Injuries as a Public Health ProblemInjuries as a Public Health Problem

Intermediate Injury Prevention Course

August 23-26, 2011

Billings, MT

Session Session ObjectivesObjectives

• Severity of injuries facing AI/AN communities

• Costs of injury / cost benefits of prevention

• Community benefits of injury prevention

• Public Health Approach to preventing injuries

• Value of data in preventing injury

Why Injury Prevention?Why Injury Prevention?

AI/AN injury rate higher than US all races

AI/AN’s ages 1-44 are greatly affected

Injuries are very costly to treat

Injuries in American Indian Injuries in American Indian and Alaska Native Communities and Alaska Native Communities

1981 - 2005, United States

All Injury Deaths and Rates per 100,000

Am Indian/AK Native and All U.S. and All U.S.

0

20

40

60

80

100

120

140

AI/AN US All Races

CDC WISQARS, 1981-2005

Fatal Injury Rates Per IHS AreaFatal Injury Rates Per IHS Area20072007

WA

Portland80.0 Billings

159.9Aberdeen

122.4 Bemidji77.2

OR ID

MT

WY

ND

SD

NE

MN

IA

WI

MI

IN

ME

NY

PA

California33.7

CA

NVUT

AZ

AK

CO

NM

KS

OK

TXLA

MS AL

FL

SC

NCTN

Tucson117.2

Navajo117.5

Albuquerque107.9

Oklahoma City62.3

Nashville47.4

Phoenix126.8

Alaska163.6

Source: National Center for Health Statistics – Vital Statistics Systems – CD WISQARS - Data includes all injury types Rates are per 100,000 service population

US All Races Rate: 59.3

Leading Causes of Death Leading Causes of Death AI/AN – Ages 1-44, US 2007AI/AN – Ages 1-44, US 2007

Cause Percentage Unintentional Injury 47.1%

Suicide 13.7%

Homicide 7.8%

Heart Disease 9.8%

Liver Disease 8.4%

Diabetes 2.3%

Other 10.6%

CDC WISQAR’S

Leading Causes of Unintentional Injury Death Leading Causes of Unintentional Injury Death AI/AN – Ages 1-44, US 2007AI/AN – Ages 1-44, US 2007

Cause Percentage Motor Vehicle 52.9%

Poisoning 21.7%

Drowning 4.9%

Pedestrian –Other 2.6%

Other 12.0%

Fire/Burn 1.9%

Natural Environmental 3.3%

CDC WISQAR’S

Leading Causes of Unintentional Injury Death Leading Causes of Unintentional Injury Death Billings AreaBillings Area

AI/AN – Ages 1-44, US 2007AI/AN – Ages 1-44, US 2007

Cause Percentage

Motor Vehicle 66.0%

Poisoning 9.4%

Drowning 7.5%

Pedestrian –Other 3.8%

Other 11.3%

Fire/Burn 1.9%

Natural Environmental 1.9%

CDC WISQAR’S

Leading Causes of Injury Death Leading Causes of Injury Death All ages AI/AN – (2007)All ages AI/AN – (2007)

Billings AreaBillings Area

Cause Rate US RateSuicide 23.9 11.4

Poisoning 27.6 9.9

MVC 69.0 13.7

Homicide 13.8 6.0

Firearms 2.5 4.9

Fall 2.5 7.0

Fire/Burn 0.0 1.0

Rates are per 100,000 service population CDC WISQAR’S

What are the costs of injury?What are the costs of injury?

Physical LossesPhysical Losses

FinancialFinancial

EmotionalEmotional

TreatmentTreatment

Financial Financial burdenburden of injury of injury

Buzz GroupBuzz Group

1. Why is cost important?2. Who would find cost interesting?

National Injury CostsNational Injury Costs$224 Billion Annually$224 Billion Annually

Cost involvedCost involved– Medical care, rehabilitation, lost wages / productivityMedical care, rehabilitation, lost wages / productivity

Who paysWho pays– Private share 72% (or about Private share 72% (or about $161 Billion$161 Billion))– Public share 28% (or about Public share 28% (or about $63 Billion$63 Billion) )

Federal shareFederal share– $12.6 Billion in medical costs$12.6 Billion in medical costs– $18.4 Billion in disability/death costs$18.4 Billion in disability/death costs

Source: CDC, National Center for Injury Prevention and ControlSource: CDC, National Center for Injury Prevention and Control

AI/AN Injury CostsAI/AN Injury Costs

IHS Injury Treatment CostsIHS Injury Treatment Costs– InpatientInpatient

» $1507/day (Medicaid reimbursement rate for 1 day at an IHS facility) $1507/day (Medicaid reimbursement rate for 1 day at an IHS facility)

– Contract HealthContract Health» $11,305/inpatient case$11,305/inpatient case» $570/outpatient case$570/outpatient case

One Alaska Corporation (TCC) spent One Alaska Corporation (TCC) spent $4.15 million$4.15 million for for injury hospitalizations from ’94-’98injury hospitalizations from ’94-’98

Sources - (1) Indian Health Focus-Injuries 1998-99 (2) Chandler B, Berger L: Financial Burden of Injury-Related Hospitalizations to an Alaska Native Health System

Financial Financial benefitsbenefits of of injury preventioninjury prevention

Interventions that Interventions that $$aveave Money Money

Primary seat belt laws/Child Car SeatsPrimary seat belt laws/Child Car Seats Streetlights and guardrailsStreetlights and guardrails Bike helmetsBike helmets DUI LawsDUI Laws Personal Floatation DevicesPersonal Floatation Devices Smoke detectorsSmoke detectors Gun locksGun locks

Safety equipment saves more Safety equipment saves more than lives . . .than lives . . .

Every bike helmet (for kids 4 – 15) saves $395 Every bike helmet (for kids 4 – 15) saves $395 in treatment costsin treatment costs

Every child seat saves $1,360Every child seat saves $1,360 Every smoke detector saves $900Every smoke detector saves $900

References: National Public Services Research Institute /References: National Public Services Research Institute /National SAFE KIDS CampaignNational SAFE KIDS Campaign

Injury Prevention:Injury Prevention: Potential for Cost SavingsPotential for Cost Savings

Victim Treatment costs resulting from each Motor Vehicle Crash:

NOT wearing a seat belt $2,395

Wearing a seat belt $470

Source - Phipps L: Cost Comparison of Medical Treatment for Restrained vs. Unrestrained Motor vehicle crash victims at a northeast Oklahoma IHS hospital (IHS Injury Prevention Fellowship)

Injury Prevention Cost Savings Injury Prevention Cost Savings Projects in Indian Country Projects in Indian Country

Navajo NationNavajo Nation – occupant restraint usage – occupant restraint usage

Whiteriver, AZWhiteriver, AZ – pedestrian crash reduction – pedestrian crash reduction

White Mountain ApacheWhite Mountain Apache – livestock control – livestock control

Y-K Delta, AKY-K Delta, AK – drowning prevention – drowning prevention

Community benefits from injury Community benefits from injury prevention cost savingsprevention cost savings

Elective medical servicesElective medical services– more non-emergent treatments (surgeries, more non-emergent treatments (surgeries,

therapies, preventive services, other programs)therapies, preventive services, other programs)

Resources for additional community servicesResources for additional community services– housing authoritieshousing authorities– transportation programstransportation programs

Public Health Public Health ApproachApproach

Define the Problem

•SurveillanceIdentify

Risk Factors

•Who, What?

Source: National Center for Injury Prevention and Control, CDC

Find what Prevents

the Problem

•What Works?

Implement &Evaluate Programs

•Prevention

Using Data to Define Injury ProblemsUsing Data to Define Injury Problems

Data identifies patterns and trends in Data identifies patterns and trends in injury injury

Observation data documents behaviorsObservation data documents behaviors

Interview and Focus Group data can be Interview and Focus Group data can be used to identify knowledge, perceptions, used to identify knowledge, perceptions, and attitudes about injuryand attitudes about injury

Collecting and Analyzing Data to Collecting and Analyzing Data to Determine Injury Risk FactorsDetermine Injury Risk Factors

Population at riskPopulation at risk – age, gender, specific groupage, gender, specific group

Location(s) of eventsLocation(s) of events– inside home, road location, at workinside home, road location, at work

Environmental factorsEnvironmental factors– lighting, road conditions, weatherlighting, road conditions, weather

Other factorsOther factors– alcohol use, use of safety devicesalcohol use, use of safety devices

Using Data to Select Using Data to Select Preventive MeasuresPreventive Measures

• Modify the EEnvironment

• EEducate the public

• Enact and EEnforce safety legislation

Using Data to Using Data to EvaluateEvaluate Programs Programs

• Help develop intervention materials

• Analyze effectiveness of methods used

• Use evaluation to improve prevention measures

SummarySummary

• Severity of injuries facing AI/AN communities

• Costs of injury / cost benefits of prevention

• Community benefits of injury prevention

• Public Health Approach to preventing injuries

• Value of data in preventing injury