Estimating the distribution of external causes in hospital data from injury diagnosis

Assessing discrepancies in estimates of road traffic deaths in Brazil

INTRODUCTION

The First UN Decade of Action for Road Safety (2011-2020) ended with most low/middle-income countries (LMICs) failing to reduce road traffic deaths. In contrast, Brazil reported a strong decline starting in 2012. However, comparisons with global health statistical estimates suggest that official statistics from Brazil under-report traffic deaths and overestimate declines. Therefore, we sought to assess the quality of official reporting in Brazil and explain discrepancies.

METHODS

We obtained national death registration data and classified deaths to road traffic deaths and partially specified causes that could include traffic deaths. We adjusted data for completeness and reattributed partially specified causes proportionately over specified causes. We compared our estimates with reported statistics and estimates from the Global Burden of Disease (GBD)-2019 study and other sources.

RESULTS

We estimate that road traffic deaths in 2019 exceeded the official figure by 31%, similar to traffic insurance claims (27.5%) but less than GBD-2019 estimates (46%). We estimate that traffic deaths have declined by 25% since 2012, close to the decline estimated by official statistics (27%) but much more than estimated by GBD-2019 (10%). We show that GBD-2019 underestimates the extent of recent improvements because GBD models do not track the trends evident in the underlying data.

CONCLUSION

Brazil has made remarkable progress in reducing road traffic deaths in the last decade. A high-level evaluation of what has worked in Brazil could provide important guidance to other LMICs.

Record linkage for road traffic injuries in Ireland using police hospital and injury claims data

INTRODUCTION

The study of non-fatal road traffic injuries is growing in importance. Since there are rarely comprehensive injury datasets, it is necessary to combine different sources to obtain better estimates on the extent and nature of the problem. Record linkage is one such technique.

METHOD

In this study, anonymized datasets from three separate sources of injury data in Ireland: hospitals, police, and injury claims are linked using probabilistic and deterministic linkage techniques. A method is proposed that creates a 'best' set of linked records for analysis, useful when clerical review of undecided cases is not feasible.

RESULTS

The linkage of police and hospital datasets shows results that are similar to those found in other countries, with significant police understatement especially of cyclist and motorcyclist injuries. The addition of the third dataset identifies a large number of additional injuries and demonstrates the error of using only the two main sources for injury data.

PRACTICAL APPLICATION

The study also underlines the risk in relying on the Lincoln-Petersen capture-recapture estimator to provide an estimate of the total population concerned.

CONCLUSION

The data show that road traffic injuries are significantly more numerous than either police or hospital sources indicate. It is also argued that no single measure can fully capture the range of impacts that a serious injury entails.

The effect of the transition from the ninth to the tenth revision of the International Classification of Diseases on external cause registration of injury morbidity in Sweden

BACKGROUND

Revisions of the International Classification of Diseases (ICD) have previously been shown to cause dramatic effects with regard to injury mortality data when implemented. However, limited knowledge exists on the effects on the coding of external causes of injury morbidity, despite this being an important aspect with regard to injury prevention.

METHOD

Hospitalised injuries in Sweden were studied using time series intervention analysis to observe the effect of the ICD change from ICD-9 to ICD-10 in 1997 on external cause coding.

RESULTS

The results would suggest considerable coding issues with a large spike in the proportion of injury admissions registered without an external cause code in 1997, with continuing, although gradually diminishing, problems up to 2002. The coding change seems to have had an immediate effect on all external cause of injury categories, although the categories that were not directly convertible from ICD-9 to ICD-10 were seemingly more greatly affected.

DISCUSSION

The study illustrates the potential issues associated with changes between ICD revisions and the importance of data quality control both during surveillance and collection of data, but also when presenting injury trends across ICD versions.

El estado de las lesiones causadas por el tránsito en México: evidencias para fortalecer la estrategia mexicana de seguridad vial

Mediante la revisión de información secundaria oficial, publicaciones científicas y el análisis de la ENSANut-2012, este trabajo busca proveer una visión integral de la magnitud actual de las lesiones causadas por el tránsito (LCT) en México y analizar críticamente la respuesta social organizada. Las altas tasas de choques, lesiones, muertes y discapacidad atribuidas a este problema de salud pública, representan un elevado costo para la sociedad mexicana, en especial para los hogares. Se discute cómo la respuesta mexicana se ha enfocado a los automovilistas, dejando fuera a usuarios vulnerables de la vía pública y se ha privilegiado la implementación de estrategias poco efectivas. A pesar de que se dispone de legislación para los principales factores de riesgo, se ha descuidado su correcta aplicación. La estrategia mexicana podría fortalecerse implementando estrategias de movilidad seguras, equitativas, saludables y sostenibles para los diferentes actores de la vía pública. A pesar de los avances que se han dado en términos de prevención de LCT, existen aún retos y oportunidades para el país.

Perfil de vítimas e tratamento de lesões por causas externas segundo atendimento pelo Centro de Reabilitação Municipal de Uberlândia, MG – Causas externas e fisioterapia

No Brasil, as causas externas são responsáveis por grande número de incapacidades. A maioria das pesquisas tem dado ênfase à mortalidade e à demanda de atendimentos hospitalares, pouco se sabendo sobre a evolução das vítimas não fatais. O objetivo do presente estudo foi conhecer o perfil das vítimas e as características das lesões por causas externas, o tratamento fisioterapêutico e a evolução funcional de pacientes atendidos em um centro público de reabilitação. Os dados foram colhidos, prospectivamente, por entrevistas com os pacientes que ingressaram no Centro de Reabilitação Municipal (CEREM) de Uberlândia, de janeiro a julho de 2005. A maioria dos pacientes era do sexo masculino e predominaram aqueles de 20 a 59 anos, com baixas renda e escolaridade; as principais causas das lesões foram as quedas e os acidentes de trânsito; quase a metade dos eventos ocorreram em vias públicas e as fraturas foram comuns, principalmente em membros superiores. Os recursos fisioterapêuticos mais utilizados foram a cinesioterapia, a eletroterapia e a termoterapia por adição, e a maioria dos tratamentos iniciados foi concluída. O perfil dos pacientes que procuram o CEREM devido a lesões por causas externas parece refletir, sobretudo, aquele das pessoas que sofrem tais lesões. Recursos fisioterapêuticos relativamente simples mostraram-se suficientes para uma boa evolução dos pacientes.

Classifying external causes of injury: history, current approaches, and future directions

The International Classification of Diseases (ICD) is used to categorize diseases, injuries, and external causes of injury, and it is a key epidemiologic tool enabling storage and retrieval of data from health and vital records to produce core international mortality and morbidity statistics. The ICD is updated periodically to ensure the classification system remains current, and work is now under way to develop the next revision, ICD-11. It has been almost 20 years since the last ICD edition was published and over 60 years since the last substantial structural revision of the external causes chapter. Revision of such a critical tool requires transparency and documentation to ensure that changes made to the classification system are recorded comprehensively for future reference. In this paper, the authors provide a history of the development of external causes classification and outline the external cause structure. They discuss approaches to manage ICD-10 deficiencies and outline the ICD-11 revision approach regarding the development of, rationale for, and implications of proposed changes to the chapter. Through improved capture of external cause concepts in ICD-11, a stronger evidence base will be available to inform injury prevention, treatment, rehabilitation, and policy initiatives to ultimately contribute to a reduction in injury morbidity and mortality.

Availability and quality of cause-of-death data for estimating the global burden of injuries

OBJECTIVE

To assess the availability and quality of global death registration data used for estimating injury mortality.

METHODS

The completeness and coverage of recent national death registration data from the World Health Organization mortality database were assessed. The quality of data on a specific cause of injury death was judged high if fewer than 20% of deaths were attributed to any of several partially specified causes of injury, such as "unspecified unintentional injury".

FINDINGS

Recent death registration data were available for 83 countries, comprising 28% of the global population. They included most high-income countries, most countries in Latin America and several in central Asia and the Caribbean. Categories commonly used for partially specified external causes of injury resulting in death included "undetermined intent," "unspecified mechanism of unintentional injury," "unspecified road injury" and "unspecified mechanism of homicide". Only 20 countries had high-quality data. Nevertheless, because the partially specified categories do contain some information about injury mechanisms, reliable estimates of deaths due to specific external causes of injury, such as road injury, suicide and homicide, could be derived for many more countries.

CONCLUSION

Only 20 countries had high-quality death registration data that could be used for estimating injury mortality because injury deaths were frequently classified using imprecise partially specified categories. Analytical methods that can derive national estimates of injury mortality from alternative data sources are needed for countries without reliable death registration systems.