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
