Burden of injury along the development spectrum: associations between the Socio-demographic Index and disability-adjusted life year estimates from the Global Burden of Disease Study 2017

Abstract

BackgroundThe epidemiological transition of non-communicable diseases replacing infectious diseases as the main contributors to disease burden has been well documented in global health literature. Less focus, however, has been given to the relationship between sociodemographic changes and injury. The aim of this study was to examine the association between disability-adjusted life years (DALYs) from injury for 195 countries and territories at different levels along the development spectrum between 1990 and 2017 based on the Global Burden of Disease (GBD) 2017 estimates.MethodsInjury mortality was estimated using the GBD mortality database, corrections for garbage coding and CODEm—the cause of death ensemble modelling tool. Morbidity estimation was based on surveys and inpatient and outpatient data sets for 30 cause-of-injury with 47 nature-of-injury categories each. The Socio-demographic Index (SDI) is a composite indicator that includes lagged income per capita, average educational attainment over age 15 years and total fertility rate.ResultsFor many causes of injury, age-standardised DALY rates declined with increasing SDI, although road injury, interpersonal violence and self-harm did not follow this pattern. Particularly for self-harm opposing patterns were observed in regions with similar SDI levels. For road injuries, this effect was less pronounced.ConclusionsThe overall global pattern is that of declining injury burden with increasing SDI. However, not all injuries follow this pattern, which suggests multiple underlying mechanisms influencing injury DALYs. There is a need for a detailed understanding of these patterns to help to inform national and global efforts to address injury-related health outcomes across the development spectrum.

A profile of a major trauma centre of North West England between 2011 and 2018

“…Third, 95% of patients were admitted with injuries caused by falls and road traffic accidents. This is not a surprising finding, as similar patterns have been found in other trauma centres globally 20 . However, the large proportion of patients (83%) admitted with significant injuries following a fall or road traffic accident and high cause-specific case-fatality rates (up to 10-12.5% in 2012 and 2013) are alarming findings that underline the importance of preventative measures and programmes on road safety and falls; known as a systematic work for trauma pre-event phase 5,21 .…”

Predictive value of a false-negative focused abdominal sonography for trauma (FAST) result in patients with confirmed traumatic abdominal injury

“…Injury is an important cause of morbidity and mortality in the developed and developing world [1]. Up to 20% of severe trauma patients are diagnosed with severe abdominal injury, and this is associated with a mortality rate of around 20% [2].…”

“…Ultrasonography is a non-invasive imaging modality that does not use any ionizing radiation, and can be performed in the emergency department simultaneously with other aspects of resuscitation [1]. Focused abdominal sonography for trauma (FAST) is an abbreviated, protocolized form of ultrasonography to rapidly screen for the presence of free intra-abdominal fluid as an indirect sign of abdominal injury [1]. However, a normal FAST does not exclude injury [3].…”

“…Meanwhile, computed tomography (CT) is considered the imaging modality of choice for the evaluation of hemodynamically stable patients [1]. Early repeated CT in initially non-operated patients with blunt bowel and mesenteric injuries has also been reported to improve the sensitivity of lesion detection requiring surgical repair and the security of patient selection for nonoperative treatment [5].…”

“…Early repeated CT in initially non-operated patients with blunt bowel and mesenteric injuries has also been reported to improve the sensitivity of lesion detection requiring surgical repair and the security of patient selection for nonoperative treatment [5]. However, a disadvantage of CT is the use of potentially harmful ionizing radiation and intravenous contrast agents [1]. Nevertheless, with the use of optimized protocols (such as biphasic CT with iterative reconstruction techniques [6]) and appropriate selection criteria for CT scanning [7], these issues can be somewhat mitigated.…”