1. Incidence of serious injury: A comparison of emergency hospital admissions for serious injury in Ireland, Northern Ireland, England, Scotland and Wales Steve Barron, Institute of Public Health in Ireland Jodie Hope, Information Services Division, NHS National Services Scotland Prof Ronan Lyons, Steven Macey, College of Medicine, Swansea University and Public Health Wales Roy Maxwell, Wendi Slater, Public Health England Injury observatory for Britain and Ireland (IOBI)

2. Outline o Injury Observatory for Britain and Ireland o Rationale o Method o Findings o Limitations o Conclusions

3. Injury Observatory for Britain and Ireland (IOBI) o Collaboration involving public health and academic institutions o Support injury prevention practitioners by making important and relevant information and tools available in one site o Analysis of injury mortality and occurrence o Inventory of data sources o Policy support for prevention o Evidence base for prevention o Access to prevention tools o News and events: Injury Prevention News newsletter http://www.injuryobservatory.net/

4. Rationale o Injury is a major public health issue o Usefulness of comparing injury occurrence o Issues in comparing injury occurrence between countries: o Comparable survey data on injury in the community? o Different capacity/admission thresholds in different countries? o What can we compare? Hospital admissions for “serious injuries”

5. Method o Hospital admission data for 2011 o Emergency “inpatient spells” o “Serious injury”: modified set of ICD 10 codes from the New Zealand Injury Prevention Strategy’s serious injury indicators o All serious injury: a serious injury code in any diagnosis field o Serious injury by cause and intent: a serious injury code AND a cause / intent code in any diagnosis field o Directly age-standardised rates (DASR)

6. Completeness of data: All serious injury versus serious injury by cause/intent Serious injury codes AND Cause/intent codes

7. Completeness of data: All serious injury versus serious injury by cause/intent Serious injury codes AND Cause/intent codes All serious injuries (n=179,380)

8. Completeness of data: All serious injury versus serious injury by cause/intent Serious injury codes AND Cause/intent codes All serious injuries (n=179,380) Subset of all serious injuries that have cause / intent data (n=159,805): Scotland99% Ireland98% England89% Wales72% Northern Ireland68%

9. Findings All serious injury o How many serious injuries? o Are the rates for all serious injuries different between countries? Serious injury by cause / intent o How are causes distributed within each country? o Are the rates by cause different between countries? o How are intents distributed within each country? o Are the rates by intent different between countries?

10. Findings: How many serious injuries? Number of emergency hospital admissions for all serious injury, 2011 Northern Ireland4,338 Ireland10,253 Wales11,735 Scotland14,382 England138,672 Total179,380

11. Findings: Are the rates for all serious injuries different between countries? Wales rate significantly higher than others England rate significantly lower than others (except Northern Ireland) No sex differences in rates within a country apart from Ireland (Male > Female)

12. Findings: How are causes distributed within each country? About two-thirds (63-71%) of serious injuries are due to falls 5-8% of serious injuries are due to motor vehicle traffic collisions (MVTC) 5-7% of serious injuries are due to struck by or against Notable exception: 6% of serious injuries in Northern Ireland are firearm related (<1% in other countries)

13. Findings: Are the rates by cause different between countries? Directly age-standardised rate of emergency hospital admissions for serious injury by cause and country, 2011 IRENISCOTWALENG MVTC17.410.213.914.2 Fall214.7140.0200.2198.8180.0 Cut3.73.27.23.22.2 Drown0.40.30.40.50.2 Fire0.40.30.40.50.2 Firearm0.59.00.20.10.2 Struck13.14.212.717.914.9 Poison1.41.91.62.51.8 Other42.721.951.537.133.4

14. Findings: Are the rates by cause different between countries? Directly age-standardised rate of emergency hospital admissions for serious injury by cause and country, 2011 IRENISCOTWALENG MVTC17.410.213.914.2 Fall214.7140.0200.2198.8180.0 Cut3.73.27.23.22.2 Drown0.40.30.40.50.2 Fire0.40.30.40.50.2 Firearm0.59.00.20.10.2 Struck13.14.212.717.914.9 Poison1.41.91.62.51.8 Other42.721.951.537.133.4 Significantly higher than other four countries

15. Findings: Are the rates by cause different between countries? Directly age-standardised rate of emergency hospital admissions for serious injury by cause and country, 2011 IRENISCOTWALENG MVTC17.410.213.914.2 Fall214.7140.0200.2198.8180.0 Cut3.73.27.23.22.2 Drown0.40.30.40.50.2 Fire0.40.30.40.50.2 Firearm0.59.00.20.10.2 Struck13.14.212.717.914.9 Poison1.41.91.62.51.8 Other42.721.951.537.133.4 Significantly higher than other four countries Significantly lower than other four countries

16. Findings: Rates by cause o Comparisons of sex-specific rates within each country  MVTC, Struck, Other: Male > Female in all  Cut: Male > Female in all except England  Fire: Male > Female in Scotland, England  Firearms: Male > Female in Northern Ireland, Scotland  Drown, Poison: No sex differences  Falls: Female > Male in all five

17. Findings: How are intents distributed within each country? About nine-tenths (89-93%) of serious injuries are unintentional 5-7% of serious injuries are due to assaults About 2% of serious injuries are due to selfharm (Northern Ireland is higher at 5%)

18. Findings: Are the rates by intent different between countries? Directly age-standardised rate of emergency hospital admissions for serious injury by intent and country, 2011 IRENISCOTWALENG Selfharm3.57.44.95.04.5 Assault11.49.117.013.813.5 Undetermined1.10.40.10.50.4 Unintentional283.4176.3270.7258.7232.7

19. Findings: Are the rates by intent different between countries? Directly age-standardised rate of emergency hospital admissions for serious injury by intent and country, 2011 IRENISCOTWALENG Selfharm3.57.44.95.04.5 Assault11.49.117.013.813.5 Undetermined1.10.40.10.50.4 Unintentional283.4176.3270.7258.7232.7 Significantly higher than other four countries

20. Findings: Are the rates by intent different between countries? Directly age-standardised rate of emergency hospital admissions for serious injury by intent and country, 2011 IRENISCOTWALENG Selfharm3.57.44.95.04.5 Assault11.49.117.013.813.5 Undetermined1.10.40.10.50.4 Unintentional283.4176.3270.7258.7232.7 Significantly higher than other four countries Significantly lower than other four countries

21. Findings: Rates by intent o Comparisons of sex-specific rates within each country  Selfharm: Male > Female in Ireland, Northern Ireland, Scotland  Assault: Male > Female in all five  Undetermined/Other: Male > Female in England  Unintentional: Female > Male in Scotland, England

22. Limitations and issues to consider o Descriptive rather than analytical study o Defining “serious injury” o Completeness of injury coding o Completeness of cause / intent coding o Multiple injuries and multiple causes / intents o Inclusion of readmissions o Unit of analysis: “Inpatient spells”

23. Conclusions o Large number of emergency admissions for serious injury o Countries have generally similar per cent distributions of causes and intents o Differences in rates by causes and intents may be partly due to differences in completeness of coding o Establishing valid incidence rates the first step in comparing countries

24. Thanks to… o Hospital Inpatient Enquiry Scheme (Ireland) o Hospital Inpatient System, Hospital Information Branch, Department of Health, Social Services and Public Safety Northern Ireland o The Scottish Morbidity Record 01 (SMR01) - General/Acute Inpatient and Day Case o Patient Episode Database for Wales (PEDW) provided by NHS Wales Informatics Service o Hospital Episode Statistics, Health & Social Care Information Centre (England)

25. Thank you for listening! Any comments or questions?