Incidence of serious injury: A comparison of emergency hospital admissions for serious injury in Ireland, Northern Ireland, England, Scotland and Wales Steve Barron, Institute of Public Health in Ireland Jodie Hope, Information Services Division, NHS National Services Scotland Prof Ronan Lyons, Steven Macey, College of Medicine, Swansea University and Public Health Wales Roy Maxwell, Wendi Slater, Public Health England Injury observatory for Britain and Ireland (IOBI)
Incidence of serious injury: A comparison of emergency hospital admissions for serious injury in Ireland, Northern Ireland, England, Scotland and Wales.
Dec 16, 2015
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Incidence of serious injury: A comparison of emergency hospital admissions for serious injury in Ireland, Northern Ireland, England, Scotland and Wales
Steve Barron, Institute of Public Health in Ireland
Jodie Hope, Information Services Division, NHS National Services Scotland
Prof Ronan Lyons, Steven Macey, College of Medicine, Swansea University and Public Health Wales
Roy Maxwell, Wendi Slater, Public Health England
Injury observatory for Britain and Ireland (IOBI)
Outline
o Injury Observatory for Britain and Irelando Rationaleo Methodo Findingso Limitationso Conclusions
Injury Observatory for Britain and Ireland (IOBI)
o Collaboration involving public health and academic institutions
o Support injury prevention practitioners by making important and relevant information and tools available in one site
o Analysis of injury mortality and occurrence
o Inventory of data sources
o Policy support for prevention
o Evidence base for prevention
o Access to prevention tools
o News and events: Injury Prevention News newsletter
http://www.injuryobservatory.net/
Rationaleo Injury is a major public health issue
o Usefulness of comparing injury occurrence
o Issues in comparing injury occurrence between countries:o Comparable survey data on injury in the community?o Different capacity/admission thresholds in different
countries?
o What can we compare? Hospital admissions for “serious injuries”
Methodo Hospital admission data for 2011
o Emergency “inpatient spells”
o “Serious injury”: modified set of ICD 10 codes from the New Zealand Injury Prevention Strategy’s serious injury indicators
o All serious injury: a serious injury code in any diagnosis field
o Serious injury by cause and intent: a serious injury code AND a cause / intent code in any diagnosis field
o Directly age-standardised rates (DASR)
Completeness of data: All serious injury versus serious injury by cause/intent
Serious injury codes
Serious injury codesAND
Cause/intent codes
Completeness of data: All serious injury versus serious injury by cause/intent
Serious injury codes
Serious injury codesAND
Cause/intent codes
All serious injuries(n=179,380)
Completeness of data: All serious injury versus serious injury by cause/intent
Serious injury codes
Serious injury codesAND
Cause/intent codes
All serious injuries(n=179,380)
Subset of all serious injuries that have cause / intent data(n=159,805):
Scotland 99%Ireland 98%England 89%Wales 72%Northern Ireland 68%
FindingsAll serious injury
o How many serious injuries?
o Are the rates for all serious injuries different between countries?
Serious injury by cause / intent
o How are causes distributed within each country?
o Are the rates by cause different between countries?
o How are intents distributed within each country?
o Are the rates by intent different between countries?
Findings: How many serious injuries?
Number of emergency hospital admissions for all serious injury, 2011Northern Ireland 4,338Ireland 10,253Wales 11,735Scotland 14,382England 138,672
Total 179,380
Findings: Are the rates for all serious injuries different between countries?
• Wales rate significantly higher than others
• England rate significantly lower than others (except Northern Ireland)
• No sex differences in rates within a country apart from Ireland (Male > Female)
Findings: How are causes distributed within each country?
• About two-thirds (63-71%) of serious injuries are due to falls
• 5-8% of serious injuries are due to motor vehicle traffic collisions (MVTC)
• 5-7% of serious injuries are due to struck by or against
• Notable exception: 6% of serious injuries in Northern Ireland are firearm related (<1% in other countries)
Findings: Are the rates by cause different between countries?
Directly age-standardised rate of emergency hospital admissions for serious injury by cause and country, 2011
IRE NI SCOT WAL ENGMVTC 17.4 10.2 13.9 14.2 14.2Fall 214.7 140.0 200.2 198.8 180.0Cut 3.7 3.2 7.2 3.2 2.2Drown 0.4 0.3 0.4 0.5 0.2Fire 0.4 0.3 0.4 0.5 0.2Firearm 0.5 9.0 0.2 0.1 0.2Struck 13.1 4.2 12.7 17.9 14.9Poison 1.4 1.9 1.6 2.5 1.8Other 42.7 21.9 51.5 37.1 33.4
Findings: Are the rates by cause different between countries?
Directly age-standardised rate of emergency hospital admissions for serious injury by cause and country, 2011
IRE NI SCOT WAL ENGMVTC 17.4 10.2 13.9 14.2 14.2Fall 214.7 140.0 200.2 198.8 180.0Cut 3.7 3.2 7.2 3.2 2.2Drown 0.4 0.3 0.4 0.5 0.2Fire 0.4 0.3 0.4 0.5 0.2Firearm 0.5 9.0 0.2 0.1 0.2Struck 13.1 4.2 12.7 17.9 14.9Poison 1.4 1.9 1.6 2.5 1.8Other 42.7 21.9 51.5 37.1 33.4 Significantly higher than other four countries
Findings: Are the rates by cause different between countries?
Directly age-standardised rate of emergency hospital admissions for serious injury by cause and country, 2011
IRE NI SCOT WAL ENGMVTC 17.4 10.2 13.9 14.2 14.2Fall 214.7 140.0 200.2 198.8 180.0Cut 3.7 3.2 7.2 3.2 2.2Drown 0.4 0.3 0.4 0.5 0.2Fire 0.4 0.3 0.4 0.5 0.2Firearm 0.5 9.0 0.2 0.1 0.2Struck 13.1 4.2 12.7 17.9 14.9Poison 1.4 1.9 1.6 2.5 1.8Other 42.7 21.9 51.5 37.1 33.4 Significantly higher than other four countries Significantly lower than other four countries
Findings: Rates by causeoComparisons of sex-specific rates within each
country MVTC, Struck, Other: Male > Female in all
Cut: Male > Female in all except England
Fire: Male > Female in Scotland, England
Firearms: Male > Female in Northern Ireland, Scotland
Drown, Poison: No sex differences
Falls: Female > Male in all five
Findings: How are intents distributed within each country?
• About nine-tenths (89-93%) of serious injuries are unintentional
• 5-7% of serious injuries are due to assaults
• About 2% of serious injuries are due to selfharm (Northern Ireland is higher at 5%)
Findings: Are the rates by intent different between countries?
Directly age-standardised rate of emergency hospital admissions for serious injury by intent and country, 2011
IRE NI SCOT WAL ENGSelfharm 3.5 7.4 4.9 5.0 4.5
Assault 11.4 9.1 17.0 13.8 13.5
Undetermined 1.1 0.4 0.1 0.5 0.4
Unintentional 283.4 176.3 270.7 258.7 232.7
Findings: Are the rates by intent different between countries?
Directly age-standardised rate of emergency hospital admissions for serious injury by intent and country, 2011
IRE NI SCOT WAL ENGSelfharm 3.5 7.4 4.9 5.0 4.5
Assault 11.4 9.1 17.0 13.8 13.5
Undetermined 1.1 0.4 0.1 0.5 0.4
Unintentional 283.4 176.3 270.7 258.7 232.7
Significantly higher than other four countries
Findings: Are the rates by intent different between countries?
Directly age-standardised rate of emergency hospital admissions for serious injury by intent and country, 2011
IRE NI SCOT WAL ENGSelfharm 3.5 7.4 4.9 5.0 4.5
Assault 11.4 9.1 17.0 13.8 13.5
Undetermined 1.1 0.4 0.1 0.5 0.4
Unintentional 283.4 176.3 270.7 258.7 232.7
Significantly higher than other four countries
Significantly lower than other four countries
Findings: Rates by intent
oComparisons of sex-specific rates within each country
Selfharm: Male > Female in Ireland, Northern Ireland, Scotland
Assault: Male > Female in all five
Undetermined/Other: Male > Female in England
Unintentional: Female > Male in Scotland, England
Limitations and issues to consider
o Descriptive rather than analytical study
o Defining “serious injury”
o Completeness of injury coding
o Completeness of cause / intent coding
o Multiple injuries and multiple causes / intents
o Inclusion of readmissions
o Unit of analysis: “Inpatient spells”
Conclusionso Large number of emergency admissions for serious
injury
o Countries have generally similar per cent distributions of causes and intents
o Differences in rates by causes and intents may be partly due to differences in completeness of coding
o Establishing valid incidence rates the first step in comparing countries
Thanks to…o Hospital Inpatient Enquiry Scheme (Ireland)
o Hospital Inpatient System, Hospital Information Branch, Department of Health, Social Services and Public Safety Northern Ireland
o The Scottish Morbidity Record 01 (SMR01) - General/Acute Inpatient and Day Case
o Patient Episode Database for Wales (PEDW) provided by NHS Wales Informatics Service
o Hospital Episode Statistics, Health & Social Care Information Centre (England)
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