injuries as a public health problem intermediate injury prevention course august 23-26, 2011...
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Injuries as a Public Health ProblemInjuries as a Public Health Problem
Intermediate Injury Prevention Course
August 23-26, 2011
Billings, MT
Session Session ObjectivesObjectives
• Severity of injuries facing AI/AN communities
• Costs of injury / cost benefits of prevention
• Community benefits of injury prevention
• Public Health Approach to preventing injuries
• Value of data in preventing injury
Why Injury Prevention?Why Injury Prevention?
AI/AN injury rate higher than US all races
AI/AN’s ages 1-44 are greatly affected
Injuries are very costly to treat
Injuries in American Indian Injuries in American Indian and Alaska Native Communities and Alaska Native Communities
1981 - 2005, United States
All Injury Deaths and Rates per 100,000
Am Indian/AK Native and All U.S. and All U.S.
0
20
40
60
80
100
120
140
AI/AN US All Races
CDC WISQARS, 1981-2005
Fatal Injury Rates Per IHS AreaFatal Injury Rates Per IHS Area20072007
WA
Portland80.0 Billings
159.9Aberdeen
122.4 Bemidji77.2
OR ID
MT
WY
ND
SD
NE
MN
IA
WI
MI
IN
ME
NY
PA
California33.7
CA
NVUT
AZ
AK
CO
NM
KS
OK
TXLA
MS AL
FL
SC
NCTN
Tucson117.2
Navajo117.5
Albuquerque107.9
Oklahoma City62.3
Nashville47.4
Phoenix126.8
Alaska163.6
Source: National Center for Health Statistics – Vital Statistics Systems – CD WISQARS - Data includes all injury types Rates are per 100,000 service population
US All Races Rate: 59.3
Leading Causes of Death Leading Causes of Death AI/AN – Ages 1-44, US 2007AI/AN – Ages 1-44, US 2007
Cause Percentage Unintentional Injury 47.1%
Suicide 13.7%
Homicide 7.8%
Heart Disease 9.8%
Liver Disease 8.4%
Diabetes 2.3%
Other 10.6%
CDC WISQAR’S
Leading Causes of Unintentional Injury Death Leading Causes of Unintentional Injury Death AI/AN – Ages 1-44, US 2007AI/AN – Ages 1-44, US 2007
Cause Percentage Motor Vehicle 52.9%
Poisoning 21.7%
Drowning 4.9%
Pedestrian –Other 2.6%
Other 12.0%
Fire/Burn 1.9%
Natural Environmental 3.3%
CDC WISQAR’S
Leading Causes of Unintentional Injury Death Leading Causes of Unintentional Injury Death Billings AreaBillings Area
AI/AN – Ages 1-44, US 2007AI/AN – Ages 1-44, US 2007
Cause Percentage
Motor Vehicle 66.0%
Poisoning 9.4%
Drowning 7.5%
Pedestrian –Other 3.8%
Other 11.3%
Fire/Burn 1.9%
Natural Environmental 1.9%
CDC WISQAR’S
Leading Causes of Injury Death Leading Causes of Injury Death All ages AI/AN – (2007)All ages AI/AN – (2007)
Billings AreaBillings Area
Cause Rate US RateSuicide 23.9 11.4
Poisoning 27.6 9.9
MVC 69.0 13.7
Homicide 13.8 6.0
Firearms 2.5 4.9
Fall 2.5 7.0
Fire/Burn 0.0 1.0
Rates are per 100,000 service population CDC WISQAR’S
What are the costs of injury?What are the costs of injury?
Physical LossesPhysical Losses
FinancialFinancial
EmotionalEmotional
TreatmentTreatment
Financial Financial burdenburden of injury of injury
Buzz GroupBuzz Group
1. Why is cost important?2. Who would find cost interesting?
National Injury CostsNational Injury Costs$224 Billion Annually$224 Billion Annually
Cost involvedCost involved– Medical care, rehabilitation, lost wages / productivityMedical care, rehabilitation, lost wages / productivity
Who paysWho pays– Private share 72% (or about Private share 72% (or about $161 Billion$161 Billion))– Public share 28% (or about Public share 28% (or about $63 Billion$63 Billion) )
Federal shareFederal share– $12.6 Billion in medical costs$12.6 Billion in medical costs– $18.4 Billion in disability/death costs$18.4 Billion in disability/death costs
Source: CDC, National Center for Injury Prevention and ControlSource: CDC, National Center for Injury Prevention and Control
AI/AN Injury CostsAI/AN Injury Costs
IHS Injury Treatment CostsIHS Injury Treatment Costs– InpatientInpatient
» $1507/day (Medicaid reimbursement rate for 1 day at an IHS facility) $1507/day (Medicaid reimbursement rate for 1 day at an IHS facility)
– Contract HealthContract Health» $11,305/inpatient case$11,305/inpatient case» $570/outpatient case$570/outpatient case
One Alaska Corporation (TCC) spent One Alaska Corporation (TCC) spent $4.15 million$4.15 million for for injury hospitalizations from ’94-’98injury hospitalizations from ’94-’98
Sources - (1) Indian Health Focus-Injuries 1998-99 (2) Chandler B, Berger L: Financial Burden of Injury-Related Hospitalizations to an Alaska Native Health System
Financial Financial benefitsbenefits of of injury preventioninjury prevention
Interventions that Interventions that $$aveave Money Money
Primary seat belt laws/Child Car SeatsPrimary seat belt laws/Child Car Seats Streetlights and guardrailsStreetlights and guardrails Bike helmetsBike helmets DUI LawsDUI Laws Personal Floatation DevicesPersonal Floatation Devices Smoke detectorsSmoke detectors Gun locksGun locks
Safety equipment saves more Safety equipment saves more than lives . . .than lives . . .
Every bike helmet (for kids 4 – 15) saves $395 Every bike helmet (for kids 4 – 15) saves $395 in treatment costsin treatment costs
Every child seat saves $1,360Every child seat saves $1,360 Every smoke detector saves $900Every smoke detector saves $900
References: National Public Services Research Institute /References: National Public Services Research Institute /National SAFE KIDS CampaignNational SAFE KIDS Campaign
Injury Prevention:Injury Prevention: Potential for Cost SavingsPotential for Cost Savings
Victim Treatment costs resulting from each Motor Vehicle Crash:
NOT wearing a seat belt $2,395
Wearing a seat belt $470
Source - Phipps L: Cost Comparison of Medical Treatment for Restrained vs. Unrestrained Motor vehicle crash victims at a northeast Oklahoma IHS hospital (IHS Injury Prevention Fellowship)
Injury Prevention Cost Savings Injury Prevention Cost Savings Projects in Indian Country Projects in Indian Country
Navajo NationNavajo Nation – occupant restraint usage – occupant restraint usage
Whiteriver, AZWhiteriver, AZ – pedestrian crash reduction – pedestrian crash reduction
White Mountain ApacheWhite Mountain Apache – livestock control – livestock control
Y-K Delta, AKY-K Delta, AK – drowning prevention – drowning prevention
Community benefits from injury Community benefits from injury prevention cost savingsprevention cost savings
Elective medical servicesElective medical services– more non-emergent treatments (surgeries, more non-emergent treatments (surgeries,
therapies, preventive services, other programs)therapies, preventive services, other programs)
Resources for additional community servicesResources for additional community services– housing authoritieshousing authorities– transportation programstransportation programs
Public Health Public Health ApproachApproach
Define the Problem
•SurveillanceIdentify
Risk Factors
•Who, What?
Source: National Center for Injury Prevention and Control, CDC
Find what Prevents
the Problem
•What Works?
Implement &Evaluate Programs
•Prevention
Using Data to Define Injury ProblemsUsing Data to Define Injury Problems
Data identifies patterns and trends in Data identifies patterns and trends in injury injury
Observation data documents behaviorsObservation data documents behaviors
Interview and Focus Group data can be Interview and Focus Group data can be used to identify knowledge, perceptions, used to identify knowledge, perceptions, and attitudes about injuryand attitudes about injury
Collecting and Analyzing Data to Collecting and Analyzing Data to Determine Injury Risk FactorsDetermine Injury Risk Factors
Population at riskPopulation at risk – age, gender, specific groupage, gender, specific group
Location(s) of eventsLocation(s) of events– inside home, road location, at workinside home, road location, at work
Environmental factorsEnvironmental factors– lighting, road conditions, weatherlighting, road conditions, weather
Other factorsOther factors– alcohol use, use of safety devicesalcohol use, use of safety devices
Using Data to Select Using Data to Select Preventive MeasuresPreventive Measures
• Modify the EEnvironment
• EEducate the public
• Enact and EEnforce safety legislation
Using Data to Using Data to EvaluateEvaluate Programs Programs
• Help develop intervention materials
• Analyze effectiveness of methods used
• Use evaluation to improve prevention measures
SummarySummary
• Severity of injuries facing AI/AN communities
• Costs of injury / cost benefits of prevention
• Community benefits of injury prevention
• Public Health Approach to preventing injuries
• Value of data in preventing injury
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