Population-based incidence and cost of non-fatal injuries in Iran: a consistent under-recognized public health concern

Direct and indirect costs of nonfatal road traffic injuries in Iran: A population-based study

OBJECTIVES

The objective of this study was to assess the incidence rate as well as direct and indirect costs of nonfatal road traffic injuries (RTIs) in Iran in 2011.

METHODS

Data from the 2011 national household survey were used. In this survey, data on demographics, history, and costs of injury were obtained in 2 steps: first, direct face-to-face interview and second, telephone calls. We estimated the incidence rate of nonfatal RTIs in this year. The direct costs included medical care as well as nonmedical costs paid by the patient or insurance services. The indirect costs were estimated by considering the cost of absence from work or education. We also used logistic regression analyses to investigate risk factors of nonfatal RTIs.

RESULTS

We found 76 nonfatal RTI cases (0.96%) out of 7,886 whole reference study cases. These 76 injured patients had a history of RTI in the preceding 3 months. The annual incidence of RTIs was estimated at 3.84%. The mean age of RTI cases was 28.5 ± 10.6 and 88.16% of them were male. Male gender was a major risk factor (odds ratio [OR] = 9.64, 95% confidence interval [CI], 4.79-19.41) and marriage was a protective factor (OR = 0.44, 95% CI, 0.28-0.70) for RTI. The medians of direct, indirect, and total costs were US$214, US$163, and US$387, respectively. The total cost of nonfatal RTIs in Iran was estimated at 1.29% of the gross domestic product (GDP) in 2011.

CONCLUSIONS

In Iran, nonfatal RTIs imposed a total cost of almost US$7 billion to the country for one year. Extension and more serious implementation of preventive measurements seem necessary to decrease this notable burden of RTIs.

Incidence and cost of non-fatal burns in Iran: a nationwide population-based study

To determine the incidence and cost of non-fatal burns in Iran; this cross-sectional household survey of a nationally representative sample of 15-64 years old was conducted. Through face-to-face interviews and telephone calls, the data on the demographics, history and cost of burns were collected. The annual incidence rate of burns was estimated 129.85 per 1000 population. Burns occurred higher in younger age, female gender and urban residency. The most common burn description was as follows: unpaid work (activity during burn), home (place of burn), heat and hot substances (mechanism of burn) and upper limb (site of burn). The average total cost of burn includes victims seeking medical care was US$124 per case. The main findings of this study suggest that burns are a major public health concern in Iran. To stop this important health issue, a national program for burn prevention and education must be developed.

Assessment of mechanism, type and severity of injury in multiple trauma patients: A cross sectional study of a trauma center in Iran

PURPOSE

To accurately assess the mechanism, type and severity of injury in Iranian multiple trauma patients of a trauma center.

METHODS

Patients with multiple traumas referring to the emergency department of Hasheminejad University Hospital in Mashhad, Iran, entered this cross sectional study from March 2013 to December 2013. All the patients with injury severity score (ISS) > 9 were included in this study. Data analysis was performed by SPSS software (Version 11.5) and P values less than 0.05 were considered as significant differences.

RESULTS

Among the 6306 hospitalized trauma patients during this period, 148 had ISS>9. The male female ratio was 80%. The mean age of the patients was (33.5 ± 19.3) years. And 71% of the patients were younger than 44 years old. There were 19 (13%) deaths from which 68.5% were older than 44 years old. The mean transfer time from the injury scene to hospital was (55 ± 26) minutes. The most frequent mechanisms of injury were motorcycle crashes and falling from height, which together included 66.2% of all the injuries. A total of 84% of hospital deaths occurred after the first 24 h of hospitalization. Head and neck were the most common body injured areas with a prevalence of 111 cases (75%).

CONCLUSION

Motorcycle crashes have high frequency in Iran. Since most victims are young males, injury prevention strategies should be considered to reduce the burden of injuries.

Return to work after trauma: A survival analysis

PURPOSE

To evaluate the return to work (RTW) rate, time and predictors among trauma patients using survival analysis.

METHODS

This cohort study was conducted with a three-month follow-up on 300 trauma patients hospitalized in Shahid Beheshti Hospital, Kashan, Iran in 2014. The data were collected through conducting interviews and referring to patients' medical records during their hospital stay and follow-up information at one & three months after discharge from hospital. Final analysis was conducted on the data retrieved from 273 patients. Data were analyzed by chi-square test, Mann-Whitney U test and survival analysis method.

RESULTS

The rate of RTW at the end of the first and the third follow-up months was respectively 21.6% and 61.2%. Survival analysis showed that the RTW time (Time between admission to first return to work) was significantly longer among patients with illiteracy, drug abuse, hospitalization history in the intensive care unit, low socioeconomic status, non-insurance coverage, longer hospital stay, multiple and severe injuries as well as severe disability.

CONCLUSION

Our findings indicated that trauma has profound effects on the rate and time of RTW. Besides disability, many personal and clinical factors can affect the outcome of RTW.

Epidemiology and short-term mortality in traumatic patients admitted to Shariati Hospital in Iran between 2012 and 2013

PURPOSE

Trauma is an inevitable part of the health burden in every country. Both the preventive and rehabilitative aspects of traumatic injuries are expensive. Since most of the injuries happen in low- and middle-income developing countries, a judicious allocation of the limited resources to the most costefficient strategies is necessary. The present study was designed to report the causes of trauma, injured body regions, trauma severity scores and the one year survival rate of a randomly selected sample of trauma patients in a major referral hospital in Tehran, Iran.

METHODS

We chose and analyzed a random subgroup of traumatic patients admitted during the oneyear period of May 2012 to May 2013 to Shariati Hospital, a major University Teaching Hospital in Tehran, Iran. Patients who stayed at the hospital for less than 24 h were excluded. In total, 73 traumatic patients were registered. The mean age was (40.19 ± 20.34) years and 67.1% of them were male.

RESULTS

In general, the most common cause of injury was falls (47.9%), followed by road traffic crashes (RTCs, 40.8%). Assault and exposure to inanimate mechanical forces each were only associated with 5.6% of all injuries. The only cause of injury in ages of more than 65 years was fall. The most common cause of injury in ages between 15 and 45 years was RTCs. During the study, two deaths occurred: one was at ICU and the other was at home. The most commonly injured body region was the head (23.8%), followed by the elbow and forearm (19%), hip and thigh (15.9%), and multiple body regions (14.3%). The mean abbreviated injury score was 2.23 ± 1.02; injury severity index was 7.26 ± 7.06; and revised trauma score was 7.84, calculated for 38 patients.

CONCLUSION

Prevention strategy of traumatic injury should focus on falls and RTCs, which are respectively the most common cause of trauma in older aged people and young males.