Jerry Abraham

The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013

Background The Global Burden of Diseases (GBD), Injuries, and Risk Factors study used the disability-adjusted life year (DALY) to quantify the burden of diseases, injuries, and risk factors. This paper provides an overview of injury estimates from the 2013 update of GBD, with detailed information on incidence, mortality, DALYs and rates of change from 1990 to 2013 for 26 causes of injury, globally, by region and by country. Methods Injury mortality was estimated using the extensive GBD mortality database, corrections for ill-defined cause of death and the cause of death ensemble modelling tool. Morbidity estimation was based on inpatient and outpatient data sets, 26 cause-of-injury and 47 nature-of-injury categories, and seven follow-up studies with patient-reported long-term outcome measures. Results In 2013, 973 million (uncertainty interval (UI) 942 to 993) people sustained injuries that warranted some type of healthcare and 4.8 million (UI 4.5 to 5.1) people died from injuries. Between 1990 and 2013 the global age-standardised injury DALY rate decreased by 31% (UI 26% to 35%). The rate of decline in DALY rates was significant for 22 cause-of-injury categories, including all the major injuries. Conclusions Injuries continue to be an important cause of morbidity and mortality in the developed and developing world. The decline in rates for almost all injuries is so prominent that it warrants a general statement that the world is becoming a safer place to live in. However, the patterns vary widely by cause, age, sex, region and time and there are still large improvements that need to be made.

Data Sources for Improving Estimates of the Global Burden of Injuries: Call for Contributors

Kavi Bhalla and colleagues invite individuals and organizations to provide local injury data sources to help inform estimates of the global burden of injuries.

National burden of road traffic injuries in Argentina

More than 1.2 million people die and as many as 50 million people are injured or disabled due to road traffic injuries (RTIs) every year worldwide. The lack of reliable data hinders efforts to describe the characteristics of the issue and prioritise prevention activities. The objective was to provide a snapshot of fatal and non-fatal RTI in Argentina. We used the methodology proposed by the Global Burden of Disease Injury Expert group. External causes of deaths with unknown codes were proportionately redistributed over the known categories. In 2007 in Argentina, we estimated 5915 RTI deaths, compared with 3983 RTI deaths reported previously by the Ministry of Health, accounting for 1931 additional cases. The highest number of deaths occurred in young men (15–29 years old), although the highest RTI death rates were in the age group of 55 years and older. Four-wheeled vehicle occupants were the most common road user type killed (59.1%); vulnerable road users represented one third (29.5%) of deaths and 64% of non-fatal RTI. The national and regional estimates of RTI in Argentina should help policy makers and public-health researchers to understand the importance of RTI prevention and design specific interventions to further reduce these preventable deaths and injuries.

The global injury mortality data collection of the Global Burden of Disease Injury Expert Group: a publicly accessible research tool

a publicly accessible research tool Kavi Bhalla*, James E. Harrison, Lois A. Fingerhut, Saeid Shahraz, Jerry Abraham and Pon-Hsiu Yeh; on behalf of the Global Burden of Disease Injury Expert Group Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA; Research Center for Injury Studies, Flinders University, Adelaide, Australia; Independent Researcher, Washington, USA

Using mortuary data for estimating urban injury mortality incidence in Africa

National vital registration systems that record causes of death do not exist in most African countries. This makes estimating incidence of mortality from injuries in African regions particularly challenging. We discuss the viability of using retrospective and prospective data gathered from death registration sites that issue death certificates for medicolegal purposes in four African cities (Lusaka, Zambia; Maputo, Mozambique; Addis Ababa, Ethiopia; and Kampala, Uganda). We describe the flow of information in the form of administrative registers and documents maintained and issued by various institutions involved with deaths (including medical institutions, forensic, police and judicial investigation records, and funeral grounds and cemeteries). In each case, we show the implications of varying social, cultural and administrative record keeping practices and identify the most complete site for collecting cause-of-death information. Next, we discuss methods for converting such data into reliable estimates of injury incidence. This requires addressing data quality issues, and estimating completeness and coverage of these data systems. We demonstrate how cause of death attribution can be improved in retrospective data gathering by following back a stratified sample of registered cases. For prospective data gathering, we recommend the adoption of a standardised surveillance instrument (currently being developed by WHO) for prospective data gathering. Finally, we demonstrate the method of estimating completeness and coverage by comparing recorded deaths with deaths predicted in the population using alternate sources.

Estimating the burden of injuries in Uganda from all available data sources

Background Estimating injury burden in low income countries is hampered by lack of structured nationally representative data collection systems. Objective To demonstrate the construction of estimates of the national burden of injuries using a systematic assessment of multiple data sources. The approach harnesses the strength of each source and accounts for biases in data. Methods We conducted an environmental scan of all existing data sources that can inform estimates of the incidence of fatal and non-fatal injuries in Uganda. These included: Mortuary data from Kampala city and Mulago hospital mortuaries. Verbal autopsy data from two district health and demographic surveillance systems. Community Injury Survey: conducted in one rural district and one urban district, Uganda National Household Survey. 2004 Northern Uganda Baseline Survey. Hospital based trauma surveillance at Mulago hospital. Outputs and Building Estimates We estimated national injury mortality from urban rates estimated from mortuary data from Kampala and rural rates based on the two HDSS sites. We estimated the population incidence of non-fatal injuries using the household surveys. Total injury incidence was obtained from the two national health surveys and the external cause disaggregation was computed from the community injury survey. Finally, we used the hospital surveillance data to estimate the distribution of nature of injuries. Conclusion Despite paucity of information, we derived national injury estimates from diverse data sources. Such an approach may have relevance to other low income settings. Development of a comprehensive national health information system that captures injuries is needed in Uganda.