11 March 2002
No reports this week
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Addressing suicide as a public-health problem.
- Jenkins R. Lancet 2002; 359: 835-840.
Correspondence: Rachel Jenkins, WHO Collaborating Centre (Mental Health Research and Training), Institute of Psychiatry, London SE5 8AF, UK (email: r.jenkins@iop.kcl.ac.uk).
Premature death from suicide is estimated to be the tenth leading cause of death in the world, and as common as deaths from road-traffic accidents. Furthermore, in all countries there is a greater or lesser degree of stigma that attaches to suicide, so not all suicides are officially recorded as such. Epidemiological necropsy studies in several countries suggest that the proportion of suicides that are "unofficial" is very great. Apart from the loss of life, suicides mean the loss of a breadwinner and parent for the family, long-lasting psychological trauma for children, friends, and relatives, and the loss of economic productivity for the nation, so there is every reason to take suicide seriously....
The study by Phillips and colleagues (see abstract below under SUICIDE) is important, not so much for its rather more conservative estimate of China's suicide rate, as for its being a key step along the path to encouraging China, and other countries, to have a complete vital registration system. Also, it highlights suicide as a leading cause of death among the young and a major cause of death in all age-groups, and the need to acknowledge and address suicide as a serious public-health problem.
Both the WHO and the UN have recommended that member states should develop national suicide-prevention programs, where possible linked to other public-health policies, and that they should establish national committees to coordinate the prevention strategies. Over the past decade, several countries have set suicide reduction as a target and have developed or are now developing and refining suicide-prevention strategies, which include: improving prevention, detection, and treatment of depression, particularly in primary care; improving access to mental-health services; improving assessment of deliberate self-harm; supporting high-risk groups; improving control of disinhibiting, facilitating factors, such as alcohol; influencing the media in their portrayal of suicide to prevent the glamorization of suicide and the reporting of the method; auditing all suicides in detail to learn the lessons for prevention; reducing access to the means of suicide; and encouraging essential research and development. Improvement in international suicide statistics will undoubtedly assist this effort.
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Socioeconomic deprivation and fatal unintentional domestic fire incidents in New Zealand 1993-1998.
- Duncanson, M., Woodward, A., Reid, P. Fire Safety Journal, 2002; 37(2): 165-179.
Correspondence: Mavis Duncanson, Department of Public Health, Wellington School of Medicine and Health Sciences, University of Otago, P.O. Box 7343, Wellington South, NEW ZEALAND (email: mduncanson@wnmeds.ac.nz).
A cross-sectional study was undertaken in Aotearoa New Zealand to investigate the relationship between socioeconomic deprivation and risk of an unintentional fatal domestic fire incident. Addresses of unintentional fatal domestic fire incidents were geocoded to small area (census meshblock) level and analysed with the New Zealand index of socioeconomic deprivation.
Fatal unintentional domestic fire incidents occurred disproportionately in dwellings in the most socioeconomically deprived meshblocks. Annual rates of fatal unintentional fire incidents per 100,000 households in the most deprived decile were significantly higher than rates in the least deprived decile (RR 5.6, 95%CI 1.9-16).
Strategies to prevent fire related deaths must overcome barriers to household fire safety in population groups experiencing increased risk, including the socioeconomically deprived, seniors, and ethnic minorities. Specific intervention strategies relevant to risks associated with socioeconomic deprivation include improving quality and affordability of housing; increasing prevalence of installed and functioning smoke detectors; and regulation of specific characteristics of cigarettes to reduce risk of ignition from abandoned heat sources. Substantial progress awaits reduction of the underlying socioeconomic determinants of disadvantage.
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Injury risks and socioeconomic groups in different settings. Differences in morbidity between men and between women at working ages.
- Laflamme L, Eilert-Petersson E. European J Pub Health, 2002; 11(3): 309-313.
Correspondence: Lucie Laflamme, Karolinska Institutet, Department of Public Health Sciences, Division of Social Medicine, SE-171 76 Stockholm, Sweden (email: lucie.laflamme@phs.ki.se).
BACKGROUND: It is unclear whether greater injury risk in lower socioeconomic groups at working ages is attributable to differences in work conditions or a reflection of a wider overall pattern of risk.
OBJECTIVES: The current study investigates socioeconomic differences in non-fatal injury risks in a variety of settings.
METHODS: Data were taken from a community-based injury register built up over one year (November 1989 to October 1990) in a semi-urban Swedish municipality (256,510 inhabitants), and then linked by record to Sweden's National Population Register (based on the census of 1990). Injuries among the age group 20-64 were considered. Age-standardized odds ratios were computed by gender for five injury settings and four socioeconomic groups, using salaried employees as the reference group.
RESULTS: Compared with salaried employees, male manual workers and from the unspecified population (long-term unemployed, students, etc.) show an excess risk of injury in all settings except sports. Males from all socioeconomic groups show significantly higher morbidity in production/education; those from the unspecified population, in home settings, transport areas, and 'other areas'.
CONCLUSIONS: Higher morbidity in lower socioeconomic groups results not only from work-related differences, where 25% of the injuries analyzed were incurred, but also from the differential impacts of other living environments, e.g. home and transport areas. Differences between socioeconomic groups in care seeking, injury lethality, injury susceptibility, and risk exposure may influence the social patterning of injury morbidity.
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See Report under Recreation and Sports
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Skateboard and Scooter Injuries
- Committee on Injury and Poison Prevention, American Academy of Pediatrics. Pediatrics, 2002; 109(3): 542-543.
Skateboard-related injuries account for an estimated 50 000 emergency department visits and 1500 hospitalizations among children and adolescents in the United States each year. Nonpowered scooter-related injuries accounted for an estimated 9400 emergency department visits between January and August 2000, and 90% of these patients were children younger than 15 years. Many such injuries can be avoided if children and youth do not ride in traffic, if proper protective gear is worn, and if, in the absence of close adult supervision, skateboards and scooters are not used by children younger than 10 and 8 years, respectively.
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No reports this week
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Suicide rates in China, 1995-1999.
- Phillips MR, Li X, Zhang Y. Lancet 2002; 359: 835-840.
Correspondence: Michael R. Phillips (email: phillips@public3.bta.net.cn).
BACKGROUND: A wide range of suicide rates are reported for China because official mortality data are based on an unrepresentative sample and because different reports adjust crude rates in different ways. We aimed to present an accurate picture of the current pattern of suicide in China on the basis of conservative estimates of suicide rates in different population cohorts.
METHODS: Suicide rates by sex, 5-year age-group, and region (urban or rural) reported in mortality data for 1995-99 provided by the Chinese Ministry of Health were adjusted according to an estimated rate of unreported deaths and projected to the corresponding population.
RESULTS: We estimated a mean annual suicide rate of 23 per 100 000 and a total of 287 000 suicide deaths per year. Suicide accounted for 3.6% of all deaths in China and was the fifth most important cause of death. Among young adults 15-34 years of age, suicide was the leading cause of death, accounting for 19% of all deaths. The rate in women was 25% higher than in men, mainly because of the large number of suicides in young rural women. Rural rates were three times higher than urban rates--a difference that remained true for both sexes, for all age-groups, and over time.
CONCLUSIONS: Suicide is a major public-health problem for China that is only gradually being recognized. The unique pattern of suicides in China is widely acknowledged, so controversy about the overall suicide rate should not delay the development and testing of China-specific suicide-prevention programs.
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Risk of Injury to Child Passengers in Compact Extended-Cab Pickup Trucks
- Winston FK, Kallan MJ, Elliott MR, Menon RA, Durbin DR. JAMA 2002; 287(9):1147-1152.
Correspondence: Flaura K. Winston, MD, PhD, the Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, 3535 TraumaLink, 10th Floor, Philadelphia, PA 19104 USA (email: flaura@mail.med.upenn.edu).
BACKGROUND: An increasing number of compact pickup trucks can accommodate restrained rear occupants. Rear seats in these pickup trucks are exempt from regulatory safety testing though their relative safety has not been determined.
OBJECTIVES: To evaluate the risk of injury to children in compact extended-cab pickup trucks compared with children in other vehicles and to determine if any unique hazards exist.
METHODS: Design- Cross-sectional study of children aged 15 years or younger in crashes of insured vehicles, with data collected via insurance claim records and a telephone survey. Setting and Participants- Probability sample of 7192 multirow vehicles involved in crashes, with 11 335 child occupants, in 3 large US regions from December 1, 1998, to November 30, 2000. Main Outcome Measure- Relative risk of injury, defined as concussions and more serious brain injuries, spinal cord injuries, internal organ injuries, extremity fractures, and facial lacerations, estimated by odds ratios (ORs) adjusting for age, restraint use, point of impact, vehicle weight, and crash severity.
RESULTS: Injuries were reported for 1356 children, representing 1.6% of the population. Children in compact extended-cab pickup trucks were at greater risk of injury than children in other vehicles (adjusted OR, 2.96; 95% confidence interval [CI], 1.68-5.21). Children in the rear seats of compact pickup trucks were at substantially greater risk of injury than rear-seated children in other vehicles (adjusted OR, 4.75; 95% CI, 2.39-9.43). Children seated in the front seat of compact extended-cab pickup trucks were at greater risk of injury than children in the front seats of other vehicles, but this risk was not statistically significant (adjusted OR, 1.70; 95% CI, 0.78-3.69).
CONCLUSIONS: Children in compact extended-cab pickup trucks are not as safe as children in other vehicles, primarily due to the increased relative risk of injury in the back seat. For families with another choice of vehicle, clinicians should advise parents against transporting children in compact pickup trucks. The current exemption for regulatory testing for occupant protection in the rear seats of compact pickup trucks should be reconsidered.
Selecting and Using the Most Appropriate Car Safety Seats for Growing Children: Guidelines for Counseling Parents.
- Committee on Injury and Poison Prevention, American Academy of Pediatrics. Pediatrics, 2002; 109(3): 550-553.
Despite the existence of laws in all 50 states requiring the use of car safety seats or child restraint devices for young children, more children are still killed as passengers in car crashes than from any other type of injury. Pediatricians and other health care professionals need to provide up-to-date, appropriate information for parents regarding car safety seat choices and proper use. Although the American Academy of Pediatrics is not a testing or standard-setting organization, this policy statement discusses the Academy's current recommendations based on the peer-reviewed literature available at the time of publication and sets forth some of the factors that parents should consider before selecting and using a car safety seat.
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Variation in Homicide Risk During Infancy --- United States, 1989--1998.
- Paulozzi M, Sells M. MMWR, 2001; 51(09);187-189.
Correspondence: Lenonard Paulozzi, CDC National Center for Injury Prevention and Control, Division of Violence Prevention, Chamblee, GA USA (email: lbp4@CDC.GOV).
The full report including tables, figures, editorial comment, and references is available online: ( Download Document ).
Homicide is the 15th leading cause of death during the first year of life (i.e., infancy) in the United States. In addition, the risk for homicide is greater in infancy than in any other year of childhood before age 17 years and is greatest during the first 4 months of life. To determine how the risk for homicide varied by week during infancy and by day during the first week of life, CDC analyzed death certificate data for 1989--1998. This report summarizes the results of this analysis, which indicated that risk for infant homicide is greatest on the day of birth. Efforts to prevent infant homicides should focus on early infancy.
Most infant deaths are certified by medical examiners or coroners. Statistical information from death certificates is consolidated into a national database through the National Vital Statistics System. Information on U.S. resident infant homicide deaths for 1989--1998 was obtained from CDC's National Center for Health Statistics. An infant was defined as a person aged <1 year at death. Homicide was defined as an underlying cause coded through the International Classification of Disease, Ninth Revision, codes E960--E969. Age at death in days was defined as one plus the difference between the dates of death and birth recorded on the death certificate. An infant killed on its date of birth had an age at death of 1 day. In comparison, homicide rates during different time periods within infancy were presented as rates per person-years of exposure. The U.S. infant population during 1989--1998 accounted for 39,941,628 person years of exposure, of which days of birth accounted for 109,354 person years, and the remainder of infancy accounted for 39,832,274 person years.
During 1989--1998, a total of 3,312 infant homicides were reported for a rate of 8.3 per 100,000 person years. Of these, 81 (2.4%) were excluded because of a missing date of birth. The proportion of homicides occurring each week of infancy varied, with 9.1% of homicides occurring during the first week of life; a secondary peak in the distribution of homicides occurred at week 8.
Among homicides during the first week of life, 82.6% occurred on the day of birth, 9.2% on the second day, and 8.2% during the remainder of the week. After the first 2 days of life, the number of deaths in the remainder of the first week was comparable to the number of deaths in the second week of life. Overall, 243 (7.3%) of all infant homicides occurred on the day of birth. When homicide rates on the first day of life and during the remainder of infancy were compared with homicide rates during later age groups, the homicide rate on the first day of life was at least ten times greater than the rate during any other time of life.
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