Injury EpidemiologyWhat are Injuries?Causes of InjuriesEnergy Transfer and InjuriesPercentage of all Injury Deaths Caused by Mechanical Energy, 1986Slide 6Where does epidemiology tie in?Leading Causes of Death in Developed Regions, 1990Leading Causes of Death Worldwide, 2000Leading Causes of Death in the United States, 1992Leading Causes of Death, USA, 2000Years of Life Lost Prior to Age 70, 1987Motor Vehicle Crash Death Rates among Males by Country, 1980Alcohol Involved Crashes by Time of DayDo injury patterns differ around the world?Mortality Rates by Cause of DeathInjury Mortality Rates of U.S. Male Travelers by Region, 1975,1984Crude Injury Mortality Rates in Males by Level of Economic DevelopmentChanges in Mortality in MexicoAdjusted Male Mortality from Homicide: Selected countriesInjury ControlDefinitionsA Model of Injury ControlAdvances in the Epidemiology of Injuries as a Basis for Public PolicySlide 25Slide 26Slide 27The Haddon MatrixSlide 29Crash Injury Prevention Strategies for the International TravelerTen Methods for Limiting Physical Energy TransferMethods to limit energy transfer...Injury EpidemiologyInjury EpidemiologyAn IntroductionreadingsThomas Songer, PhDUniversity of PittsburghWhat are Injuries?Causes of Injuries•Abnormal Energy Transfer–Mechanical Energy (moving objects)–Thermal–Electric–Chemical–RadiationEnergy Transfer and Injuries•Penetrating•Non-Penetrating•Compression•BurnPercentage of all Injury Deaths Caused by Mechanical Energy, 198631%22%8%13%26%Motor VehicleFirearmsFallsOther Mech. E.Not MechanicalUnited StatesBaker, 1992•Motor Vehicle Crashes•Homicide•Suicide•Sports and Recreation•Drownings•Poisonings•Falls•Occupational Injuries•Burns•AsphyxiationWhere does epidemiology tie in?Leading Causes of Death in Developed Regions, 1990(Based on number of deaths)1. Ischemic Heart Disease2. Cerebrovascular Disease3. Lung Cancer4. Lower Respiratory Infections5. COPD6. Colon and Rectum Cancer7. Stomach Cancer8. Road Traffic Accidents9. Self-Inflicted Injuries10. Diabetes MellitusGlobalBurden of DiseaseLeading Causes of Death Worldwide, 2000(Based on number of global deaths)1. Ischemic Heart Disease2. Cerebrovascular Disease3. Lower Respiratory Infections4. HIV/AIDS5. COPD6. Perinatal Conditions7. Diarrhoeal Diseases8. Tuberculosis9. Road Traffic Injuries10. Lung CancersWHR 2001Leading Causes of Death in the United States, 1992(Based on number of deaths)1. Heart Disease2. Malignant Neoplasms3. Cerebrovascular Disease4. COPD5. Accidents/Injuries6. Pneumonia7. Diabetes mellitus8. HIV infection9. Suicide10. HomicideLeading Causes of Death, USA, 2000(number of deaths)1. Heart Disease2. Neoplasms3. Cerebrovascular Disease4. Chronic Pulmonary Disease5. Accidents/Injuries6. Diabetes mellitus7. Influenza and pneumonia8. Alzheimer’s Disease9. Nephritis, nephrotic syndrome10. SepticemiaYears of Life Lost Prior to Age 70, 1987010002000300040005000Injury Cancer CHD AIDS StrokeBaker, 1992Motor Vehicle Crash Death Rates among Males by Country, 1980020406080Rate per 100,000 pop.USA France Japan GER UKAge groupAlcohol Involved Crashes by Time of Day1991 GESNumber of Crashes050100150Number (thousands)6-10 10-2 2-6 6-10 10-2 2-6Afternoon Early MorningDo injury patterns differ around the world?Mortality Rates by Cause of Death1101001000India China DevelopingCountriesOECDCountriesComm. NCD Injurydeaths per 100,000 populationSource: World Bank,Investing in Health, 1993Injury Mortality Rates of U.S. Male Travelers by Region, 1975,1984010020030040025-34 35-44 45-54 55-64 65+rate per 100,000Developing DevelopedAge GroupHargarten, 1991Crude Injury Mortality Rates in Males by Level of Economic Development020406080100120140SriLan Egypt Thai Chile Mex Arg Swe USAper 100,000 populationGNP $ 400 760 810 1320 1973 2350 13,160 17,980Changes in Mortality in Mexico0204060801001201950 1955 1960 1965 1970 1975 1980Rate per 100,000 pop.Injuries Malaria Heart Dis. DiabetesFrenk 1991Adjusted Male Mortality from Homicide: Selected countries 01530456075Japan Switz Israel USA - whiteUSA- AArate per 100,000 pop.Fra Can Chile USSR1989-1991Injury ControlDefinitionsDefinitions•Reducing the incidence of disease•Reducing the prevalence of disease•Ongoing programs aimed at reducing the incidence and/or prevalence of diseasePreventionPreventionControlControlLast, Dictionary of EpidemiologyA Model of Injury ControlMonitorincidenceIdentifyrisk factorsIntervene EvaluateIdentifymorbiditymortalitycostsocialgeneticenvironmentalhealth careAdvances in the Epidemiology of Injuries as a Basis for Public PolicyAdvances in the Epidemiology of Injuries as a Basis for Public PolicyWilliam Haddon, MD, MPHWilliam Haddon, MD, MPHPublic Health Reports 1980; 95(5):411-421HostEnvironmentAgentHumanEnvironmentVehicleInjuries and the Epidemiology TriadPhysicalSocialRisk factors for motor vehicle crashesHumanEnvironmentalVehicularFailureDesignSpeedAgeGenderExperienceAlcoholFatigueRoad ConditionsTrafficWeatherThe Haddon Matrixuse for planning, resource allocation, strategy identificationHuman Vehicle EnvironmentPre-eventEventPost-eventThe Haddon MatrixHuman Vehicle EnvironmentPre-eventEventPost-eventalcoholno seatbeltno air bagnight, raintree too close to roadslow emergencyresponseCrash Injury Prevention Strategies for the International TravelerTraveler Vehicle EnvironmentPre-eventEventPost-eventAvoidalcoholuse seatbeltsAvoid nightdrivingKnow localmedical systemChoosesafe carsTen Methods for Limiting Physical Energy Transfer1. Prevent the development of energy form2. Reduce the amount of energy3. Prevent the energy release4. Alter the rate of energy release from it’s source or it’s spatial distribution5. Separate structures from the energy release by space or timeMethods to limit energy transfer...6. Place a barrier between the released energy and susceptible structures7. Modify surfaces that can be impacted8.Strengthen structures susceptible to damage from energy transfer9. Prevent the extension of existing damage10. Carry out intermediate and long-term repair and