Risk factors associated with unintentional house fire incidents, injuries and deaths in high-income countries: a systematic review.

OBJECTIVE: To identify the distinguishing risk factors associated with unintentional house fire incidents, injuries and deaths. STUDY DESIGN: Systematic review. METHODS: A range of bibliographical databases and grey literature were searched from their earliest records to January 2016. To ensure the magnitude of risk could be quantified, only those study types which contained a control group, and undertook appropriate statistical analyses were included. A best evidence synthesis was conducted instead of a meta-analysis due to study heterogeneity. RESULTS: Eleven studies investigating a variety of risk factors and outcomes were identified. Studies ranged from medium to low quality with no high quality studies identified. Characteristics commonly associated with increased risk of house fire incidents, injuries and fatalities included: higher numbers of residents, male, children under the age of 5 years, non-working households, smoking, low income, non-privately owned properties, apartments and buildings in poor condition. Several risk factors were only associated with one outcome (eg, living alone was only associated with increased risk of injurious fires), and households with older residents were at increased risk of injurious fires, but significantly less likely to experience a house fire in the first place. CONCLUSIONS: This best evidence synthesis indicates that several resident and property characteristics are associated with risk of experiencing house fire incidents, injuries or death. These findings should be considered by the Fire and Rescue Services and others with a role in fire prevention. Future research should adopt robust, standardised study designs to permit meta-analyses and enable stronger conclusions to be drawn.

How socioeconomic status influences road traffic injuries and home injuries in Rome.

Road traffic injuries (RTI) and home injuries (HI) are a relevant public health problem, especially among people living in deprived areas. The objective of this study was to explore the relationship between morbidity, hospitalisation, mortality from RTI and HI, and socioeconomic status (SES) of the area of residence. RTI and HI surveillance based on the Emergency Information System, the Hospital Information System and the Mortality Registry of Lazio region are the three sources of this study to create a unique surveillance system. For each subject, the SES index (5 levels) of its census tract of residence was obtained. The study population included emergency department admissions (year 2005) of residents in Rome, Italy. Incidence Rate Ratios (IRRs) have been estimated using Poisson Regression. The rates of RTI and HI emergency department visits were higher among the most deprived level of SES (IRR = 1.27, 95% CI: 1.24-1.30; IRR = 1.33, 95% CI: 1.29-1.37, respectively) compared to the most privileged ones; a similar result was found for hospitalisation (IRR = 1.19, 95% CI: 1.08-1.32; IRR = 1.11, 95% CI: 1.01-1.22). A strong relation was found between RTI mortality rates and poor level of SES. The study concluded that RTI and HI incidence were associated to sociodemographic factors.

Profiling the ethnic characteristics of domestic injuries in children younger than age 5 years.

The home remains a very common location for deadly injuries among children younger than 5 years. The aim of this study is to describe the demographic and injury characteristics of domestic injuries in children younger than 5 years. The National Trauma Data Bank's National Sample Program data set was queried for children younger than 5 years with the injury site classified as home. Bivariate analysis was performed to determine unadjusted differences by ethnicity. Appropriate weight was applied to the sample to determine accurate national estimates. A total of 7,364 children, representing 32,033 children, were analyzed. Overall mortality was 1.6 per cent. Among whites, blacks, Hispanics, Asians, and Native Americans, intentional injuries accounted for 6.5, 12.8, 10.2, 5.2, and 19.0 per cent of all injuries by intent, respectively (P < 0.003). Burn injury was disproportionately higher in blacks (24.1%) followed by Native Americans and Asians (15.3 and 11.5%, P = 0.008). On multivariate analysis, black ethnicity was associated with increased length of stay. Intentional injuries were significantly higher in blacks and Native Americans with black patients sustaining a disproportionately higher proportion of burn injury. Therefore, greater attention is needed to provide more effective home safety interventions to children among high-risk ethnic groups.

Estimation of the social costs of home injury: a comparison with estimates for road injury.

Home injury is thought to constitute a major health burden in most developed countries. However, efforts to address this burden have been hampered by reluctance from outside agencies to interfere with the home environment of individuals, even if it benefits the occupant's safety. This paper outlines cost-benefit evaluation methods established in the transport safety domain applied to home safety to estimate the social cost of unintentional home injury in New Zealand. Estimates of costs imposed on society by home injury can provide an important motivator for initiating research and programmes to reduce home injury risk. Data sources used included mortality data, hospitalisation data and data on minor injuries that required medical treatment, but not hospital admission. We estimated that unintentional home injuries in New Zealand impose an annual social cost of about $NZ 13 billion (about $US 9 billion), which is about 3.5 times the annual social cost of road injury. These estimates provide a rational evidence base for decisions on housing-focused safety regulation or interventions that always carry some cost, and therefore need to be weighed against the benefits of injuries potentially prevented.

The epidemiology of domestic injurious falls in a community dwelling elderly population: an outgrowing economic burden.

In Italy, more than 3 million people annually sustain a domestic injury; the elderly experience it the most. From a healthcare perspective, elderly falls are a major clinical issue with an outgrowing socioeconomic burden. The aim of the study was to evaluate the epidemiology of injurious falls in a community dwelling population, admitted to the emergency room (ER) because of a domestic injury, to assess the socioeconomic burden. Seventy-four hospitalized patients among 227 were examined. Falls represented the main cause of admittance to the ER; the average cost for fall-related hospitalization was of €5479.09.

Fire-related deaths in India in 2001: a retrospective analysis of data.

BACKGROUND: Hospital-based studies have suggested that fire-related deaths might be a neglected public-health issue in India. However, no national estimates of these deaths exist and the only numbers reported in published literature come from the Indian police. We combined multiple health datasets to assess the extent of the problem. METHODS: We computed age-sex-specific fire-related mortality fractions nationally using a death registration system based on medically certified causes of death in urban areas and a verbal autopsy based sample survey for rural populations. We combined these data with all-cause mortality estimates based on the sample registration system and the population census. We adjusted for ill-defined injury categories that might contain misclassified fire-related deaths, and estimated the proportion of suicides due to self-immolation when deaths were reported by external causes. FINDINGS: We estimated over 163 000 fire-related deaths in 2001 in India, which is about 2% of all deaths. This number was six times that reported by police. About 106 000 of these deaths occurred in women, mostly between 15 and 34 years of age. This age-sex pattern was consistent across multiple local studies, and the average ratio of fire-related deaths of young women to young men was 3:1. INTERPRETATION: The high frequency of fire-related deaths in young women suggests that these deaths share common causes, including kitchen accidents, self-immolation, and different forms of domestic violence. Identification of populations at risk and description of structural determinants from existing data sources are urgently needed so that interventions can be rapidly implemented.

Ecological level analysis of the relationship between smoking and residential-fire mortality.

OBJECTIVES: To examine the association between tobacco smoking and residential-fire mortality and to investigate whether this association is explained by the confounding effects of selected socioeconomic factors (ie, educational attainment and median household income). DESIGN: An ecological analysis relating state-level residential-fire mortality to state-level percentages of adults who smoke was conducted. Negative binomial rate regression was used to model this relationship, simultaneously controlling for the selected socioeconomic factors. RESULTS: After educational attainment and median household income had been controlled for, smoking percentages among adults correlated significantly with state-level, population-based residential-fire mortality (estimated relative rate for a 1% decrease in smoking = 0.93; 95% CI 0.89 to 0.97). CONCLUSIONS: Mortality from residential fires is high in states with high smoking rates. This relationship cannot be explained solely by the socioeconomic factors examined in this study.

The contribution of alcohol to falls at home among working-aged adults.

The role of alcohol in the occurrence and burden of fall related injury at home is unclear. We examined the contribution of alcohol to fatal and hospitalized injuries due to unintentional falls at home among working-aged adults. We conducted a population-based case-control study in Auckland, New Zealand between July 2005 and July 2006. Cases were 335 people aged 25-60 years who were admitted to hospital or died as a result of unintentional falls at home. Control subjects were 352 people randomly selected from the electoral roll from the same age band as the cases. The participants or next-of-kin completed a structured interview that ascertained data on sociodemographic, personal, and lifestyle factors including alcohol consumption. After controlling for confounding, the consumption of two or more standard alcoholic drinks in the preceding 6h relative to none was associated with a significantly increased risk of fall related injury (for two standard drinks: odds ratio: 3.7, 95% confidence interval: 1.2-10.9; for three or more drinks: odds ratio: 12.9, 95% confidence interval: 5.2-31.9). Approximately 20% of unintentional falls at home in this population may be attributable to the consumption of two or more alcoholic drinks in the preceding 6h. Drinking is strongly associated with unintentional falls at home that result in admission to hospital or death. Moreover, a substantial proportion of falls at home among working-age people can be attributed to alcohol consumption. This largely unrecognized problem should be addressed in falls prevention programs.

Prevention of falls in older patients.

Falls are one of the most common geriatric syndromes threatening the independence of older persons. Between 30 and 40 percent of community-dwelling adults older than 65 years fall each year, and the rates are higher for nursing home residents. Falls are associated with increased morbidity, mortality, and nursing home placement. Most falls have multiple causes. Risk factors for falls include muscle weakness, a history of falls, use of four or more prescription medications, use of an assistive device, arthritis, depression, age older than 80 years, and impairments in gait, balance, cognition, vision, and activities of daily living. Physicians caring for older patients should ask about any falls that have occurred in the past year. Assessment should include evaluating the circumstances of the fall and a complete history and physical examination, looking for potential risk factors. The most effective fall prevention strategies are multifactorial interventions targeting identified risk factors, exercises for muscle strengthening combined with balance training, and withdrawal of psychotropic medication. Home hazard assessment and modification by a health professional also is helpful.

Domestic accidental deaths in the Niger Delta Region, Nigeria.

BACKGROUND: Domestic accidental deaths constitute a public health burden in the Niger Delta Region of Nigeria. This study is aimed at highlighting this public health burden. OBJECTIVE: This is study is aimed at highlighting this public health burden. DESIGN: A six year retrospective study using mortuary records. SETTING: University of Port Harcourt Teaching Hospital, Port Harcout, Nigeria. PATIENTS AND METHODS: Coroner's forms data were used from University of Port Harcout Teaching Hospital, Anatomical Pathology Department, which is the foremost health institution in the region serving a core population of about six million people. RESULTS: Eighty three domestic accidental deaths seen at the University of Port Harcourt Teaching Hospital in the Niger Delta Region of Nigeria between January 1995 and December 2001 were analysed. The 83 deaths occurred in 63 males and 20 females, giving a ratio of 3:1, between the ages of six months and 86 years. There was a bimodal age distribution, with 20 cases (24.1%) occurring in preschool age children, and 22 cases (26.5%) occurring in the elderly over 70 years. Fifty one deaths (61.4%) occurred in the urban areas, while 32 cases (36.8%) occurred in the rural areas. Seventeen cases (20.5%) occurred from falls from height or same level, thereby, constituting the commonest mechanism of injuries that lead to death in the elderly. In children, the commonest mechanism of injuries leading to death was poisoning. The yearly incidence of these deaths is decreasing with the peak of 26.5% in 1995, and 6.0% in 1999. CONCLUSION: Enforceable legislation by government coupled with public education to reduce occurrence should be encouraged. Safety at home must be taken very seriously.

Home safety.

There are more accidents in the home than many other environments, yet there is no duty on local authorities to promote domestic safety per se and the discretionary powers under the Home Safety Act 1961 are rarely used. The local authority remit in safe housing is therefore largely through housing enforcement and grant led activity. The main statutory controls available to local authorities in addressing home safety are found under various Housing Acts, in particular the statutory standard of fitness for habitation, which can provide remedy for some, although not all, potential home accidents. There are many potential hazards in the home which current legislation fails to address. This is one reason why a new standard of assessing domestic conditions--the Housing Health and Safety Rating System--is currently being considered. This new system seeks to change the current emphasis on a 'materials and construction specification' type approach to a system based on known domestic hazards and their reduction ('performance specification') although there remains much debate around the subject. This paper considers the current and proposed systems and other opportunities available to local authorities in addressing the major area of home safety.

How well do socio-demographic characteristics explain variation in childhood safety practices?

BACKGROUND: Unintentional injury is the leading cause of death in children older than 1 year. Deaths from accidents have a steeper class gradient than any other fatal condition and this inequality is widening. There are few published data on the relationship between safety practices and sociodemographic characteristics, hence this study has been undertaken to examine this relationship. METHODS: The study population comprised all parents and guardians of children aged 3-12 months in 36 practices throughout Nottingham (n = 2,152). A postal questionnaire was used to survey current childcare safety practices (from which safe practices scores were derived), together with socio-demographic variables and known risk factors for childhood unintentional injury. RESULTS: Unsafe childcare practices were common. Socioeconomically disadvantaged families had more unsafe practices than more affluent families, but few parents undertook safe practices all the time. The child's age (p<0.01), ethnicity (p<0.01) and living in non-owner-occupied accommodation (p<0.01) were independently associated with the safe practices score. Multivariate regression modelling showed that these risk factors explained only 11 per cent of the variation in the safety practices score. Socio-economic factors explained more of the variation in possession and use of items of safety equipment (13 per cent) than the variation in safety behaviours with no cost implications (3 per cent). CONCLUSIONS: Most of the variation in the number of safety practices is not explained by socio-demographic characteristics and further work is required to examine other possible determinants of safe practice.

[Home and leisure accidents in young persons under 25 years of age in the European Union: challenges for tomorrow]. / Les accidents domestiques et de loisirs des jeunes de moins de 25 ans dans I'Union Européenne: défis pour demain.

In all industrialised countries, the health status of children and adolescents has improved considerably. Today mortality in youngsters of one year and above is low, with the exception of mortality due to accidents: in childhood and adolescence, accidents (in particular those that occur at home or in leisure activities) represent the major cause of death. The objective of this paper is to assess the epidemiological evolution in the European Union in this respect and to review community actions aimed at reducing home and leisure accidents among youngsters living in the EU-region. Research underlines the multiple factors that bring about injuries caused by accidents and the role of environmental and behavioural factors in particular. The complexity and diversity of these factors suggest that priorities in prevention should be based on the severity of injuries and on the feasibility to prevent them. However, within the European Union, a consistent monitoring of mortality and morbidity related to home and leisure injuries is severely hampered by flaws in reporting current mortality and by the absence of a harmonized reporting system for morbidity. Launched in 1981, the European Home and Leisure Accident Surveillance System (EHLASS) is supposed to repair some of those deficiencies, but has not yet been in operation in all member states. Information from both systems is presented in this paper. Prevention policy itself requires coordination at various levels: between behavioural and environmental interventions and between various actors and intermediary groups involved. In the European Union a number of regulatory measures have been taken in order to improve of the safety of youngsters. However, only through clear-targeted programmes and well-coordinated structures and investments one can expect to achieve any change in injury among youngsters.

Household firearm storage practices: do responses differ by whether or not individuals ever use firearms?

INTRODUCTION: The prevalence with which firearms are stored loaded or unlocked has been measured in previous surveys. Our purpose was to compare household firearm storage practices reported by firearm users and nonusers. METHODS: We analyzed telephone survey data from the 1992 and 1993 Oregon Behavioral Risk Factor Surveillance System on 2454 randomly selected adults in households with firearms. We compared reported firearm storage practices among persons who ever used firearms with persons who had never used firearms by demographics and type of firearm. RESULTS: Nonusers of firearms were much less likely than firearm users to report that household firearms were always or sometimes stored loaded [odds ratio (OR) = 0.45, 95% confidence interval (CI):0.36-0.54] or stored loaded and unlocked (OR = 0.46, 95% CI: 0.36-0.57). Except for persons aged 18 to 34 years and persons in handgun-only households, differences in reported firearm storage practices between nonusers and users varied little by demographic characteristics or by type of firearm. Nonusers of household firearms may be unaware that firearms are stored loaded or stored loaded and unlocked in their homes. CONCLUSIONS: Surveys that do not consider firearm use status may underestimate household exposure to loaded firearms or to loaded and unlocked firearms.

Acidentes na infancia / Accidents in children

Os acidentes tem se tornado, ao longo dos ultimos anos, um importante problema da saude publica, ocupando papel de destaque nas estatisticas de morbidade e mortalidade infantil em todo o mundo. Principalmente nos paises subdesenvolvidos o tema "Prevencao de Acidentes" deve ser considerado como prioritario, exigindo maior discussao e divulgacao desse importante agravo a saude infantil

[Morbidity-mortality related to domestic accidents in Belgium: Epidemiology and strategy of prevention]. / Morbi-mortalité liée aux accidents domestiques en Belgique. Epidémiologie et stratégie de prévention.

Home accidents, especially those occurring in children in the younger age group, are a considerable concern to the public health authorities. In addition to the informations registered on the death certificates, the EHLASS-program, i.e. European Health and Leisure Accident Surveillance System, was organized since 1986 by the European Community in order to collect data on the morbidity related to this type of accidents. In Belgium, the collection of data started in 1987, and actually four hospitals provide information. Each year, several thousands of cases are reported. This poster will summarize the Belgian situation from the two sources of data. General strategies for prevention of home accidents are proposed, and some types of intervention are suggested.

Snowy roofs--a potential hazard.

An accumulation of injuries and fatal accidents associated with shovelling snow from roofs was observed in the beginning of 1986 in Northern Sweden. Injury mechanisms and injury panorama are analyzed and preventive measures are suggested. Slipping on roofs or ladders, often caused by sliding snow, was a common cause of accident. Five subjects died of suffocation after having been buried under sliding snow. We would like to emphasize the importance of a co-worker when shovelling snow off roofs, of being well anchored by a safety-line and, if using a ladder, taking care that the ladder is well anchored and that the shovelling is not done on an ascent. Special snow conditions should also be noticed.