Differences in cause-specific patterns of unintentional injury mortality among 15–44-year-olds in income-based country groups
Introduction
Today, injuries are recognized as an important public health problem not only in developed countries, but also in many developing countries where injuries are gradually becoming one of the major causes of death (Bangdiwala and Anzola-Perez, 1990, Bangdiwala et al., 1990, Rahman et al., 1998). As a means for understanding the extent of the problem and method of controlling accidents and injuries, numerous studies have been conducted in developed countries, but few in developing countries. In many developing countries, the victims of injuries are still too often blamed for their injuries; in road traffic accidents, it is the drivers who are invariably blamed for the accidents. The World Health Organization predicts that by the year 2020, injuries will be responsible for more deaths, disability, and morbidity combined than communicable diseases. Currently, injuries account for one in seven healthy life years lost world-wide; by 2020, they will account for one in five with low and middle-income countries bearing the brunt of this increase (Zwi et al., 1996) Among injury deaths, unintentional injuries are responsible for more death and disability. Globally, unintentional injuries cause as many Disability Adjusted Life Years Lost (DALYs) as diarrhea, and more than those lost from cardiovascular disease, malignant neoplasm, or vaccine-preventable childhood infections (Michaud and Murray, 1994). The relative importance of injuries is not only related to an absolute increase in injury, but also, in many countries, to an overall decline in mortality rates and to the increasing proportion of adults who are at higher risk for injuries (Mosley et al., 1990).
Injuries impose one of the greatest health risks in terms of mortality and morbidity among adolescents and young adults (15–44-year-olds). In 1990, in developing regions of the world, injuries among males aged 15–44 years led to 55 million DALYs lost in the world, with over one-third of DALYs lost from all causes coming from this sex and age group (Murray et al., 1994). When only premature deaths are considered and calculated by Years of Potential Life Lost (YPLLs), injuries lead all other causes (Rodriquez and daMotta, 1989). In the United States, unintentional injury mortality is the leading cause of death among 15–44-year-olds of all races and both sexes (Singh and Yu, 1996). Studies in developing countries also reveal the importance of this age group for the risk for injury deaths, with examples including Zimbabwe (Zwi et al., 1996), Bangladesh (Fauveau et al., 1989), and Egypt (Grubb et al., 1988).
The economic discrepancy between rich and poor countries is enormous. There is now evidence that lower socio-economic status is related to injury risk, but the results are non-linear and inconsistent (Berger and Mohan, 1996, Laflamme, 1998). One of the important measures of socio-economic development is gross national product (GNP) per capita. GNP per capita has been found to be inversely related to unintentional injury deaths among 1–14 (Plitponkarnpim et al., 1999a, Plitponkarnpim et al., 1999b) and 15–44-year-olds (Ahmed and Andersson, 2000). However, the relationship is not that straightforward, and development does not always directly reduce the injury mortality. In Taiwan, where the status of the country during the period 1960–1977 moved from that of developing to developed status, unintentional injuries rose from the seventh to the third leading cause of death, and the annual injury mortality rate increased from 39 to 57 per 100 000 population (Selya, 1980). Söderlund and co-workers describe an initial positive correlation between GNP per capita and road traffic accidents, which becomes negative with increasing GNP per capita (Söderlund and Zwi, 1995). Road traffic and other transport-related accidents are the most common cause of unintentional injury mortality in most countries (Söderlund and Zwi, 1995, Odero et al., 1997). Developed countries have long experienced motor vehicle traffic accidents as a major killer. Even in developing countries, these accidents are increasing rapidly: in Sri-Lanka, motor vehicle traffic mortality increased from 3 to 11 per 100 000 males from 1960 to 1983 (Smith and Barss, 1991). Other common causes of unintentional injury mortality are poisoning, drowning, burns, and falls.
The aim of the present study was to investigate the cause-specific pattern of unintentional injury mortality among 15–44-year-olds in income-based country groups, and to analyze which specific causes contribute the most to the unintentional injury mortality in each country group.
Section snippets
Source of data and study population
World Health Statistics Annuals 1993–1996 were used as the source of data (World Health Organization, 1994–1996). Data for all countries reporting to the World Health Statistics Annuals 1993–1996 were reviewed. Data for 1993 or the closest preceding or subsequent year in the period of 1991–1994 (if information for 1993 was unavailable) were collected. Some countries were excluded due to small population size (less than 1 million), out-dated data (before 1991), or lack of information about
Results
Fig. 1 shows aggregated unintentional injury mortality rates among 15–44-year-olds in the 57 countries. The unintentional injury mortality rates started to increase in the countries with a GNP per capita income of more than US$1000. The mortality rates then gradually declined when GNP per capita income reached approximately US$5000.
Table 2 depicts the mean rates of the five most common specific causes of unintentional injury mortality in four income-based country groups by age and sex
GNP per capita and wealth
GNP per capita was used to classify the countries and the intention was to choose GNP as a proxy for the countries’ developmental status. Other parameters could also be added to the analysis, such as income disparity, gross domestic product, exports, the level of external debts, vehicle ownership, the number of vehicles per capita, energy or newspaper consumption, women's literacy, etc. Income disparity could be one of the most suitable alternatives. For the analysis of MVT accident mortality,
Conclusion
Motor vehicle traffic accidents were the most common cause of injury death and contributed the most to the unintentional injury mortality rates among 15–44-year-olds in all country groups. In the 15–24-year age group, HICs displayed a higher risk of MVT mortality than was the case in LICs, while in the 35–44-year age group, all other country groups showed a higher risk of MVT mortality than the HICs. Poisoning mortality could be used as a sensitive indicator of unintentional injury mortality
Acknowledgements
The authors wish to thank Karen Leander, Department of Public Health Sciences, Karolinska Institutet, for her excellent efforts in correcting the English manuscripts.
References (36)
- et al.
Unintentional injury mortality and socio-economic development among 15–44 year-olds: In A Health Transition Perspective
Public Health
(2000) - et al.
Injury mortality in adults 25–64 years of age: Implications for prevention
Australian and New Zealand Journal of Public Health
(1996) - et al.
Trend and current status of child injury fatalities in Thailand compared with Sweden and Japan
Journal of Safety Research
(1999) - et al.
Medical help seeking behaviour of injury patients in a community of Bangladesh
Public Health
(1998) Deaths due to accidents in Taiwan: a possible indicator of development
Social Science and Medicine (D)
(1980)Epidemiology of accidental drowning in Denmark 1989–1993
Accident Analysis Prevention
(1998)- et al.
The incidence of injuries in young people: II. Log-linear multivariable models for risk factors in a collaborative study in Brazil, Chile, Cuba and Venezuela
International Journal of Epidemiology
(1990) - et al.
The incidence of injuries in young people: I. Methodology and results of a collaborative study in Brazil, Chile, Cuba and Venezuela
International Journal of Epidemiology
(1990) - et al.
Public Health at the Crossroads: Achievements and prospects
(1997) - et al.
Injury Control: A Global view
(1996)
Deaths from drowning
New Zealand Medical Journal
A study of burn injury cases from three hospitals
Indian Journal of Public Health
Epidemiology and cause of deaths among women in rural Bangladesh
International Journal of Epidemiology
Traumatic accidents in rural tropical regions: An epidemiological field study in Panjab, India
American Journal of Medical Science
A comparison of two cause-of-death classification systems for deaths among women of reproductive age in Menoufia, Egypt
International Journal of Epidemiology
Vital statistics (of Shanghai County)
American Journal of Public Health
World Table 1995
Cited by (24)
Patterns of unintentional fatal drowning among children in North Tunisia: A 10-year study
2022, Revue d'Epidemiologie et de Sante PubliqueCitation Excerpt :High rates of mortality were reported in a study by Işın et al. [13] in the 10-14 year and 15-17 year age groups compared to the 0-4 year and 5-9 year age groups. However, the majority of studies worldwide showed that fatal drowning among children concerns mostly the 0-4 year age class [1,17–24]. The tendency observed in our country is explained by the fact that children aged between 1 and 6 years are more supervised by parents compared to adolescents, especially near water [14].
A review of major trauma admissions to a tertiary adult referral hospital over a ten year period: Fewer patients, similar survival
2012, SurgeonCitation Excerpt :Observation of this young cohort over time will demonstrate whether such behavioural change is sustained into later life, reducing accidents and their associated injuries as this generation ages. Despite some cause for optimism, in both periods, two-thirds of males admitted were under the age of 45, in keeping with previously published data and most deaths occurred in this group confirming that trauma is predominantly a disease of young men.3,8,9 The introduction of the penalty points system in Ireland on 31st October 2002 saw a 10% reduction in RTA-related fatalities as well as a 20% reduction in non-fatal injuries in the 12 months subsequent.10
Cross-national injury mortality differentials by income level: The possible role of age and ageing
2008, Public HealthCitation Excerpt :Most analysis and attention is focused on historical shifts from communicable to non-communicable disease patterns. Recent cross-sectional studies on injury in a health transition perspective, however, suggest that economic development may play a fundamental role as a driver of changing patterns of injury mortality.9–15 The strength and direction of the association vary considerably with age, sex and type of injury.
Unintentional non-fatal home-related injuries in Central Anatolia, Turkey: Frequencies, characteristics, and outcomes
2008, InjuryCitation Excerpt :Although men have similar rates of non-fatal injury when compared to women,47 the death rate in unintentional home-related injuries is higher in males than in females.13,46 Countries with mid-level income have not recognised injuries as a major public health problem as very few have actually studied the magnitude of the problem.3,35 There are very few population-based studies on injuries in developing countries.42
Economic development as a determinant of injury mortality - A longitudinal approach
2008, Social Science and MedicineCitation Excerpt :The current study provides longitudinal evidence on the national income (GDP per capita) – injury relationship among high-income countries. Inverted U-shaped curves for injury mortality over time and over GDP per capita have been found, as predicted in earlier cross-sectional studies (Ahmed & Andersson, 2000, 2002; Moniruzzaman & Andersson, 2004, 2005a, 2005b; Plitponkarnpim, Andersson, Hörte, et al., 1999; Plitponkarnpim, Andersson, Jansson, et al., 1999). Our results show that in most countries, economic development has been accompanied by safety improvements since the early 1980s, but by increased injury risks in earlier years of the study period.