Last data update: Nov 04, 2024. (Total: 48056 publications since 2009)
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Accelerometer-Measured Daily Steps, Physical Function, and Subsequent Fall Risk in Older Women: The Objective Physical Activity and Cardiovascular Disease in Older Women Study
Schumacher BT , Bellettiere J , LaMonte MJ , Evenson KR , Di C , Lee IM , Sleet DA , Eaton CB , Lewis CE , Margolis KL , Tinker LF , LaCroix AZ . J Aging Phys Act 2021 30 (4) 1-11 Steps per day were measured by accelerometer for 7 days among 5,545 women aged 63-97 years between 2012 and 2014. Incident falls were ascertained from daily fall calendars for 13 months. Median steps per day were 3,216. There were 5,473 falls recorded over 61,564 fall calendar-months. The adjusted incidence rate ratio comparing women in the highest versus lowest step quartiles was 0.71 (95% confidence interval [0.54, 0.95]; ptrend across quartiles = .01). After further adjustment for physical function using the Short Physical Performance Battery, the incidence rate ratio was 0.86 ([0.64, 1.16]; ptrend = .27). Mediation analysis estimated that 63.7% of the association may be mediated by physical function (p = .03). In conclusion, higher steps per day were related to lower incident falls primarily through their beneficial association with physical functioning. Interventions that improve physical function, including those that involve stepping, could reduce falls in older adults. |
Pediatric sports-related concussion: An approach to care
Podolak OE , Arbogast KB , Master CL , Sleet D , Grady MF . Am J Lifestyle Med 2021 16 (4) 469-484 Sports-related concussion (SRC) is a common sports injury in children and adolescents. With the vast amount of youth sports participation, an increase in awareness of concussion and evidence that the injury can lead to consequences for school, sports and overall quality of life, it has become increasingly important to properly diagnose and manage concussion. SRC in the student athlete is a unique and complex injury, and it is important to highlight the differences in the management of child and adolescent concussion compared with adults. This review focuses on the importance of developing a multimodal systematic approach to diagnosing and managing pediatric sports-related concussion, from the sidelines through recovery. |
Using behavioral science theory to enhance public health nursing
Sleet DA , Dellinger AM . Public Health Nurs 2020 37 (6) 895-899 The application of behavioral science theory is instrumental in advancing nursing research and practice. Nurses can benefit from a thorough understanding of theoretical perspectives related to health behavior change. Behavioral science theory can provide a conceptual context for understanding patient behavior, it can guide research on the determinants of health behavior and health service delivery, and it can offer alternative approaches to nursing practice that may improve the effectiveness of patient care. The aim of this paper is to provide some examples of behavioral theories that can be used in nursing research and practice, and provide an example of how one theory, Stages of Change (Transtheoretical Model), can be applied to older adult fall prevention. Given the critical role behavior plays in premature morbidity and mortality, public health nurses and researchers can benefit by broadening the use of theory in the design and implementation of interventions, using behavioral theory as their guide. |
State-level seat belt use in the United States, 20112016: Comparison of self-reported with observed use and use by fatally injured occupants
Shakya I , Shults RA , Stevens MR , Beck LF , Sleet DA . J Safety Res 2020 73 103-109 Introduction: Despite 49 states and the District of Columbia having seat belt laws that permit either primary or secondary enforcement, nearly half of persons who die in passenger vehicle crashes in the United States are unbelted. Monitoring seat belt use is important for measuring the effectiveness of strategies to increase belt use. Objective: Document self-reported seat belt use by state seat belt enforcement type and compare 2016 self-reported belt use with observed use and use among passenger vehicle occupant (PVO) fatalities. Methods: We analyzed the Behavioral Risk Factor Surveillance System (BRFSS) self-reported seat belt use data during 2011–2016. The Pearson correlation coefficient (r) was used to compare the 2016 BRFSS state estimates with observed seat belt use from state-based surveys and with unrestrained PVO fatalities from the Fatality Analysis Reporting System. Results: During 2011–2016, national self-reported seat belt use ranged from 86–88%. In 2016, national self-reported use (87%) lagged observed use (90%) by 3 percentage points. By state, the 2016 self-reported use ranged from 64% in South Dakota to 93% in California, Hawaii, and Oregon. Seat belt use averaged 7 percentage points higher in primary enforcement states (89%) than in secondary states (82%). Self-reported state estimates were strongly positively correlated with state observational estimates (r = 0.80) and strongly negatively correlated with the proportion of unrestrained PVO fatalities (r = −0.77). Conclusion: National self-reported seat belt use remained essentially stable during 2011–2016 at around 87%, but large variations existed across states. Practical Applications: If seat belt use in secondary enforcement states matched use in primary enforcement states for 2016, an additional 3.98 million adults would have been belted. Renewed attention to increasing seat belt use will be needed to reduce motor-vehicle fatalities. Self-reported and observational seat belt data complement one another and can aid in designing targeted and multifaceted interventions. |
Using behavioral theory to enhance occupational safety and health: Applications to health care workers
Guerin RJ , Sleet DA . Am J Lifestyle Med 2020 15 (3) 269-278 Work-related morbidity and mortality are persistent public health problems across all US industrial sectors, including health care. People employed in health care and social services are at high risk for experiencing injuries and illnesses related to their work. Social and behavioral science theories can be useful tools for designing interventions to prevent workplace injuries and illnesses and can provide a roadmap for investigating the multilevel factors that may hinder or promote worker safety and health. Specifically, individual-level behavioral change theories can be useful in evaluating the proximal, person-related antecedents (such as perceived behavioral control) that influence work safety outcomes. This article (1) provides a brief overview of widely used, individual-level behavior change theories and examples of their application to occupational safety and health (OSH)–related interventions that involve the health care community; (2) introduces an integrated theory of behavior change and its application to promoting the OSH of health care workers; and (3) discusses opportunities for application of individual-level behavior change theory to OSH research and practice activities involving health care workers. The use of behavioral science to consider the role of individual behaviors in promoting health and preventing disease and injury provides a necessary complement to structural approaches to protecting workers in the health care industry. |
Societal determinants of violent death: The extent to which social, economic, and structural characteristics explain differences in violence across Australia, Canada, and the United States
Wilkins NJ , Zhang X , Mack KA , Clapperton AJ , Macpherson A , Sleet D , Kresnow-Sedacca MJ , Ballesteros MF , Newton D , Murdoch J , Mackay JM , Berecki-Gisolf J , Marr A , Armstead T , McClure R . SSM Popul Health 2019 8 100431 In this ecological study, we attempt to quantify the extent to which differences in homicide and suicide death rates between three countries, and among states/provinces within those countries, may be explained by differences in their social, economic, and structural characteristics. We examine the relationship between state/province level measures of societal risk factors and state/province level rates of violent death (homicide and suicide) across Australia, Canada, and the United States. Census and mortality data from each of these three countries were used. Rates of societal level characteristics were assessed and included residential instability, self-employment, income inequality, gender economic inequity, economic stress, alcohol outlet density, and employment opportunities). Residential instability, self-employment, and income inequality were associated with rates of both homicide and suicide and gender economic inequity was associated with rates of suicide only. This study opens lines of inquiry around what contributes to the overall burden of violence-related injuries in societies and provides preliminary findings on potential societal characteristics that are associated with differences in injury and violence rates across populations. |
The Influence of Older Adults' Beliefs and Attitudes on Adopting Fall Prevention Behaviors
Stevens JA , Sleet DA , Rubenstein LZ . Am J Lifestyle Med 2018 12 (4) 324-330 Among Americans aged 65 years and older, falls are the leading cause of injury death and disability, and finding effective methods to prevent older adult falls has become a public health priority. While research has identified effective interventions delivered in community and clinical settings, persuading older adults to adopt these interventions has been challenging. Older adults often do not acknowledge or recognize their fall risk. Many see falls as an inevitable consequence of aging. Health care providers can play an important role by identifying older adults who are likely to fall and providing clinical interventions to help reduce fall risks. Many older people respect the information and advice they receive from their providers. Health care practitioners can encourage patients to adopt effective fall prevention strategies by helping them understand and acknowledge their fall risk while emphasizing the positive benefits of fall prevention such as remaining independent. To help clinicians integrate fall prevention into their practice, the Centers for Disease Control and Prevention launched the STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative. It provides health care providers in primary care settings with resources to help them screen older adult patients, assess their fall risk, and provide effective interventions. |
The global challenge of child injury prevention
Sleet DA . Int J Environ Res Public Health 2018 15 (9) If a disease were killing our children at the rate unintentional injuries are, the public would be outraged and demand that this killer be stopped” | | -C. Everett Koop, MD13th Surgeon General of the United States of America (1982 to 1989). | Go to: | 1. Background | The health of children has changed significantly during the past 50 years. Widespread immunization programs have nearly eliminated the threat of infectious diseases, such as polio, diphtheria, and measles. However, a major public health problem that continues to threaten the health of all children has no vaccine: injury. Child injury represents one of the most immediate public health threats, resulting in the death of nearly 2000 children under age 14 every day around the world. (http://www.who.int/healthinfo/global_burden_disease/estimates/en/). According to Margaret Chan, former Director General of the World Health Organization (WHO), and Ann Veneman, former Executive Director of the United Nations Children’s Fund [1]: | | Once children reach the age of five years, unintentional injuries are the biggest threat to their survival. Unintentional injuries are also a major cause of disabilities, which can have a long-lasting impact on all facets of children’s lives: relationships, learning and play. Among those children who live in poverty, the burden of injury is highest. Child injuries have been neglected for many years and are largely absent from child survival initiatives presently on the global agenda. The World Health Organization, the United Nations Children’s Fund and many partners have set out to elevate child injury to a priority for the global public health and development communities. |
Injury prevention and health promotion: A global perspective
Franklin RC , Sleet DA . Health Promot J Austr 2018 29 (2) 113-116 Since its inception 27 years ago (1990), the Health Promotion Journal of Australia has featured many articles on aspects of injury prevention, particularly noticeable during the past five years. With this issue, it will be only the second time the journal has launched a Special Issue on injury prevention, the first one appearing in Volume 1, issue 2, in 1991.1 As editors of the current issue, we felt the dedicated emphasis on injury prevention and health promotion in the journal is long overdue, given that our careers in injury prevention have changed considerably since the first Special Issue was published (and that a new cadre of health promotion professionals have entered the field). Therefore, we believe it is timely and important to feature some of the recent research focusing on injury prevention and health promotion. |
The epidemiology of unintentional and violence-related injury morbidity and mortality among children and adolescents in the United States
Ballesteros MF , Williams DD , Mack KA , Simon TR , Sleet DA . Int J Environ Res Public Health 2018 15 (4) Injuries and violence among young people have a substantial emotional, physical, and economic toll on society. Understanding the epidemiology of this public health problem can guide prevention efforts, help identify and reduce risk factors, and promote protective factors. We examined fatal and nonfatal unintentional injuries, injuries intentionally inflicted by other (i.e., assaults and homicides) among children ages 0-19, and intentionally self-inflicted injuries (i.e., self-harm and suicides) among children ages 10-19. We accessed deaths (1999-2015) and visits to emergency departments (2001-2015) for these age groups through the Centers for Disease Control and Prevention's (CDC) Web-based Injury Statistics Query and Reporting System (WISQARS), and examined trends and differences by age, sex, race/ethnicity, rural/urban status, and injury mechanism. Almost 13,000 children and adolescents age 0-19 years died in 2015 from injury and violence compared to over 17,000 in 1999. While the overall number of deaths has decreased over time, there were increases in death rates among certain age groups for some categories of unintentional injury and for suicides. The leading causes of injury varied by age group. Our results indicate that efforts to reduce injuries to children and adolescents should consider cause, intent, age, sex, race, and regional factors to assure that prevention resources are directed at those at greatest risk. |
A comprehensive approach to motorcycle-related head injury prevention: Experiences from the field in Vietnam, Cambodia, and Uganda
Craft G , Van Bui T , Sidik M , Moore D , Ederer DJ , Parker EM , Ballesteros MF , Sleet DA . Int J Environ Res Public Health 2017 14 (12) Motorcyclists account for 23% of global road traffic deaths and over half of fatalities in countries where motorcycles are the dominant means of transport. Wearing a helmet can reduce the risk of head injury by as much as 69% and death by 42%; however, both child and adult helmet use are low in many countries where motorcycles are a primary mode of transportation. In response to the need to increase helmet use by all drivers and their passengers, the Global Helmet Vaccine Initiative (GHVI) was established to increase helmet use in three countries where a substantial portion of road users are motorcyclists and where helmet use is low. The GHVI approach includes five strategies to increase helmet use: targeted programs, helmet access, public awareness, institutional policies, and monitoring and evaluation. The application of GHVI to Vietnam, Cambodia, and Uganda resulted in four key lessons learned. First, motorcyclists are more likely to wear helmets when helmet use is mandated and enforced. Second, programs targeted to at-risk motorcyclists, such as child passengers, combined with improved awareness among the broader population, can result in greater public support needed to encourage action by decision-makers. Third, for broad population-level change, using multiple strategies in tandem can be more effective than using a single strategy alone. Lastly, the successful expansion of GHVI into Cambodia and Uganda has been hindered by the lack of helmet accessibility and affordability, a core component contributing to its success in Vietnam. This paper will review the development of the GHVI five-pillar approach in Vietnam, subsequent efforts to implement the model in Cambodia and Uganda, and lessons learned from these applications to protect motorcycle drivers and their adult and child passengers from injury. |
Economic burden of informal caregiving associated with history of stroke and falls among older adults in the U.S
Joo H , Wang G , Yee SL , Zhang P , Sleet D . Am J Prev Med 2017 53 S197-s204 INTRODUCTION: Older adults are at high risk for stroke and falls, both of which require a large amount of informal caregiving. However, the economic burden of informal caregiving associated with stroke and fall history is not well known. METHODS: Using the 2010 Health and Retirement Study, data on non-institutionalized adults aged ≥65 years (N=10,129) in 2015-2017 were analyzed. Two-part models were used to estimate informal caregiving hours. Based on estimates from the models using a replacement cost approach, the authors derived informal caregiving hours and costs associated with falls in the past 2 years for stroke and non-stroke persons. RESULTS: Both the prevalence of falls overall and of falls with injuries were higher among people with stroke than those without (49.5% vs 35.1% for falls and 16.0% vs 10.3% for injurious falls, p<0.01). Stroke survivors needed more informal caregiving hours than their non-stroke counterparts, and the number of informal caregiving hours was positively associated with non-injurious falls and even more so with injurious falls. The national burden of informal caregiving (2015 U.S. dollars) associated with injurious falls amounted to $2.9 billion (95% CI=$1.1 billion, $4.7 billion) for stroke survivors (about 0.5 million people), and $6.5 billion (95% CI=$4.3 billion, $8.7 billion) for those who never had a stroke (about 3.6 million people). CONCLUSIONS: In U.S. older adults, informal caregiving hours and costs associated with falls are substantial, especially for stroke survivors. Preventing falls and fall-related injuries, especially among stroke survivors, therefore has potential for reducing the burden of informal caregiving. |
Trends in the leading causes of injury mortality, Australia, Canada, and the United States, 2000-2014
Mack K , Clapperton A , Macpherson A , Sleet D , Newton D , Murdoch J , Mackay JM , Berecki-Gisolf J , Wilkins N , Marr A , Ballesteros M , McClure R . Can J Public Health 2017 108 (2) e185-e191 OBJECTIVES: The aim of this study was to highlight the differences in injury rates between populations through a descriptive epidemiological study of population-level trends in injury mortality for the high-income countries of Australia, Canada and the United States. METHODS: Mortality data were available for the US from 2000 to 2014, and for Canada and Australia from 2000 to 2012. Injury causes were defined using the International Classification of Diseases, Tenth Revision external cause codes, and were grouped into major causes. Rates were direct-method age-adjusted using the US 2000 projected population as the standard age distribution. RESULTS: US motor vehicle injury mortality rates declined from 2000 to 2014 but remained markedly higher than those of Australia or Canada. In all three countries, fall injury mortality rates increased from 2000 to 2014. US homicide mortality rates declined, but remained higher than those of Australia and Canada. While the US had the lowest suicide rate in 2000, it increased by 24% during 2000-2014, and by 2012 was about 14% higher than that in Australia and Canada. The poisoning mortality rate in the US increased dramatically from 2000 to 2014. CONCLUSION: Results show marked differences and striking similarities in injury mortality between the countries and within countries over time. The observed trends differed by injury cause category. The substantial differences in injury rates between similarly resourced populations raises important questions about the role of societal-level factors as underlying causes of the differential distribution of injury in our communities. |
Universal motorcycle helmet laws to reduce injuries: A Community Guide Systematic Review
Peng Y , Vaidya N , Finnie R , Reynolds J , Dumitru C , Njie G , Elder R , Ivers R , Sakashita C , Shults RA , Sleet DA , Compton RP . Am J Prev Med 2017 52 (6) 820-832 CONTEXT: Motorcycle crashes account for a disproportionate number of motor vehicle deaths and injuries in the U.S. Motorcycle helmet use can lead to an estimated 42% reduction in risk for fatal injuries and a 69% reduction in risk for head injuries. However, helmet use in the U.S. has been declining and was at 60% in 2013. The current review examines the effectiveness of motorcycle helmet laws in increasing helmet use and reducing motorcycle-related deaths and injuries. EVIDENCE ACQUISITION: Databases relevant to health or transportation were searched from database inception to August 2012. Reference lists of reviews, reports, and gray literature were also searched. Analysis of the data was completed in 2014. EVIDENCE SYNTHESIS: A total of 60 U.S. studies qualified for inclusion in the review. Implementing universal helmet laws increased helmet use (median, 47 percentage points); reduced total deaths (median, -32%) and deaths per registered motorcycle (median, -29%); and reduced total injuries (median, -32%) and injuries per registered motorcycle (median, -24%). Repealing universal helmet laws decreased helmet use (median, -39 percentage points); increased total deaths (median, 42%) and deaths per registered motorcycle (median, 24%); and increased total injuries (median, 41%) and injuries per registered motorcycle (median, 8%). CONCLUSIONS: Universal helmet laws are effective in increasing motorcycle helmet use and reducing deaths and injuries. These laws are effective for motorcyclists of all ages, including younger operators and passengers who would have already been covered by partial helmet laws. Repealing universal helmet laws decreased helmet use and increased deaths and injuries. |
Using the public health model to address unintentional injuries and TBI: A perspective from the Centers for Disease Control and Prevention (CDC)
Baldwin G , Breiding M , Sleet D . NeuroRehabilitation 2016 39 (3) 345-9 Traumatic brain injury (TBI) can have long term effects on mental and physical health, and can disrupt vocational, educational, and social functioning. TBIs can range from mild to severe and their effects can last many years after the initial injury. CDC seeks to reduce the burden of TBI from unintentional injuries through a focus on primary prevention, improved recognition and management, and intervening to improve health outcomes after TBI. CDC uses a 4-stage public health model to guide TBI prevention, moving from 1) surveillance of TBI, 2) identification of risk and protective factors for TBI, 3) development and testing of evidence-based interventions, to 4) bringing effective intervention to scale through widespread adoption. CDC's unintentional injury prevention activities focus on the prevention of sports-related concussions, motor vehicle crashes, and older adult falls. For concussion prevention, CDC developed Heads Up - an awareness initiative focusing on ways to prevent a concussion in sports, and identifying how to recognize and manage potential concussions. In motor vehicle injury prevention, CDC has developed a tool (MV PICCS) to calculate the expected number of injuries prevented and lives saved using various evidence-based motor vehicle crash prevention strategies. To help prevent TBI related to older adult falls, CDC has developed STEADI, an initiative to help primary care providers identify their patients' falls risk and provide effective interventions. In the future, CDC is focused on advancing our understanding of the public health burden of TBI through improved surveillance in order to produce more comprehensive estimates of the public health burden of TBI. |
The safety assessment measure for persons with traumatic brain injury: Item pool development and content validity
Seel RT , Macciocchi S , Velozo CA , Shari K , Thompson N , Heinemann AW , Sander AM , Sleet D . NeuroRehabilitation 2016 39 (3) 371-87 BACKGROUND: Persons with moderate to severe TBI are at increased risk for unintentional injury or harm in the home and community; however, there is currently no standard measure of safety risk they face now and in the future. OBJECTIVE: To develop comprehensive and content valid scales and item pools for assessing safety and risk for persons with moderate to severe traumatic brain injuries. METHOD: Qualitative psychometric methods for developing scales and items were used including literature review, item development and revision, focus groups with interdisciplinary rehabilitation staff (n = 26) for rating content validity, and cognitive interviewing of TBI family members (n = 9) for assuring item clarity. RESULTS: The Safety Assessment Measure is comprised of 6 primary scales-Cognitive Capacity, Visuomotor Capacity, Wheelchair Use, Risk Perception, Self-Regulation, and Compliance Failures with Safety Recommendations-in which family caregivers or clinicians rate the risk for unintentional injury or harm in adults who have sustained moderate or severe TBI. The scale item pools encompass a broad spectrum of everyday activities that pose risk in the home and community and were rated as having excellent levels of content validity. CONCLUSIONS: The Safety Assessment Measure scales and items cover a broad range of instrumental activities of daily living that can increase the risk of unintentional injuries or harm. Empirical evidence suggests that the Safety Assessment Measure items have excellent content validity. Future research should use modern psychometric methods to examine each scale unidimensionality, model fit, and precision. |
Injury Prevention at the US-Centers for Disease Control and Prevention
Sleet D , Ying C , Sauber-Schatz E . Inj Med 2015 4 (2) 44-53 Injuries kill more than 180 000 people each year in the USA—that’s 1 death every 3 minutes. Regardless of sex, race, or economic status, violence and injuries affect everyone. From ages 1~44, more Americans die from violence and injuries—such as motor vehicle crashes, falls or homicides—than from any other cause, including infectious and non-communicable diseases[1] (Fig 1). And injury deaths are only part of the picture. Millions of Americans are injured each year and survive. Many of them are faced with life-long health, social and financial problems. | | In 1985, the US National Research Council and the Institute of Medicine (IOM) recognized the need for a coordinated effort to prevent injuries in the United States[2]. They identified CDC as the federal agency best suited to lead injury research. CDC had a strong history of interdisciplinary research, data collection and analysis, information sharing, and relationships with states-elements the Research Council and IOM deemed important. And unlike other federal agencies involved in injury prevention, CDC had no regulatory or enforcement role. In 1997, the IOM Committee on Injury Prevention and Control recommended that no one agency could effectively serve as the sole leader for injury. Rather, agencies should collaborate in injury prevention and control activities, with each agency leading in its area of expertise. CDC’s Injury Center now functions as the focal point and lead agency within the US Department of Health and Human Services for preventing injuries. |
Preventing unintentional injuries in the home using the Health Impact Pyramid
Mack KA , Liller KD , Baldwin G , Sleet D . Health Educ Behav 2015 42 115s-22s Injuries continue to be the leading cause of death for the first four decades of life. These injuries result from a confluence of behavioral, physical, structural, environmental, and social factors. Taken together, these illustrate the importance of taking a broad and multileveled approach to injury prevention. Using examples from fall, fire, scald, and poisoning-related injuries, this article illustrates the utility of an approach that incorporates a social-environmental perspective in identifying and selecting interventions to improve the health and safety of individuals. Injury prevention efforts to prevent home injuries benefit from multilevel modifications of behavior, public policy, laws and enforcement, the environment, consumer products and engineering standards, as demonstrated with Frieden's Health Impact Pyramid. A greater understanding, however, is needed to explain the associations between tiers. While interventions that include modifications of the social environment are being field-tested, much more work needs to be done in measuring social-environmental change and in evaluating these programs to disentangle what works best. |
Building safety into active living initiatives
Pollack K , Bailey M , Gielen A , Wolf S , Auld ME , Sleet DA , Lee KK . Prev Med 2014 69 Suppl 1 S102-5 OBJECTIVE: Efforts to promote environmental designs that facilitate opportunities for physical activity should consider the fact that injuries are the leading cause of death for Americans ages 1 to 44, with transportation-related injuries the most common cause. Drawing on the latest research and best practices in the field of injury prevention, the purpose of this article is to provide those working to promote physical activity with evidence-based recommendations on building in safety while designing active environments. METHOD: A systematic review of the peer-reviewed and gray literature published from 1995 to 2012 was conducted to identify injury prevention strategies applicable to objectives in the Active Design Guidelines (ADG), which present design strategies for active living. Injury prevention strategies were rated according to the strength of the research evidence. RESULTS: We identified 18 urban design strategies and 9 building design strategies that promote safety. Evidence was strong or emerging for 14/18 urban design strategies and 7/9 building design strategies. CONCLUSION: ADG strategies are often wholly compatible with well-accepted injury prevention principles. By partnering with architects and planners, injury prevention and public health professionals can help ensure that new and renovated spaces maximize both active living and safety. |
Can an evidence-based fall prevention program be translated for use in culturally diverse communities?
Sleet DA , Baldwin GT . J Sport Health Sci 2014 3 (1) 32-33 Older adult falls remain a significant public health problem amenable to preventive interventions (CDC, 2009; CDC, 2011). Despite the progress made in identifying risk factors, developing efficacious health-related interventions, and promoting evidence-based programs in the community, much work remains before these strategies are broadly available and effectively used to reduce fall-related injuries (Noonan, Sleet, Stevens, 2011). Newton and Scott-Findlay (2007) point out that the translation of basic scientific knowledge into clinical studies, and from clinical studies to improvements in health services and public health practices, remain major obstacles to widespread adoption. | Donaldson and Finch (2013) showed the feasibility of applying implementation science to sports injury prevention and Li et al (2008) demonstrated how an exercise and balance program (Tai Chi) can successfully be translated into a community program. As important, Li and colleagues maintained program fidelity and adherence to their intervention, at least over the short term, to prevent older adult falls. Manson et al (2013) showed positive results taking a Tai Chi program to low-income older adults, concluding that “non-(Tai chi) culturally related ethnic groups did not experience a barrier to participation in an older low-socioeconomic population sample” (p270). However, the sample consisted of only 56 participants who were recruited into a 16-week program and no attempt was made to translate the findings to the wider multi-ethnic community through the use of existing stakeholders. |
CDC Grand Rounds: evidence-based injury prevention
Degutis LC , Sleet DA , Kohn M , Benjamin G , Cohen N , Iskander J . MMWR Morb Mortal Wkly Rep 2014 62 1048-50 Approximately 5.8 million persons die from injuries each year, accounting for 10% of all deaths worldwide. In the United States, 180,000 persons die each year from injuries, making the category the country's leading cause of death for those aged 1-44 years and the leading cause of years of potential life lost before age 65 years. Injuries also result in 2.8 million hospitalizations and 29 million emergency department visits each year in the United States. Motor vehicle crashes, falls, homicides, suicides, domestic violence, child maltreatment, and other forms of intentional and unintentional injury affect all strata of society, with widespread physical, mental, and reproductive health consequences. Injuries and violence affect not only individuals, but also families and communities, producing substantial economic and societal burdens related to health-care costs, work loss, and disruption of education. The estimated annual U.S. cost in medical expenses and lost productivity resulting from injuries is $355 billion. |
Motor vehicle injury prevention
Sleet DA , Viano DC , Dellinger A . Oxford Bibliographies, Public Health 2013 One hundred years after the first self-propelled vehicle was invented, the world’s first recorded traffic death occurred when Mary Ward was thrown from the passenger seat of her cousin’s steam-powered car and rolled underneath the vehicle traveling 3-4 mph in Ireland on August 31, 1869. The first traffic fatality in the United States reportedly occurred in New York City in 1899 when Henry H. Bliss stepped off a streetcar and was struck by a passing electric-powered taxicab at the corner of Central Park West and 74th Street. By 1900 the yearly traffic death toll in the United States was up to thirty-six, and by 1972 a staggering 54,000 people were killed in traffic, and 2 million maimed. In 2009, traffic injuries were the leading cause of death of Americans aged 10–14, 15–19, and 20–24. The annual cost of motor vehicle–related fatal and nonfatal injuries is $99 billion in medical expenses and lost productivity, which is nearly the equivalent of $500 for each licensed driver in the United States. Motor vehicle travel is the most common form of transportation in the United States, although pedestrians, motorcyclists, and bicyclists are also injured in traffic. The number of registered automobiles in the United States grew from 8,000 in 1900 to 250 million in 2010, yet deaths per 100 million vehicle miles traveled actually declined by 77 percent between 1966 and 2010. Advances in the safety of vehicles, improved roads, and changes in driver behavior have led to this improvement. The conceptualization of this approach was fostered by William Haddon Jr., who developed models for exploring countermeasures to reduce or prevent injuries involving elements in the causal sequence related to the host (driver and passenger), agent (vehicle), and environment (roads and highways). Still, in 2009, the United States lost 33,808 people in traffic crashes. The major risk factors include non-use of seat belts and child restraints, alcohol, speed, non-use of helmets, and distracted driving. According to Rumar (The role of perceptual and cognitive filters in observed behavior, in Human behavior and traffic safety, Edited by L. Evans and R. Schwing. New York: Plenum, 1985) only 3 percent of crashes are due solely to the roadway environment, 2 percent solely to vehicles, and 27 percent to the combination of road environment and drivers. Globally, 1.3 million people die each year from road traffic injuries, or about 3,000 each day. Around 90 percent of those deaths occur in low- and middle-income countries. By 2020, traffic-related injuries will be the third leading contributor to the global burden of disease and injury, up from the eighth leading cause in 2009. This article describes the science of motor vehicle injury prevention and control, and identifies resources on the history, development, and application of principles of injury control to reduce traffic injury. |
Case study: the Argentina Road Safety Project: lessons learned for the decade of action for road safety, 2011-2020
Raffo V , Bliss T , Shotten M , Sleet D , Blanchard C . Glob Health Promot 2013 20 20-36 This case study of the Argentina Road Safety Project demonstrates how the application of World Bank road safety project guidelines focused on institution building can accelerate knowledge transfer, scale up investment and improve the focus on results. The case study highlights road safety as a development priority and outlines World Bank initiatives addressing the implementation of the World Report on Road Traffic Injury's recommendations and the subsequent launch of the Decade of Action for Road Safety, from 2011-2020. The case study emphasizes the vital role played by the lead agency in ensuring sustainable road safety improvements and promoting the shift to a 'Safe System' approach, which necessitated the strengthening of all elements of the road safety management system. It summarizes road safety performance and institutional initiatives in Argentina leading up to the preparation and implementation of the project. We describe the project's development objectives, financing arrangements, specific components and investment staging. Finally, we discuss its innovative features and lessons learned, and present a set of supplementary guidelines, both to assist multilateral development banks and their clients with future road safety initiatives, and to encourage better linkages between the health and transportation sectors supporting them. |
Prevention of injury and violence in the USA
Haegerich TM , Dahlberg LL , Simon TR , Baldwin GT , Sleet DA , Greenspan AI , Degutis LC . Lancet 2014 384 (9937) 64-74 In the first three decades of life, more individuals in the USA die from injuries and violence than from any other cause. Millions more people survive and are left with physical, emotional, and financial problems. Injuries and violence are not accidents; they are preventable. Prevention has a strong scientific foundation, yet efforts are not fully implemented or integrated into clinical and community settings. In this Series paper, we review the burden of injuries and violence in the USA, note effective interventions, and discuss methods to bring interventions into practice. Alliances between the public health community and medical care organisations, health-care providers, states, and communities can reduce injuries and violence. We encourage partnerships between medical and public health communities to consistently frame injuries and violence as preventable, identify evidence-based interventions, provide scientific information to decision makers, and strengthen the capacity of an integrated health system to prevent injuries and violence. |
Publicized sobriety checkpoint programs: a Community Guide systematic review
Bergen G , Pitan A , Qu S , Shults RA , Chattopadhyay SK , Elder RW , Sleet DA , Coleman HL , Compton RP , Nichols JL , Clymer JM , Calvert WB . Am J Prev Med 2014 46 (5) 529-539 CONTEXT: Publicized sobriety checkpoint programs deter alcohol-impaired driving by stopping drivers systematically to assess their alcohol impairment. Sobriety checkpoints were recommended in 2001 by the Community Preventive Services Task Force for reducing alcohol-impaired driving, based on strong evidence of effectiveness. Since the 2001 review, attention to alcohol-impaired driving as a U.S. public health problem has decreased. This systematic review was conducted to determine if available evidence supports the effectiveness of publicized sobriety checkpoint programs in reducing alcohol-impaired driving, given the current context. The economic costs and benefits of the intervention were also assessed. EVIDENCE ACQUISITION: This review focused on studies that evaluated the effects of publicized sobriety checkpoint programs on alcohol-involved crash fatalities. Using Community Guide methods, a systematic search was conducted for studies published between July 2000 and March 2012 that assessed the effectiveness of publicized sobriety checkpoint programs. EVIDENCE SYNTHESIS: Fourteen evaluations of selective breath testing and one of random breath testing checkpoints met the inclusion criteria for the systematic review, conducted in 2012. Ten evaluations assessed the effects of publicized sobriety checkpoint programs on alcohol-involved crash fatalities, finding a median reduction of 8.9% in this crash type (interquartile interval=-16.5%, -3.5%). Five economic evaluations showed benefit-cost ratios ranging from 2:1 to 57:1. CONCLUSIONS: The number of studies, magnitude of effect, and consistency of findings indicate strong evidence of the effectiveness of publicized sobriety checkpoint programs in reducing alcohol-involved crash fatalities. Economic evidence shows that these programs also have the potential for substantial cost savings. |
Motorcycle helmet attitudes, behaviours and beliefs among Cambodians
Roehler DR , Sann S , Kim P , Bachani AM , Campostrini S , Florian M , Sidik M , Blanchard C , Sleet DA , Hyder AA , Ballesteros MF . Int J Inj Contr Saf Promot 2013 20 (2) 179-83 Motorcycle fatalities are increasing at an alarming rate in many South-East Asian countries, including Cambodia. Through brief face-to-face roadside interviews in Phnom Penh and four other Cambodian provinces, this article assesses Cambodian motorcyclists' attitudes, behaviours and beliefs related to motorcycle helmets. Out of 1016 motorcyclists interviewed, 50% were drivers, 40% were older passengers and 10% were child passengers. More drivers (50%) reported consistently wearing helmets, compared with older passengers (14%). Saving their life in the event of a crash was the impetus for drivers and older passengers to wear a helmet (96% and 98%, respectively). The top barriers to helmet use were: (1) 'depends on where I drive,' (2) 'I forget' and (3) 'inconvenient' or 'uncomfortable'. These descriptive findings were instrumental in shaping the Cambodian Helmet Vaccine Initiative passenger campaign to reduce the motorcycle-related injuries and fatalities to support the United Nations Decade of Action for Road Safety. |
The state of US health, 1990-2010: burden of diseases, injuries, and risk factors
Murray CJ , Abraham J , Ali MK , Alvarado M , Atkinson C , Baddour LM , Bartels DH , Benjamin EJ , Bhalla K , Birbeck G , Bolliger I , Burstein R , Carnahan E , Chen H , Chou D , Chugh SS , Cohen A , Colson KE , Cooper LT , Couser W , Criqui MH , Dabhadkar KC , Dahodwala N , Danaei G , Dellavalle RP , Des Jarlais DC , Dicker D , Ding EL , Dorsey ER , Duber H , Ebel BE , Engell RE , Ezzati M , Felson DT , Finucane MM , Flaxman S , Flaxman AD , Fleming T , Forouzanfar MH , Freedman G , Freeman MK , Gabriel SE , Gakidou E , Gillum RF , Gonzalez-Medina D , Gosselin R , Grant B , Gutierrez HR , Hagan H , Havmoeller R , Hoffman H , Jacobsen KH , James SL , Jasrasaria R , Jayaraman S , Johns N , Kassebaum N , Khatibzadeh S , Knowlton LM , Lan Q , Leasher JL , Lim S , Lin JK , Lipshultz SE , London S , Lozano R , Lu Y , Macintyre MF , Mallinger L , McDermott MM , Meltzer M , Mensah GA , Michaud C , Miller TR , Mock C , Moffitt TE , Mokdad AA , Mokdad AH , Moran AE , Mozaffarian D , Murphy T , Naghavi M , Narayan KM , Nelson RG , Olives C , Omer SB , Ortblad K , Ostro B , Pelizzari PM , Phillips D , Pope CA , Raju M , Ranganathan D , Razavi H , Ritz B , Rivara FP , Roberts T , Sacco RL , Salomon JA , Sampson U , Sanman E , Sapkota A , Schwebel DC , Shahraz S , Shibuya K , Shivakoti R , Silberberg D , Singh GM , Singh D , Singh JA , Sleet DA , Steenland K , Tavakkoli M , Taylor JA , Thurston GD , Towbin JA , Vavilala MS , Vos T , Wagner GR , Weinstock MA , Weisskopf MG , Wilkinson JD , Wulf S , Zabetian A , Lopez AD . JAMA 2013 310 (6) 591-608 IMPORTANCE: Understanding the major health problems in the United States and how they are changing over time is critical for informing national health policy. OBJECTIVES: To measure the burden of diseases, injuries, and leading risk factors in the United States from 1990 to 2010 and to compare these measurements with those of the 34 countries in the Organisation for Economic Co-operation and Development (OECD) countries. DESIGN: We used the systematic analysis of descriptive epidemiology of 291 diseases and injuries, 1160 sequelae of these diseases and injuries, and 67 risk factors or clusters of risk factors from 1990 to 2010 for 187 countries developed for the Global Burden of Disease 2010 Study to describe the health status of the United States and to compare US health outcomes with those of 34 OECD countries. Years of life lost due to premature mortality (YLLs) were computed by multiplying the number of deaths at each age by a reference life expectancy at that age. Years lived with disability (YLDs) were calculated by multiplying prevalence (based on systematic reviews) by the disability weight (based on population-based surveys) for each sequela; disability in this study refers to any short- or long-term loss of health. Disability-adjusted life-years (DALYs) were estimated as the sum of YLDs and YLLs. Deaths and DALYs related to risk factors were based on systematic reviews and meta-analyses of exposure data and relative risks for risk-outcome pairs. Healthy life expectancy (HALE) was used to summarize overall population health, accounting for both length of life and levels of ill health experienced at different ages. RESULTS: US life expectancy for both sexes combined increased from 75.2 years in 1990 to 78.2 years in 2010; during the same period, HALE increased from 65.8 years to 68.1 years. The diseases and injuries with the largest number of YLLs in 2010 were ischemic heart disease, lung cancer, stroke, chronic obstructive pulmonary disease, and road injury. Age-standardized YLL rates increased for Alzheimer disease, drug use disorders, chronic kidney disease, kidney cancer, and falls. The diseases with the largest number of YLDs in 2010 were low back pain, major depressive disorder, other musculoskeletal disorders, neck pain, and anxiety disorders. As the US population has aged, YLDs have comprised a larger share of DALYs than have YLLs. The leading risk factors related to DALYs were dietary risks, tobacco smoking, high body mass index, high blood pressure, high fasting plasma glucose, physical inactivity, and alcohol use. Among 34 OECD countries between 1990 and 2010, the US rank for the age-standardized death rate changed from 18th to 27th, for the age-standardized YLL rate from 23rd to 28th, for the age-standardized YLD rate from 5th to 6th, for life expectancy at birth from 20th to 27th, and for HALE from 14th to 26th. CONCLUSIONS AND RELEVANCE: From 1990 to 2010, the United States made substantial progress in improving health. Life expectancy at birth and HALE increased, all-cause death rates at all ages decreased, and age-specific rates of years lived with disability remained stable. However, morbidity and chronic disability now account for nearly half of the US health burden, and improvements in population health in the United States have not kept pace with advances in population health in other wealthy nations. |
Years of potential life lost from unintentional child and adolescent injuries - United States, 2000-2009
Borse NN , Rudd RA , Dellinger AM , Sleet DA . J Safety Res 2013 45 127-31 INTRODUCTION: Quantifying years of potential life lost (YPLL) highlights childhood causes of mortality and provides a simple method to identify important causes of premature death. METHODS: CDC analyzed data from the National Vital Statistics System multiple cause of death files for 2000-2009. RESULTS: An average of 890YPLL were lost each year due to unintentional injuries for every 100,000 persons aged 0-19 years. YPLL rates differed by sex, age group, race/ethnicity, injury mechanism and state. CONCLUSIONS: This report provides new information which can be used to prioritize interventions and identify subgroups of the population most at risk. |
Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010
Vos Theo , Flaxman Abraham D , Naghavi Mohsen , Lozano Rafael , Michaud Catherine , Ezzati Majid , Shibuya Kenji , Salomon Joshua A , Abdalla Safa , Aboyans Victor , Abraham Jerry , Ackerman Ilana , Aggarwal Rakesh , Ahn Stephanie Y , Ali Mohammed K , Alvarado Miriam , Anderson H Ross , Anderson Laurie M , Andrews Kathryn G , Atkinson Charles , Baddour Larry M , Bahalim Adil N , Barker-Collo Suzanne , Barrero Lope H , Bartels David H , Basanez Maria-Gloria , Baxter Amanda , Bell Michelle L , Benjamin Emelia J , Bennett Derrick , Bernabe Eduardo , Bhalla Kavi , Bhandari Bishal , Bikbov Boris , Bin Abdulhak Aref , Birbeck Gretchen , Black James A , Blencowe Hannah , Blore Jed D , Blyth Fiona , Bolliger Ian , Bonaventure Audrey , Boufous Soufiane , Bourne Rupert , Boussinesq Michel , Braithwaite Tasanee , Brayne Carol , Bridgett Lisa , Brooker Simon , Brooks Peter , Brugha Traolach S , Bryan-Hancock Claire , Bucello Chiara , Buchbinder Rachelle , Buckle Geoffrey , Budke Christine M , Burch Michael , Burney Peter , Burstein Roy , Calabria Bianca , Campbell Benjamin , Canter Charles E , Carabin Helene , Carapetis Jonathan , Carmona Loreto , Cella Claudia , Charlson Fiona , Chen Honglei , Cheng Andrew Tai-Ann , Chou David , Chugh Sumeet S , Coffeng Luc E , Colan Steven D , Colquhoun Samantha , Colson K Ellicott , Condon John , Connor Myles D , Cooper Leslie T , Corriere Matthew , Cortinovis Monica , de Vaccaro Karen Courville , Couser William , Cowie Benjamin C , Criqui Michael H , Cross Marita , Dabhadkar Kaustubh C , Dahiya Manu , Dahodwala Nabila , Damsere-Derry James , Danaei Goodarz , Davis Adrian , De Leo Diego , Degenhardt Louisa , Dellavalle Robert , Delossantos Allyne , Denenberg Julie , Derrett Sarah , Des Jarlais Don C , Dharmaratne Samath D , Dherani Mukesh , Diaz-Torne Cesar , Dolk Helen , Dorsey E Ray , Driscoll Tim , Duber Herbert , Ebel Beth , Edmond Karen , Elbaz Alexis , Ali Suad Eltahir , Erskine Holly , Erwin Patricia J , Espindola Patricia , Ewoigbokhan Stalin E , Farzadfar Farshad , Feigin Valery , Felson David T , Ferrari Alize , Ferri Cleusa P , Fevre Eric M , Finucane Mariel M , Flaxman Seth , Flood Louise , Foreman Kyle , Forouzanfar Mohammad H , Fowkes Francis Gerry R , Franklin Richard , Fransen Marlene , Freeman Michael K , Gabbe Belinda J , Gabriel Sherine E , Gakidou Emmanuela , Ganatra Hammad A , Garcia Bianca , Gaspari Flavio , Gillum Richard F , Gmel Gerhard , Gosselin Richard , Grainger Rebecca , Groeger Justina , Guillemin Francis , Gunnell David , Gupta Ramyani , Haagsma Juanita , Hagan Holly , Halasa Yara A , Hall Wayne , Haring Diana , Haro Josep Maria , Harrison James E , Havmoeller Rasmus , Hay Roderick J , Higashi Hideki , Hill Catherine , Hoen Bruno , Hoffman Howard , Hotez Peter J , Hoy Damian , Huang John J , Ibeanusi Sydney E , Jacobsen Kathryn H , James Spencer L , Jarvis Deborah , Jasrasaria Rashmi , Jayaraman Sudha , Johns Nicole , Jonas Jost B , Karthikeyan Ganesan , Kassebaum Nicholas , Kawakami Norito , Keren Andre , Khoo Jon-Paul , King Charles H , Knowlton Lisa Marie , Kobusingye Olive , Koranteng Adofo , Krishnamurthi Rita , Lalloo Ratilal , Laslett Laura L , Lathlean Tim , Leasher Janet L , Lee Yong Yi , Leigh James , Lim Stephen S , Limb Elizabeth , Lin John Kent , Lipnick Michael , Lipshultz Steven E , Liu Wei , Loane Maria , Ohno Summer Lockett , Lyons Ronan , Ma Jixiang , Mabweijano Jacqueline , MacIntyre Michael F , Malekzadeh Reza , Mallinger Leslie , Manivannan Sivabalan , Marcenes Wagner , March Lyn , Margolis David J , Marks Guy B , Marks Robin , Matsumori Akira , Matzopoulos Richard , Mayosi Bongani M , McAnulty John H , McDermott Mary M , McGill Neil , McGrath John , Medina-Mora Maria Elena , Meltzer Michele , Mensah George A , Merriman Tony R , Meyer Ana-Claire , Miglioli Valeria , Miller Matthew , Miller Ted R , Mitchell Philip B , Mocumbi Ana Olga , Moffitt Terrie E , Mokdad Ali A , Monasta Lorenzo , Montico Marcella , Moradi-Lakeh Maziar , Moran Andrew , Morawska Lidia , Mori Rintaro , Murdoch Michele E , Mwaniki Michael K , Naidoo Kovin , Nair M Nathan , Naldi Luigi , Narayan K M Venkat , Nelson Paul K , Nelson Robert G , Nevitt Michael C , Newton Charles R , Nolte Sandra , Norman Paul , Norman Rosana , O'Donnell Martin , O'Hanlon Simon , Olives Casey , Omer Saad B , Ortblad Katrina , Osborne Richard , Ozgediz Doruk , Page Andrew , Pahari Bishnu , Pandian Jeyaraj Durai , Rivero Andrea Panozo , Patten Scott B , Pearce Neil , Padilla Rogelio Perez , Perez-Ruiz Fernando , Perico Norberto , Pesudovs Konrad , Phillips David , Phillips Michael R , Pierce Kelsey , Pion Sebastien , Polanczyk Guilherme V , Polinder Suzanne , Pope C Arden 3rd , Popova Svetlana , Porrini Esteban , Pourmalek Farshad , Prince Martin , Pullan Rachel L , Ramaiah Kapa D , Ranganathan Dharani , Razavi Homie , Regan Mathilda , Rehm Jurgen T , Rein David B , Remuzzi Guiseppe , Richardson Kathryn , Rivara Frederick P , Roberts Thomas , Robinson Carolyn , De Leon Felipe Rodriguez , Ronfani Luca , Room Robin , Rosenfeld Lisa C , Rushton Lesley , Sacco Ralph L , Saha Sukanta , Sampson Uchechukwu , Sanchez-Riera Lidia , Sanman Ella , Schwebel David C , Scott James Graham , Segui-Gomez Maria , Shahraz Saeid , Shepard Donald S , Shin Hwashin , Shivakoti Rupak , Singh David , Singh Gitanjali M , Singh Jasvinder A , Singleton Jessica , Sleet David A , Sliwa Karen , Smith Emma , Smith Jennifer L , Stapelberg Nicolas J C , Steer Andrew , Steiner Timothy , Stolk Wilma A , Stovner Lars Jacob , Sudfeld Christopher , Syed Sana , Tamburlini Giorgio , Tavakkoli Mohammad , Taylor Hugh R , Taylor Jennifer A , Taylor William J , Thomas Bernadette , Thomson W Murray , Thurston George D , Tleyjeh Imad M , Tonelli Marcello , Towbin Jeffrey A , Truelsen Thomas , Tsilimbaris Miltiadis K , Ubeda Clotilde , Undurraga Eduardo A , van der Werf Marieke J , van Os Jim , Vavilala Monica S , Venketasubramanian N , Wang Mengru , Wang Wenzhi , Watt Kerrianne , Weatherall David J , Weinstock Martin A , Weintraub Robert , Weisskopf Marc G , Weissman Myrna M , White Richard A , Whiteford Harvey , Wiersma Steven T , Wilkinson James D , Williams Hywel C , Williams Sean R M , Witt Emma , Wolfe Frederick , Woolf Anthony D , Wulf Sarah , Yeh Pon-Hsiu , Zaidi Anita K M , Zheng Zhi-Jie , Zonies David , Lopez Alan D , Murray Christopher J L , Global Burden of Disease Study 2010 . Lancet 2013 380 (9859) 2163-96 BACKGROUND: Non-fatal health outcomes from diseases and injuries are a crucial consideration in the promotion and monitoring of individual and population health. The Global Burden of Disease (GBD) studies done in 1990 and 2000 have been the only studies to quantify non-fatal health outcomes across an exhaustive set of disorders at the global and regional level. Neither effort quantified uncertainty in prevalence or years lived with disability (YLDs). METHODS: Of the 291 diseases and injuries in the GBD cause list, 289 cause disability. For 1160 sequelae of the 289 diseases and injuries, we undertook a systematic analysis of prevalence, incidence, remission, duration, and excess mortality. Sources included published studies, case notification, population-based cancer registries, other disease registries, antenatal clinic serosurveillance, hospital discharge data, ambulatory care data, household surveys, other surveys, and cohort studies. For most sequelae, we used a Bayesian meta-regression method, DisMod-MR, designed to address key limitations in descriptive epidemiological data, including missing data, inconsistency, and large methodological variation between data sources. For some disorders, we used natural history models, geospatial models, back-calculation models (models calculating incidence from population mortality rates and case fatality), or registration completeness models (models adjusting for incomplete registration with health-system access and other covariates). Disability weights for 220 unique health states were used to capture the severity of health loss. YLDs by cause at age, sex, country, and year levels were adjusted for comorbidity with simulation methods. We included uncertainty estimates at all stages of the analysis. FINDINGS: Global prevalence for all ages combined in 2010 across the 1160 sequelae ranged from fewer than one case per 1 million people to 350,000 cases per 1 million people. Prevalence and severity of health loss were weakly correlated (correlation coefficient -0.37). In 2010, there were 777 million YLDs from all causes, up from 583 million in 1990. The main contributors to global YLDs were mental and behavioural disorders, musculoskeletal disorders, and diabetes or endocrine diseases. The leading specific causes of YLDs were much the same in 2010 as they were in 1990: low back pain, major depressive disorder, iron-deficiency anaemia, neck pain, chronic obstructive pulmonary disease, anxiety disorders, migraine, diabetes, and falls. Age-specific prevalence of YLDs increased with age in all regions and has decreased slightly from 1990 to 2010. Regional patterns of the leading causes of YLDs were more similar compared with years of life lost due to premature mortality. Neglected tropical diseases, HIV/AIDS, tuberculosis, malaria, and anaemia were important causes of YLDs in sub-Saharan Africa. INTERPRETATION: Rates of YLDs per 100,000 people have remained largely constant over time but rise steadily with age. Population growth and ageing have increased YLD numbers and crude rates over the past two decades. Prevalences of the most common causes of YLDs, such as mental and behavioural disorders and musculoskeletal disorders, have not decreased. Health systems will need to address the needs of the rising numbers of individuals with a range of disorders that largely cause disability but not mortality. Quantification of the burden of non-fatal health outcomes will be crucial to understand how well health systems are responding to these challenges. Effective and affordable strategies to deal with this rising burden are an urgent priority for health systems in most parts of the world. FUNDING: Bill & Melinda Gates Foundation. |
A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010
Lim Stephen S , Vos Theo , Flaxman Abraham D , Danaei Goodarz , Shibuya Kenji , Adair-Rohani Heather , Amann Markus , Anderson H Ross , Andrews Kathryn G , Aryee Martin , Atkinson Charles , Bacchus Loraine J , Bahalim Adil N , Balakrishnan Kalpana , Balmes John , Barker-Collo Suzanne , Baxter Amanda , Bell Michelle L , Blore Jed D , Blyth Fiona , Bonner Carissa , Borges Guilherme , Bourne Rupert , Boussinesq Michel , Brauer Michael , Brooks Peter , Bruce Nigel G , Brunekreef Bert , Bryan-Hancock Claire , Bucello Chiara , Buchbinder Rachelle , Bull Fiona , Burnett Richard T , Byers Tim E , Calabria Bianca , Carapetis Jonathan , Carnahan Emily , Chafe Zoe , Charlson Fiona , Chen Honglei , Chen Jian Shen , Cheng Andrew Tai-Ann , Child Jennifer Christine , Cohen Aaron , Colson K Ellicott , Cowie Benjamin C , Darby Sarah , Darling Susan , Davis Adrian , Degenhardt Louisa , Dentener Frank , Des Jarlais Don C , Devries Karen , Dherani Mukesh , Ding Eric L , Dorsey E Ray , Driscoll Tim , Edmond Karen , Ali Suad Eltahir , Engell Rebecca E , Erwin Patricia J , Fahimi Saman , Falder Gail , Farzadfar Farshad , Ferrari Alize , Finucane Mariel M , Flaxman Seth , Fowkes Francis Gerry R , Freedman Greg , Freeman Michael K , Gakidou Emmanuela , Ghosh Santu , Giovannucci Edward , Gmel Gerhard , Graham Kathryn , Grainger Rebecca , Grant Bridget , Gunnell David , Gutierrez Hialy R , Hall Wayne , Hoek Hans W , Hogan Anthony , Hosgood H Dean 3rd , Hoy Damian , Hu Howard , Hubbell Bryan J , Hutchings Sally J , Ibeanusi Sydney E , Jacklyn Gemma L , Jasrasaria Rashmi , Jonas Jost B , Kan Haidong , Kanis John A , Kassebaum Nicholas , Kawakami Norito , Khang Young-Ho , Khatibzadeh Shahab , Khoo Jon-Paul , Kok Cindy , Laden Francine , Lalloo Ratilal , Lan Qing , Lathlean Tim , Leasher Janet L , Leigh James , Li Yang , Lin John Kent , Lipshultz Steven E , London Stephanie , Lozano Rafael , Lu Yuan , Mak Joelle , Malekzadeh Reza , Mallinger Leslie , Marcenes Wagner , March Lyn , Marks Robin , Martin Randall , McGale Paul , McGrath John , Mehta Sumi , Mensah George A , Merriman Tony R , Micha Renata , Michaud Catherine , Mishra Vinod , Hanafiah Khayriyyah Mohd , Mokdad Ali A , Morawska Lidia , Mozaffarian Dariush , Murphy Tasha , Naghavi Mohsen , Neal Bruce , Nelson Paul K , Nolla Joan Miquel , Norman Rosana , Olives Casey , Omer Saad B , Orchard Jessica , Osborne Richard , Ostro Bart , Page Andrew , Pandey Kiran D , Parry Charles D H , Passmore Erin , Patra Jayadeep , Pearce Neil , Pelizzari Pamela M , Petzold Max , Phillips Michael R , Pope Dan , Pope C Arden 3rd , Powles John , Rao Mayuree , Razavi Homie , Rehfuess Eva A , Rehm Jurgen T , Ritz Beate , Rivara Frederick P , Roberts Thomas , Robinson Carolyn , Rodriguez-Portales Jose A , Romieu Isabelle , Room Robin , Rosenfeld Lisa C , Roy Ananya , Rushton Lesley , Salomon Joshua A , Sampson Uchechukwu , Sanchez-Riera Lidia , Sanman Ella , Sapkota Amir , Seedat Soraya , Shi Peilin , Shield Kevin , Shivakoti Rupak , Singh Gitanjali M , Sleet David A , Smith Emma , Smith Kirk R , Stapelberg Nicolas J C , Steenland Kyle , Stockl Heidi , Stovner Lars Jacob , Straif Kurt , Straney Lahn , Thurston George D , Tran Jimmy H , Van Dingenen Rita , van Donkelaar Aaron , Veerman J Lennert , Vijayakumar Lakshmi , Weintraub Robert , Weissman Myrna M , White Richard A , Whiteford Harvey , Wiersma Steven T , Wilkinson James D , Williams Hywel C , Williams Warwick , Wilson Nicholas , Woolf Anthony D , Yip Paul , Zielinski Jan M , Lopez Alan D , Murray Christopher J L , Ezzati Majid , Global Burden of Disease Study 2010 . Lancet 2013 380 (9859) 2224-60 BACKGROUND: Quantification of the disease burden caused by different risks informs prevention by providing an account of health loss different to that provided by a disease-by-disease analysis. No complete revision of global disease burden caused by risk factors has been done since a comparative risk assessment in 2000, and no previous analysis has assessed changes in burden attributable to risk factors over time. METHODS: We estimated deaths and disability-adjusted life years (DALYs; sum of years lived with disability [YLD] and years of life lost [YLL]) attributable to the independent effects of 67 risk factors and clusters of risk factors for 21 regions in 1990 and 2010. We estimated exposure distributions for each year, region, sex, and age group, and relative risks per unit of exposure by systematically reviewing and synthesising published and unpublished data. We used these estimates, together with estimates of cause-specific deaths and DALYs from the Global Burden of Disease Study 2010, to calculate the burden attributable to each risk factor exposure compared with the theoretical-minimum-risk exposure. We incorporated uncertainty in disease burden, relative risks, and exposures into our estimates of attributable burden. FINDINGS: In 2010, the three leading risk factors for global disease burden were high blood pressure (7.0% [95% uncertainty interval 6.2-7.7] of global DALYs), tobacco smoking including second-hand smoke (6.3% [5.5-7.0]), and alcohol use (5.5% [5.0-5.9]). In 1990, the leading risks were childhood underweight (7.9% [6.8-9.4]), household air pollution from solid fuels (HAP; 7.0% [5.6-8.3]), and tobacco smoking including second-hand smoke (6.1% [5.4-6.8]). Dietary risk factors and physical inactivity collectively accounted for 10.0% (95% UI 9.2-10.8) of global DALYs in 2010, with the most prominent dietary risks being diets low in fruits and those high in sodium. Several risks that primarily affect childhood communicable diseases, including unimproved water and sanitation and childhood micronutrient deficiencies, fell in rank between 1990 and 2010, with unimproved water and sanitation accounting for 0.9% (0.4-1.6) of global DALYs in 2010. However, in most of sub-Saharan Africa childhood underweight, HAP, and non-exclusive and discontinued breastfeeding were the leading risks in 2010, while HAP was the leading risk in south Asia. The leading risk factor in Eastern Europe, most of Latin America, and southern sub-Saharan Africa in 2010 was alcohol use; in most of Asia, North Africa and Middle East, and central Europe it was high blood pressure. Despite declines, tobacco smoking including second-hand smoke remained the leading risk in high-income north America and western Europe. High body-mass index has increased globally and it is the leading risk in Australasia and southern Latin America, and also ranks high in other high-income regions, North Africa and Middle East, and Oceania. INTERPRETATION: Worldwide, the contribution of different risk factors to disease burden has changed substantially, with a shift away from risks for communicable diseases in children towards those for non-communicable diseases in adults. These changes are related to the ageing population, decreased mortality among children younger than 5 years, changes in cause-of-death composition, and changes in risk factor exposures. New evidence has led to changes in the magnitude of key risks including unimproved water and sanitation, vitamin A and zinc deficiencies, and ambient particulate matter pollution. The extent to which the epidemiological shift has occurred and what the leading risks currently are varies greatly across regions. In much of sub-Saharan Africa, the leading risks are still those associated with poverty and those that affect children. FUNDING: Bill & Melinda Gates Foundation. |
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