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

2. What are Injuries?

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

4. How do we measure injuries?

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

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

7. Definition and Perception accident misfortune mishap injury casualty disaster misadventure

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

9. 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

10. ICD Codes and Injuries InjuryICD-9ICD-10 Road Traffic Injury E810-919 V02-04, V09, V12-14, V19, V20-79, V86-89 Poisoning E850-869X40-X49 Falls E880-888W00-W19 Fires E890-899X00-X09 Drowning E910W65-W74 Firearm accidents E922W32-W34 Self-inflicted injury E950-959X60-X84 Homicide/assault E960-969X85-Y09 War E990-999Y35-Y36

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

12. Leading Causes of Death, USA, 2000 (number of deaths) 1. Heart Disease 2.Neoplasms 3.Cerebrovascular 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

13. 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

14. Average Annual Injury Death Rates, Injury ICE Countries CAN ENG ISR NZ SCOT

15. SOURCE: United States, NCIPC, 1998.

16. 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.

17. Years of Potential Life Lost, USA, 2000 0510152025 Unintentional Injury Malignant Neoplasms Heart Disease Perinatal Period Suicide Homicide Congenital Anomalies HIV Cerebrovascular Liver Disease Percent of Total YPLL

18. Years of Potential Life Lost, Black Males, USA, 2000 0246810121416 Homicide Unintentional Injury Heart Disease Perinatal Period Malignant Neoplasm HIV Congenital Anomaly Suicide Cerebrovascular Diabetes Mellitus Percent of Total YPLL

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

20. Do all injuries result in death?

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

22. Injury Outcomes Mortality Hospitalization Disability Quality of Life

23. 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

24. 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

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

26. 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

27. DALYs in Developing Areas 1990 2020 Infectious DiseaseNCDsInjury

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

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

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

31. Leading Causes of Injury Death by Region, 1998 RegionRank 1Rank 2Rank 3 Africa War injuries Assault/HomicideRoad accidents Americas (high income)Road accidentsSelf-inflicted Americas (low income)Assault/HomicideRoad accidents EMRO (high income)War injuriesRoad accidentsSelf-inflicted EMRO (low income)War injuriesRoad accidentsAssault/Homicide Europe (high income)Road accidentsSelf-inflicted Europe (low income)Road accidentsSelf-inflictedWar injuries IndiaRoad accidentsFiresSelf-inflicted SE AsiaRoad accidentsSelf-inflicted ChinaSelf-inflictedRoad accidentsDrowning W. Pacific (high income)Road accidentsSelf-inflicted W. Pacific (low income)Road accidentsDrowningSelf-inflicted Assault/Homicide WHO 1999