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OCR for page 18
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Injury: Magnitude and Characteristics
of the Problem
Two types of health problems--infectious disease and
injury--have been the most important causes of lost years
of productive 1 if e for Amer icans . Improvements in sani-
tation and housing and other public health measures in
the nineteenth century made it possible to reduce the
prevalence of infectious disease. In the early twentieth
century, infectious disease ceased to be a major cause of
lost years of life before age 6S, leaving in jury alone in
that position in the United States, exceeding cancer and
heart disease combined. This report deals with injury
that is severe enough to cause one to seek medical care
or to be unable to perform usual activity for a day or
longer. Such injury ';trzkes almost one-third of Americans
in a given year.~23
Consider some of the pr imary facts concerning in jury
in the United States:
.
In jury caused 143,000 deaths in 1983. ~ 2`
· Injury is the fourth leading cause of death anteing
all Americans, accounting for 61 deaths per 100,000
population in 1983, compared with 328 for heart disease,
188 for cancer, and 67 for stroke . -I 2 ~
· Injury causes almost half the deaths of children
aged 1-4, more than half the deaths of children aged
5-14, and nearly four-fifths of the deaths of persons
aged 1S-24. Thus, in jury is the leading cause of death
among children and young adults tFigure 1-1).
Among young children, the largest numbers of in jury
deaths are caused by motor-vehicle crashes, drowning, and
fire; pedestrian deaths constitute a major problem in
urban areas. Especially high death rates among teen
18
OCR for page 19
19
14 5 14
INJU~URY
1 ~ l
it
~ 1
_
- ~4 45-64 66+
_
Congenital Pneumonia/ Heart Liver
Age Injuries Anomalies Cancer Influenza Disease Disease Stroke Other
1 4 48% t 3° ~7% 3% 4% - - 27%
5-1 4 55% 5% 14% - 3% - - 23%
1 5-24 79% - 5% - 3% - - 1 3%
25-34 62% - 1 0% - 6% 3% - 19%
35 - 31% - 21% - 20% 6% 4% 1 8%
45-64 7% - 32% - 36% 4% 5% ~ 6%
65 ~2% - 19% 3% "% - 10% 18%
FIGURE 1-1 Percentages of deaths from injury and other
causes in the United States in 1980, by age. Modified
from Baker et al.
agers and young adults are associated with motor-vehicle
crashes, firearms, and drowning.
Up to age 44, injury deaths continue to outnumber
deaths from any other cause. Only after age 4S do other
health problems--notably heart disease and cancer--cause
more deaths than injuries. Even among the elderly,
however, injury is an important cause of death; in fact,
the death rate from injury tthe number of injury deaths
per 100,000 of population) is higher among the elderly
than among younger people.
Injury is the leading cause of physician contacts--in
1980, there were 99 million such contacts, compared with
72 million for heart disease, the second leading cause of
such visits, and 64 million for respiratory disease, the
third leading cause. And more than IS percent of
hospital emergency-room visits are for the treatment of
injuries. 2S
Injury is also a leading cause of short- and long-term
disability. In 1981, people spent 144 million days in
OCR for page 20
;
:
~ :'
': ! "
/
-
All Other
Diseases
24.8% Inj ury
~ 40.8%
-
~eart / \\
_ _.
Disease
16.4%
/ Cancers \
18.0% \
FIGURE 1-2 Percentages of years of potential life lost
to in jury, cancer, heart disease, and other diseases
before age 65. Modified from Centers for Disease
Control. 3 2
bed because of injuries.~23 "I'm ~
disability, more than 7S, _ _
brain injuries that result in long-term disability,
including 2,000 who remain in persistent vegetative
states.9' ~' In addition, over 6,000 persons who were
injured are discharged from hospitals with paraplegia or
quadriplegic. ~ °° Each year, over 4 million years of
future worklife are lost to injury, compared with 2.1
million to heart disease and 1.7 million to cancer32
(Figure 1-2).
The importance of health problems to society can be
seen by measuring the dollar costs of their effects, such
an lost productivity tindirec:t costs to society) and the
use of medical and other resources (direct costs to
society). The societal costs of all injuries occurring
in a given year have not been computed, but the costs of
the largest class of severe injuries--those resulting
from motor-vehicle crashes have been estimated:
With respect to long-term
000 Amer loans each year sustain
· Motor-vehicle crash in jur ies in 1980 were
estimated to cost society over S36 billion. ~3 °
· Injuries resulting from motor-'rehicle crashes
cost the federal government about S7.5 billion and state
governments about $3.5 billion in direct payments and
revenue loss in 1980.~°
OCR for page 21
21
· The societal costs of motor-vehicle crash
injuries are second only to those of cancer, among the
other leading causes of death.'9
· The direct costs resulting from motor-vehicle
crash injuries are approximately twice those resulting
from heart disease.79
· The indirect costs of motor-vehicle crash in jur ies
are especially high, because the average age at which
in jur yes occur is much lower than the average ages at
initial onset of the ocher leading causes of death . ~ 9
Motor-`rehicle crashes are the leading cause of severe
injury and death and have been studied in more detail
than most other in jury causes . Although police reports
generally understate the magnitude of the problem, ~ s
consider the following statistics on motor-vehicle
crashes: Approximately 3.2 million people were in jured
in motor-vehicle crashes in 1982.~ 32 Of these,
approximately 1.4 million were treated in emergency rooms
and 350~000 were hospitalized.t 32 In 1982, over 50,000
person-years of work (not counting housewives, students,
and others who are not classified as part of the work
force) were lost by injured persons.~32
Given that the total number of ~njury-related deaths
per year is about 3 times the number resulting from motor-
vehicle crashes, and that the total number of nonfatal
injuries is more than 10 times the number resulting from
motor-vehicle crashes, a conservative estimate of the
societal costs of all injuries in 1980 is approximately
$75-S100 billion (in 1980 dollars).
The dollar costs of injury, as large as they are,
account for only a portion of the total costs. Addi-
tional, less easily measured costs include pain, grief,
f amity and social disruption, and the social and psychos
logic effects of disfigurement and long-term disability,
such as those caused by severe burns, epilepsy from head
injury, limitations of mobility from spinal cord injury,
amputations, traumatic artier itis, and severe reduction in
mental function from head injury.
Injury and death result not only from unintentional
events, such as motor-vehicle crashes and falls, but also
from deliberate events, such as assault and suicide. Tt
is common to think of injuries as different from disease
because they occur suddenly--in a few milliseconds or a
few minutes--but that is not always the case. The cause
of injury to the human body is excessive exposure to
energy (kinetic, thermal, and chemical energy, elec-
tricity, and radiation) or the absence of essentials,
OCR for page 22
22
such as oxygen and heat.- The five forms of energy that
cause injuries are termed agents of injury. Typically,
injuries result from short-term exposure to large amounts
of energy (e.g., involvement in a car crash, contact with
a hot stove, or ingestion of an overdose of aspirin) .
However, in juries can also result from repeated exposure
to smaller amounts of energy (e.g. , deafness resulting
from prolonged exposure to excessive noise or back pain
or arthritis in a worker exposed to repeated vibration)
or from a combination of acute and chronic exposure (as
in the greater sensitivity to head injury in a football
player or boxer who has previously had head injury or to
acute back injury in a worker who has had back trouble).
Kinetic or mechanical energy (e.g., from motor vehicles
and firearms and in falls, jumps, and cutting) is by far
the leading cause of injury-related death in the United
States and accounts for more than 9S,000 deaths a year
(Table 1-1). Asphyxiation (drowning, suffocation,
hanging, and strangulation) causes over 13,000 deaths,
chemical energy (poisoning by solids, liquids, and
motor-vehicle carbon monoxide) approximately 10,000, and
fires and burns about 6,000. Deaths from electricity
make up only a =mall percentage of all injury deaths
(about 1,000 a year). Deaths from radiation are extremely
rare. Mechanical energy is also the leading cause of
nonfatal injuries, although the relative importance of
specific causes differs somewhat from the relative
importance of causes of fatal injuries. For example,
falls are the second leading cause of death from
unintentional injury, but the leading cause of injuries
treated in hospital emergency rooms.
Even though they are important, with many of the
characteristics of injuries, health problems resulting
from chronic exposure to injury agents will not be
addressed in this report. Rather, it focuses on acute
injuries and death associated with transportation, the
workplace, the home, and recreational and public
environments and on assaultive and self-inflicted
injuries.
There are many misconceptions about the causes and
control of injury. An event that produces injury is
often thought of as an isolated occurrence with a single
cause, and prevention of that single cause as the only,
or best, solution to the problem. Note, for example, the
coon oversimplification in a report that someone died
in a highway crash because the driver was drunk. The
associated perception of ten is of a fatal in jury attr ib-
u~ble to a single cause--in this case, the misuse of
OCR for page 23
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OCR for page 24
24
alcoholic beverages. That leads to the misperception
that such deaths could be prevented by eliminating exces-
sive alcoholic beverage consumption by dr Avers or by
separating such dr inters from their vehicles. In fact,
many ways of preventing or limiting such deaths are
pass ible .
Over the last 2 decades, useful ways have been devel-
oped for systematically considering the potential to
produce injury, and those ways lead to options for
preventing or reducing injuries. In one such approach,
presented by Haddon, 7 3 an event that could result in
injury is considered to have three phases--the pre-event,
event, and post-event phases. The pre-event phase covers
the period during which people use or are otherwise
exposed to a source of energy before a potentially
injurious event occurs. The event phase begins once the
energy source is out of control. The post-event phase
begins after acute exposure to the energy. Each phase
presents opportunities for intervention to reduce the
likelihood or severity of injury, if one systematically
considers interactions of each of the three phases with
var. ious entities, such as vehicles, humans, and the
environment. This report examines the status of and
needs for research in all three phases of injury-
producing events that will permit development of effec-
tive injury~control measures.
The medical treatment of injury has a long history.
Descriptions of treatments of 48 cases of head and foot
injuries appear on papyrus dating to approximately 1600
B.C. In approximately 500 B.C., Hippocrates studied
wounds and fractures and suggested mechanisms of injury
and methods of treatment. Most early physicians spent
much time managing wounds that occurred in civilian life
and in warfare. Although treating injuries and wounds
has occupied the primary attention of physicians since
the beginnings of scientific medicine, coordinated
research in the treatment of injury has been generally
lacking.
Injury control, encompassing activities from pre-
vention through treatment and rehabilitation, is
relatively young--in many ways still in its infancy.
Newtonian laws of motion have been known for some 300
years, but biomechanical concepts of injury were not -
developed until this century, and it was not until World
War II that biomechanics research was systematized.
There is now a growing body of scientific literature and
research on injury control, but substantially more needed
research can be identified than can be supported by the
1 imited resources available today.
Representative terms from entire chapter:
heart disease
