Determining National Injury Prevention Priorities

描述（由申请人提供）：创伤性损伤是世界范围内死亡和残疾的主要原因，在美国，在生命的前半期造成的死亡人数超过了所有其他疾病的总和。伤害和由此导致的残疾对个人、家庭和社会造成的损失是惊人的。在美国，与伤害相关的医疗费用和生产力损失每年超过4000亿美元。尽管伤害对美国人口产生了深远的影响，但与用于其他疾病的资金相比，用于伤害研究和伤害预防举措的资金是微不足道的。在过去的4年里，NIH的研究预算中只有不到0.5%被用于与伤害相关的活动。由于伤害预防的资金有限，必须根据伤害机制（例如，机动车碰撞~跌倒~溺水）的相对负担程度来确定伤害机制的优先次序。然后，研究和预防工作可以集中在确定承担不成比例负担的伤害机制上。然而，确定伤害预防资金分配的优先次序的挑战远非直截了当。不同的指标被用来量化伤害负担，以检查频率、死亡率、发病率或金钱成本。然而，试图确定值得重点关注的伤害类型的研究通常只研究了两个以上的指标。这在一定程度上是因为缺乏能够进行更全面评价的数据。此外，这些指标的不同焦点和尺度的不同度量使得它们之间的比较难以客观地进行。此外，这些努力所依据的数据不具有全国代表性，因此不能用于负责任地提出预防建议。我们最近应用了一种新的损伤机制优先排序方法，该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）。这种方法在过去的尝试上有了很大的改进，过去的尝试分别检查频率或严重程度，这样做可能会产生误导性的结果，即哪些损伤机制实际上是高负担的优先事项。我们还开发了创新的新指数，可以根据三个额外的标准来比较损伤机制：它们在死亡率方面的相对负担、医院费用和潜在生命损失年数。在方法进步的基础上，本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科数据与全国死亡率数据相结合，以代表2007年美国发生的所有死亡。此外，我们纳入了关于终身医疗和工作损失费用的数据，从而使伤害机制能够根据全部六项负担标准进行量化。通过利用这些综合数据与我们新颖的方法方法，本提案利用机会，使我们在美国伤害预防优先事项的理解重大进步。我们还将确定具体亚组的伤害预防优先级，并将研究结果传达给政策制定者，使伤害预防计划能够客观地完成。

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.