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December 1, 2000


  • Hijar M, Chu LD, Kraus JF. Cross-national comparison of injury mortality: Los Angeles County, California and Mexico City, Mexico. International Journal of Epidemiology 2000; 29(4):715-721. (E.45.02 S)

    Cross-national comparisons of injury mortality can suggest possible causal explanations for injuries across different countries and cultures. This study identifies differences in injury mortality between Los Angeles (LA) County, California and Mexico City DF, Mexico. Using LA County and Mexico City death certificate data for 1994 and 1995, injury deaths were classified according to the International Classification of Diseases Ninth Revision-Clinical Modification external cause of injury codes. Crude, gender-, and age- adjusted annual fatality rates were calculated and comparisons were made between the two regions. Overall and age-adjusted injury death rates were higher for Mexico City than for LA County. Injury death rates were found to be higher for young adults in LA County and for elderly residents of Mexico City. Death rates for motor vehicle crashes, falls, and undetermined causes were higher in Mexico City, and relatively high rates of poisoning, homicide, and suicide were found for LA County. Motor vehicle crash and fall death rates in Mexico City increased beginning at about age 55, while homicide death rates were dramatically higher among young adults in LA County. The largest proportion of motor vehicle crash deaths was to motor vehicle occupants in LA County and to pedestrians in Mexico City. These findings illustrate the importance of primary injury prevention in countries having underdeveloped trauma care systems and should aid in setting priorities for future work. The high frequency of pedestrian fatalities in Mexico City may be related to migration of rural populations, differing vehicle characteristics and traffic patterns, and lack of safety knowledge. Mexico City's higher rate of fall-related deaths may be due to concurrent morbidity from chronic conditions, high- risk environments, and delay in seeking medical treatment.

  • Weed DL. Interpreting epidemiological evidence: how meta-analysis and causal inference methods are related. International Journal of Epidemiology 2000; 29(3):387-390. (E.01 S)

    Interpreting observational epidemiological evidence can involve both the quantitative method of meta-analysis and the qualitative criteria- based method of causal inference. The relationships between these two methods are examined in terms of the capacity of meta-analysis to contribute to causal claims, with special emphasis on the most commonly used causal criteria: consistency, strength of association, dose- response, and plausibility. Although meta-analysis alone is not sufficient for making causal claims, it can provide a reproducible weighted average of the estimate of effect that seems better than the rules-of-thumb (e.g. majority rules and all-or-none) often used to assess consistency. A finding of statistical heterogeneity, however, need not preclude a conclusion of consistency (e.g. consistently greater than 1.0). For the criteria of strength of association and dose- response, meta-analysis provides more precise estimates, but the causal relevance of these estimates remains a matter of judgement. Finally, meta-analysis may be used to summarize evidence from biological, clinical, and social levels of knowledge, but combining evidence across levels is beyond its current capacity. Meta-analysis has a real but limited role in causal inference, adding to an understanding of some causal criteria. Meta-analysis may also point to sources of confounding or bias in its assessment of heterogeneity.


  • Leistikow BN, Martin DC, Milano CE. Fire injuries, disasters, and costs from cigarettes and cigarette lights: a global overview. Preventive Medicine 2000; 31(2 Pt 1):91-99. (E.55.08 S)

    Fires cause 1% of the global burden of disease. Fire (includes explosion) disasters have immense health, social, and environmental costs. The authors provide initial estimates of overall U. S. and global fire tolls from smoking, by tabulating and summarizing smoking-related fire and disaster tolls from published documents. They compared those tolls to U.S. fire, burn, and fire death rates per billion cigarettes extrapolated globally. Smoking- attributable percentages of adult and child access to cigarette lighter and match ignitions (lights), and resultant fires, burns, and deaths ignited by young children, were estimated from likely smoking- attributable lights usage. Cigarette plus cigarette lights fire tolls were multiplied times published and estimated fire costs. Smoking is the leading cause of residential or total fire death in all eight countries with available statistics. Smoking is a leading cause of fires in many more countries. Cigarettes cause numerous fire disasters. Cigarette lights cause an estimated 100,000 U.S. and one million global, child-playing fires per year. Cigarette lights fire injuries likely rival U.S., and possibly global, cigarette fire injury numbers. Smoking causes an estimated 30% of U. S. and 10% of global fire death burdens. Smoking's estimated U.S. and global fire costs were $6.95 (sensitivity range $5.34-22.8) and $27.2 (sensitivity range $8.2- 89.2) billion, respectively, in 1998 U. S. dollars. Smoking likely causes large global fire tolls. U.S. fire tolls have fallen when smoking decreased. Further reducing smoking can substantially reduce fire and disaster tolls.

  • Stevens RR, Lane GA, Milkovich SM, Stool D, Rider G, Stool SE. Prevention of accidental childhood strangulation. A clinical study. Annals of Otololgy, Rhinololgy and Laryngology 2000; 109(9):797-802. (E.55.04 S)

    : Accidental strangulation is a preventable problem, and there is limited scientific understanding of its mechanism in children. If the amount of external pressure that occludes the airway can be determined, design changes may be made to allow for production of household objects that would break apart at safe pressure levels. A force gauge was applied to the suprahyoid region in 90 children under standardized anesthesia. Three blinded observers performed the study. The anesthesiologist maintained the airway and used a stethoscope to auscultate for breath sounds and monitor the CO2 curves to evaluate obstruction. The recorder noted the numbers from the gauge. A single observer applied the force gauge. Age was the most significant variable in occluding the airway. Obstruction appears to occur at the level of the larynx. Increased knowledge regarding the external pressure required for airway occlusion would allow for the design and manufacture of products with a reduced potential for accidental strangulation.


  • Powell JW, Barber-Foss KD. Sex-related injury patterns among selected high school sports. American Journal of Sports Medicine 2000; 28(3):385-391. (E.61 S)

    This cohort observational study was undertaken to test the hypothesis that the incidence of injuries for girls participating in high school sports is greater than that for boys. From 1995 through 1997, players were included in our study if they were listed on the school's varsity team roster for boys' or girls' basketball, boys' or girls' soccer, boys' baseball, or girls' softball. Injuries and opportunities for injury were recorded daily. Certified athletic trainers reported injury and exposure data. Based on 39,032 player-seasons and 8988 reported injuries, the injury rates per 100 players for softball (16.7) and for girls' soccer (26.7) were higher than for baseball (13.2) and boys' soccer (23.4). The knee injury rates per 100 players for girls' basketball (4.5) and girls' soccer (5.2) were higher than for their male counterparts. Major injuries occurred more often in girls' basketball (12.4%) and soccer (12.1%) than in boys' basketball (9.9%) and soccer (10.4%). Baseball players (12.5%) had more major injuries than softball players (7.8%). There was a higher number of surgeries, particularly knee and anterior cruciate ligament surgeries, for female basketball and soccer players than for boys or girls in other sports.


  • Booth N, Briscoe M, Powell R. Suicide in the farming community: methods used and contact with health services. Occupational Environmental Medicine 2000; 57(9):642-644. (E.90.02 S)

    Farmers have a high rate of suicide (1% of suicides in England and Wales). This study sought to test whether farmers would be less likely to have been in contact with primary or mental health services before death due to their reluctance to seek help. The study also sought to identify other characteristics that differentiated suicide among male farmers from other professional groups. A retrospective case-control design was used comparing male farmers with an age and sex matched control group. Cases were all members of the farming community within the Exeter Health District on whom suicide or open verdict had been recorded between 1979 and 1994. 63 Cases were identified and entered into the study. Controls were non-farmers with the same verdict who were matched for age (5 year age bands) sex and social class. Farmers were significantly more likely to use firearms to kill themselves (42% of farmers v 11% controls). They were less likely to use a car exhaust or to die by poisoning (9% farmers v 50% controls). Farmers were significantly less likely to leave a suicide note (21% farmers v 41% controls). There was no significant difference between farmers and controls for numbers in contact with their general practitioner or mental health services in the 3 months before death. There may be some differences in help seeking behaviour between farmers and the general population as over 30% of farmers presented with exclusively physical symptoms. General practitioners should consider depressive and suicidal intention in farmers presenting with physical problems. When depression is diagnosed consideration should be given to the temporary removal of firearms as the high rate of suicide in the farming community may be strongly influenced by access to means.

  • McGwin G, Jr., Enochs R, Roseman JM. Increased risk of agricultural injury among African-American farm workers from Alabama and Mississippi. American Journal of Epidemiology 2000; 152(7):640-650. (E.65 S)

    Research on the epidemiology of agriculture-related injuries has largely ignored African-Americans and farm workers. This cohort study is the first to estimate injury rates and to evaluate prospectively risk factors for agriculture-related injuries and compare them among African-American and Caucasian farmers and African-American farm workers. A total of 1,246 subjects (685 Caucasian owners, 321 African- American owners, and 240 African-American workers) from Alabama and Mississippi were selected from Agricultural Statistics Services databases and other sources and were enrolled between January 1994 and June 1996. Baseline data included detailed demographic, farm and farming, and behavioral information. From January 1994 to April 1998, subjects were contacted biannually to ascertain the occurrence of an agriculture-related injury. Injury rates were 2.9 times (95% confidence interval (CI): 2.0, 4.3) higher for African-American farm workers compared with Caucasian and African-American owners. Part-time farming (relative risk (RR) = 2.0, 95% CI: 1.3, 2.5), prior agricultural injury (RR = 1.5, 95% CI: 1.0, 2.1), and farm machinery in fair/poor condition (RR = 1.8, 95% CI: 1.2, 2.7) were also independently associated with injury rates. The results demonstrate the increased frequency of agricultural injury among farm workers and identify a number of possible ways of reducing them.

  • Baarts C, Mikkelsen KL, Hannerz H, Tuchsen F. Use of a national hospitalization register to identify industrial sectors carrying high risk of severe injuries: A three-year cohort study of more than 900,000 Danish men. American Journal of Industrial Medicine 2000; 38(6):619-627. (E.65 S)

    Data indicates that Denmark has relatively high risks of occupational injuries. This study evaluated all injuries resulting in hospitalization by occupation. All gainfully employed men younger than 60 in 1990 were divided into 47 industrial groups and followed using the National Inpatient Registry, for hospitalized injuries 1991-1993. Following ICD-8, injuries were grouped into six categories: head, upper extremities, back, trunk, lower extremities and ruptures, sprains and strains. Standardized industrial hospitalization ratios (SHRs) were calculated and Pearson's independence test was performed for each category. Industrial differences were ascertained for each injury category. The highest associated injury category was upper extremity injuries ranging from SHR = 43 (fire services and salvage corps) to SHR = 209 (slaughterhouse industry). Carpentry, joinery, bricklaying and construction work had significantly high SHRs for all injury categories, whereas administrative work was significantly low throughout. Occupational surveillance systems based on hospitalized injuries can be used to identify high- risk industries, and thereby suggest where to direct prevention efforts.

  • McCurdy SA, Carroll DJ. Agricultural injury. American Journal of Industrial Medicine 2000; 38(4):463-480. (E.65 S)
    Agriculture is one of the most hazardous industries in the US. The authors reviewed MEDLINE and NIOSHTIC to identify English- language studies addressing occupational injury among agricultural populations, focusing on North America. Additional references were identified from the reference lists of identified studies and from contacts with experts in the field. U.S. data indicate up to approximately 780 deaths and 140,000 cases of nonfatal disabling injuries in 1998. Risk of agricultural injuries is approximately 5- 10/100 persons per year, but is higher in certain risk groups, such as males and cattle workers. Falls, machinery, and animals are among the most common causes. Unique features of the agricultural workplace and exposed population combine to increase risk and hinder accurate measurement. These features include a wide range of activities, hazards, and dispersed work places in agriculture; a seasonal hired work force that often has brief tenure, poor English skills, and a distrust of officialdom; and a history of exemption regarding occupational health and safety regulations. Research in agricultural injury should include epidemiologic study of risk factors and evaluation of interventions. Although only limited data are available documenting efficacy of specific preventive approaches, prevention should focus on engineering controls, regulatory approaches, and education.

  • Strunin L, Boden LI. Paths of reentry: employment experiences of injured workers. American Journal of Industrial Medicine 2000; 38(4):373-384. (E.65 S)

    An injury at work can result in a change in jobs or employers, unemployment, or withdrawal from the labor force. Substantial life changes can occur, often mediated by the initial attempt to return to employment. This study uses ethnographic interviews of 204 workers injured in Florida. The study describes three paths to reemployment taken by the injured workers. The "welcome back" path provides workers with a sense of being valued by their preinjury employers. This positive effect remains, even for those who are unable to continue working because of limitations imposed by their injuries. Other paths cause workers to feel undervalued, as discarded or damaged goods, and generate hostility and resentment. Females in all groups are less likely to be currently working. White males were more likely than other groups to be employed in skilled jobs and are also the most likely to return to light-duty jobs and to remain in their preinjury jobs over time. Half of the workers in this study experience employer indifference or hostility in response to their attempts to return to work after an occupational back injury. After injury, there are both commonalities and meaningful disparities in post-injury experiences of White, Black, and Hispanic male and female workers.


  • Brayne C, Dufouil C, Ahmed A, Dening TR, Chi LY, McGee M et al. Very old drivers: findings from a population cohort of people aged 84 and over. International Journal of Epidemiology 2000; 29(4):704-707. (E.52 S)

    Increases in longevity will involve a significant increase among the number of drivers in the very old, who are at greater risk of being involved in road accidents. Data are thus needed from studies of older populations to characterize those still driving, the reasons for giving up and to help formulate appropriate policies for dealing with the problems faced and created by an increase in older drivers. A driving questionnaire was administered to surviving members of a cohort comprising a representative sample of individuals aged >/=84, the Cambridge City over 75 Cohort. Out of 546 survivors 404 completed the driving questionnaire at the 9-year follow-up. In addition, subjects were assessed, at baseline and at each follow-up, for cognitive performance using the Mini-Mental State Examination (MMSE) and for physical impairment using the Instrumental of Activities in Daily Living (IADL) scale. Of the sample, 37% had driven in the past, and 8.4% were still driving, the majority regularly. The drivers tended to be younger (mean age 86.6 years), men (71%) and to be married (67.7%). Although physical disability and cognitive impairment are common in this age group, current drivers had few physical limitations on their daily activities and were not impaired on MMSE. None of the current drivers had visual impairment and 22.6% had hearing loss. Of those who had given up driving, 48.5% had given up at the age of >/=80. The commonest reasons for giving up driving were health problems (28.6%), and loss of confidence (17.9%). One-third reported giving up driving on advice. A process of self-selection takes place among older drivers. People over the age of 84 who are still driving have generally high levels of physical fitness and mental functioning, although some have some sensory loss. Given the likely increase in the number of older drivers over the next decades, safety will be improved most by strategies aimed at the entire driving population with older drivers in mind, rather than relying on costly screening programmes to identify the relatively small numbers of impaired older people who continue to drive.

  • van Beeck EF, Borsboom GJ, Mackenbach JP. Economic development and traffic accident mortality in the industrialized world, 1962-1990. International Journal of Epidemiology 2000; 29(3):503-509. (E.50 S)

    The authors examined the association between prosperity and traffic accident mortality in the industrialized world in a long-term perspective, by calculating traffic accident mortality, traffic mobility and the fatal injury rate of 21 industrialized countries from 1962 until 1990. They used mortality and population data of the World Health Organization (WHO), and figures on motor vehicle ownership of the International Road Federation (IRF) to examin cross-sectional and longitudinal associations of these traffic-related variables with the prosperity level per country, derived from data of the Organization for Economic Cooperation and Development (OECD). Results showed a reversal from a positive relation between prosperity and traffic accident mortality in the 1960s to a negative association currently. At a certain level of prosperity, the growth rate of traffic mobility decelerates and the fatal injury rate continues to decline at a similar rate to earlier phases. In a long-term perspective, the relation between prosperity and traffic accident mortality appears to be non-linear: economic development first leads to a growing number of traffic-related deaths, but later becomes protective. Prosperity growth is not only associated with growing numbers of motor vehicles in the population, but also seems to stimulate adaptation mechanisms, such as improvements in the traffic infrastructure and trauma care.

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