Researchers see a decline in injuries worldwide

"The world is becoming a safer place to live," scientists write in a new paper.

People are getting injured much less frequently today than just two decades ago. In fact, the global injury rate has dropped by nearly a third from 1990 to 2013. 

Researchers attribute that progress in part to safety regulations and other injury prevention measures.

"Injury is always seen as an accident, like something that's happening to somebody and there's not a lot you can do to prevent it," study author Juanita Haagsma tells The Christian Science Monitor in an interview. But, she says, this study shows that injuries can be prevented.

Traffic accidents were linked to the most serious injuries in 2013, making up 29.1 percent of all injury-related deaths, according to the study published Dec. 3 in the journal Injury Prevention. But this number represents a decline in the frequency of transport-related injuries from 1990, by about 10 percent.

Dr. Haagsma says that traffic laws, seat belts, and other safety measures may have contributed to lowering that rate and the severity of those injuries. 

"Particularly in sub-saharan Africa, the decreases are not as large as in other parts of the world," she says. "Many of the countries in that region don't have any seatbelt laws or speed laws or other laws for traffic safety. I think that plays an important part here."

The researchers examined injuries associated with falls, self-harm, disasters, wars, and violence, and other factors in addition to road traffic accidents. In order to be counted, the injury must have prompted medical attention. That could mean a short trip to a doctor's office or a hospital stay.

Haagsma says that in 2013 some about 970 million people sustained injuries that were treated with some type of healthcare. Of, those, 6 percent, or about 5.6 million people, were hospitalized.

Injuries were defined under the World Health Organization's International Classification of Disease, which considers injury as one cause of disease. By this definition, injuries made up about 10 percent of the global toll of disease. The researchers categorized injuries by cause. 

The researchers looked at how frequently injuries in each category occurred and the severity of those injuries.

Using the metric disability-adjusted life year, or DALY, the researchers quantified the burden of these injuries. DALY measures what is considered one year of healthy life lost from the injury. It was the DALY rate that the researchers found decreased by 31 percent between 1990 and 2013.

The most injuries in 2013 – 29.1 percent of the total – were attributed to car accidents, with self harm (17.6 percent), falls (11.6 percent), and violence (8.5 percent), accounting for other major categories.

Mariana Brussoni, a scientist in the British Columbia Injury Research & Prevention Unit at the Child & Family Research Institute at BC Children's Hospital not affiliated with the study, tells the Monitor, "I know the Canadian situation quite intimately, but it was heartening to see that we're seeing patterns of most injuries going down right across the world."

Karen Sheehan, a doctor in the United States, agrees, "What we're seeing in this paper is mirrored with the local data at the national level that I'm more familiar with."

"It's good for us to know as a society where to put our efforts and to learn from our successes," Dr. Sheehan, a professor of pediatrics and preventive medicine at Northwestern University and an attending physician at Ann & Robert H. Lurie Children’s Hospital of Chicago, who is not affiliated with the study, tells the Monitor.

The burden of injury globally may be down, but that progress is not uniform across the globe. 

"Especially in Latin America and sub-saharan Africa, the burden of disease due to injury is very high and they are driven by road injuries and interpersonal violence. In Eastern Europe and Central Asia they're also high and those are driven by, for instance, drowning and self-harm," Haagsma explains. "You see very different patterns across the world."

Haagsma says the difference comes down to resources. The largest cause of injury is road traffic-related. Countries with fewer resources likely have worse infrastructure, such as roads, and fewer law enforcement officers to make sure people abide by seat belt, helmet, and speed laws, if the country even has those laws in place, she says.

Dr. Brussoni agrees, "You need political will, you need advocacy, you need resources. Even if you have the political will to put in laws against impaired driving," for example, she says, "You still have to have the resources at the police level to enforce them, education to the population to let them know the dangers of driving while impaired, those sorts of things. It needs to be a multi-tiered process."

With mass shootings, wars, homicides and other dramatic violence frequently in the news, it might be surprising to see that injury rates as a result of interpersonal violence have dropped as well. Although some regions, like South sub-Saharan Africa and Oceania saw increases, the global rate of injury attributed to interpersonal violence dropped 19.1 percent from 1990 to 2013 overall.

"We've also seen decreases in violence in the United States," Sheehan says. But, "you wouldn't always know that from the news. We have not been always successful in different pockets. What we're seeing now, or appreciating more, at least in the violence arena in the United States, is the disparities."

Sheehan points to the city she lives in, Chicago, where certain neighborhoods are not seeing a decrease in violence-related injuries and some are even seeing increased violence. 

Brussoni adds that domestic violence is more complex too. Some injuries might go unreported or be misclassified as unintentional injuries, "like falls for example," she says. A fall, for example down the stairs, is considered an unintentional injury, she explains, "but were you pushed?"

Both Brussoni and Sheehan suggest education of women, informing them of resources available to them and making sure they they know that they are not alone, could help.

People may be getting injured less, but "there's still a lot of progress that can be made," Haagsma says. More injury prevention measures can be put in place, for one, she says. 

Sheehan adds that this research "raises a lot more questions than gives us answers. I think it's great that we're seeing this decrease, and I can believe it's true, but then you have to ask yourself, why is it true? What's really going on? Then what we can learn from what's successful in one country? That's what I'd like to know, so we can translate it to the other countries that are not there yet."