Burden of injury in childhood and adolescence in 8 European countries
BMC Public Health
Burden of injury in childhood and adolescence in 8 European countries
Suzanne Polinder 0
Juanita A Haagsma 0
Hidde Toet 1
Marco JP Brugmans 1
Ed F van Beeck 0
the EUROCOST
APOLLO reference groups
0 Department of Public Health, Erasmus Medical Centre, University Medical Centre Rotterdam , The Netherlands
1 Consumer Safety Institute , Amsterdam , The Netherlands
Background: Injury is the major cause of death and suffering among children and adolescents, but awareness of the problem and political commitment for preventive actions remain unacceptably low. We have assessed variation in the burden of injuries in childhood and adolescence in eight European countries. Methods: Hospital, emergency department, and mortality databases of injury patients aged 0-24 years were analyzed for Austria, Denmark, Ireland, Latvia, Netherlands, Norway, Slovenia and the United Kingdom (England, Wales). Years lost due to premature mortality (YLL), years lived with disability (YLD), and disability adjusted life years (DALYs) were calculated. Results: Differences in the burden of injury in childhood and adolescence are large, with a fourfold gap between the safest countries (Netherlands and UK) in western-Europe and the relatively unsafe countries (Latvia and Slovenia) in the east. Variation between countries is attributable to high variation in premature mortality (YLL varied from 14-58 per 1000 persons) and disability (YLD varied from 3-10 per 1000 persons). Highest burden is observed among males ages 15-24. If childhood and adolescence injuries are reduced to the level of current best injury prevention practices, 6 DALYs per 1000 child years can be avoided. Conclusions: Injuries in childhood and adolescence cause a high disability and mortality burden in Europe. In all developmental stages large inequalities between west and east are observed. Potential benefits up to almost 1 million healthy child years gained across Europe are possible, if proven ways for prevention are more widely implemented. Our children deserve action now.
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Background
All over the globe, injuries in childhood and adolescence
have a major impact on individual and population
health. Each day, the ideals of thousands of our vivid
and promising youth are suddenly destroyed by road
traffic crashes, injuries at home or during leisure time,
or acts of violence. This is largely unnecessary, since an
abundance of simple and effective countermeasures are
available (e.g. use of bicycle helmets, reduced speed
limits, barrier fencing on swimming pools, lower tap water
temperatures), but these are underused[1]. For this
reason, even in high-income countries, injury is still the
leading cause of death and disability among children
and adolescents[2,3]. In Europe, each year more than
40,000 children die from injury, [4] and for every child
fatality, there are several thousand victims of injury or
violence who live with varying degrees of disability or
psychological scarring[1]. According to WHO,
awareness of the problem and its preventability, as well as
political commitment to act to prevent child injury,
remain unacceptably low[1]. Therefore, as a first step
in addressing this problem, among health policy makers
awareness should be raised and priority areas with the
highest potential health gains should be identified.
This can be accomplished by providing decision
makers with summary measures of population health,
such as the disability-adjusted life year (DALY)[5]. The
DALY is the sum of years lost due to premature
mortality (YLL) and years lived with disability (YLD). A high
number of DALYs reflects a greater burden of death
and disability. The DALY was aimed at national and
international health policies, to develop unbiased
epidemiological assessments for major disorders, and to
provide an outcome measure that could also be used for
cost-effectiveness analysis[6].
The human impact of childhood and adolescence
injury in terms of DALYs in Europe by country, age,
sex, injury type and external cause specifically has not
been addressed yet. Expected variation in the burden of
injury among the European countries may be caused by
differences in exposure, injury risk and type of sustained
injury, differences in demography, (socio)economic and
cultural factors, safety technology, injury-prevention
strategies, and the effectiveness of trauma care.
Assessment of the variation of the burden of injury and its
separate components can be used to identify high-risk
groups in Europe as well as in specific European
countries, and it can be used to prioritise injury-prevention
programmes.
In this paper we assess the impact and variation in the
burden of injury in childhood and adolescence in eight
European countries. This is expressed in the summary
measure of DALYs and its components, namely
premature mortality (years of life lost, YLL) and disability
(years lived with disability, YLD). To show potential
health gains, we estimate the impact on mortality and
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