Academic journal article Canadian Journal of Public Health

Trends in the Leading Causes of Injury Mortality, Australia, Canada and the United States, 2000–2014

Academic journal article Canadian Journal of Public Health

Trends in the Leading Causes of Injury Mortality, Australia, Canada and the United States, 2000–2014

Article excerpt

Epidemiology is the study of the distribution and determinants of health conditions in human populations.1 Implicit in the definition of epidemiology is that a principal activity of epidemiologists is to compare rates, and this comparison of rates leads to the generation of hypotheses that might explain the differences. Geoffrey Rose (1992) described the concept of sick populations versus sick individuals, noting that within-population variation in exposure around the population's mean is usually less than the exposure variation between populations.2 As a corollary of this, Rose generalized that while one might not know how to cure a health condition, at the very least we can work to advance health of the least healthy population towards that of the most healthy by trying to redress the population differences in the exposure to risks that threaten health.

While these are basic epidemiological principles, their application to injury prevention has been limited. National efforts to study the distribution and determinants of injury remain largely focused on identifying high-risk individuals within populations rather than exploring population-level differences for injury rate between populations. Although the mass strategy is common in injury (e.g., the recommended use of seatbelts for all vehicle occupants), efforts to address the identified problems frequently focus on energy control in high-risk settings rather than on structural interventions that address the underlying causes of injury and consequently reduce risk in the entire population. The limitations of this approach are described by Frieden (2010) in his presentation of a Health Impact Pyramid, where it is argued that addressing socio-economic factors has the greatest potential to improve health, with the next most effective strategy being to change the context for individual behaviour to make the healthiest choices the easiest choices, followed by clinical interventions, with the least effective methods suggested as educating people about how to reduce their individual level of risk.3 In injury prevention, it may be necessary to address all four levels in the pyramid simultaneously, as each can build on the other to facilitate change.4,5

The essential value of studying deaths in the population as a population approach to public health was underscored by William Farr in the early 19th century: "The death-rate is a fact; anything beyond this is an inference."6 Deaths are the facts we are setting out to prevent, and comparing rates between populations allows us to make inferences about causation that will support preventive efforts.7

When the population is the unit of analysis, then systemic explanations for population-level injury rates can only be identified by comparing one population with another, because within a single population the overall injury rate is simply the consequence of the social system that population defines. As a first step in a program of work seeking to quantify systemic risk factors for population-level injury rates, we undertook a descriptive epidemiological study of population-level trends in injury mortality for Australia, Canada and the US over the period from 2000 to 2014. The aim of this descriptive study was to describe and compare the incidence of external cause injury by cause category, country and year.


Study design and setting

A descriptive epidemiological study was undertaken reporting trends in injury mortality since 2000 in Australia, Canada and the United States. Data were available for the US from 2000 to 2014, and for Canada and Australia from 2000 to 2012. The primary country of interest was the US, with Canada and Australia chosen as comparison countries given their close match to the US in terms of historical and cultural development. The demographic profile of each country in terms of summary socio-demographic indicators is provided in Table 1.

Data and data sources

Injury causes were defined using the International Classification of Diseases, Tenth Revision (ICD-10) external cause codes for select causes and overall (Table 2). …

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