseases (ICD) have previously been shown to cause dramatic effects with regard to injury mortality data when implemented. However, limited knowledge exists on the effects on the coding of external causes of injury morbidity, despite this being an important aspect with regard to injury prevention. Method Hospitalised injuries in Sweden were studied using time series intervention analysis to observe the effect of the ICD change from ICD-9 to ICD-10 in 1997 on external cause coding. Results The results would suggest considerable coding issues with a large spike in the proportion of injury admissions registered without an external cause code in 1997, with continuing, although gradually diminishing, problems up to 2002. The coding change seems to have had an immediate effect on all external cause of injury categories, although the categories that were not directly convertible from ICD-9 to ICD-10 were seemingly more greatly affected. Discussion The study illustrates the potential issues associated with changes between ICD revisions and the importance of data quality control both during surveillance and collection of data, but also when presenting injury trends across ICD versions.

Hospitalized fall-related injury trends in Sweden between 2001 and 2010

Previous studies have indicated increasing trends of hospitalized fall-related injuries amongst elderly. Whether this is true also in Sweden is unknown though it is important to study considering the potential societal impact. Data were obtained regarding hospitalized injuries with falls as external cause among those aged 65 years and above with information on injury type, gender and age, on a yearly basis, from 2001 to 2010. Age- and sex-specific incidence rates were calculated (per 100,000 population) for all fall-related injuries, and for each injury type and trend lines were drawn. Linear regression analyses and percentage change were calculated for the types of fall-related injuries. A decreasing incidence was observed in the younger age groups (65–79 years) with greater decreases amongst women (women: −14.6%, men 65–79 years: −10.5%). However, increasing rates were observed in the older age group (80 years and above), with greater increases amongst men (women: 4.3%, men: 11.4%). Superficial injuries showed greater increases than fractures amongst those aged 80 years and above. This study indicates that older elderly in Sweden are increasingly being hospitalized for less serious injuries. This changing injury panorama is important to include in the future planning of both health care and fall-related prevention.

Investigating the effect of banning non-reduced ignition propensity cigarettes on fatal residential fires in Sweden

BACKGROUND Annually, 100 people die as a result of residential fires in Sweden and almost a third of the fatal fires are known to be caused by smoking. In an attempt to reduce the occurrence of these events, reduced ignition propensity (RIP) cigarettes have been developed. They are designed to reduce the risk of fire by preventing the cigarette from burning through the full length when left unattended. In November 2011, a ban was introduced, forbidding the production and sale of all non-RIP cigarettes in all member states of the European Union, including Sweden. METHODS Monthly data on all recorded residential fires and associated fatalities in Sweden from January 2000 to December 2013 were analyzed using an interrupted time series design. The effect of the intervention [in relative risk (RR)] was quantified using generalised additive models for location, shape and scale. RESULTS There were no statistically significant intervention effects on residential fires (RR 0.95 [95% CI: 0.89-1.01]), fatal residential fires (RR 0.99 [95% CI: 0.80-1.23]), residential fires where smoking was a known cause (RR 1.10 [95% CI: 0.95-1.28]) or fatal residential fires where smoking was a known cause (RR 0.92 [95% CI: 0.63-1.35]). CONCLUSION No evidence of an effect of the ban on all non-RIP cigarettes on the risk of residential fires in Sweden was found. The results may not be generalisable to other countries.

Preventing fall injuries among elderly by shock absorbing flooring

Background Within nursing homes, the fall-related fracture incidence rate is between 5 and 10%. For those living in nursing homes there are limited options for active fall injury prevention, due to physical impairments and diseases. Instead, passive fall injury prevention is a more realistic alternative. Shock absorbing flooring has been suggested as a potential passive safety measure for this group of individuals. Aims/Objectives/Purpose To evaluate the fall injury reducing effect of shock absorbing flooring in a nursing home setting in Sunne, Sweden. Methods The study is case controlled, with the shock absorbing flooring installed on one ward with a maximum of 12 residents and the other five wards are controls. The total number of residents including control wards is approximately 60. Baseline measurements are made with estimates of the risk of falling as well as the risk of fall-related injury. Results/Outcome After 1 year, there has been 22 falls on the shock absorbing flooring, with no resulting injury compared to 130 falls and four fractures on the control wards. An unexpected finding is that the acoustic environment has improved considerably, creating a calmer environment for the elderly. Significance/Contribution to the Field To our knowledge, this is the first time a shock absorbing flooring has been tested and evaluated as a means of injury prevention in a nursing home. Although this is a pilot study, it contributes towards improved passive safety for this frail group of elderly.

The state of the residential fire fatality problem in Sweden: Epidemiology, risk factors, and event typologies

INTRODUCTION Residential fires represent the largest category of fatal fires in Sweden. The purpose of this study was to describe the epidemiology of fatal residential fires in Sweden and to identify clusters of events. METHOD Data was collected from a database that combines information on fatal fires with data from forensic examinations and the Swedish Cause of Death-register. Mortality rates were calculated for different strata using population statistics and rescue service turnout reports. Cluster analysis was performed using multiple correspondence analysis with agglomerative hierarchical clustering. RESULTS Male sex, old age, smoking, and alcohol were identified as risk factors, and the most common primary injury diagnosis was exposure to toxic gases. Compared to non-fatal fires, fatal residential fires more often originated in the bedroom, were more often caused by smoking, and were more likely to occur at night. Six clusters were identified. The first two clusters were both smoking-related, but were separated into (1) fatalities that often involved elderly people, usually female, whose clothes were ignited (17% of the sample), (2) middle-aged (45-64years old), (often) intoxicated men, where the fire usually originated in furniture (30%). Other clusters that were identified in the analysis were related to (3) fires caused by technical fault, started in electrical installations in single houses (13%), (4) cooking appliances left on (8%), (5) events with unknown cause, room and object of origin (25%), and (6) deliberately set fires (7%). CONCLUSIONS Fatal residential fires were unevenly distributed in the Swedish population. To further reduce the incidence of fire mortality, specialized prevention efforts that focus on the different needs of each cluster are required. PRACTICAL APPLICATIONS Cooperation between various societal functions, e.g. rescue services, elderly care, psychiatric clinics and other social services, with an application of both human and technological interventions, should reduce residential fire mortality in Sweden.