Corrigendum to: Evolution of non-fatal burden estimates for cardiovascular disease in Australia: a comparison of national and state-wide methodology of burden of disease.

Objective Burden of disease studies measure the impact of disease at the population level;however, methods and data sources for estimates of prevalence vary. Using a selection of cardiovascular diseases, we aimed to describe the implications of using different disease models and linked administrative data on prevalence estimation within three Australian burden of disease studies. Methods Three different methods (A = 2011 Australian Burden of Disease Study; B = 2015 Australian Burden of Disease Study; C = 2015 Western Australian Burden of Disease Study), which used linked data, were used to compare prevalence estimates of stroke, aortic aneurysm, rheumatic valvular heart disease (VHD) and non-rheumatic VHD. We applied these methods to 2015 Western Australian data, and calculated crude overall and age-specific prevalence for each condition. Results Overall, Method C produced estimates of cardiovascular prevalence that were lower than the other methods, excluding non-rheumatic VHD. Prevalence of acute and chronic stroke was up to one-third higher in Method A and B compared to Method C. Aortic aneurysms had the largest change in prevalence, with Method A producing an eight-fold higher estimate compared to Method C, but Method B was 10-20% lower. Estimates of VHD varied dramatically, with an up to six-fold change in prevalence in Method C due to substantial changes to disease models and the use of linked data. Conclusions Prevalence estimates require the best available data sources, updated disease models and constant review to inform government policy and health reform. Availability of nation-wide linked data will markedly improve future burden estimates.

Evolution of non-fatal burden estimates for cardiovascular disease in Australia: a comparison of national and state-wide methodology of burden of disease.

Objective Burden of disease studies measure the impact of disease at the population level;however, methods and data sources for estimates of prevalence vary. Using a selection of cardiovascular diseases, we aimed to describe the implications of using different disease models and linked administrative data on prevalence estimation within three Australian burden of disease studies. Methods Three different methods (A = 2011 Australian Burden of Disease Study; B = 2015 Australian Burden of Disease Study; C = 2015 Western Australian Burden of Disease Study), which used linked data, were used to compare prevalence estimates of stroke, aortic aneurysm, rheumatic valvular heart disease (VHD) and non-rheumatic VHD. We applied these methods to 2015 Western Australian data, and calculated crude overall and age-specific prevalence for each condition. Results Overall, Method C produced estimates of cardiovascular prevalence that were lower than the other methods, excluding non-rheumatic VHD. Prevalence of acute and chronic stroke was up to one-third higher in Method A and B compared to Method C. Aortic aneurysms had the largest change in prevalence, with Method A producing an eight-fold higher estimate compared to Method C, but Method B was 10-20% lower. Estimates of VHD varied dramatically, with an up to six-fold change in prevalence in Method C due to substantial changes to disease models and the use of linked data. Conclusions Prevalence estimates require the best available data sources, updated disease models and constant review to inform government policy and health reform. Availability of nation-wide linked data will markedly improve future burden estimates.

Health-Related Quality of Life in Motorcycle Crash Victims One Year After Injury: A Longitudinal Study in Ho Chi Minh City, Vietnam.

Despite the burden of injury associated with motorcycle crashes and injuries in Vietnam, there are no studies investigating health-related quality of life (HRQoL) following a nonfatal motorcycle crash in this country. Therefore, this study aimed to evaluate the change of HRQoL preinjury, and at 6 and 12 months postinjury motorcycle crash in Ho Chi Minh City, Vietnam. Outcome measures were Physical Component Scores (PCS) and Mental Component Scores (MCS) of the Short Form 12 Health Survey (SF-12) version 2 and the EQ-5D. Multilevel mixed models were undertaken. A total of 352 hospitalized motorcyclists were followed-up. Compared with preinjury, the SF-12 PCS reduced by 6.61 points (95% confidence interval [CI] = -8.21 to -5.03) and 5.12 points (95% CI = -6.74 to -3.51) at 12 months postinjury. MCS also reduced by 4.23 points (95% CI = -5.99 to -2.47) at 6 months but increased by 1.29 points (95% CI = -0.49 to 3.08) at 12 months postinjury. The EQ-5D Visual Analogue Scale score decreased by 10.41 points (95% CI = -11.49 to -9.33) at 6 months and 6.48 points (95% CI = -7.58 to -5.38) at 12 months postinjury. The HRQoL among injured motorcycle riders improved between 6 and 12 months after injury but had not returned to the levels before injury.

Functional status, pain and return to work of injured motorcyclists involved in a motorcycle crash over one-year post-injury in Vietnam.

OBJECTIVE: This study aimed to determine changes in functional status, pain, and return to work/study (RTW/study) over 12 months post-injury in motorcyclists admitted to a large hospital in Ho Chi Minh City (HCMC), Vietnam. METHODS: A prospective study was undertaken with adult motorcyclists who were injured due to a crash and were admitted to hospital for more than 24 h. Pain and functional status data were collected at baseline (time of injury), and follow-up at 6 and 12 months post-injury. RTW/study was collected at 6 and 12 months post-injury. Multilevel mixed models and multiple logistic regression models were used to determine the changes in outcomes and predictors of outcomes including age, sex, education, Injury Severity Score, length of stay in the hospital and health-related quality of life. RESULTS: A total of 352 hospitalised motorcyclists were followed-up. The proportion of motorcyclist RTW/study was 60% (n = 165) at 6 months and 82% (n = 210) at 12 months post-injury. After adjusting for covariates, pain scores improved significantly at 6 months (ß = -3.31, 95% CI: -3.61, -3.01) and 12 months post-injury (ß = -3.62, 95% CI: -3.92, -3.32) compared to baseline. Functional status increased significantly by 2.89 points (95% CI: 2.64, 3.13) at 6 months and by 3.51 points (95% CI: 3.27, 3.75) at 12 months compared to baseline. CONCLUSIONS: The study found improvements in outcomes over the study period, although there was ongoing disability at 12 months post-injury (18% had not RTW/study). This study provides further evidence on the burden of motorcycle injuries in Vietnam and priorities for research, and further informs treatment and rehabilitation service planning.

Characteristics and severity of motorcycle crashes resulting in hospitalization in Ho Chi Minh City, Vietnam.

Objective: This study aims to describe the crash characteristics, injury outcomes, and risk factors associated with injury severity for motorcycle crashes resulting in hospitalization in Ho Chi Minh City (HCMC), Vietnam. Methods: A cross-sectional study was undertaken of motorcyclists who were injured as the result of a crash and were admitted to hospital for more than 24 h. Information was collected using a researcher-administered questionnaire and a medical record review. Descriptive statistics and a multiple logistic regression model were undertaken. The outcome of interest was severity of the injury, measured using the Injury Severity Score (ISS). Results: A total of 352 hospitalized motorcyclists were included in the study, of which 6.8% (n = 24) were classified as severe injuries (ISS > 15). At the time of the crash, 41% of participants were not licensed to drive a motorcycle, 26% were speeding, 13% were not wearing a helmet, and 9% were using their mobile phone. The results of the multiple logistic regression model found that not being licensed to drive a motorcycle (adjusted odds ratio [AOR] = 3.32; 95% confidence interval [CI], 1.18-9.34) and crashing at nighttime (AOR = 4.28; 95% CI, 1.33-13.78) were significantly associated with increased injury severity among hospitalized motorcyclists. Conclusions: This study highlighted several high-risk behaviors among hospitalized motorcyclists in Vietnam. In addition, the study found that being unlicensed and crashing at night were associated with higher injury severity among hospitalized motorcyclists. The findings suggest that prevention and enforcement interventions targeting high-risk behaviors may reduce the significant morbidity and mortality associated with motorcycle crashes in Vietnam.

Alcohol and non-alcohol-related motor vehicle crashes in Perth, Australia: Do alcohol outlets make a difference?

This study examined the effects of distance from alcohol outlets to motor vehicle crashes across the Perth metropolitan area. A retrospective population-based study was undertaken using measures of alcohol- and non-alcohol-related crashes, and their proximity to alcohol outlets, using a geographic information system. Two logistic regression models were developed with the following outcomes: i) crashes including drivers with BAC ≥ 0.05%, and ii) weekend single vehicle night-time crashes, a surrogate measure of alcohol-related crashes. The surrogate measures of non-alcohol-related crashes for these models were all day-time and single vehicle day-time crashes respectively. The major predictors of alcohol-related crashes were number of on-premise outlets and bottleshops in buffer zones up to 2 km, 2 km-5 km, 5 km-10 km and 10 km-20 km from crashes. The distance from the central business district (CBD) and sociodemographic factors were controlled for. The study included 341,467 crashes that occurred between 2005 and 2015. The highest crash incidence rates occurred in the CBD. The statistical models indicated that crashes with a higher number of on-premise outlets in adjacent buffer zones were more likely to be alcohol-related than non-alcohol-related crashes. Crashes with a higher number of on-premise outlets less than 2 km, 2 km-5 km, 5 km-10 km, and 10 km-20 km from the crashes were significantly more likely to be weekend single vehicle night-time crashes than day-time crashes (OR = 1.014; 95% CI:1.002-1.027, OR = 1.022; 95% CI:1.014-1.029, OR = 1.019; 95% CI:1.014-1.024, and OR = 1.017; 95% CI:1.014-1.020 respectively). There was some evidence that crashes with lower number of bottleshops in adjacent buffer zones were more likely to be alcohol-related crashes, although this was not consistent across both models and all buffer zones. When other predictors were controlled for, alcohol-related crashes were more likely to occur further from the CBD, than in the CBD. Recommendations about the timing and location of roadside alcohol testing are made.

Identification of high risk metropolitan intersection sites in Perth, Australia.

As convergence points for road users approaching from multiple directions, intersections have more opportunities for conflicts, thus higher crash risk than other parts of the road network. Given the limited resources available for road safety, it is important to identify high risk intersections so that they can be prioritised for infrastructure improvement. This study used a three-stage approach to identify intersections in Perth, Western Australia: using Road Trauma Risk Analysis, then Comparative Safety Performance Analysis and finally ranking the intersections by the KSI (Killed and Serious Injury) metric. These methodologies were developed by Main Roads Western Australia. Crash data from 2011 to 2015 were used in the analyses. The results identify the top high risk intersections for each intersection type (by speed environment and control type). Recommendations are made for extensions to this process to improve identification of high risk intersections, and the use of a taxonomy to identify candidate treatments.

A Population-Based Study Examining Injury in Older Adults with and without Dementia.

OBJECTIVES: To estimate the incidence of and risk factors for injuries in older adults with and without dementia. DESIGN: Retrospective, population-based cohort study. SETTING: Western Australian Data Linkage System (WADLS). PARTICIPANTS: Cases included 29,671 (47.9%) older adults aged 50 and older with an index hospital admission for dementia between 2001 and 2011. Comparison participants without dementia included a random sample of 32,277 (52.1%) older adults aged 50 and older from the state electoral roll. MEASUREMENTS: Hospital admission to a metropolitan tertiary hospital for at least 24 hours with an injury. RESULTS: Age-standardized all-cause injury rates for older adults with dementia (≥60) were 117 per 1,000 population and 24 per 1,000 population for older adults without dementia. Falls caused the majority of injuries for both groups (dementia, 94%; without dementia, 87%), followed by transport-related injuries and burns. Multivariate modeling found that older adults with a diagnosis of dementia had more than twice the risk of hospital admission for an injury than those without dementia (incidence rate ratio (IRR) = 2.05, 95% confidence interval (CI) = 1.96-2.15). Other significant risk factors for a hospital admission for injury were age 85 and older (IRR = 1.43, 95% CI = 1.13-1.81), being unmarried (IRR = 1.07, 95% CI = 1.03-1.12), and a history of falls (IRR = 1.03, 95% CI = 1.01-1.06). Women were at lower risk then men of a hospital admission due to an injury (IRR = 0.92, 95% CI = 0.87-0.97). CONCLUSIONS: Older adults with dementia are at greater risk of a hospital admission for an injury. Multifactorial injury prevention programs would benefit older adults with and without dementia, especially those aged 85 and older, living alone, and with a history of previous falls.

Effect of the Australian "Alcopops Tax" on Alcohol-Related Emergency Department Presentations for Injury in Two States.

OBJECTIVE: The purpose of this study was to examine the impact of a specific tax increase on ready-to-drink beverages (the "alcopops" tax) on male injuries presenting to emergency departments during times likely to be highly alcohol related in two Australian states. METHOD: Poisson regression was used to compare annual risk of Western Australian and Victorian male emergency department injuries occurring during high alcohol-related times before and after the implementation of the alcopops tax. A range of age groups was examined. Surrogate methodology was applied to identify numbers of emergency department injuries that occurred during high and low alcohol-related times. RESULTS: Risk of injury during high alcohol-related times (incident rate ratio [IRR]) was lower among Western Australian 12- to 15-year-olds beginning from the year of the tax increase and continued throughout. Lower IRRs were also apparent for 15- to 19-year-olds, although some delay was implicated. There was no change for 12- to 15-year-old Victorians, but immediate declines were evident for 15- to 19-year-olds. To a lesser extent, delayed effects were also indicated for 20- to 29-year-olds in both states. There was no evidence of a change in injury risk during high alcohol-related times among the oldest age group (35-39 years). CONCLUSIONS: Previous research on beverage-specific taxes has suggested that they may increase alcohol-related harms among the target group. This study found no evidence of increased injury during high alcohol-related times associated with the alcopops tax in two states. Evidence of reduced harm was apparent, however, and strongest for Western Australian males aged 19 years and younger. These outcomes are consistent with documented national reductions in alcopops sales.

Associations between alcohol outlets and emergency department injury presentations: effects of distance from the central business district.

OBJECTIVE: To examine the effects of licensed outlets and sales on levels of alcohol-related injuries presenting to emergency departments (EDs) in the Inner, Middle and Outer postcode zones of Perth, Australia. METHODS: Using panel data (2002-2010), a surrogate measure (based on day of week and time of day of presentation) was used to identify alcohol-related injuries presenting at EDs. Postcodes were grouped according to their distance from the central business district (CBD). Numbers of alcohol outlets and their sales were the primary explanatory variables. Data were analysed using negative binomial regression with random effects. RESULTS: In the Inner and Outer postcode zones, counts of on-site outlets were positively associated with alcohol-related injury (IRR: 1.008; 95%CI 1.003-1.013 and IRR: 1.021; 95%CI 1.013-1.030 respectively). An additional off-site outlet was associated with 6.8% fewer alcohol-related injuries (95%CI 0.887-0.980). In the Middle postcode zone, mean off-site sales were positively associated with injury (IRR: 1.024; 95%CI 1.003-1.044). CONCLUSIONS: Associations between alcohol availability variables and injury differed by outlet type and distance from the CBD. IMPLICATIONS: These findings provide further evidence to support stronger controls on liquor licensing, and indicate the need for different controls according to the location and type of licence.

The effect of alcohol outlets, sales and trading hours on alcohol-related injuries presenting at emergency departments in Perth, Australia, from 2002 to 2010.

BACKGROUND AND AIMS: Few studies have investigated the combined effects of alcohol sales, outlet numbers and trading hours on alcohol-related harms. This study aimed to test whether associations: (i) exist between alcohol-related emergency department (ED) injuries and alcohol sales and counts of outlets; (ii) vary between on- and off-premises outlets; and (iii) vary by trading hours conditions [extended trading permits (ETP) versus standard hours]. DESIGN: Panel study using 117 postcodes over 8 years (2002-10): 936 data points. SETTING: Perth, Australia. PARTICIPANTS: ED injury presentations, aggregated to postcode-level. MEASUREMENTS: Alcohol-related injuries were identified using time-based surrogate measures: night injuries (n=51,241) and weekend night injuries (n=30,682). Measures of alcohol availability included number of outlets with standard and extended trading hours and mean sales per postcode. Negative binomial regression modelling with random effects was used to examine associations between availability and alcohol-related injury, controlling for socio-demographic characteristics. FINDINGS: (i) Night injuries were associated significantly with counts of on-premises outlets [incident rate ratio (IRR)=1.046; 95% confidence interval (CI)=1.014-1.078] and sales per off-premises outlet (IRR=1.019; 95% CI=1.004-1.035); (ii) counts of on-premises outlets were positively associated with alcohol-related injury while counts of off-premises outlets indicated a negative association; and (iii) weekend night injuries increased by about 5% per on-premises outlet with an ETP (IRR=1.049; 95% CI=1.015-1.084) and by less than 1% for outlets with standard trading hours (IRR=1.008; 95% CI=1.004-1.013). CONCLUSIONS: Regions of Perth, Australia with greater off-premises alcohol sales and counts of on-premises alcohol outlets, particularly those with extended trading hours, appear to have higher levels of alcohol-related injuries.

Motor vehicle collisions involving adult pedestrians in eThekwini in 2007.

Motor vehicle collisions involving adult pedestrians are an important cause of injury in South Africa. Using the eThekwini Transport Authority Database for 2007, the data about collisions involving pedestrians over the age of 15 years in the eThekwini metropolitan area were analysed. The incidence risk and proportions were calculated for risk factors involving pedestrians, drivers and the environment. Male pedestrians aged 25-34 years were at highest risk of injury compared to other male pedestrians (incidence risk ratio (IRR): 1.36; 95% confidence interval (CI): 1.26-1.48). The group with the highest fatality risk was males aged 50-54 years (IRR: 1.67; 95% CI: 1.04-2.67). Male drivers had a greater than seven times risk of involvement in pedestrian collisions when compared to females. The highest proportion of fatal pedestrian collisions involved trucks, occurred on freeways, in wet conditions and at night in unlit conditions. The findings point to the need to (a) improve pedestrian visibility and (b) implement engineering interventions to protect adult pedestrians. Enforcement should target high-risk drivers and pedestrians. For the first time in research involving road traffic injuries, this study provides an overall picture of both fatal and non-fatal pedestrian collisions in a South African municipality.

Motor vehicle collisions involving child pedestrians in eThekwini in 2007.

The burden of disability and death on child pedestrians has not been widely researched in the developing world. Using the eThekwini Transport Authority database for 2007, data about collisions involving pedestrians under the age of 15 in the eThekwini metropolitan area were analysed. Incidence risk and proportions were calculated for risk factors involving pedestrians, drivers and the environment. Male pedestrians aged 5 to 9 were at highest risk of injury compared to other male pedestrians (IRR: 1.63; 95% CI: 1.38 to 1.91). This group also had the highest fatality risk (IRR: 2.12; 95% CI: 1.05 to 4.29). Male drivers had nearly five times the risk of involvement in pedestrian collisions compared to females. The highest proportion of fatal pedestrian collisions involved buses and trucks, on freeways, in wet conditions and at night. The findings point to the need to: (a) improve pedestrian visibility; (b) design safe routes to schools; and (c) develop practical roadside skills. For the first time in research in road traffic injuries, this study provides an overall picture of both fatal and non-fatal child pedestrian collisions in a South African municipality.