Increase in suicide by hanging/suffocation in the U.S., 2000-2010.

BACKGROUND: Recently, suicide exceeded motor vehicle crashes as the leading cause of injury death in the U.S. However, details of this change in suicide methods and the relationship to individual demographics, such as age and societal influences, have not been reported. PURPOSE: To determine the characteristics of the changes in suicide rates between 2000 and 2010. METHODS: Data came from CDC's Web-Based Injury Statistics Query and Reporting System (WISQARS™). Line charts were plotted to reveal changes in suicide rates by firearm, poisoning, and hanging/suffocation (ICD-10 codes: X72-X74, X60-X69, and X70). The measure of change used is the percentage change in suicide rate between 2000 and 2010. RESULTS: The overall suicide rate increased from 10.4 to 12.1 per 100,000 population between 2000 and 2010, a 16% increase. The majority of the increase was attributable to suicide by hanging/suffocation (52%) and by poisoning (19%). Subgroup analysis showed: (1) suicide by hanging/suffocation increased by 104% among those aged 45-59 years and rose steadily in all age groups except those aged ≥70 years; (2) the largest increase in suicide by poisoning (85%) occurred among those aged 60-69 years; and (3) suicide by firearm decreased by 24% among those aged 15-24 years but increased by 22% among those aged 45-59 years. The case fatality rates for suicide by hanging/suffocation during 2000-2010 ranged from 69% to 84%, close to those for suicide by firearm. Analyses were conducted in 2012. CONCLUSIONS: Substantial increases in suicide by hanging/suffocation and poisoning merit attention from policymakers and call for innovations and changes in suicide prevention approaches.

Trauma in the Russian Federation: then and now.

BACKGROUND: Russia has made substantial, largely unrecognized contributions to the field of trauma. These include the early development of triage, improvement of blood transfusions and blood bank networks, and Mobile Emergency Medical Services. Despite these advances, injury fatality rates in Russia are alarmingly high (∼50% higher than other Eastern European countries). They fluctuated dramatically during 1980 to 2006, a period that included the dissolution of Union of Soviet Socialist Republics. Suggested causes, including inaccurate data, alcohol use, and economic hardship, are investigated in this article. METHODS: Injury mortality rates for homicide, suicide, accidental poisoning, and total injuries (source: World Health Organization), alcohol consumption (source: World Health Organization), and economic data (source: United Nations Economic Commission for Europe) for the Russian Federation from 1980 to 2006 were examined and compared with the Baltic States, Central Asian Republics, other Eastern European nations, and the United States. RESULTS: Injury mortality rates declined in Russia from 1980 to 1987. The total injury mortality rate more than doubled between 1987 and 1994, followed by a 40% decline from 1994 to 1998. The 1984 to 1994 mortality rates generally parallel alcohol consumption trends. The 1991 to 1994 climb coincides with the dissolution of the Union of Soviet Socialist Republics. A smaller rise in fatality rates occurred in the early 2000s. CONCLUSIONS: Deaths caused by injuries in the Russian Federation are related to multiple factors. Some authors conclude that the data accurately reflect injury mortality. Financial concerns during these times may have led to riskier behaviors resulting in more deaths from injuries. Heavy alcohol consumption also likely contributes to high injury mortality rates. Excessive injury mortality calls for action by Russian policy makers.

Urban-rural disparities in injury mortality in China, 2006.

CONTEXT: Urban-rural disparity is an important issue for injury control in China. Details of the urban-rural disparities in fatal injuries have not been analyzed. PURPOSE: To target key injury causes that most contribute to the urban-rural disparity, we decomposed total urban-rural differences in 2006 injury mortality by gender, age, and cause. METHODS: Mortality data came from the Chinese Vital Registration data, covering a sample of about 10% of the total population. The chi-square test was used to test the significance of urban-rural disparities. FINDINGS: For all ages combined, the injury death rate for males was 60.1/100,000 in rural areas compared with 40.9 in urban areas; for females, the respective rates were 31.5 and 23.6/100,000. The greatest disparity was at age <1 year for both sexes, where the rate from unintentional suffocation in rural areas was more than twice the urban rate. The higher mortality from drowning among males of all ages and among females ages 1-24 and 35+ contributed substantially to the age-specific urban-rural disparities. For both sexes, transportation incidents and suicide were the most important contributors to higher rates among rural residents ages 15+. CONCLUSIONS: Unintentional suffocation, drowning, transportation incidents, and suicide not only are the major causes of injury death, but also play a key role in explaining the urban-rural disparities in fatal injuries. Further research is needed to identify factors leading to higher rural death rates and to explore economical and feasible interventions for reducing injuries and narrowing the urban-rural gap in injury mortality.

Productivity losses from road traffic deaths in Turkey.

The importance of road traffic injuries in Turkey is not generally appreciated, in part due to lack of knowledge of its economic burden and in part due to major underestimation in official statistics. The total years of potential life lost and potentially productive years of life lost from mortality were calculated in order to estimate the cost of productivity losses from road traffic deaths in Turkey. More years of potentially productive life are lost due to road traffic deaths than to respiratory tract illnesses or diabetes mellitus, two other serious health problems in Turkey. Road traffic deaths cost Turkey an estimated USD 2.6 billion every year in productivity losses alone, more than the World Bank estimate of the indirect costs from the 1999 Marmara earthquake (USD 1.2-2 billion), Turkey's worst earthquake since 1939 (World Bank Turkey Country Office, 1999). This study highlights the importance of accurate information in ameliorating the burden of road traffic safety in Turkey. Turkey has great opportunities to implement cost-effective interventions to reduce the economic burden of fatal and non-fatal road traffic injuries.

The impact of the national polio immunization campaign on levels and equity in immunization coverage: evidence from rural North India.

Few studies have investigated the impact of immunization campaigns conducted under the global polio eradication program on sustainability of polio vaccination coverage, on coverage of non-polio vaccines (administered under Expanded Program on Immunization (EPI)), and on changes in social inequities in immunization coverage. This study proposes to fill the gaps in the evidence by investigating the impact of a polio immunization campaign launched in India in 1995. The study uses a before-and-after study design using representative samples from rural areas of four North Indian states. The National Family Health Survey I (NFHS I) and NFHS II, conducted in 1992-93 and 1998-99 respectively, were used as pre- and post-intervention data. Using pooled data from both the surveys, multivariate logistic regression models with interaction terms were used to investigate the changes in social inequities. During the study period, a greater increase was observed in the coverage of first dose of polio compared to three doses of polio. Moderate improvements in at least one dose of non-polio EPI vaccinations, and no improvements in complete immunization against non-polio EPI diseases were observed. The polio campaign was successful, to some extent, in reducing gender-, caste- and wealth-based inequities, but had no impact on religion- or residence-based inequities. Social inequities in non-polio EPI vaccinations did not reduce during the study period. Significant dropouts between first and third dose of polio raise concerns of sustainability of immunization coverage under a campaign approach. Similarly, little evidence to support synergy between polio campaign and non-polio EPI vaccinations raises questions about the effects of polio campaign on routine health system's functions. However, moderate success of the polio campaign in reducing social inequities in polio coverage may offer valuable insights into the routine health systems for addressing persistent social inequities in access to health care.