Burden of Fire Injuries in Finland: Lost Productivity and Benefits.

Background: The aim of this study was to assess the economic burden of fire-related injury from two perspectives: post-injury social security compensations and also productivity losses due to the lost productive time from a societal perspective induced by the injury. Design and methods: A cohort of 1503 inpatients who sustained fire-related injury during the period 2001-2005 was retrospectively followed up for 5-10 years until the end of 2010, using linkages between several administrative registers. The study process was started in 2015 and finalized on March 2016. Results: Annual productivity loss was on average EUR 5.72 million, giving a total for the five-year study period of EUR 28.6 million, with a mean value of EUR 19,070 per person. Mean/median disability time for those who received benefits was 572/63 days, ranging from 3 days to 36.5 years. Total average cost of benefits to the injured annually during the study period was EUR 1.03 million. This equates to EUR 3430 per patient for the whole cohort or EUR 14,860 for those who received benefits. Conclusions: The burden of fire-related injuries in terms of payment transfers and lost productivity due to periods of disability as indirect costs is high; in a population of 5.4 million, the annual loss exceeded EUR 5.7 million. The results could be used in planning preventive measures and therefore yield savings.

Economic burden of fire-related deaths in Finland, 2000-2010: Indirect costs using a human capital approach.

BACKGROUND: The aim of this study was to examine the indirect economic burden of fire-related deaths in Finland in the period 2000-2010. METHODS: The Human Capital (HC) approach was the main method used to estimate productivity losses due to fire-related deaths. Additionally, Potential Years of Life Lost (PYLL) due to deaths were reported. RESULTS: A total of 1090 fire-related deaths occurred in the period 2000-2010 within a population of some 5.4 million. The majority were male (76% vs 24%), with a mean age of 52 (CI: 51.0-53.2) years for males and 57 (CI: 54.6-59.6) for females; 24% (CI: 21.1-26.2%) of victims were over the retirement age. Most of the victims died of combustion gas poisoning (65%, CI: 61.8-67.6%), followed by burns (33%, CI: 30.6-36.3%). Alcohol was often involved and victims were often socially disadvantaged, with socioeconomic features significantly deviating from those of the general population. Annual PYLL ranged from 2094 (CI: 1861-2326) to 3299 (CI: 3008-3594), with an annual average PYLL of 2763 (CI: 2675-2851). PYLL per death fell in the study period from 34.3 (2000, CI: 31.0-37.7) to 24.6 (2010, CI: 21.8-27.6). The reduction is attributable to a decreasing fraction of young victims and an increase in average ages. CONCLUSIONS: Total productivity loss in the period 2000-2010 was c.a. EUR 342 million (CI: 330-354 million), giving an annual average of EUR 31.1 million (CI: 30.0-32.2 million), with the mean for a victim being EUR 0.315 million (CI: 0.30-0.33 million). The economic burden of deaths is considerable and this study remedies the lack of academic knowledge about the burden of fire-related deaths.

Inpatient costs of fire-related injuries in Finland.

The aim of this study was to approximate the direct health care costs of fire-related injuries in inpatient care in Finland. Using the PERFECT costing method, cost data from both Finnish burn centres were linked to the fire-related injury patient data from the Finnish National Hospital Discharge Register (FHDR, 2001-2009). Additionally, a sample of 168 patients from the Helsinki Burn Centre was linked to the FHDR to examine the relation of %TBSA. Burn was involved in approximately 77% of the cases, the remainder consisting mainly of combustion gas poisonings. Burns were generally much more expensive to treat. Fire-related injuries incurred EUR 6.2 million per year in inpatient costs for the whole country. Mean cost per burn patient was EUR 25,000 and for combustion gas poisoning it was EUR 3600. As expected there was a strong relationship between %TBSA and cost. Older age had a strong effect on costs. The most severe injuries cost over EUR 400,000 to treat. Approximately 7-8% of the most expensive cases constitute 50% of the total costs. Successful prevention of extreme cases would yield considerable savings in relation to total annual inpatient care costs. However, a cost-benefit analysis would be needed.

Methodological challenges in using the Finnish Hospital Discharge Register for studying fire-related injuries leading to inpatient care.

BACKGROUND: The objective was to examine feasibility of using hospital discharge register data for studying fire-related injuries. METHODS: The Finnish National Hospital Discharge Register (FHDR) was the database used to select relevant hospital discharge data to study usability and data quality issues. Patterns of E-coding were assessed, as well as prominent challenges in defining the incidence of injuries. Additionally, the issue of defining the relevant amount of hospital days accounted for in injury care was considered. RESULTS: Directly after the introduction of the ICD-10 classification system, in 1996, the completeness of E-coding was found to be poor, but to have improved dramatically around 2000 and thereafter. The scale of the challenges to defining the incidence of injuries was found to be manageable. In counting the relevant hospital days, psychiatric and long-term care were found to be the obvious and possible sources of overestimation. CONCLUSIONS: The FHDR was found to be a feasible data source for studying fire-related injuries so long as potential challenges are acknowledged and taken into account. Hospital discharge data can be a unique and powerful means for injury research as issues of representativeness and coverage of traditional probability samples can frequently be completely avoided.

Fire-related injuries with inpatient care in Finland: a 10-year nationwide study.

The aim of this study was to examine fire-related injuries leading to inpatient care in Finland. The Finnish National Hospital Discharge Register (2000-2009) and a sample of 222 patients from the Helsinki Burn Centre who sustained flame burns was used. During the 10-years study period, the incidence of fire-related injuries with inpatient care was approximately 5.6 per 100000 persons-years (n=295; males 74%, females 26%). Approximately three quarters involved burns and the remaining cases were mostly combustion gas poisonings. Burns declined from 5.4 in 2000 to 4.0 per 100000 person-years in 2009. The decline was accounted for by young people primarily. Socio-economic features and smoking habits differ between the injured and general population. House fire victims were mainly middle aged and older, while injures involving flammable substances, campfires, etc., were mostly associated with young people. House fires caused the worst damage in terms of Total Body Surface Area burned and inhalation burns. Significantly more people die on the scene of the incident than during the hospital care. Targeting preventive measures in particular at older people and those with a tendency for alcohol abuse and smoking could potentially reduce the burden of the most severe flame burns.

Trends in driving under the influence of drugs: a register-based study of DUID suspects during 1977-2007.

Our aim was to describe the incidence and trends of driving under the influence of drugs (DUID) and to examine the main drug findings and their trends in suspected DUID cases in Finland. A register-based study was conducted of all suspected DUID cases during 1977-2007. The data included 31,963 DUID offenders apprehended by the police with a positive finding for illicit/licit drug impairing driving performance. Toxicological results were analyzed in blood and/or urine specimens in one central laboratory. The incidence of suspected DUID cases increased 18-fold during 1977-2007. Most of the suspects were men (89.7%). However, the male-female ratio decreased from 13.9 to 7.3. The mean age decreased from 36.2 years in 1977 to 29.9 years in 2001 but has since reincreased. Most often found substances were benzodiazepines (75.7%), amphetamines (46.0%), cannabinoids (27.7%) and opioids (13.8%). Most common illicit drugs, amphetamines and cannabinoids, started to appear at the end of the 1980s. Poly-drug findings were common (77.1%). Suspected DUID cases have increased sharply after the introduction of a zero tolerance law, especially in regard to amphetamines. DUID is an increasing problem in Finland, and needs serious attention.