Injury mortality and morbidity in Ireland

Anthony Staines and Mairín Boland for The Injury in

Ireland group.

Injury in Ireland Group

• Anthony Staines (UCD)• Patricia Fitzpatrick (UCD)• Elaine Scallan (FSAI)• Alan Kelly (TCD)• Conor Teljeur (TCD/SAHRU)• Marie Laffoy (ERHA)

Background

• Major public health problem• Most injuries never come to

medical notice• A minority are fatal• Very important cause of acquired

long-term disability in children and younger adults

Data sources

• Three data sources

• Irish census 1981,1986,199,1996

• Hipe hospital admissions data 1993-2000

• Mortality data 1980-200

Geography

• Not much available!

• Two geographies

• Hipe: city and county level only

• Mortality: city, town, and rural areas as well

Area populations (1996)

• Total 3,626,087• Hipe geography

• City 1,337,271• Other 2,288,816

• Mortality geography• City 1,337,271• Urban districts 355,368• Rural areas 1,933,448

Admissions (1993-2000)

• Injury admissions by area

• No area identified 9,889• Not in a city 350,432• In a city 184,035

• Total 544,356

Restrictions (Admissions)

• Remove 9,889 admissions of people with no fixed abode (537) (0.1%), or normally resident outside Ireland (9352) (1.7%).

• Remove 59,181 (10.8%) admissions with no E-code, which cannot be classified as to Cause or Intent.

• Exclude 3,098 (0.6%) admissions of people with E-codes indicating only the location of the injury (E8490-E8499).

• 472,796 admissions left (86.5%)

Admissions by sex

• Injury admissions by sex• Females 216,738• Males 327,618

• Unintentional injury• 396,243 admissions• (83% of eligible cases)• (72% of all cases)

Deaths 1981 – 1997

• Total 24,912

• Unintentional18,185

• Males 12,026• Females 6,159

Areas (Unintentional deaths)

• Two level geography• City 6,039• Other 12,146

• Three level geography• City 6,039• Urban 1,954• Rural 10,192

Principal questions

• Concentrate on unintentional injury• 396,243 admissions• 18,185 deaths

• Rates of unintentional injury by area, age and sex

• SMR’s/SAR’s comparing cities to the remainder of the country by cause

Death rates Males and Females

1

10

100

1000

00_04 05_09 10_14 15_19 20_24 25_29 30_34 35_39 40_44 45_49 50_54 55_59 60_64 65_69 70_74 75_79 80_84 85+

Age group

Dea

th r

ate

per

100,

000

(log

scal

e)

Female

Male

Death rates City and Other

1

10

100

1000

00_04 10_14 20_24 30_34 40_44 50_54 60_64 70_74 80_84

Age group

Dea

th r

ate

per

100

,000

(lo

g s

cale

)

Other

City

Ratios of death rates

0

1

2

3

4

5

6

00_04 05_09 10_14 15_19 20_24 25_29 30_34 35_39 40_44 45_49 50_54 55_59 60_64 65_69 70_74 75_79 80_84 85+

Age group

Rat

io o

f mor

talit

y ra

tes

M:F

O:C

Death rates City;Urban;Rural

1

10

100

1000

00_04 05_09 10_14 15_19 20_24 25_29 30_34 35_39 40_44 45_49 50_54 55_59 60_64 65_69 70_74 75_79 80_84 85+

Age group

Dea

th r

ate

per

100,

000

(log

scal

e)

Rural

Urban

City

Admissions Males and Females

0

1000

2000

3000

4000

5000

6000

7000

00_04 05_09 10_14 15_19 20_24 25_29 30_34 35_39 40_44 45_49 50_54 55_59 60_64 65_69 70_74 75_79 80_84 85+

Age group

Adm

issi

on r

ate

per

1000

00

Female

Male

Admissions City and Other

0

1000

2000

3000

4000

5000

6000

7000

00_04 10_14 20_24 30_34 40_44 50_54 60_64 70_74 80_84

Age group

Ad

mis

sio

n r

ate

per

100

000

Other

City

Ratios of admission rates

0

0.5

1

1.5

2

2.5

3

3.5

00_04 05_09 10_14 15_19 20_24 25_29 30_34 35_39 40_44 45_49 50_54 55_59 60_64 65_69 70_74 75_79 80_84 85+

Age group

Rat

io o

f adm

issi

on r

ates

M:F

O:C

SMR’s and SAR’s by area

Deaths Deaths Admissions

75

100

125

City Urban Rural City Other City Other

Areas

SMR

+/-

95%

CI

SMR’s by cause, City and Other

0

25

50

75

100

125

150

175

Cause

SMR

+/- 9

5% C

I

Other

City

SAR’s by cause, City and Other

0

25

50

75

100

125

150

Cause

SA

R +

/- 95

% C

I

Other City

SAR’s by selected causes, City, Urban, Rural

0

25

50

75

100

125

150

175

Poisoning Suffocation Fall Drowning Transport Machinery Firearm

Cause

City Urban Rural

Limitations

• Problems of geography• Coarse, and may be unreliable

• Problems of coding• External causes often poorly documented

in hospital records• May be better for mortality, because of

coroners

• Definitions of ‘Injury’• For our purposes, external cause actually

coded

• Incomplete data• Location coding is poor, for example

Conclusions

• Substantial differences between injury experience in major cities, and other parts of the country

• Observed for deaths and admissions

• Fairly consistent ordering for all causes by sex and age• City < Urban < Rural

Cause specific variations

• Some have obvious explanations• Natural• Machinery

• Some not so obvious• Firearm deaths higher in country, but

admissions higher in city• ?Suicide vs. Crime

• Poisoning• ?Agrochemicals

Implications

• Need to target injury prevention measures to different areas as well as different age groups

• Need to address transport hazards in rural areas

• Improve geography on HIPE system!

• More systematic training for coders on injury coding