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=
Module Three =
3;
This module addre=
sses
the magnitude of the
problem related t=
o the
morbidity and mortality
of injuries.
=
By the end of this module, you wil=
l be
able to:
1. Describe the
magnitude of the problem
2. Identify popul=
ation
cohorts and their
related risks of
injuries.
CLINICAL PREVENTION
AND POPUL=
ATION
HEALTH
MAGNITUDE OF THE PROBLEM
![3D"Autopsy](3D"slide0015_image005.jpg")
Injury Pyramid
1 out of 5 US Residents seek medical treatment for injuries each year
![](3D"slide0015_image007.gif")
![](3D"slide0015_image009.jpg")
![](3D"slide0015_image011.jpg")
![](3D"slide0015_image013.jpg")
29.500,000
=
ED Visits
148,209
Deaths
1,476,719
<=
/div>
Hospitalizations=
Injury
In the United States
Unintentional and intentional injuries combine to be th=
e leading cause of de=
ath
for Americans aged 1 to 44 years.
In the United States, more than 400
people die of injuries every day; at least 58 of the daily death t=
oll
are children.
In addition to these deaths, thousands more are non-fat=
ally
=
injured,
many of whom suffer permanent disabilities.
Injuries also claim=
more
years of potential life lost before age 65 (YPLL-65) than a=
ny
other cause of death.
YPLL-65, which is a=
way
of calculating the magnitude of the loss from injury and disease, measures the
difference between a person's age at death and age 65. By calculating loss of life this w=
ay,
the measurement weighs more heavily those conditions that kill children, teenag=
ers,
and young adults.
Children
–Die or Serious Injuries
•More children die or become seriously h=
urt from injuries than from all childhood diseases combined.&#=
13;
•
• Each year, more than 21,000 childr=
en aged 1 to 19 are kil=
led;
an estimated 600,000 are hospitalized;
•
•12 million are seen in emergency departments because =
of
injuries; and more than 50,000 are permanently disabled. The number of childr=
en who
have serious lasting impairments as a result of brain =
injury is estimated =
to be
even greater than the number who die from this cause.
=
•
•CDC estimates that, each year, there ar=
e more than 10,000 chi=
ldren
who become disabled from brain injury. The lifetime cost of injury for 0=
-14
year olds is estimated to be well over $13.8 billion <=
span
style=3D'position:absolute;top:79.5%;left:9.73%;width:36.89%;height:3.25%'=
>annually
![](3D"slide0003_image015.jpg")
•=
Injury
Maps
M=
aps
the geographic distribution of U.S. injury mortality rates.
•=
Download
Charts
Ten leading ca= uses of death and injury. •
Information and tools to aid preparation for and response to mass casualties events. <= /div>
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Ten leading ca= uses of death and injury. •
Information and tools to aid preparation for and response to mass casualties events. <= /div>
=
National
Center for Injury Prevention
=
and Control (NCIPC)
•<=
/span>Average Economic Cost per Death, Inj=
ury,
or Crash, 2004
–Dea=
th $1,130,000
–Non=
fatal
Disabling Injury $49,700
<=
/span>
–Pro=
perty
Damage Crash (including non-disabling injuries) $7,400
–
•Expressed on a per death basis, the cos=
t of
all motor vehicle crashes—i.e. fatal, nonfatal injury, and
property damage—was $5,200,000.
– This includes the cost of one
death,
• 52 nonfatal disabling injuries, an=
d
• 201 property damage crashes (inclu=
ding
minor injuries).
•This
average may be used to estimate the motor vehicle crash costs for a state provided that there are at leas=
t 10
deaths and only one or two occurred in each fatal crash.
• If fewer than 10 deaths, estimate =
the
costs of deaths, nonfatal disabling injuries, and property damage crashes separately.
![](3D"slide0005_image017.jpg")
Definitions
•Wage
and productivity losses include the total of wages and fringe benefits =
together with an est=
imate
of the replacement-cost value of household services. Also includes travel dela=
y for
motor-vehicle crashes.
•Medical
expenses include doctor fees, hospital charges, the cost of medicines, <=
/span>future medical costs=
, and
ambulance, helicopter, and other emergency medical services
•Administrative
expenses include the administrative cost of public and private insurance, and polic=
e and
legal costs. Private insurance administrative costs are the =
difference between
premiums paid to insurance companies and claims paid out by =
them. It is their co=
st of
doing business and is part of the cost total. Claims paid out by insurance companies =
are
not identified separately, as every claim is compensation for losses such as wages,
medical expenses, property damage, etc.
•Motor-vehicle
damage
includes the value of property damage to vehicles from motor-vehicle crashe=
s. The
cost of normal wear and tear to vehicles is not included.
•Employers’
uninsured costs are an estimate of the uninsured costs incurred by employers and repres=
ents
the money value of time lost by uninjured workers. It includes time spent
investigating and reporting injuries, giving first aid, production =
slowdowns, training =
of
replacement workers, and extra cost of overtime for uninjured workers.
=
•Disabling
injury is
one which results in death, some degree of permanent impairment, or rende=
rs the
injured person unable to effectively perform his or her regular duties for a=
full
day beyond the day of injury.
•=
•<=
/span>Motor vehicle injuries by severity=
.
•
Estimates are given here of the costs by severity of injuries, as
defined in sections 2.3.4 through 2.3.6 of the =
Manual
on Classification of Motor Vehicle Traffic Accidents (S=
ixth =
Edi=
tion)
ANSI Standard D16.1-1996.
•
•
• These
injury severity designations are sometimes referred to as class "A,&q=
uot;
"B," and "C.“
•
•<=
/span>Average Economic Cost by Injury
Severity, 2004
•
–Incapacitating injury
•(A) $58,500 Non-incapacitating evident injury
=
•
•(B) $18,900
Possible injury
•
•(C) $10,700
Other
•
•
•Comprehensive
costs of motor-vehicle crashes. In addition to the economic cost components listed above, the
following comprehensive costs also include a measure of the value of
lost quality of life which was obtained through empirical studies of w=
hat
people actually pay to reduce their safety and health risks. The
average comprehensive costs on a per injured person basis were:
•
•
•Average
Comprehensive Cost by Injury Severity, 2004
–Death&=
nbsp;
=
$3,760,000
–Inc=
apacitating
injury =
$188,000
–Non=
-incapacitating
evident injury =
=
$48,200
–Pos=
sible
injury =
$22,900
–No
injury =
$2,100
•<=
/span>Costs of Other Injuries
•Bec=
ause
obtaining information on the number and severity of =
non=
fatal
injuries for home, public nonmotor-vehicle, and work is dif=
ficult,
the best approach is to estimate total costs on the =
per
death basis using the following averages. Th=
ese
averages are based on their respective injury/death ratio:&#=
13;
•
•Average
Economic Cost of Fatal and Nonfatal Injuries by Class of Injury, 2004
=
•
–Home
injuries (fatal and nonfatal) per death $3,400,000
=
–Pub=
lic
nonmotor-vehicle injuries (fatal and nonfatal) per death =
$3,400,000
–Work
injuries (fatal and nonfatal) per death,
•&nb=
sp; without
employers’ uninsured costs =
$27,100,000&nb=
sp;
•&nb=
sp; with
employers’ uninsured costs $28,700,000
Source: Statistics
Department, National Safety Council, and Children's Safety Network, Econom=
ics
and Data Analysis Resource Center.
![](3D"slide0004_image018.gif")
Prevention versus Treatment
•Alt=
hough
the greatest cost of injury is in human suffering and loss, =
=
the
financial cost is staggering. Including direct medical care and reh=
abilitation
as well as lost income and productivity, injury costs are =
est=
imated
at more than $224 billion. This represents an increase of =
42%=
over
the last decade. The savings from preventing injury, as =
com=
pared
with treating it and its consequences, are dramatic.
•
• Every dollar spent on:
–bicycle
helmets saves $29
–child
safety seats saves $29
–smoke
detectors saves $65
–counseling
by pediatricians to prevent injuries saves $10
–poison
control center services saves $7 in medical costs
•
![](3D"slide0011_image019.gif")
<=
span
style=3D'color:white;mso-color-index:0'>Modeling the cost effectiveness=
of
injury interventions in lower and middle income countries:
opportunities and challenges
<=
span
style=3D'mso-special-format:bullet;position:absolute;left:-1.44%'>•<=
/span>
Back=
ground
This paper estimates the
cost-effectiveness of five interventions that could counter injuries in low=
er and
middle income countries(LMICs): better traffic enforcement, erecting speed
bumps, promoting helmets for bicycles, promoting
helmets for motorcycles, and storing kerosene in chi=
ld
proof containers.
Meth=
ods
We adopt an ingredients based approach=
to
form models of what each intervention would =
cos=
t in 6
world regions over a 10 year period discounted at both 3% and 6% from both=
the
governmental and societal perspectives. Costs are expre=
ssed
in local currency converted into US $2001. Each of these
interventions has been assessed for effectiveness in a LMIC in lim=
ited
region, these effectiveness estimates have been used to form models of
disability adjusted life years (DALYs) averted for var=
ious
regions, taking account of regional differences in =
the
baseline burden of injury.
Resu=
lts
The interventions modeled in this paper
have cost effectiveness ratios ranging from US $5 to $ 5=
56 per
DALY averted depending on region. Depending on local acceptability thresho=
lds man=
y of
them could be judged cost-effective relative to interventions that are alr=
eady
adopted. Enhanced enforcement of traffic regulations=
is
the most cost-effective interventions with an ave=
rage
cost per DALY of $64
Conc=
lusion
Injury counter measures appear to be
cost-effective based on models. More evaluations of real
interventions will help to strengthen the evidence basis.
Cost-outcome analysis in injury prevention and control: =
eighty-four recent estimates for the =
United
States.
Med Ca= re. 2000 Jun;38(6):562-82.
Med Ca= re. 2000 Jun;38(6):562-82.
•OBJECTIVES: The objectives of t=
his
study were to review cost-outcome analyses in injury prevention and contr=
ol and
estimate associated benefit-cost ratios and cost per quality-adjusted life-year.
•DATA
SOURCES:
Medline and Internet search, bibliographic review, and federal agency cont=
acts
=
identified
published and unpublished studies from 1987 to 1998 for the United States.
Studies of low quality and analyses of occupational, air, rail, and water transport
safety programs were excluded.
•MEASURES: Selected results we=
re
recomputed to increase discount rate, benefit category, and =
benefit estimate
comparability and to update injury incidence rates.
•RESULTS: More than half of t=
he 84
injury prevention measures reviewed yielded net societal cost savings. Twelve meas=
ures
had costs that exceeded benefits. Of 33 road safety measures analyzed, 19 yielded=
net
cost savings. Of 34 violence prevention approaches studied, 19 yielded net cost savings, wh=
ereas
8 had costs that exceeded benefits. Interventions with the highest =
benefit-cost ratios
included juvenile delinquent therapy programs, fire-safe cigarettes, feder=
al
road and traffic safety program funding, lane markers painted on roads,
post-mounted reflectors on hazardous curves, safety belts in front sea=
ts,
safety belt laws with primary enforcement, child safety seats, child
bicycle helmets, enforcement of laws against serving alcohol to the
intoxicated, substance abuse treatment, brief medical interventions =
with
heavy drinkers, and a comprehensive safe communities program in a low-income
neighborhood. Studies of cost-saving measures do not exist for several in=
jury
types.
•=
CONCLUSIONS: Injury prevention o=
ften
can reduce medical costs and save lives. Wider implementation of pr=
oven
measures is warranted.
Magnitude Of Alcohol-related Mortality and Morbidity Among U.S. College Students Ages
18–24
•
•=
Objective: Integrating data fr=
om the
National Highway Traffic Safety Administration, the Centers for Disease Con=
trol
and Prevention, national coroner studies, census and college enrollment data=
for
18–24-year-olds, the National Household Survey on Drug Abuse, and the Har=
vard
College Alcohol Survey, we calculated the alcohol related unintentional
injury deaths and other health problems among college studen=
ts
ages 18–24 in 1998 and 2001.
•
• Among college students ages 18R=
11;24
from 1998 to 2001, alcohol-related unintentional injury deaths increased from
nearly 1600 to more than 1700, an increase of 6% per college population.
=
;
•The proportion of 18–24-year-old
college students who reported driving under the influence of alcohol
increased from 26.5% to 31.4%, an increase from 2.3 million =
students to 2.8 mill=
ion.
During both years more than 500,000 students were unintentionally inju=
red
because of drinking and more than 600,000 were hit/assaulted by ano=
ther
drinking student.
• Greater enforcement of the legal
drinking age of 21 and zero tolerance laws, increases in alcohol
taxes, and wider implementation of screening and counseling =
programs and compreh=
ensive
community interventions can reduce college drinking and associated harm =
to
students and others.
![3D"Don't](3D"slide0014_image020.gif")
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