Hearing Loss Prevalence, Years Lived With Disability, and Hearing Aid Use in the United States From 1990 to 2019: Findings From the Global Burden of Disease Study.

OBJECTIVES: This article describes key data sources and methods used to estimate hearing loss in the United States, in the Global Burden of Disease study. Then, trends in hearing loss are described for 2019, including temporal trends from 1990 to 2019, changing prevalence over age, severity patterns, and utilization of hearing aids. DESIGN: We utilized population-representative surveys from the United States to estimate hearing loss prevalence for the Global Burden of Disease study. A key input data source in modeled estimates are the National Health and Nutrition Examination Surveys (NHANES), years 1988 to 2010. We ran hierarchical severity-specific models to estimate hearing loss prevalence. We then scaled severity-specific models to sum to total hearing impairment prevalence, adjusted estimates for hearing aid coverage, and split estimates by etiology and tinnitus status. We computed years lived with disability (YLDs), which quantifies the amount of health loss associated with a condition depending on severity and creates a common metric to compare the burden of disparate diseases. This was done by multiplying the prevalence of severity-specific hearing loss by corresponding disability weights, with additional weighting for tinnitus comorbidity. RESULTS: An estimated 72.88 million (95% uncertainty interval (UI) 68.53 to 77.30) people in the United States had hearing loss in 2019, accounting for 22.2% (20.9 to 23.6) of the total population. Hearing loss was responsible for 2.24 million (1.56 to 3.11) YLDs (3.6% (2.8 to 4.7) of total US YLDs). Age-standardized prevalence was higher in males (17.7% [16.7 to 18.8]) compared with females (11.9%, [11.2 to 12.5]). While most cases of hearing loss were mild (64.3%, 95% UI 61.0 to 67.6), disability was concentrated in cases that were moderate or more severe. The all-age prevalence of hearing loss in the United States was 28.1% (25.7 to 30.8) higher in 2019 than in 1990, despite stable age-standardized prevalence. An estimated 9.7% (8.6 to 11.0) of individuals with mild to profound hearing loss utilized a hearing aid, while 32.5% (31.9 to 33.2) of individuals with hearing loss experienced tinnitus. Occupational noise exposure was responsible for 11.2% (10.2 to 12.4) of hearing loss YLDs. CONCLUSIONS: Results indicate large burden of hearing loss in the United States, with an estimated 1 in 5 people experiencing this condition. While many cases of hearing loss in the United States were mild, growing prevalence, low usage of hearing aids, and aging populations indicate the rising impact of this condition in future years and the increasing importance of domestic access to hearing healthcare services. Large-scale audiometric surveys such as NHANES are needed to regularly assess hearing loss burden and access to healthcare, improving our understanding of who is impacted by hearing loss and what groups are most amenable to intervention.

Successful Optimization of Tobacco Dependence Treatment in the Emergency Department: A Randomized Controlled Trial Using the Multiphase Optimization Strategy.

STUDY OBJECTIVE: Tobacco dependence treatment initiated in the hospital emergency department (ED) is effective. However, trials typically use multicomponent interventions, making it difficult to distinguish specific components that are effective. In addition, interactions between components cannot be assessed. The Multiphase Optimization Strategy allows investigators to identify these effects. METHODS: We conducted a full-factorial, 24 or 16-condition optimization trial in a busy hospital ED to examine the performance of 4 tobacco dependence interventions: a brief negotiation interview; 6 weeks of nicotine replacement therapy with the first dose delivered in the ED; active referral to a telephone quitline; and enrollment in SmokefreeTXT, a free short-messaging service program. Study data were analyzed with a novel mixed methods approach to assess clinical efficacy, cost-effectiveness, and qualitative participant feedback. The primary endpoint was tobacco abstinence at 3 months, verified by exhaled carbon monoxide using a Bedfont Micro+ Smokerlyzer. RESULTS: Between February 2017 and May 2019, we enrolled 1,056 adult smokers visiting the ED. Odd ratios (95% confidence intervals) from the primary analysis of biochemically confirmed abstinence rates at 3 months for each intervention, versus control, were: brief negotiation interview, 1.8 (1.1, 2.8); nicotine replacement therapy, 2.1 (1.3, 3.2); quitline, 1.4 (0.9, 2.2); SmokefreeTXT, 1.1 (0.7, 1.7). There were no statistically significant interactions among components. Economic and qualitative analyses are in progress. CONCLUSION: The brief negotiation interview and nicotine replacement therapy were efficacious. This study is the first to identify components of ED-initiated tobacco dependence treatment that are individually effective. Future work will address the scalability of the brief negotiation interview and nicotine replacement therapy by offering provider-delivered brief negotiation interviews and nicotine replacement therapy prescriptions.

Escalating costs of self-injury mortality in the 21st century United States: an interstate observational study.

BACKGROUND: Estimating the economic costs of self-injury mortality (SIM) can inform health planning and clinical and public health interventions, serve as a basis for their evaluation, and provide the foundation for broadly disseminating evidence-based policies and practices. SIM is operationalized as a composite of all registered suicides at any age, and 80% of drug overdose (intoxication) deaths medicolegally classified as 'accidents,' and 90% of corresponding undetermined (intent) deaths in the age group 15 years and older. It is the long-term practice of the United States (US) Centers for Disease Control and Prevention (CDC) to subsume poisoning (drug and nondrug) deaths under the injury rubric. This study aimed to estimate magnitude and change in SIM and suicide costs in 2019 dollars for the United States (US), including the 50 states and the District of Columbia. METHODS: Cost estimates were generated from underlying cause-of-death data for 1999/2000 and 2018/2019 from the US Centers for Disease Control and Prevention's (CDC's) Wide-ranging ONline Data for Epidemiologic Research (WONDER). Estimation utilized the updated version of Medical and Work Loss Cost Estimation Methods for CDC's Web-based Injury Statistics Query and Reporting System (WISQARS). Exposures were medical expenditures, lost work productivity, and future quality of life loss. Main outcome measures were disaggregated, annual-averaged total and per capita costs of SIM and suicide for the nation and states in 1999/2000 and 2018/2019. RESULTS: 40,834 annual-averaged self-injury deaths in 1999/2000 and 101,325 in 2018/2019 were identified. Estimated national costs of SIM rose by 143% from $0.46 trillion to $1.12 trillion. Ratios of quality of life and work losses to medical spending in 2019 US dollars in 2018/2019 were 1,476 and 526, respectively, versus 1,419 and 526 in 1999/2000. Total national suicide costs increased 58%-from $318.6 billion to $502.7 billion. National per capita costs of SIM doubled from $1,638 to $3,413 over the observation period; costs of the suicide component rose from $1,137 to $1,534. States in the top quintile for per capita SIM, those whose cost increases exceeded 152%, concentrated in the Great Lakes, Southeast, Mideast and New England. States in the bottom quintile, those with per capita cost increases below 70%, were located in the Far West, Southwest, Plains, and Rocky Mountain regions. West Virginia exhibited the largest increase at 263% and Nevada the smallest at 22%. Percentage per capita cost increases for suicide were smaller than for SIM. Only the Far West, Southwest and Mideast were not represented in the top quintile, which comprised states with increases of 50% or greater. The bottom quintile comprised states with per capita suicide cost increases below 24%. Regions represented were the Far West, Southeast, Mideast and New England. North Dakota and Nevada occupied the extremes on the cost change continuum at 75% and - 1%, respectively. CONCLUSION: The scale and surge in the economic costs of SIM to society are large. Federal and state prevention and intervention programs should be financed with a clear understanding of the total costs-fiscal, social, and personal-incurred by deaths due to self-injurious behaviors.

Managed care updates of subscriber jail release to prompt community suicide prevention: clinical trial protocol.

BACKGROUND: Recent jail detention is a marker for trait and state suicide risk in community-based populations. However, healthcare providers are typically unaware that their client was in jail and few post-release suicide prevention efforts exist. This protocol paper describes an effectiveness-implementation trial evaluating community suicide prevention practices triggered by advances in informatics that alert CareSource, a large managed care organization (MCO), when a subscriber is released from jail. METHODS: This randomized controlled trial investigates two evidence-based suicide prevention practices triggered by CareSource's jail detention/release notifications, in a partial factorial design. The first phase randomizes ~ 43,000 CareSource subscribers who pass through any Ohio jail to receive Caring Contact letters sent by CareSource or to Usual Care after jail release. The second phase (running simultaneously) involves a subset of ~ 6,000 of the 43,000 subscribers passing through jail who have been seen in one of 12 contracted behavioral health agencies in the 6 months prior to incarceration in a stepped-wedge design. Agencies will receive: (a) notifications of the client's jail detention/release, (b) instructions for re-engaging these clients, and (c) training in suicide risk assessment and the Safety Planning Intervention for use at re-engagement. We will track suicide-related and service linkage outcomes 6 months following jail release using claims data. CONCLUSIONS: This design allows us to rigorously test two intervention main effects and their interaction. It also provides valuable information on the effects of system-level change and the scalability of interventions using big data from a MCO to flag jail release and suicide risk. TRIAL REGISTRATION: The trial is registered at clinicaltrials.gov (NCT05579600). Registered 27 June, 2023.

Monetised estimated quality-adjusted life year (QALY) losses for non-fatal injuries.

BACKGROUND: Quality-adjusted life years (QALYs) provide a means to compare injuries using a common measurement which allows quality of life and duration of life from an injury to be considered. A more comprehensive picture of the economic losses associated with injuries can be found when QALY estimates are combined with medical and work loss costs. This study provides estimates of QALY loss. METHODS: QALY loss estimates were assigned to records in the 2018 National Electronic Injury Surveillance System - All Injury Program. QALY estimates by body region and nature of injury were assigned using a combination of previous research methods. Injuries were rated on six dimensions, which identify a set of discrete qualitative impairments. Additionally, a seventh dimension, work-related disability, was included. QALY loss estimates were produced by intent and mechanism, for all emergency department-treated cases, by two disposition groups. RESULTS: Lifetime QALY losses ranged from 0.0004 to 0.388 for treated and released injuries, and from 0.031 to 3.905 for hospitalised injuries. The 1-year monetary value of QALY losses ranged from $136 to $437 000 among both treated and released and hospitalised injuries. The lifetime monetary value of QALY losses for hospitalised injuries ranged from $16 000 to $2.1 million. CONCLUSIONS: These estimates provide information to improve knowledge about the comprehensive economic burden of injuries; direct cost elements that can be measured through financial transactions do not capture the full cost of an injury. Comprehensive assessment of the long-term cost of injuries, including quality of life losses, is critical to accurately estimate the economic burden of injuries.

Screening and brief intervention for alcohol use disorder risk in three middle-income countries.

BACKGROUND: This study examined the prevalence of screening and brief intervention (SBI) for alcohol use disorder (AUD) risk in samples of adult drinkers in three middle-income countries (Brazil, China, South Africa), and the extent to which meeting criteria for AUD risk was associated with SBI. METHODS: Cross-sectional survey data were collected from adult samples in two cities in each country in 2018. Survey measures included past-year alcohol use, the CAGE assessment for AUD risk, talking to a health care professional in the past year, alcohol use screening by a health care professional, receiving advice about drinking from a health care professional, and sociodemographic characteristics. The prevalence of SBI was determined for past-year drinkers in each country and for drinkers who had talked to a health care professional. Logistic regression analyses were conducted to examine whether meeting criteria for AUD risk was associated with SBI when adjusting for sociodemographic characteristics. RESULTS: Among drinkers at risk for AUD, alcohol use screening rates ranged from 6.7% in South Africa to 14.3% in Brazil, and brief intervention rates ranged from 4.6% in South Africa to 8.2% in China. SBI rates were higher among drinkers who talked to a health care professional in the past year. In regression analyses, AUD risk was positively associated with SBI in China and South Africa, and with brief intervention in Brazil. CONCLUSION: Although the prevalence of SBI among drinkers at risk for AUD in Brazil, China, and South Africa appears to be low, it is encouraging that these drinkers were more likely to receive SBI.

The Contribution of Alcohol Beverage Types to Consumption, Heavy Drinking, and Alcohol-Related Harms: A Comparison across Five Countries.

BACKGROUND: This study examined the relative contribution of alcoholic beverage types to overall alcohol consumption and associations with heavy alcohol use and alcohol-related harms among adults. METHODS: Cross-sectional survey data were collected from adult samples in two cities involved in the Global Smart Drinking Goals (GSDG) initiative in each of five countries (Belgium, Brazil, China, South Africa, United States). Survey measures included past-30-day consumption of beer, wine, flavored alcoholic drinks, spirits, and homemade alcohol; past-30-day heavy drinking; 14 alcohol-related harms in the past 12 months; and demographic characteristics. Within in each country, we computed the proportion of total alcohol consumption for each beverage type. Regression analyses were conducted to estimate the relative associations between consumption of each alcoholic beverage type, heavy alcohol use, and alcohol-related harms, controlling for demographic characteristics. RESULTS: Beer accounted for at least half of total alcohol consumption in GSDG cities in Belgium, Brazil, the U.S., and South Africa, and 35% in China. Regression analyses indicated that greater beer consumption was associated with heavy drinking episodes and with alcohol-related harms in the cities in Belgium, Brazil, South Africa, and the U.S. Significant increases in heavy drinking and alcohol-related harms were also consistently observed for spirits consumption. CONCLUSIONS: Beer accounts for the greatest proportion of total alcohol consumption in most of the GSDG cities and was consistently associated with more heavy drinking episodes and alcohol-related harms. Reducing beer consumption through evidence-based interventions may therefore have the greatest impact on hazardous drinking and alcohol-related harms.

A Comparison of Chinese Adults Who Consume Homemade versus Commercial Alcohol.

BACKGROUND: Little is known about adults in China who drink homemade alcohol, and whether they are at elevated risk of harms relative to those who drink alcohol from commercial sources. Purpose: We describe and contrast adults in China who regularly consume either homemade or commercially available alcohol, or both. Methods: Household-based in-person interviews were conducted in 2018 with adults in Jiangshan and Lanxi. We examined the characteristics of 833 adults who had consumed alcohol within the previous 30 days, comparing those who drank commercial alcohol only with those who drank homemade alcohol only and alcohol from both sources. Results: Regression analyses revealed that drinkers of both homemade and commercial alcohol consumed more drinks and were more likely to report heavy drinking than did drinkers of commercial or homemade alcohol only and were also more likely to meet criteria for alcohol use disorder. We also found that homemade-only alcohol drinkers were at elevated risk for this disorder. Conclusions: Drinkers of both homemade and commercial alcohol in China may be at risk for alcohol-related problems and constitute a little understood population for whom further research is needed. The AB InBev Foundation supported this study.

The global burden of falls: global, regional and national estimates of morbidity and mortality from the Global Burden of Disease Study 2017.

BACKGROUND: Falls can lead to severe health loss including death. Past research has shown that falls are an important cause of death and disability worldwide. The Global Burden of Disease Study 2017 (GBD 2017) provides a comprehensive assessment of morbidity and mortality from falls. METHODS: Estimates for mortality, years of life lost (YLLs), incidence, prevalence, years lived with disability (YLDs) and disability-adjusted life years (DALYs) were produced for 195 countries and territories from 1990 to 2017 for all ages using the GBD 2017 framework. Distributions of the bodily injury (eg, hip fracture) were estimated using hospital records. RESULTS: Globally, the age-standardised incidence of falls was 2238 (1990-2532) per 100 000 in 2017, representing a decline of 3.7% (7.4 to 0.3) from 1990 to 2017. Age-standardised prevalence was 5186 (4622-5849) per 100 000 in 2017, representing a decline of 6.5% (7.6 to 5.4) from 1990 to 2017. Age-standardised mortality rate was 9.2 (8.5-9.8) per 100 000 which equated to 695 771 (644 927-741 720) deaths in 2017. Globally, falls resulted in 16 688 088 (15 101 897-17 636 830) YLLs, 19 252 699 (13 725 429-26 140 433) YLDs and 35 940 787 (30 185 695-42 903 289) DALYs across all ages. The most common injury sustained by fall victims is fracture of patella, tibia or fibula, or ankle. Globally, age-specific YLD rates increased with age. CONCLUSIONS: This study shows that the burden of falls is substantial. Investing in further research, fall prevention strategies and access to care is critical.

Global trends of hand and wrist trauma: a systematic analysis of fracture and digit amputation using the Global Burden of Disease 2017 Study.

BACKGROUND: As global rates of mortality decrease, rates of non-fatal injury have increased, particularly in low Socio-demographic Index (SDI) nations. We hypothesised this global pattern of non-fatal injury would be demonstrated in regard to bony hand and wrist trauma over the 27-year study period. METHODS: The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 was used to estimate prevalence, age-standardised incidence and years lived with disability for hand trauma in 195 countries from 1990 to 2017. Individual injuries included hand and wrist fractures, thumb amputations and non-thumb digit amputations. RESULTS: The global incidence of hand trauma has only modestly decreased since 1990. In 2017, the age-standardised incidence of hand and wrist fractures was 179 per 100 000 (95% uncertainty interval (UI) 146 to 217), whereas the less common injuries of thumb and non-thumb digit amputation were 24 (95% UI 17 to 34) and 56 (95% UI 43 to 74) per 100 000, respectively. Rates of injury vary greatly by region, and improvements have not been equally distributed. The highest burden of hand trauma is currently reported in high SDI countries. However, low-middle and middle SDI countries have increasing rates of hand trauma by as much at 25%. CONCLUSIONS: Certain regions are noted to have high rates of hand trauma over the study period. Low-middle and middle SDI countries, however, have demonstrated increasing rates of fracture and amputation over the last 27 years. This trend is concerning as access to quality and subspecialised surgical hand care is often limiting in these resource-limited regions.

Morbidity and mortality from road injuries: results from the Global Burden of Disease Study 2017.

BACKGROUND: The global burden of road injuries is known to follow complex geographical, temporal and demographic patterns. While health loss from road injuries is a major topic of global importance, there has been no recent comprehensive assessment that includes estimates for every age group, sex and country over recent years. METHODS: We used results from the Global Burden of Disease (GBD) 2017 study to report incidence, prevalence, years lived with disability, deaths, years of life lost and disability-adjusted life years for all locations in the GBD 2017 hierarchy from 1990 to 2017 for road injuries. Second, we measured mortality-to-incidence ratios by location. Third, we assessed the distribution of the natures of injury (eg, traumatic brain injury) that result from each road injury. RESULTS: Globally, 1 243 068 (95% uncertainty interval 1 191 889 to 1 276 940) people died from road injuries in 2017 out of 54 192 330 (47 381 583 to 61 645 891) new cases of road injuries. Age-standardised incidence rates of road injuries increased between 1990 and 2017, while mortality rates decreased. Regionally, age-standardised mortality rates decreased in all but two regions, South Asia and Southern Latin America, where rates did not change significantly. Nine of 21 GBD regions experienced significant increases in age-standardised incidence rates, while 10 experienced significant decreases and two experienced no significant change. CONCLUSIONS: While road injury mortality has improved in recent decades, there are worsening rates of incidence and significant geographical heterogeneity. These findings indicate that more research is needed to better understand how road injuries can be prevented.

Evaluation of a Mystery Shopper Intervention to Reduce Sales of Alcohol to Minors in Zacatecas and Guadalupe, Mexico.

We report the results of a quasi-experimental evaluation of a mystery shopper intervention in Zacatecas and Guadalupe, Mexico. Underage youth attempted to purchase beer at 50 Modelorama stores and 32 Oxxo stores (intervention groups), and at 19 comparison convenience stores in March, July, and August 2018. After each attempt, intervention store operators were informed if a sale was made. Modelorama operators also received training and were warned that repeated sales to minors could jeopardize their franchise. Average sales rates to minors were 63.8% at Modeloramas, 86.5% at Oxxo stores, and 98.2% at comparison stores. The findings suggest that mystery shopper interventions with training, feedback to store operators, and sanctions after repeated sales to underage youth may reduce sales to minors in low- and middle-income countries.

Alcohol Availability, Use, and Harms Among Adolescents in Three Mexican Cities.

Alcohol remains readily available to youth in most countries. We examined the associations between both the on- and off-premises commercial availability of alcohol to youth and their alcohol use, heavy episodic drinking, and alcohol-related harms. We conducted the study using data from a survey of a sample of 594 students in central Mexico between 12 and 17 years of age in 2016. Both the perceived availability of alcohol and the purchasing of alcohol at an off-premises establishment were positively related to past-30-day alcohol use and heavy episodic drinking, as well as to alcohol-related harms in the past year. Consumption at on-premises establishments was also positively associated with alcohol-related harms. Preventive efforts to reduce the availability of alcohol at off- and on-premises establishments, by such strategies as mystery shopper and responsible beverage service programs, are imperative.

Products and activities associated with non-fatal traumatic brain injuries in children and adolescents - United States 2010-2013.

Background: Traumatic brain injury (TBI) is prevalent in children and adolescents ages <1-19 years, yet we have limited understanding of consumer products that are associated with TBIs in children and adolescents of varying ages. To address this gap, we combined two data sources to investigate leading products and activities associated with TBIs in children and adolescents in different developmental age groups (i.e. <1, 1-4, 5-9, 10-14, and 15-19 years). Methods: We analysed data from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP), augmented with product information from the National Electronic Injury Surveillance System (NEISS), for the years 2010 through 2013. Results: From 2010 to 2013, children and adolescents aged <1-19 years accounted for 4.1 million non-fatal TBI-related emergency department visits. TBIs from home furnishings and fixtures, primarily beds, were highest among infants aged <1 year and children aged 1-4 years. TBIs from sports/recreation, especially bicycles and football, were highest among those aged 5-9 years, 10-14 years, and 15-19 years. Conclusions: The combined NEISS and NEISS-AIP data allow us to comprehensively examine products and activities that contribute to emergency department visits for TBIs in children and adolescents. Our findings indicate priority areas for TBI prevention and intervention.

Enduring enrolments in West Virginia's Medicaid programme due to severe injury.

OBJECTIVE: To assess frequency, duration and costs of Medicaid conversions that occur when severe injury causes patients to enrol in Medicaid to pay their hospital bills. Once enrolled, Medicaid pays all their medical bills, not simply their injury bill. DATA SOURCES: 2000-2005 West Virginia Medicaid claims data and 2000-2006 eligibility data for new enrollees under the age of 65. To model national costs, published Medicaid conversion rates across 14 states for 2003 and 2008 Healthcare Cost and Utilization Program Nationwide Inpatient Sample data. METHODS: We identified enrollees who had hospital inpatient claims for injury within 30 days of enrolment, then tabulated eligibility duration and payments by year and in aggregate. For those with open-ended eligibility, we assumed future annual claims payments would equal average payments in eligibility years 5-6. We multiplied the mean payments data adjusted to national prices with the estimated conversions nationally. RESULTS: Overall, 5.4% of hospitalised patients with injury in West Virginia converted to Medicaid, with 17% of conversions on Medicaid 7 years post injury. In 2010 dollars, Medicaid payments averaged $93 900 per conversion for non-injury medical care before the age of 65. Conversions added an estimated $87 in payments for non-injury care to governments' medical payments per medically treated injury in the USA. They added 14% to governments' gunshot and assault medical payments, 7.5% to its road crash medical payments and 6% to its total injury medical payments. CONCLUSIONS: These findings increase the rationale for governments to partner in injury prevention efforts.

Empirical validation of the New Zealand serious non-fatal injury outcome indicator for 'all injury'.

Our purpose was to empirically validate the official New Zealand (NZ) serious non-fatal 'all injury' indicator. To that end, we aimed to investigate the assumption that cases selected by the indicator have a high probability of admission. Using NZ hospital in-patient records, we identified serious injury diagnoses, captured by the indicator, if their diagnosis-specific survival probability was ≤0.941 based on at least 100 admissions. Corresponding diagnosis-specific admission probabilities from regions in Canada, Denmark and Greece were estimated. Aggregate admission probabilities across those injury diagnoses were calculated and inference made to New Zealand. The admission probabilities were 0.82, 0.89 and 0.90 for the regions of Canada, Denmark and Greece, respectively. This work provides evidence that the threshold set for the official New Zealand serious non-fatal injury indicator for 'all injury' captures injuries with high aggregate admission probability. If so, it is valid for monitoring the incidence of serious injuries.

Estimated total costs from non-fatal and fatal bicycle crashes in the USA: 1997-2013.

INTRODUCTION: Emergency department visits and hospital admissions resulting from adult bicycle trauma have increased dramatically. Annual medical costs and work losses of these incidents last were estimated for 2005 and quality-of-life losses for 2000. METHODS: We estimated costs associated with adult bicycle injuries in the USA using 1997-2013 non-fatal incidence data from the National Electronic Injury Surveillance System with cost estimates from the Consumer Product Safety Commission's Injury Cost Model, and 1999-2013 fatal incidence data from the National Vital Statistics System costed by similar methods. RESULTS: Approximately 3.8 million non-fatal adult bicycle injuries were reported during the study period and 9839 deaths. In 2010 dollars, estimated adult bicycle injury costs totalled $24.4 billion in 2013. Estimated injury costs per mile bicycled fell from $2.85 in 2001 to $2.35 in 2009. From 1999 to 2013, total estimated costs were $209 billion due to non-fatal bicycle injuries and $28 billion due to fatal injuries. Inflation-free annual costs in the study period increased by 137% for non-fatal injuries and 23% for fatal injuries. The share of non-fatal costs associated with injuries to riders age 45 and older increased by 1.6% (95% CI 1.4% to 1.9%) annually. The proportion of costs due to incidents that occurred on a street or highway steadily increased by 0.8% (95% CI 0.4% to 1.3%) annually. CONCLUSIONS: Inflation-free costs per case associated with non-fatal bicycle injuries are increasing. The growth in costs is especially associated with rising ridership, riders 45 and older, and street/highway crashes.

Lifetime Cost of Abusive Head Trauma at Ages 0-4, USA.

This paper aims to estimate lifetime costs resulting from abusive head trauma (AHT) in the USA and the break-even effectiveness for prevention. A mathematical model incorporated data from Vital Statistics, the Healthcare Cost and Utilization Project Kids' Inpatient Database, and previous studies. Unit costs were derived from published sources. From society's perspective, discounted lifetime cost of an AHT averages $5.7 million (95% CI $3.2-9.2 million) for a death. It averages $2.6 million (95% CI $1.0-2.9 million) for a surviving AHT victim including $224,500 for medical care and related direct costs (2010 USD). The estimated 4824 incident AHT cases in 2010 had an estimated lifetime cost of $13.5 billion (95% CI $5.5-16.2 billion) including $257 million for medical care, $552 million for special education, $322 million for child protective services/criminal justice, $2.0 billion for lost work, and $10.3 billion for lost quality of life. Government sources paid an estimated $1.3 billion. Out-of-pocket benefits of existing prevention programming would exceed its costs if it prevents 2% of cases. When a child survives AHT, providers and caregivers can anticipate a lifetime of potentially costly and life-threatening care needs. Better effectiveness estimates are needed for both broad prevention messaging and intensive prevention targeting high-risk caregivers.

Linked data systems for injury surveillance and targeted prevention planning: Identifying geographical differences in injury in Western Australia, 2009-2012.

ISSUE ADDRESSED: Injuries are a leading preventable cause of disease burden in Australia. Understanding how injuries vary by geographical location is important to guide health promotion planning. Therefore, the geographical and temporal distribution of injury across Western Australia from 2009 to 2012 is explored. METHODS: Three Western Australian health datasets were linked and the expected number of injury cases per postcode calculated. A Standardised Injury Ratio was calculated by comparing the observed and expected number of injury cases. Priority areas and associated injury mechanisms were identified by postcode based on injury rates and temporal trends. RESULTS: Injury levels varied across health region, health district and postcode. All nonmetropolitan regions had at least one health district classified as High or Medium-High priority. In contrast, neither metropolitan health region had health districts in these categories. Adopting the finer postcode level of analysis showed localised injury priority areas, even within health districts not classified as High or Medium-High injury areas. Postcodes classified as High or Medium-High injury priority were located alongside those with lower priority categories. CONCLUSION: Injury prevention priority areas had consistent trends both geographically and over time. Finer scale analysis can provide public health policy makers with more robust information to plan, evaluate and support a range of injury prevention programs. SO WHAT?: The use of linked data systems and spatial analysis can assist health promotion decision-makers and practitioners by demonstrating area-based differences in injury prevention allowing effective targeting of limited resources to populations at the highest risk of injury.

Heterogeneous Costs of Alcohol and Drug Problems Across Cities and Counties in California.

BACKGROUND: Estimates of economic and social costs related to alcohol and other drug (AOD) use and abuse are usually made at state and national levels. Ecological analyses demonstrate, however, that substantial variations exist in the incidence and prevalence of AOD use and problems including impaired driving, violence, and chronic disease between smaller geopolitical units like counties and cities. This study examines the ranges of these costs across counties and cities in California. METHODS: We used estimates of the incidence and prevalence of AOD use, abuse, and related problems to calculate costs in 2010 dollars for all 58 counties and an ecological sample of 50 cities with populations between 50,000 and 500,000 persons in California. The estimates were built from archival and public-use survey data collected at state, county, and city levels over the years from 2009 to 2010. RESULTS: Costs related to alcohol use and related problems exceeded those related to illegal drugs across all counties and most cities in the study. Substantial heterogeneities in costs were observed between cities within counties. CONCLUSIONS: AOD costs are heterogeneously distributed across counties and cities, reflecting the degree to which different populations are engaged in use and abuse across the state. These findings provide a strong argument for the distribution of treatment and prevention resources proportional to need.