Trends in external causes of child and adolescent mortality in Poland, 1999-2012

Trends in mortality from non-natural causes in children and adolescents (0-19 years) in Europe from 2000 to 2018

BACKGROUND

Non-natural mortality in children and adolescents is a global public health problem that varies widely from country to country. Data on child and adolescent maltreatment are not readily available, and mortality due to violent causes is also underestimated.

METHODS

Injury-related mortality rates (overall and by specific causes) from 2000 to 2018 in selected European countries were analysed to observe mortality patterns in children and adolescents using data from the Eurostat database. Age-standardized mortality rates per 100,000 person-years were calculated for each country. Joinpoint regression analysis with a significance level of 0.05 and 95% confidence intervals was performed for mortality trends.

RESULTS

Children and adolescent mortality from non-natural causes decreased significantly in Europe from 10.48 around 2005 to 5.91 around 2015. The Eastern countries (Romania, Bulgaria, Poland, Slovakia, Czech Republic) had higher rates; while Spain, Denmark, Italy, and the United Kingdom had the lowest. Rates for European Country declined by 5.10% per year over the entire period. Larger downward trends were observed in Ireland, Spain and Portugal; smaller downward trends were observed for Eastern countries (Bulgaria, Czech Republic, Poland, Slovakia) and Finland. Among specific causes of death, the largest decreases were observed for accidental causes (-5.9%) and traffic accidents (-6.8%).

CONCLUSIONS

Mortality among children and adolescents due to non-natural causes has decreased significantly over the past two decades. Accidental events and transport accidents recorded the greatest decline in mortality rates, although there are still some European countries where the number of deaths among children and adolescents from non-natural causes is high. Social, cultural, and health-related reasons may explain the observed differences between countries.

Analysis of the patients hospitalised in paediatric trauma centers in Poland in 2019

BACKGROUND

Paediatric trauma centers (PTCs) are facilities that were established to provide traumatised patients with fast, accurate diagnoses and optimal treatments. In Poland, they have been functioning since 2017. Our research aimed to assess the overall activity of the PTCs and cross-sectional data of their patients in Poland in 2019.

MATERIAL AND METHODS

We have analysed data provided by the National Health Fund (NHF) about the activity of seven trauma centers for children. For the PTC in the Paediatric Teaching Clinical Hospital University Clinical Center of the Medical University of Warsaw, we have gathered the data from the internal documentation system.

RESULTS

In Poland, in 2019, there were seven operating PTCs. During that year, they hospitalised 195 severely traumatised patients. The available data have shown that no specialised tracking system of children admitted to PTCs was used; we have obtained data reporting final diagnoses, not the preliminary ones. Summarising the data from the PTC in Warsaw, in the first year of its operation there were 32 patients admitted, of which only 8 have met the criteria of admission.

CONCLUSIONS

Due to the small number of patients reported, it is difficult to draw specific conclusions about the efficacy of PTCs in Poland. Obtaining reliable data is difficult, as there is no paediatric trauma patients database. To assess and improve the quality of PTCs, it would be profitable to create a national system monitoring the events and collecting data on the treatment results.

Early changes in white blood cell, C-reactive protein and procalcitonin levels in children with severe multiple trauma

BACKGROUND

To analyze early changes in white blood cells (WBCs), C-reactive protein (CRP) and procalcitonin (PCT) in children with multiple trauma, before secondary inflammation develops.

METHODS

This single-center retrospective study collected data from patients with blunt traumatic injury admitted to the pediatric intensive care unit (PICU). According to the prognostic outcome of 28 d after admission to the PICU, patients were divided into survival group (n=141) and non-survival group (n=36). Characteristics between the two groups were compared. Receiver operation characteristic (ROC) curve analysis was conducted to evaluate the capacity of different biomarkers as predictors of mortality.

RESULTS

The percentages of children with elevated WBC, CRP, and PCT levels were 81.36%, 31.07%, and 95.48%, respectively. Patients in the non-survival group presented a statistically significantly higher injury severity score (ISS) than those in the survival group: 37.17±16.11 vs. 22.23±11.24 (t=6.47, P<0.01). WBCs were also higher in non-survival group than in the survival group ([18.70±8.42]×10⁹/L vs. [15.89±6.98] ×10⁹/L, t=2.065, P=0.040). There was no significant difference between the survival and non-survival groups in PCT or CRP. The areas under the ROC curves of PCT, WBC and ISS for predicting 28-day mortality were 0.548 (P=0.376), 0.607 (P=0.047) and 0.799 (P<0.01), respectively.

CONCLUSIONS

Secondary to multiple trauma, PCT levels increased in more patients, even if their WBC and CRP levels remained unchanged. However, early rising WBC and ISS were superior to PCT at predicting the mortality of multiple trauma patients in the PICU.

Health Care Resources and 24,910 Deaths Due to Traffic Accidents: An Ecological Mortality Study in Poland

Background: Deaths due to traffic accidents are preventable and the access to health care is an important determinant of traffic accident case fatality. This study aimed to assess the relation between mortality due to traffic accidents and health care resources (HCR), at the population level, in 66 sub-regions of Poland. Methods: An area-based HCR index was delivered from the rates of physicians, nurses, and hospital beds. Associations between mortality from traffic accidents and the HCR index were tested using multivariate Poisson regression models. Results: In the sub-regions studied, the average mortality from traffic accidents was 11.7 in 2010 and 9.3/100.000 in 2015. After adjusting for sex, age and over time trends in mortality, out-of-hospital deaths were more frequently compared to hospitalized fatal cases (incidence rate ratio (IRR) = 1.68, 95% CI 1.45–1.93). Compared to sub-regions with high HCR, mortality from traffic accidents was higher in sub-regions with low and moderate HCR (IRR = 1.25, 95% CI 1.11–1.42 and IRR = 1.19, 95% CI 1.02–1.38, respectively), which reflected the differences in out-of-hospital mortality most pronounced in car accidents. Conclusions: Poor HCR is an important factor that explains the territorial differentiation of mortality due to traffic accidents in Poland. The high percentage of out-of-hospital deaths indicates the importance of preventive measures and the need for improvement in access to health care to reduce mortality due to traffic accidents.

Suicide among Polish Adolescents-A 20 Year Analysis

Background: The study aimed to analyze the burden and territorial diversification of adolescent suicide and the link between suicide attempts and selected socioeconomic variables in Poland. Methods: Rates of suicide by voivodeships for years 1999–2019 were obtained from the General Police Headquarters of Poland database. The burden of premature death was expressed in years of life lost (YLL) and costs of lost productivity, which were estimated using the human capital approach. The link between suicide rates and socioeconomic determinants has been analyzed with Pearson’s correlation coefficient. Results: Over the analyzed period, an increase in suicide attempt rates and a decrease in suicide death rates have been observed. Mean YLL and costs of lost productivity per year amounted to 11,982 and 153,172,415 PLN, respectively. Territorial diversification in suicide attempt rates corresponds to the living condition, poverty, association-based capital, and satisfaction with family situation in individual voivodeships. The number of deaths due to suicide is negatively correlated with an indicator of good living conditions. Conclusions: Our findings provide quantitative evidence of the national impact of suicide and suggest that addressing social capital and poverty may have a role in preventing adolescent mortality due to suicide.

Pattern of intentional drowning mortality: a total population retrospective cohort study in Australia, 2006-2014

BACKGROUND

While a downward trend in unintentional drowning deaths in Australia has been observed, little is known about intentional drowning mortality. Limited information on intentional drowning death impedes the planning, implementation, and evaluation of prevention strategies. This study aims to describe rates of intentional fatal drowning in Australia and compare these to other categories of drowning.

METHODS

Data were sourced from the Australian Bureau of Statistics (ABS) over a 9-year period (2006-2014). Rates and trends of intentional drowning were compared with unintentional, water-transport related and undetermined intent drowning. Rates of intentional drowning deaths across gender, age groups, states/territories, remoteness of residence and First Peoples of Australia were calculated. Relative risk (RR) (95% confidence interval [CI]) was calculated, and chi-square tests of independence were performed (p < 0.05).

RESULTS

The crude mortality rate for intentional drowning deaths in Australia over the study period was 0.23/100000, lower than unintentional drowning (0.89/100000). Males were 1.6 (CI: 1.4-2.0) times more likely than females to intentionally drown, however females made up a significantly larger proportion of intentional drowning deaths (38.2%) compared to unintentional deaths (22.4%) (χ2 = 47.3; df = 1; p < 0.05). A significant linear association between age group and intentional drowning was observed (χ2 = 131.3; p < 0.05), with individuals aged 75 years and over 32.6 times more likely to intentionally drown. Non-Indigenous peoples were 4.1 times more likely to intentionally drown in comparison to First Peoples of Australia. Residents of Inner Regional, Outer Regional, and Major Cities were 4.2 times (CI: 0.6-30.0), 4.1 times (CI: 0.6-29.9), and 4.0 times (CI: 0.6-28.6) more likely to intentionally drown, respectively, compared with residents of Very Remote areas.

CONCLUSIONS

This study adds to the limited evidence currently available about intentional drowning rates and trends in Australia. Being male, of older age groups, non-Indigenous, residing in Inner and Outer Regional areas, and Major Cities were risk factors for intentional drowning deaths. Improving data collection systems and furthering understanding of the risk factors of intentional drowning, as well as the development, implementation, and evaluation of prevention programmes, are required to reduce the risk of intentional drowning death in Australia.

Global and regional child deaths due to injuries: an assessment of the evidence

Background

Injuries result in substantial number of deaths among children globally. The burden across many settings is largely unknown. We estimated global and regional child deaths due to injuries from publicly available evidence.

Methods

We searched for community-based studies and nationally representative data reporting on child injury deaths published after year 1990 from CINAHL, EMBASE, IndMed, LILACS, Global Health, MEDLINE, SCOPUS, and Web of Science. Specific and all-cause mortality due to injuries were extracted for three age groups (0-11 months, 1-4 years, and 0-4 years). We conducted random-effects meta-analysis on extracted crude estimates, and developed a meta-regression model to determine the number of deaths due to injuries among children aged 0-4 years globally and across the World Health Organization (WHO) regions.

Results

Twenty-nine studies from 16 countries met the selection criteria. A total of 230 data-points on 15 causes of injury deaths were retrieved from all studies. Eighteen studies were rated as high quality, although heterogeneity was high (I² = 99.7%, P < 0.001) reflecting variable data sources and study designs. For children aged 0-11 months, the pooled crude injury mortality rate was 29.6 (95% confidence interval (CI) = 21.1-38.1) per 100 000 child population, with asphyxiation being the leading cause of death (neonatal) at 189.1 (95% CI = 142.7-235.4) per 100 000 followed by suffocation (post-neonatal) at 18.7 (95% CI = 11.8-25.7) per 100 000. Among children aged 1-4 years, the pooled crude injury mortality rate was 32.7 (95% CI = 27.3-38.1) per 100 000, with traffic injuries and drowning the leading causes of deaths at 10.8 (95% CI = 8.9-12.8) and 8.8 (95% CI = 7.5-10.2) per 100 000, respectively. Among children under five years, the pooled injury mortality rate was 37.7 (95% CI = 32.7-42.7) per 100 000, with traffic injuries and drowning also the leading causes of deaths at 10.3 (95% CI = 8.8-11.8) and 8.9 (95% CI = 7.8-9.9) per 100 000 respectively. When crude mortality changes over age, WHO regions, and study period were accounted for in our model, we estimated that in 2015 there were 522 167 (95% CI = 395 823-648 630) deaths among children aged 0-4 years, with South East Asia (SEARO) recording the highest number of deaths at 195 084 (95% CI = 159476-230502), closely followed by the Africa region (AFRO) with 176523 (95% CI = 115 040-237 831) deaths. Globally, traffic injuries and drowning were the leading causes of under-five injury fatalities in 2015 with 142 661 (22.0/100 000) and 123 270 (19.0/100 000) child deaths, respectively. The exception being burns in AFRO with 57 784 deaths (38.6/100 000).

Conclusions

Varying study designs, case definitions, and particularly limited country representation from Africa and South-East Asia (where we reported higher estimates), imply a need for more studies for better population representative estimates. This study may have however provided improved understanding on child injury death profiles needed to guide further research, policy reforms and relevant strategies globally.

Childhood death rates declined in Sweden from 2000 to 2014 but deaths from external causes were not always investigated

AIM

Countries that conduct systematic child death reviews report a high proportion of modifiable characteristics among deaths from external causes, and this study examined the trends in Sweden.

METHODS

We analysed individual-level data on external, ill-defined and unknown causes from the Swedish cause of death register from 2000 to 2014, and mortality rates were estimated for children under the age of one and for those aged 1-14 and 15-17 years.

RESULTS

Child deaths from all causes were 7914, and 2006 (25%) were from external, ill-defined and unknown causes: 610 (30%) were infants, 692 (34%) were 1-14 and 704 (35%) were 15-17. The annual average was 134 cases (range 99-156) during the study period. Mortality rates from external, ill-defined and unknown causes in children under 18 fell 19%, from 7.4 to 6.0 per 100 000 population. A sizeable number of infant deaths (8.0%) were registered without a death certificate during the study period, but these counts were lower in children aged 1-14 (1.3%) and 15-17 (0.9%).

CONCLUSION

Childhood deaths showed a sustained decline from 2000 to 2014 in Sweden and a quarter were from external, ill-defined or unknown causes. Systematic, interagency death reviews could yield information that could prevent future deaths.

The impact of neighborhood socioeconomic disparities on injury

OBJECTIVES

To examine the relationship between neighborhood socioeconomic level (NSEL) and injury-related hospitalization.

METHODS

The National Trauma Registry (INTR) and the National Population Census (NPC), including NSEL, were linked by individual identity number. Age-adjusted logistic regression predicted injury hospitalization. Mantel-Haenszel  X² was used for linear trends. NSEL was divided into 20 clusters.

RESULTS

The population comprised 7,412,592 residents, of which 125,829 (1.7%) were hospitalized due to injury. The injury hospitalization rate was at least 42 per 10,000 per year. Except for the very low SEL, an inverse relationship between NSEL and all-cause injury was found: 46.1/10,000 in cluster 3 compared to 22.9/10,000 in cluster 20. Hip fracture-related hospitalizations among ages 65 + decreased as SEL increased (2.19% o in cluster 2 compared to 0.95% in cluster 19). In comparison with Jews, non-Jews were 1.5 times more likely to have an injury-related hospitalization [OR 1.5 (95% CI 1.50-1.55)].

CONCLUSIONS

The INTR and the NPC were successfully linked providing individual and injury hospitalization data. The outcomes confirm the strong relationship between injury mechanism and NSEL.

Unintentional Child and Adolescent Drowning Mortality from 2000 to 2013 in 21 Countries: Analysis of the WHO Mortality Database

Limited research considers change over time for drowning mortality among individuals under 20 years of age, or the sub-cause (method) of those drownings. We assessed changes in under-20 drowning mortality from 2000 to 2013 among 21 countries. Age-standardized drowning mortality data were obtained through the World Health Organization (WHO) Mortality Database. Twenty of the 21 included countries experienced a reduction in under-20 drowning mortality rate between 2000 and 2013, with decreases ranging from −80 to −13%. Detailed analysis by drowning method presented large variations in the cause of drowning across countries. Data were missing due to unspecified methods in some countries but, when known, drowning in natural bodies of water was the primary cause of child and adolescent drowning in Poland (56–92%), Cuba (53–81%), Venezuela (43–56%), and Japan (39–60%), while drowning in swimming pools and bathtubs was common in the United States (26–37%) and Japan (28–39%), respectively. We recommend efforts to raise the quality of drowning death reporting systems and discuss prevention strategies that may reduce child and adolescent drowning risk, both in individual countries and globally.