Kristiansen Thomas, Lossius Hans Morten, Rehn Marius, Kristensen Petter, Gravseth Hans Magne, Røislien Jo, Søreide Kjetil
Department of Research and Development, The Norwegian Air Ambulance Foundation, PO Box 94, N-1441 Drøbak, Norway; University of Oslo, Faculty Division Oslo University Hospital, Kirkeveien 166, N-0450 Oslo, Norway; Diakonhjemmet Hospital, Department of Anaesthesiology, PO Box 23 Vinderen, N-0319 Oslo, Norway.
Injury. 2014 Jan;45(1):23-30. doi: 10.1016/j.injury.2013.07.007. Epub 2013 Aug 1.
Trauma is a major global cause of morbidity and mortality. Population-based studies identifying high-risk populations and regions may facilitate primary prevention and the development of optimal trauma systems. This study describes the epidemiology of adult trauma deaths in Norway and identifies high-risk areas by assessing different geographical measures of rurality.
All trauma-related deaths in Norway from 1998 to 2007 among individuals aged 16-66 years were identified by accessing national registries. Mortality data were analysed by linkage to population and geographical data at municipal, county and national levels. Three measures of rurality (centrality, population density and settlement density) were compared based on their association with trauma mortality rates.
The study included 8466 deaths, of which 78% were males. The national annual trauma mortality rate was 28.7 per 100,000. Population density was the best predictor of high-risk areas, and there was a consistent inverse relationship between mortality rates and population density. The most rural areas had 52% higher trauma mortality rates compared to the most urban areas. This difference was largely due to deaths following transport-related injury. Seventy-eight per cent of all deaths occurred in the prehospital phase. Rural areas and death following self-harm had higher proportion of prehospital deaths.
Rural areas, as defined by population density, are at a higher risk of deaths following traumatic injuries and have higher proportions of prehospital deaths and deaths following transport-related injuries. The heterogeneous characteristics of trauma populations with respect to geography and mode of injury should be recognised in the planning of preventive strategies and in the organisation of trauma care.
创伤是全球发病和死亡的主要原因。基于人群的研究确定高危人群和地区可能有助于初级预防和优化创伤系统的发展。本研究描述了挪威成人创伤死亡的流行病学情况，并通过评估不同的农村地理指标来确定高危地区。
通过访问国家登记处，确定了1998年至2007年挪威16至66岁个体中所有与创伤相关的死亡。通过与市、县和国家层面的人口和地理数据相链接，对死亡率数据进行了分析。基于与创伤死亡率的关联，比较了三种农村指标（中心性、人口密度和定居点密度）。
该研究纳入了8466例死亡病例，其中78%为男性。全国年度创伤死亡率为每10万人28.7例。人口密度是高危地区的最佳预测指标，死亡率与人口密度之间存在一致的反比关系。与最城市化地区相比，最农村地区的创伤死亡率高出52%。这种差异主要是由于交通相关伤害后的死亡。所有死亡病例中有78%发生在院前阶段。农村地区和自残后的死亡病例中，院前死亡的比例更高。
以人口密度定义的农村地区遭受创伤性损伤后死亡风险更高，院前死亡和交通相关伤害后死亡的比例也更高。在制定预防策略和组织创伤护理时，应认识到创伤人群在地理和伤害方式方面的异质性特征。
