Abstract
Background
Injury is the leading cause of preventable morbidity and mortality in Canada. The “iceberg” effect in injuries was proposed to address the injury statistics that are often poorly documented. The aim of this investigation was to quantify the severity and magnitude of iceberg effect in Ontario, Canada.
Methods
Data from Vital Statistics (1999, mortality), Canadian Institute for Health Information (2001, hospitalizations), Census (2001, demographic information), National Ambulatory Care Reporting System (2001, emergency department visits), and the Canadian Community Health Survey (2000/01, other injuries) were used to construct the Ontario injury iceberg for ages 12 years and older.
Results
There were 79,577 fatalities in Ontario in 1999; 2,645 were attributable to injuries (crude rate: 2.3 per 10,000). Of the 913,540 hospitalizations (2001), 67,301 were caused by injuries. There were 3,520,253 emergency department (ED) visits (2001) and 959,278 were attributable to injuries. For injuries treated elsewhere, the most common treatment site was the physician’s office (23.3%). The most common cause of injuries (CCHS) was falls (37.4%) and exertion/movement (20.5%). There were 1,928,000 injuries causing functional impairment (one injury to five individuals in the population).
Interpretation
The high ratio of injury-related ED visits to deaths illustrated the high volume of injuries that present to the ED. The ratio of injuries resulting in functional impairment to the population demonstrates that such injuries can be problematic, even if not resulting in hospitalization. Constructing the injury iceberg using valid data should assist researchers and decision-makers in priority setting.
MeSH terms: Wounds and injuries, health services, public health, accidents
Résumé
Contexte
Les blessures corporelles constituent la principale cause de morbidité et de mortalité au Canada. On a proposé la théorie de l’effet « iceberg » pour mieux comprendre les données statistiques relatives aux blessures, souvent peu documentées. Cette étude vise à quantifier la gravité et l’importance de l’effet iceberg dans la province de l’Ontario, au Canada.
Méthodes
Les statistiques de l’état civil (1999, mortalité), de l’Institut canadien d’information sur la santé (2001, hospitalisations), et du recensement (2001, données démographiques), du Système national d’information sur les soins ambulatoires (2001, nombre de visites aux services d’urgence) et de l’Enquête sur la santé dans les collectivités canadiennes (ESCC) (2000–2001, autres blessures) ont servi à la construction de l’effet iceberg en Ontario, pour les personnes de 12 ans et plus.
Résultats
En 1999, on a signalé 79 577 décès en Ontario, dont 2 645 attribuables à des blessures (taux brut: 2,3 pour 10 000). Des 913 540 hospitalisations relevées (2001), 67 301 étaient attribuables à des blessures. De même, des 3 520 253 visites des services d’urgence (SU) (2001), 959 278 étaient dues à des blessures. Les blessures qui ne sont pas traitées dans les services d’urgence l’étaient de façon prédominante dans un cabinet de médecin (23,3 %). Les chutes représentaient la principale cause de blessures (ESCC) (37,4 %), suivie de la fatigue et des mouvements (20,5 %). On constate que 1 928 000 blessures ont entraîné une invalidité fonctionnelle (dans la population, une personne sur cinq a subi des blessures).
Interprétation
Le taux élevé de visites aux services d’urgence pour cause de blessures et de mortalité témoignent du nombre important de blessures traitées par les services d’urgence. Le taux de blessures entraînant des invalidités fonctionnelles permet de conclure que les blessures peuvent poser problème et ce, même si elles ne donnent pas lieu à une hospitalisation. La construction de l’effet iceberg, à l’aide de données valides, devrait aider les chercheurs et les décideurs dans l’établissement des priorités.
Footnotes
Acknowledgements: The work of Vic Sahai and Mary Ward is supported and funded by the Ministry of Health and Long-Term Care (Ontario, Canada). Dr. Rowe’s research is supported by the Canadian Institute of Health Research (CIHR, Ottawa, ON) as a Canada Research Chair.
Funding: Northern Health Information Partnership is supported by the Ministry of Health and Long- Term Care–Ontario and the Canadian Institute of Health Research Canada Chairs program. Dr. Rowe holds a Canada Research Chair in Emergency Airway Diseases from the Canadian Institutes of Health Research (CIHR).
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