Determining National Injury Prevention Priorities

描述(申请人提供)：创伤性损伤是世界范围内导致死亡和残疾的主要原因，在美国，在前半生导致的死亡人数超过所有其他疾病的总和。伤害和由此导致的残疾给个人、家庭和社会造成的代价之大令人震惊。在美国，与伤害相关的医疗成本和生产力损失每年超过4000亿美元。尽管伤害对美国人口有深远的影响，但与致力于其他疾病的资金相比，用于伤害研究和伤害预防倡议的资金微不足道。在过去的4年里，美国国立卫生研究院的研究预算中只有不到0.5%用于与伤害相关的活动。在伤害预防资金有限的情况下，努力根据伤害机制(如机动车撞车~坠落~溺水)的相对负担程度来确定伤害机制的优先顺序是至关重要的。然后，研究和预防工作可以集中在确定的伤害机制上，这些机制承担了不成比例的负担。然而，确定伤害预防资金分配的优先次序的挑战远非一帆风顺。不同的指数被用来量化受伤的负担，检查受伤的频率、死亡率、发病率或金钱成本。然而，试图确定值得优先关注的伤害类型的研究通常只研究两个以上的指标。这在一定程度上是因为缺乏能够进行更全面评估的数据。此外，这些指数的侧重点不同，其衡量标准也不同，因此很难客观地进行比较。此外，努力的基础是不具有全国代表性的数据，因此不能用来负责任地提出预防建议。我们最近应用了一种新的方法来确定损伤机制的优先顺序，这种方法考虑了特定人群中损伤机制的频率以及每种损伤机制的严重程度(即解剖损伤)。这种方法比过去单独检查频率或严重程度的尝试有很大改进，这样做可能会产生误导性的结果，即哪些伤害机制实际上是高负担优先级。我们还开发了创新的新指数，能够从三个额外的标准来比较伤害机制：它们在死亡率、医院费用和潜在寿命损失年数方面的相对负担。在这一方法进步的基础上，该应用程序提出了一种高度创新的方法，将具有全国代表性的急诊部数据与全国死亡率数据结合起来，以表示2007年在美国发生的所有死亡事件。此外，我们纳入了关于终生医疗和工作损失成本的数据，从而使伤害机制能够根据完全六个负担标准进行量化。通过利用这些全面的数据和我们新的方法方法，这项建议利用了这一机会，使我们在理解美国的伤害预防优先事项方面取得了重大进展。我们还将确定特定分组中的伤害预防优先事项，并将结果传达给决策者，以使伤害预防规划能够客观地完成。 公共卫生相关性：这一应用程序综合了来自三个具有全国代表性的来源的数据，以代表美国所有年龄段的伤害受害者，包括那些在医院接受治疗的人和那些死亡但没有被送往医院的人。将采用一种创新的方法来衡量每种特定伤害机制(如烧伤、跌倒、溺水)的相对伤害严重程度。结果将是根据伤害机制的总体排名，客观地量化美国伤害机制的负担，该排名由六个标准衡量，包括终身医疗成本和工作损失成本。这些方法将分层次，分别侧重于13个年龄组，分别侧重于妇女和男子，侧重于该国的不同地区，以及按照城乡连续体的定义，侧重于该国的不同地区。结果将提供客观指导，并将传达给政策制定者。这项研究的结果将提供急需的客观数据，可用于制定和实施为产生最大公共健康利益而量身定做的伤害预防战略。

DESCRIPTION (provided by applicant): Traumatic injury is a leading cause of death and disability worldwide, and in America causes more deaths in the first half of the lifespan than all other diseases combined. The magnitude of the costs of injury and resulting disability to individuals, families, and society is staggering. The medical costs and productivity losses associated with injury in the US exceed $400 billion annually. Despite the profound impact of injury on the US population, funds directed to injury research and injury prevention initiatives are minute when compared to those dedicated to other diseases. Less than 0.5% of the research budget of the NIH over the last 4 years has been directed to injury-related activities. With funding for injury prevention limited, an effort to prioritize injury mechanisms (eg, motor vehicle crash~ fall~ drowning) according to the relative magnitude of their burden is essential. Research and prevention efforts could then be focused on the injury mechanisms identified to carry a disproportionate share of the burden. However, the challenge of determining priorities for the allocation of injury prevention funding is far from straightforward. Different indices have been used to quantify the burden of injuries, to examine frequency, mortality, morbidity, or monetary costs. However, research that has tried to identify the injury types that warrant being focused on as priorities typically study only one more two indices. In part this is because data to enable a more comprehensive evaluation are lacking. Also, the divergent foci of these indices and the different metrics of their scales make comparisons between them difficult to do objectively. Also, efforts have been based on data that are not nationally representative and thus cannot be used to make prevention recommendations responsibly. We recently applied a novel method for prioritizing injury mechanisms in a fashion that accounts for the frequency of an injury mechanism in a given population as well as the severity (that is, anatomic damage) of each injury mechanism. This method improves greatly upon past attempts, which examine either frequency or severity separately, and in so doing may yield misleading results about which injury mechanisms are actually high-burden priorities. We also developed innovative new indices that enabled comparing injury mechanisms in terms of three additional criteria: their relative burden in terms of mortality, hospital costs, and years of potential life lost. Building upon that methodological advancement, this application proposes a highly innovative approach that combines nationally representative emergency department data with national mortality data to represent all deaths occurring in the US in 2007. Additionally, we incorporate data on lifetime medical and work loss costs, thereby enabling injury mechanisms to be quantified according to fully six criteria of burden. By utilizing these comprehensive data with our novel methodological approach, this proposal capitalizes on the opportunity make a major advancement in our understanding of the injury prevention priorities in the US. We will also identify the injury prevention priorities in specific subgroups and will communicate the findings policy makers to enable injury prevention planning to be accomplished objectively. PUBLIC HEALTH RELEVANCE: This application comprehensive brings together data from three nationally representative sources to represent injury victims in the United States of all ages, including those treated in hospitals and those who died and were not transported to a hospital. An innovative methodologic approach to measuring the relative injury severity of each specific mechanism of injury (eg, burns, falls, drowning) will be applied. The result will be to objectively quantify the burden of injury mechanisms in the US according to their overall ranking as measured by six criteria, including lifetime medical costs and work loss costs. The methods will be stratified to focus separately on 13 age groups, on women and men separately, on different regions of the country, and on different areas of the country as defined along a rural-urban continuum. The results will provide objective guidance that will be communicated to policy makers. The results of this study will provide much needed objective data that can used to develop and implement injury prevention strategies tailored to yield the greatest public health benefit.