Burden of disease due to injury rising in low income regions

India, China buck the global trend when it comes to injuries due to road crashes and self-harm  

Prevention measures and improved access to better quality care after an injury have brought about a significant decline in the burden of injury in high income regions. However emerging economies such as India, Brazil, Russia, China and South Africa continue to experience disproportionately high rates of injury and few of the declines.

As part of a global collaboration, researchers mined the latest GBD update in 2013 to assess the impact of 26 causes of injury and 47 types of injury, dating back to 1990, for 188 countries in 21 regions of the world. They used data on the number of injuries, deaths from injuries, and a measure known as disability-adjusted life years, or DALYs for short. The DALY is calculated by adding together years of life lost to death and years of life lived with a disability.

The researchers, who published the findings in the Injury Prevention recently, calculated that in 2013 almost 1 billion people (973 million) sustained injuries that required medical attention/treatment, accounting for 10% of the global toll of disease.

Major causes included road injury, which made up 29% of the total, followed by self-harm (17.6%); falls (11.6%); and violence (8.5%).

With good prevention measures since the 1970s countries like Australia and Sweden have significantly reduced road traffic fatalities. However, when it comes to low and middle income countries, the numbers are increasing significantly. 

“It is to be noted that many of the low and middle income countries do not have comprehensive road safety laws that cover all five major risk factors for road traffic injuries. And the problem is further accentuated by poor enforcement where the laws exist,” said Professor Rebecca Ivers, Head of the Injury Division at the George Institute for Global Health.

“Good laws accompanied with education and enforcement, are the key to reduce road injury mortality,” she added.

Self-harm is the second leading cause of death from injury and it is a main contributor to injury DALYs. Over the period 1950–1995 the global self-harm death rates were reported by WHO to have increased, although the authors noted that the figures should be interpreted with caution because the 1950 estimates were based on data from 11 countries. 

More than half of all self-harm DALYs occur in East and South Asia. The trends in these regions are in opposite directions, decreasing significantly and by a great margin in East Asia but rising, though not significantly, in South Asia between 1990 and 2013.

“Over the past two decades China and India have experienced rapid economic growth and urbanization and therefore the opposing trends would need to be explained by other factors, such as the distribution of increasing wealth, cultural shifts, ease of access to mental health treatment, ease of access to the main means for self-harm, and other factors,” reported the paper’s authors.  

Coverage of vital registration is low or absent in large parts of the world and there are issues in standardization of data, completeness and validity. “For these regions where robust data is unavailable, best estimates can only be made using models, relying on covariates and verbal autopsy,” pointed out Prof Ivers. 

Besides hospital data collection systems hospital-based trauma registries have become well established in high-income countries and are emerging in some low-income and middle-income countries. “Such registries are critical to help understand the burden of trauma, plan clinical care and evaluate effectiveness of prevention and treatment programs” Prof Ivers said.

“Injuries continue to be a major cause of death and disability in both high and low income settings. Given increases that are still seen in many countries and population groups, we must not be complacent about either prevention, or care. There remains a huge need for Governments and donors to provide universal access to health care, and invest in prevention programs, particularly in the developing economies of the world,” she added.