Dessypris Nick, Dikalioti Stavroula K, Skalkidis Ilias, Sergentanis Theodoros N, Terzidis Agapios, Petridou Eleni Th
Department of Hygiene, Epidemiology and Medical Statistics, University of Athens, School of Medicine, Athens, Greece.
J Trauma. 2009 Feb;66(2):519-25. doi: 10.1097/TA.0b013e31817dac79.
Unintentional injury remains the leading cause of death among individuals <45-year-old in several developed countries, including the United States, despite the availability of evidence-based preventive policies and practices. This study aims to estimate the preventable fraction of unintentional injury mortality in the United States and critically examine variability components and time trends among four different US regions.
ICD-10 coded unintentional injury mortality data were electronically obtained for all available years (1999-2004) from the National Center for Injury Prevention and Control database; inter-region variability and time trends were calculated to assess age-specific and injury type-specific components. A theoretical model was applied to estimate the preventable fraction of unintentional injuries, assuming that all US regions could achieve the region-specific lowest mortality rate.
Children enjoy the lowest injury mortality rates, whereas adults present 4-fold and elderly 10-fold higher rates. Of all injury deaths approximately 25%, nearly 25,000 deaths, could have been averted (approximately 2,300 among children; approximately 17,200 among adults [15-64 years] and approximately 5,500 among elderly) provided that preventive strategies of the best performing region were implemented across the United States. During the studied period, a statistically significant annual increase of 1.6% was observed, caused by an alarming rising trend in poisoning (+11.5%) mainly among adults, and falls (+5.5%) among elderly. Contrary, a noticeable (-2.4%) and statistically significant decrease of all types of injuries except suffocation was noted among children.
A substantial number of lives might be saved if established injury preventive programs in low-mortality regions were also implemented in the less-privileged ones. Given the stable trends reported for motor vehicle and occupational injury mortality rates, poisoning and fall injuries occurring at home or during leisure time among the workforce population should be considered as main public health priority areas pending further elucidation of underlying mechanisms, such as the role of alcohol, drugs, and comorbidity in their causation.
在美国等几个发达国家，意外伤害仍是45岁以下人群的主要死因，尽管已有基于证据的预防政策和措施。本研究旨在估计美国意外伤害死亡率中可预防的比例，并严格审查美国四个不同地区的变异成分和时间趋势。
从国家伤害预防与控制中心数据库以电子方式获取了所有可用年份（1999 - 2004年）的国际疾病分类第十版（ICD - 10）编码的意外伤害死亡率数据；计算区域间变异和时间趋势，以评估特定年龄和特定伤害类型的成分。应用理论模型估计意外伤害的可预防比例，假设美国所有地区都能达到特定区域的最低死亡率。
儿童的伤害死亡率最低，而成人的死亡率是儿童的4倍，老年人的死亡率是儿童的10倍。在所有伤害死亡中，约25%（近25000例死亡）本可避免（儿童中约2300例；15 - 64岁成年人中约17200例；老年人中约5500例），前提是在美国各地实施表现最佳地区的预防策略。在研究期间，观察到年增长率有统计学意义的上升，为1.6%，这是由中毒（主要在成年人中，上升11.5%）和老年人跌倒（上升5.5%）的惊人上升趋势导致的。相反，儿童中除窒息外的所有伤害类型均有明显（-2.4%）且有统计学意义的下降。
如果在低死亡率地区实施的既定伤害预防项目也能在条件较差的地区实施，可能会挽救大量生命。鉴于机动车和职业伤害死亡率报告的趋势稳定，在进一步阐明潜在机制（如酒精、药物和合并症在其病因中的作用）之前，劳动力人群在家中或休闲时间发生的中毒和跌倒伤害应被视为主要的公共卫生优先领域。
