Chapter 3. |
How Big is the Injury Problem? By Mark Rosenberg, MD |
Overview |
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Consider the statistics. This slide is a matrix that shows the 10 leading causes of death in this country by age group in 1994. If there is only one thing that you commit to memory from this entire course, I would like it to be the information on this chart. Just look at the colors, that's all that you'll really need to remember. If you look at that first row, everything that falls into the category of unintentional injuries is printed in blue. But to get the complete injury picture for each column, you must also add to the blue figures all of the numbers in red that represent homicides and in green that represent suicides.The chart tells a story: that injuries dominate the pattern of death in the United States. For people ages 1 to 4, 5 to 9, 10 to 14, 15 to 24, 25 to 34, injury is the leading cause of death. And if you look at the 35 to 44 age group, and add together unintentional injuries with suicide and homicide, there too injury is the leading cause of death. So for people between the ages of 1 and 44 in this country, injury is the leading cause of death. The total number of Americans who died from injuries in 1994 was about 151,000. About 43,000 of these deaths were from motor vehicle crashes, about 31,000 were from suicide, about 25,000 were from homicides, 10,000 were from falls, 9,000 were from poisonings, 4,000 were from fires and burns, and another 4,000 were from drownings. But keeping track of deaths is just one way of measuring the injury problem. Another, and perhaps preferable way, is to calculate years of potential life lost. The calculation is based on an assumption that for most people, our productivity ends at age 65. So, if someone dies at age 64 from a heart attack, it would be registered as one year of potential life lost. But if a young person dies from a motor vehicle crash at age 20 then you should subtract 20 from 65, and you've lost 45 years of potential life. By comparing years of life lost from injuries to years of life lost from other public health problems, it becomes evident that injury is an even more severe problem than death rates alone would indicate. This is not to say that measuring years of potential life lost is a perfect index. There is certainly no rule that says that people cannot be productive well past the age of 65. However, looking at years of life lost does help us to factor important information about when deaths occur into our understanding of the injury problem. If you look at years of potential life lost, injury accounts for more years of potential life lost than any other cause. Another way to understand the scope of the injury problem is to look at nonfatal injuries. While we have much more accurate information about the number of deaths that occur in this country than about the number of nonfatal injuries, many more people suffer from nonfatal injuries each year than are killed as a result of injuries. |
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This point is illustrated on this slide. The graphic shows that deaths are just the small tip of the injury pyramid, and that that there are many more nonfatal injuries than there are deaths. The ratio between nonfatal injuries and deaths does vary for different types of injuries. But it may be more important to recognize that as big a problem as injury deaths represent, the complete injury problem is much, much bigger.Another way to measure the size of the injury problem is to assess the costs of injury. The financial costs of injuries are staggering. Our best estimates suggest that injuries cost the nation about $200 billion a year. At least one large company has estimated that injuries cost it $250,000 a day. Nevertheless, not all costs can be measured in dollars. Perhaps the greatest cost of injuries in this country must be measured in terms of the human pain and suffering that is often not accounted for in figures. Who is affected? We can also look at demographic and geographic characteristics to get a clearer idea of exactly who is affected by the injury problem. We use age, gender and race to look more closely at particular injury problems. Let's look first at age; take the example of suicide. In the early 1980's, when people first started looking at the problem of suicide, they looked at the overall death rate for suicide and they said, "oh, this line is just flat, it's not going anywhere, nothing significant is happening." But upon further inspection, they saw that the suicide rate for older people was coming way, way down, and the suicide rate for younger people was going way, way up. Stratifying by age helped people to recognize that what drove younger people to commit suicide was very different from what was causing the older people to commit suicide, and therefore that strategies designed to save the lives of these younger people needed to be very different from those designed to save the lives of the older people. Age can also be a surrogate for other risk factors for injuries. For example, if you look closely at car crashes or other motor vehicle injury deaths to young people, it often turns out that they are not due to intoxication as often as you might think. Instead, many are caused by inexperience. On a wet or dark road, young people who had been driving for less than a year were not as good at controlling their car, and were much more susceptible to crashes. So this turned out to be a risk factor for younger drivers. Would it apply to older drivers if they had just started driving at a later age? Of course. But again, age held an initial clue to figuring out the role of inexperience. Next, let's look at gender. Considering again suicide as an example, males seem to commit suicide at a much higher rate than females. But suicide attempts are much higher among females than among males. Recognizing these differences can help us to start exploring the underlying reasons for the differences, and ultimately can help us to devise more effective strategies to prevent suicide. So gender is very important in helping us to understand the problem of injury. |
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Race is also an important factor in understanding the nature of the injury problem. Let's consider the homicide rates of young men in this country. |
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Next: Chapter 4. A Systematic Approach to Injury Control and Violence Prevention |
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