The Global Burden of Injuries Thomas Songer, PhD University

The Global Burden of Injuries Thomas Songer, PhD University of Pittsburgh

What are Injuries?

Injuries occur as the result of energy transfer that is delivered in excess of a threshold

How do we measure injuries?

Documents used to Record Injuries Death certificates Medical records Work records coroner’s reports police reports crash reports registry forms

Is there validity and reliability in measuring injuries around the world?

Definition and Perception accident misfortune mishap injury casualty disaster misadventure

Death is the most common measure of health and injuries across the world

ICD Codes ICD - 9 N Codes - Nature of injury, anatomy E-Codes - External cause of injury ICD - 10 S/T codes - Nature of injury, anatomy V/W/X/Y codes - external causes

ICD Codes and Injuries Injury ICD-9 ICD-10 Road Traffic Injury Poisoning Falls Fires Drowning Firearm accidents E810-919 E850-869 E880-888 E890-899 E910 E922 V02-04, V09, V12-14, V19, V20-79, V86-89 X40-X49 W00-W19 X00-X09 W65-W74 W32-W34 Self-inflicted injury Homicide/assault War E950-959 E960-969 E990-999 X60-X84 X85-Y09 Y35-Y36

Framework for Presenting Injury Mortality Data Mechanism/ Cause Manner/Intent Unintentional Intentional Homicide Suicide etc. Fall Firearm MVA Poison

Leading Causes of Death, USA, 2000 (number of deaths) 1. Heart Disease 2.Neoplasms Cerebrovascular 3. Disease 4. Chronic Pulmonary Disease 5. Accidents/Injuries 6. Diabetes mellitus 7. Influenza and pneumonia 8. Alzheimer’s Disease 9. Nephritis, nephrotic syndrome 10. Septicemia

Leading Causes of Death Worldwide, 2000 (Based on number of global deaths) 1. Ischemic Heart Disease 2. Cerebrovascular Disease 3. Lower Respiratory Infections 4. HIV/AIDS 5. COPD 6. Perinatal Conditions 7. Diarrhoeal Diseases 8. Tuberculosis 9. Road Traffic Injuries 10. Lung Cancers WHR 2001

Average Annual Injury Death Rates, Injury ICE Countries AUS CAN DEN ENG FRA ISR HOL NZ NOR SCOT USA 0 10 20 30 40 50 60 Deaths per 100,000 pop. 70 80

SOURCE: United States, NCIPC, 1998.

Years of Potential Life Lost Premature mortality is measured by the Years of Potential Life Lost (YPLL) statistic. For the purpose of calculating YPLL, premature death is defined as death occurring before the age of 65. YPLL are calculated using death certificate data. To calculate YPLL, the person’s age at death is subtracted from 64.5.

Years of Potential Life Lost, USA, 2000 Liver Disease Cerebrovascular HIV Congenital Anomalies Homicide Suicide Perinatal Period Heart Disease Malignant Neoplasms Unintentional Injury 0 5 10 15 20 Percent of Total YPLL 25

Years of Potential Life Lost, Black Males, USA, 2000 Diabetes Mellitus Cerebrovascular Suicide Congenital Anomaly HIV Malignant Neoplasm Perinatal Period Heart Disease Unintentional Injury Homicide 0 2 4 6 8 10 12 Percent of Total YPLL 14 16

What are some examples of bias associated with measuring injury deaths globally?

Do all injuries result in death?

Degrees of Injury Severity Injury Deaths Hospitalization Emergency Dept. Physician Visit Households

Injury Outcomes Mortality Hospitalization Disability Quality of Life

Burden of Disease The total significance of disease for society beyond the immediate cost of treatment. It is measured in years of life lost to ill health as the difference between life expectancy and disability adjusted life expectancy. WHR 2000

Global Burden of Disease Population data Mortality data (age, gender specific rates) Cause of death distribution Estimate years lived with a disability incident cases*disability weight*duration of disability

DALY Disability Adjusted Life Year Years of life adjusted for premature mortality and disability

Disability Adjusted Life Year Developed by the World Bank and WHO to characterize the Global Burden of Disease used in health policy to assist in setting priorities Also has a descriptive epidemiology application

DALYs in Developing Areas 1990 Infectious Disease 2020 NCDs Injury

1998 Leading Causes of . Death Heart Disease Stroke Respiratory Infections HIV/AIDS COPD Diarrhoeal Diseases Perinatal Conditions Tuberculosis Lung Cancer Accidents DALYs Respiratory Infections Perinatal Conditions Diarrhoeal Diseases HIV/AIDS Unipolar depression Heart Disease Stroke Malaria Accidents Measles

1998 Leading Causes of . Death Heart Disease Stroke Respiratory Infections COPD HIV/AIDS Diarrhoeal Diseases Perinatal Conditions Lung Cancer Tuberculosis Road Accidents In Males DALYs Respiratory Infections Perinatal Conditions Diarrhoeal Diseases HIV/AIDS Heart Disease Road Accidents Stroke Unipolar Depression Malaria Interpersonal Violence

1998 Leading Causes of . Death HIV/AIDS Malaria Respiratory Infections Diarrhoeal Diseases Perinatal Conditions Measles Stroke War Injuries Heart Disease Interpersonal Violence Africa DALYs HIV/AIDS Malaria Diarrhoeal Diseases Respiratory Infections Perinatal Conditions Measles War Injuries Interpersonal Violence Road Accidents Tropical Diseases

Leading Causes of Injury Death by Region, 1998 Region Africa Americas (high income) Americas (low income) EMRO (high income) EMRO (low income) Europe (high income) Europe (low income) India SE Asia China W. Pacific (high income) W. Pacific (low income) Rank 1 War injuries Road accidents Assault/Homicide War injuries War injuries Road accidents Road accidents Road accidents Road accidents Self-inflicted Road accidents Road accidents Rank 2 Assault/Homicide Self-inflicted Road accidents Road accidents Road accidents Self-inflicted Self-inflicted Fires Self-inflicted Road accidents Self-inflicted Drowning Rank 3 Road accidents Assault/Homicide Self-inflicted Assault/Homicide War injuries Self-inflicted Drowning Self-inflicted WHO 1999