Do the risks and consequences of hospitalized fall injuries among older adults in California vary by type of fall?

BACKGROUND: Research on fall injuries in older persons generally does not examine different types of falls separately. (The main types are same level, from one level to another, and on or from stairs and steps.) There is no a priori reason to believe that various types of falls have similar demographic risk factors and consequences. Therefore, we examined patterns in types of falls, place of falls, and consequences of fall injuries as Californians move through their later decades. METHODS: We analyzed all computerized patient discharge records for all adults 20 years and over hospitalized with a fall as the principal external cause of injury in California nonfederal acute care hospitals, from 1995 through 1997 (N = 242,166). Older-adult age groups were compared with all younger adults. Place of fall, hospital charges, and disposition at discharge were analyzed by type of fall. RESULTS: The three main types of fall injury increase with age, but each type shows variation by age and sex. Women have the highest rates for the main types but not for the less common types. Hospitalized falls vary by place of fall. Mean hospital charges ($17,086) vary by type of fall, with falls from one level to another having the largest mean hospital charge ($19,632). Disposition at discharge does not vary by type of fall. CONCLUSIONS: We found significant variation in demographic factors, place of fall, and mean hospital charges for falling by type of fall, suggesting that future research should focus on individual types of falls rather than on aggregated falls.

Hospitalized fall injuries and race in California.

OBJECTIVE: To compare risks for falls and their consequences among four major race/ethnic groups in California. METHODS: Cases are 104,902 hospital discharges of California residents with a same level fall injury as the principal external cause of injury. Included are all discharges for a first hospitalization for a given injury in any California non-federal hospital from 1995-97. Analysis includes crude and age standardized rates to describe risks, diagnoses, and consequences. RESULTS: Rates per 100 000 for same level hospitalized fall injuries for whites (161) are distinctively higher than for blacks (64), Hispanics (43), and Asian/Pacific Islanders (35). Whites are more likely to have a fracture diagnosis and to be discharged to long term care rather than home, suggesting a poorer outcome or greater severity. Same level falls absorb a large proportion of hospital resources directed to the treatment of injuries. CONCLUSIONS: In a four way comparison among race/ethnic groups, whites are distinguished by their high incidence, rates of fracture, and unfavorable discharge status. Prevention, particularly aimed at whites, has potential to improve health and save treatment resources.

Population-based analysis of 10,766 hospitalizations for mandibular fractures in California, 1991 to 1993.

BACKGROUND: This study describes mandibular fracture incidence, causes, and consequences in a large population. METHODS: California hospital discharge data from 1991 to 1993 were examined to describe causes, lengths of stay, and hospital charges for patients hospitalized for mandibular fractures. Rates were calculated per 100,000 population. RESULTS: There were 10,766 discharges with mandibular fracture as principal diagnosis or as diagnoses two through five on the discharge record (rate=11.5). Of these, 2,694 had mandibular fracture as the only diagnosis (principal diagnosis). For all 10,766 cases, assaults were responsible for more than half (54.0%) of all admissions for mandibular fracture. The highest rates were found among males (18.7), blacks (43.0), and adults aged 16 to 20 (26.5). Charges for the initial hospitalization (excluding physician's fees) for the 2,694 cases with only a diagnosis of mandibular fracture were used to estimate mean charges ($8,740). The total extrapolated 1993 inflation-adjusted hospital charges for mandibular fractures were $34 million per year. Most patients' bills were submitted to government payers, such as Medicaid. CONCLUSION: Treatment of mandibular fractures represents a considerable cost to public-supported programs as well as to patients.

Firearm-related injury surveillance in California.

CONTEXT: Although firearms are the leading cause of injury death in California, no staff resources were devoted to surveillance of firearm-related injuries until 1995, when The California Wellness Foundation funded the Firearm Injury Surveillance Program (FISP). OBJECTIVE: To develop and evaluate surveillance of serious firearm-related injuries and risk factors. DESIGN: Passive surveillance using several data sources: death records, homicide data, hospital discharge data, and Behavioral Risk Factor Surveys. To evaluate FISP, we follow the Centers for Disease Control and Prevention's Guidelines for Evaluating Surveillance Systems. SETTING: State of California. PARTICIPANTS: California Department of Health Services, Epidemiology and Prevention for Injury Control Branch. MAIN OUTCOME MEASURES: Deaths and hospitalizations resulting from firearm-related injuries and presence and storage of firearms in the home. We evaluated FISP's utility, simplicity, flexibility, acceptability, representativeness, and timeliness. RESULTS: Firearm-related injuries were the leading cause of death among children as young as 13 or 14 years of age. In 1994, more than 13,000 California residents died or were hospitalized as a result of firearm-related injuries. Except among whites, most of these serious firearm-related injuries were from assaults. The predominance of handguns as murder weapons increased with time and was more marked among younger and racial/ethnic minority victims. FISP provides data needed for setting policy and preventing firearm-related injuries. The system is acceptable and represents the serious firearm-related injury problem well, but lacks flexibility, timeliness, and detail. CONCLUSIONS: Despite the limitations inherent in passive surveillance, FISP serves many of our surveillance needs well.

Swimming pool drownings and near-drownings among California preschoolers.

OBJECTIVE: To describe a significant but poorly understood public health problem, the authors compiled data on swimming pool drownings and near-drownings requiring hospitalization for California children ages 1 to 4. METHODS: Data from death certificates were used to analyze swimming pool drownings, and hospital discharge data were used to analyze near-drownings. RESULTS: Among California preschoolers in 1993, pool immersion incidents were the leading cause of injury death and the eighth leading cause of injuries leading to hospitalization. Rates per 100,000 population were 3.2 for fatalities and 11.2 for nonfatal incidents, with a fatality-to-case ratio of 1:3.5. Total charges for initial hospital stays (excluding physicians' fees) were $5.2 million for 1227 hospital days. CONCLUSIONS: Swimming pools remain a serious hazard for young children. Primary prevention continues to be an important public health goal. Public health officials should support the adoption of laws designed to protect children from drowning and near-drownings.

Hospitalizations for near drowning in California: incidence and costs.

California hospital discharge data for 1991 were examined to describe persons hospitalized for near drownings (i.e., a submersion incident for which the victim was admitted to a hospital). Among residents with near-drowning injuries, there were 865 discharges, regardless of outcome (rate = 2.8/100,000); 785 persons survived the hospitalization, and 80 (9%) did not. Swimming pools were the most common submersion site (62%). Highest rates per 100,000 were found among males (3.6), Blacks (3.6), and children 1 through 5 years old (18.4). Charges for the initial hospitalization (excluding physicians' fees) amounted to $11.4 million. The state government's share of these charges was $5.4 million, with Medi-Cal expected to pay $4.1 million. Blacks, males, Medi-Cal recipients, and young children are most at risk and should be targeted for prevention programs.