From injury epidemiology to injury prevention: Lithuanian experience Skirmante Starkuviene MD, PhD Department of Social Medicine Kaunas University of Medicine

From injury epidemiology to From injury epidemiology to injury prevention: Lithuanian injury prevention: Lithuanian experienceexperience

Skirmante Starkuviene MD, PhDSkirmante Starkuviene MD, PhD

Department of Social MedicineDepartment of Social Medicine

Kaunas University of MedicineKaunas University of Medicine

LithuaniaLithuania

SCIENTIFIC NETWORKING AND THE GLOBAL HEALTH SUPERCOURSE FOR SCIENTIFIC NETWORKING AND THE GLOBAL HEALTH SUPERCOURSE FOR THE PREVENTION OF THREAT FROM MAN MADE AND NATURAL DISASTERS, THE PREVENTION OF THREAT FROM MAN MADE AND NATURAL DISASTERS,

Kaunas, Lithuania, August 8-10, 2005Kaunas, Lithuania, August 8-10, 2005

IntroductionIntroduction (1) (1)

Rapid development of the country is Rapid development of the country is inevitably associated with an initial inevitably associated with an initial deterioration of health and increasing deterioration of health and increasing inequalities.inequalities.

There are about 400 000 admissions There are about 400 000 admissions to health care institutions and more to health care institutions and more than 5000 deaths due to external than 5000 deaths due to external causes registered per year in causes registered per year in Lithuania.Lithuania.

Although mortality from external Although mortality from external causes have a decreasing tendency in causes have a decreasing tendency in Lithuania, increasing number of non-Lithuania, increasing number of non-fatal injuries and several times higher fatal injuries and several times higher injury rates, if compared with other injury rates, if compared with other European countries, demonstrates the European countries, demonstrates the great need for the definite, well-great need for the definite, well-coordinated and competent injury coordinated and competent injury prevention strategyprevention strategy..

IntroductionIntroduction ( (22))

The aim of the presentation -The aim of the presentation -

tto highlight the burden of injury in o highlight the burden of injury in Lithuania and examine Lithuania and examine injury injury prevention activities in order to assess prevention activities in order to assess what may work in prevention of injuries.what may work in prevention of injuries.

MethodsMethods The patterns and trends of external causes The patterns and trends of external causes

mortality and injury prevention activities mortality and injury prevention activities and programs in Lithuania were studied. and programs in Lithuania were studied.

The data was derived from Lithuanian The data was derived from Lithuanian Department of Statistics, Lithuanian Health Department of Statistics, Lithuanian Health Information Center, and different studies Information Center, and different studies conducted at the Kaunas University of conducted at the Kaunas University of Medicine, Lithuania. Medicine, Lithuania.

International comparisons were performed International comparisons were performed using Health for all Database, WHO/Europe, using Health for all Database, WHO/Europe, January 2005.January 2005.

The “Injury iceberg”The “Injury iceberg”

11 deathdeath

1144 hospitalizationshospitalizations

7799 admissions to admissions to outpatient clinicsoutpatient clinics

Source: Lithuanian Health Information Center, 2004 Source: Lithuanian Health Information Center, 2004

?????????? thousands of thousands of injuries treated at homeinjuries treated at home

Proportion of the external causes of death Proportion of the external causes of death in the overall mortality structure by sex in the overall mortality structure by sex and age in Lithuaniaand age in Lithuania, , 20032003

Source: Lithuanian Health Information Center, 2004 Source: Lithuanian Health Information Center, 2004

60.2 63.2

24.0

5.0

34.8 39.2

14.8

2.60

20

40

60

80

100

1-14 15-44 45-64 65+ Age

%

Males Females

Mortality from external causes of death Mortality from external causes of death by sex and age inby sex and age in Lithuania Lithuania, 2002 , 2002

0

100

200

300

400

500

0 1 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85+

Age

Mortality per 100 000

Male Female

Source: Source: Kalediene R. et al 2003Kalediene R. et al 2003

Mortality from external causes of death Mortality from external causes of death by by place of residenceplace of residence and age in and age in Lithuania Lithuania, 2002, 2002

0

100

200

300

400

500

0 1 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85+

Age


Urban Rural

Source: Source: Kalediene R. et al 2003Kalediene R. et al 2003

Comparison of external causes mortality of Comparison of external causes mortality of Lithuanian population with university and Lithuanian population with university and primary/lower education in 1989 and 2001primary/lower education in 1989 and 2001

Mortality ratio

4.6*4.4*

6.7*

1.5

5.6*

3.7*

0

1

2

3

4

5

6

7

1989 2001 Year

MalesFemalesAll

Mortality of the university educational group = 1Mortality of the university educational group = 1

* p<0.05 compare to university educational group* p<0.05 compare to university educational group

Source: Starkuviene S. et al 2Source: Starkuviene S. et al 2000044

Comparison of external causes mortality of Comparison of external causes mortality of Lithuanian population by marital status in Lithuanian population by marital status in 1989 and 20011989 and 2001

Mortality ratio Widowed4.8*

Widowed3.3*

Single2.4*

Single1.7*

Single2.6*Single

2.1*

0

1

2

3

4

5

1989 2001 Year

MalesFemalesAll

Mortality of the married = 1Mortality of the married = 1Source: Kalediene R. et al 2Source: Kalediene R. et al 2000055

* p<0.05 compare to married* p<0.05 compare to married

Trends in mTrends in mortality from external causes of ortality from external causes of death in selected European countries, death in selected European countries, 1988-20031988-2003

Source: Health for all Database, WHO/Europe, January 2005 Source: Health for all Database, WHO/Europe, January 2005

0

50

100

150

200

250

1988 1990 1992 1994 1996 1998 2000 2002 Year

Mortality per100 000

Lithuania LatviaEstonia European RegionEU before May 2004 EU since May 2004

Mortality from external causesMortality from external causes in in selected European countriesselected European countries

34.3

40.6

38.5

64.2

73.4

87.9

136.3

142.2

147.8

165.2

225.8

0 50 100 150 200 250

Germany (2001)

Sweden (2001)

EU before May 2004 (2002)

Czech Republic (2003)

EU since May 2004 (2003)

European Region (2003)

Latvia (2003)

Estonia (2002)

Lithuania (2003)

Kazakhstan (2003)

Russian Federation (2003)



Mortality from suicides in selected Mortality from suicides in selected European countriesEuropean countries



41.1

33.8

31.5

26.0

24.1

18.2

16.6

15.3

12.2

11.7

10.4

5.9

0 10 20 30 40 50

I taly (2001)


Germany (2001)

Sweden (2001)12,2

Czech Republic (2003)

European Region(2003)


Latvia (2003)

Estonia (2002)

Kazakhstan (2003)


Lithuania (2003)


Road traffic accidents involving alcoholRoad traffic accidents involving alcohol in in selected European countries per 100 000 selected European countries per 100 000 populationpopulation

Per 100 000

5.1

11.3

15.3

19.4

23.9

25.3

26.0

28.7

30.9

38.7

47.2

77.7

0 20 40 60 80

I taly (2002)

Sweden (2002)

Kazakhstan (2003)





Lithuania (2002)

Germany (2002)

Latvia (2002)

Estonia (2002)

Slovenia (2002)

Number of killed persons in traffic accidents per 1 Number of killed persons in traffic accidents per 1 million inhabitants in selected European countries, million inhabitants in selected European countries, 20012001

56

61

81

118

130

140

143

147

179

202

221

0 50 100 150 200 250

Norway

Sweden

Denmark

Austria

France

Spain

Poland

Estonia

Greece

Lithuania

Latvia

Source: ECMT, 2002 Source: ECMT, 2002

Structure of external causes of death among Structure of external causes of death among children and adolescents (0-19 years old) in children and adolescents (0-19 years old) in Lithuania, 1988-2000Lithuania, 1988-2000

11.8%

5.5%5.3% 3.5% 2.9%

31.7%

22%17.3%

Traffic accidents Drowning Other causesSuicides Suffocations HomicidesFires Falls

Source: Starkuviene S. Source: Starkuviene S. 20032003

Mortality from external causes among Mortality from external causes among 00--4 4 years years old children in selected European countriesold children in selected European countries

Source: Health for all Database, WHO/Europe, January 2005

5

41.7

7.5

12.6

19.1

26.6

29.0

42.1

0 10 20 30 40 50

Russia (2003)

Latvia (2003)

Estonia (2002)

Lithuania (2003)




Sweden (2001)

Mortality per100 000 pop.

Mortality from external causes among 5-19Mortality from external causes among 5-19 years years old children in selected European countriesold children in selected European countries

Source: Health for all Database, WHO/Europe, January 2005

3.4

20.9

5.0

8.8

12.6

13.9

17.1

26.4

0 5 10 15 20 25 30

Russia (2003)

Latvia (2003)

Estonia (2002)

Lithuania (2003)




Sweden (2001)

Mortality per100 000 pop.

Frequency of accidents, requiring medical Frequency of accidents, requiring medical attention, among 11-15 years old Lithuanian attention, among 11-15 years old Lithuanian schoolchildren during one year in 1994, 1998, and schoolchildren during one year in 1994, 1998, and 20022002

1994

22.9%Accidents

1998

39%

2002

50.3%

Source: WHO Cross-National Study on Health Source: WHO Cross-National Study on Health Behaviour in School-Aged children (HBSC)Behaviour in School-Aged children (HBSC)

Safety habits among Lithuanian Safety habits among Lithuanian schooschoochildren in 2002children in 2002

1.4%Always wearbicyclehelmet

36.3%Always wearseatbelts

Source: WHO Cross-National Study on Health Source: WHO Cross-National Study on Health Behaviour in School-Aged children (HBSC)Behaviour in School-Aged children (HBSC)

Injury costsInjury costsThe structure of expenditure from health

insurance fund for the treatment of injuries

11.3%

7. 7% 4.2%

77.1%

Hospital care Outpatient careEmergency care Rehabilitation

37 million Euro or 9.2% of the 37 million Euro or 9.2% of the total budget of Lithuanian total budget of Lithuanian Health Insurance Fund was Health Insurance Fund was spent on the treatment of spent on the treatment of injuries, poisonings and injuries, poisonings and certain other consequences of certain other consequences of external causes in 2001external causes in 2001

26 million Euro was spent 26 million Euro was spent from the Social Insurance from the Social Insurance Fund for the temporal and Fund for the temporal and permanent disability caused permanent disability caused by the injuries in 2001 by the injuries in 2001

Indirect injury costs were Indirect injury costs were about 300 million Euro in about 300 million Euro in 20002000

Baubinas H. et al 2003

What are the reasons?What are the reasons? (1) (1)

Political, social and economic transition during Political, social and economic transition during last decades in Lithuanialast decades in Lithuania

- exposure to risks (increased availability of - exposure to risks (increased availability of motor vehicles and greater traffic flows etc.)motor vehicles and greater traffic flows etc.)

-- insufficient insufficient policy development, policy development, legislation, legislation, implementation and enforcement to manage implementation and enforcement to manage effectively the changing environmenteffectively the changing environment

- socio-economic level and inequalities within - socio-economic level and inequalities within the countrythe country

What are the reasons?What are the reasons? (2) (2)

Unsafe behaviour, poor safety culture, Unsafe behaviour, poor safety culture, perceiving risks and injury as unpredictable perceiving risks and injury as unpredictable and inevitable and inevitable

Hazardous environmentHazardous environment However, we cannot determine how far high However, we cannot determine how far high

injury rates in Lithuania are due to unsafe injury rates in Lithuania are due to unsafe behaviour, lack of regulations, absence of behaviour, lack of regulations, absence of enforcement, unsafe environment, lack of enforcement, unsafe environment, lack of safety training, or even weaknesses in safety training, or even weaknesses in emergency services or trauma careemergency services or trauma care

Lithuanian Health Program Lithuanian Health Program 1998 – 20101998 – 2010, approved by the Parliament , approved by the Parliament of Lithuaniaof Lithuania

Target:Target: bby the year 2010 to reduce rate of accidents, y the year 2010 to reduce rate of accidents, accidentaccident related deaths and disabilities by 30related deaths and disabilities by 30%.%.

StrategyStrategy To develop complex program for accident preventionTo develop complex program for accident prevention Prevention of accidents should be carried out on national Prevention of accidents should be carried out on national

and regional levelsand regional levels On the regional level more cities should be involved into On the regional level more cities should be involved into

programs of healthy and safe cities. Activities of programs of healthy and safe cities. Activities of individuals, communities and non-governmental individuals, communities and non-governmental organizations aimed at safe environment should be organizations aimed at safe environment should be promoted and supportedpromoted and supported

Research should be aimed at accident prevention and Research should be aimed at accident prevention and mechanogenesis of injurymechanogenesis of injury

National ANational Accidentccident Prevention Program (2000-2010), Prevention Program (2000-2010),

approved by the Lithuanian Goveapproved by the Lithuanian Goverrnment in 2000 nment in 2000

The aim of the ProgramThe aim of the Program – to develop sustained, well- – to develop sustained, well-coordinated safety system, which could help to prevent deaths coordinated safety system, which could help to prevent deaths and health impairments due to injuries. and health impairments due to injuries.

Strategy of the Program targeted at the three Strategy of the Program targeted at the three types of the preventiontypes of the prevention

Accident prevention or active preventionAccident prevention or active prevention Prevention of the harm on health or passive preventionPrevention of the harm on health or passive prevention Prevention of the death and disabilityPrevention of the death and disability

However…However… The focus is on the health care in cases of injuries The focus is on the health care in cases of injuries Poorly fundedPoorly funded

Conclusions Conclusions It can be expected that entering society into It can be expected that entering society into

more stable period of development, mortality more stable period of development, mortality and morbidity from external causes will level off and morbidity from external causes will level off and inequalities will gradually decline.and inequalities will gradually decline.

Multisectoral commitment to educational, Multisectoral commitment to educational, engineering, environmental, legislative and engineering, environmental, legislative and enforcement interenforcement intervventions and ensuring a entions and ensuring a proper allocation of resources to prevention proper allocation of resources to prevention efforts efforts areare highly desirable at the national level highly desirable at the national level as much as at the community level to prevent as much as at the community level to prevent accidents, violence and suicides.accidents, violence and suicides.

Documents

From injury epidemiology to injury prevention: Lithuanian experience Skirmante Starkuviene MD, PhD Department of Social Medicine Kaunas University of Medicine