An international team of researchers assessed injury damage in 195 countries over 1990–2017, and examined possible relationships between injury burden and sociodemographic index. Among the co-authors of the work were Russian scientists - representatives of the Moscow Institute of Physics and Technology, the Higher School of Economics and employees of institutions of the Ministry of Health.
In the course of the study, the values of mortality and socio-economic damage, that is, the burden of injuries, were assessed (indicators DALY, disability-adjusted life years, the number of years of life adjusted for disability, and its terms - YLL, years of life are lost, the number of years of life lost, and YLD - years lost due to disability, the number of years lived with disability) according to data for the period 1990-2017, including in terms of the values of the socio-demographic index (which characterizes the state or region of the integral indicator, the value of which will be the higher, the higher the level of income of the population and the level of education and the lower the total fertility rate).
Stanislav Otstavnov, one of the authors of the work, deputy head of the laboratory for analysis of population health indicators and digitalization of health care at MIPT (Tsifromed Phystech), illustrates statistics with a tragic example: “Today the name of Elena Mukhina is known mainly to the older generation and gymnastics fans. The absolute world champion, while improving her program, received a terrible injury in training on the eve of the home Olympics. For the next 26 years of her life, the outstanding gymnast was confined to a wheelchair (this is the number of years lived with a disability, YLD) and left this world, about 28 years before the value of life expectancy (this is YLL). The example clearly explains the essence of the indicators that we evaluated."
According to the data received, 55.9 million people died in 2017. Of these deaths, about 4.5 million (8%) were caused by injuries. At the same time, the death rate from injuries in men is more than twice as high as in women. The main causes of death from injuries were road injuries (27.7%), self-harm (17.7%), falls (15.5%) and interpersonal violence (9%).
During this period, the world also recorded about 521 million cases of injuries that did not lead to death (for comparison, their number in 1990 was 354 million). Of the total socio-economic damage from all diseases in 2017, injuries accounted for 10.1%, of which, in turn, 77% accounted for the lost years of life. Traffic injuries (26.7%), falls (14.1%), self-harm (13.1%), and interpersonal violence (10.2%) were recognized as the main causes of the injury burden.
The damage from road traffic injuries is so significant that reducing it is recognized as one of the key objectives of the United Nations Sustainable Development Goal “Ensure healthy lifestyles and promote well-being for all at all ages”. Of the countries in the world, the highest injury damage, adjusted for the age structure of the population, was noted in Syria, the Central African Republic and Lesotho, and the lowest in the Maldives, Bermuda and Italy.
The study also found that, for most injuries, disease burden rates fall as the socio-demographic index rises. In fact, this means that the more favorable the economic situation in the state, the less the population suffers from injuries. However, injuries sustained in road traffic accidents, violent injuries and self-harm, causing the main damage, as noted above, are an exception to this rule, for them there is a reverse trend, most pronounced in the case of self-harm.
There are also other exceptions. Our country and other countries of Eastern Europe (former Soviet republics) are characterized by a socio-demographic index above the average, but our injury rates are higher than the average for countries with a comparable index value. The study noted that the reasons for this, to varying degrees, may be associated with the collapse of the Soviet Union, social upheavals, adherence to bad habits, growing social inequality, but it is directly emphasized that the exact conclusions require further research.
Stanislav Otstavnov concretizes: “There are a number of sometimes mutually influencing reasons, including a unique climate (cold winters, sharp temperature changes that contribute to the formation of ice; mountain ranges distributed over an extended territory), and the spread of alcoholism, and, unfortunately, the traditionally disdainful attitude towards human life and health, and many others. Adherence to an active life, a healthy lifestyle also leads to injuries: I myself broke my arm while preparing for school football competitions, knocked out my finger while playing volleyball, and injured my neck while skiing."
According to the study, taking into account the age structure of the population, the number of injury-associated deaths decreased by 24% compared to 1990, the number of years of life lost decreased by 28.2%, those lived with disability - by 9.2%, adjusted for disability - by 24%.
Stanislav Otstavnov concludes: “Such dynamics, on the one hand, may indicate positive changes in the field of public safety, injury prevention, improvement of health technologies, but the values of the indicators are still high. It is necessary to understand in detail the causes and mechanisms and propose comprehensive solutions that will help prevent injuries and reduce the overall burden of disease. This is a direction of promising research and a reason for further work."
A group of collaborators in the field of disease burden, injury and risk factors, which includes MIPT employees, traditionally monitors many indicators under the 10 Sustainable Development Goals adopted by the UN, and related not only to health, but also to the protection of human rights. ending poverty, hunger and gender inequality.