Injuries. Manitoba. A 10-Year Review. January 2004

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1 Injuries in Manitoba A 1-Year Review January 24

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3 Executive Summary From 1992 to 21, 5,72 Manitobans died as a result of injuries. As well, there were 12,611 hospitalizations for injuries in the province. Deaths and hospitalizations due to injuries are preventable. This Report is designed to show the details of the burden of injury in our province, in order to assist policy makers and service providers with planning for injury prevention. It includes data about both unintentional and intentional injuries. More details about the types of data used in this Report can be found in Chapter 1. Injury Deaths In 21, approximately seven per cent of Manitoba deaths were the result of injuries. From 1992 to 1999, injury deaths represented 125,619 potential years of life lost, an average of 28.4 years of lost life for each Manitoban who was fatally injured. Males were over twice as likely to die as the result of injuries as were females. From 1992 to 1999, Manitobans had an injury death rate of 48.3/1,. For males the rate was 65.8/1,; for females it was 31.4/1,. The risk of dying as the result of injuries also varied by age. The rate of injury deaths is highest among seniors, and those aged 85 years and older were at highest risk (see Chapter 5). However, when the risk of injury death is considered as a percentage of total deaths by age, then a different picture emerges. Injuries were the most frequent cause of death for Manitoba males aged one to 54 and for Manitoba females aged one to 24. As illustrated by the chart below, in 21, injuries were responsible for about 7 per cent of deaths among Manitobans aged 15 to 24 years. i

4 Deaths from External Causes* as a Percentage of All Deaths Manitoba Per cent of Deaths Total Age Males Females All % % % Source: Decision Support Services, Manitoba Health, Provincial Deaths by Diagnosis Data Source: Vital Statistics 21 * External causes includes injuries and adverse effects of medical treatment. Injuries account for over 96 per cent of the deaths in this category The leading causes 1 of injury deaths in Manitoba from 1992 to 1999 were: 1. Suicide 2. Motor Vehicle Traffic Injuries unintentional 2 3. Falls unintentional 4. Fractures, Cause Unspecified unintentional 5. Suffocation and Choking unintentional equal to Assault Unfortunately, from 1992 to 1999, injury deaths among all Manitobans increased by 2.3 per cent. 3 Deaths among males increased 7.4 per cent. Deaths among females increased 47.9 per cent during this period. Some 1 Leading causes of injury deaths are defined as those which resulted in the most deaths. 2 This includes pedal cycling and pedestrian injuries where motor vehicle traffic was involved. 3 In all charts in this Report which present three-year rolling average data about injury deaths, the first six data points each cover a three-year period, using the ICD-9 classifications, while the last data point covers only two years and uses the ICD1 classification. Because of the lack of direct comparability between the ICD-9 and ICD-1 systems, the data for 2-1 are shown separately. See Appendix 2 for more information on the issues involved in comparing data between the two ICD classification systems. ii

5 of this increase is attributable to the aging of the population, as seniors are more likely to die from injuries, and there were more seniors at the end of the study period than at the beginning Leading Causes of Injury Deaths in Manitoba 1992 to 1999 per 1, Suicide Unintentional motor Unintentional falls Unintentional fractures Unintentional vehicle traffic - cause unspecified suffocation and choking Males Females All Assault , One other important way to examine the impact of injury deaths is to consider the potential years of life lost (PYLL) due to injuries. PYLL is calculated as the years of life lost before 75 years of age. From 1992 to 1999, there were 125,619 potential years of life lost due to all injuries, or an average of 15,72 potential years of life lost each year. Of these, 74,916 potential years of life were lost due to unintentional injuries, 35,157 due to suicide, 8,972 due to assault, 6,442 where the intent was undetermined and 132 where the intent was classified as other. 4 In 1992 there were 149,181 seniors 65 years of age and older living in Manitoba. They represented 13.2 per cent of the Manitoba population. This increased to 157,289, or 13.6 per cent of the population in 21. During this same period, seniors aged 75 years of age and older increased from 5.8 per cent of the population to 6.8 per cent (Manitoba Health, Health Information Management). iii

6 Injury Deaths Due to All Injuries Three-year Rolling Average Manitoba 1992 to 1999 and 2 to per 1, Males Females Manitoba Injury Hospitalizations From 1992 to 21, there were 12,611 hospitalizations for injuries in Manitoba. To place this in a larger perspective, in the fiscal year 21/22, preventable hospitalizations for external causes (injuries plus adverse effects of medical treatment) represented 8.3 per cent of hospitalizations and 6.6 per cent of hospital days. 5 In 21, Manitobans spent 143,423 days in hospital because of injuries, an average of 13.3 days per hospitalization. It is important to note that only those injuries that were serious enough to require inpatient hospital admission (generally at least one night s stay) are included in this Report. Those that resulted only in emergency room visits, day surgeries, or visits to physicians in their offices, are not included in these data. From 1992 to 21, Manitobans had an injury hospitalization rate of 1,54/1,. For males the rate was 114/1,; for females the rate was 15/1,. While injuries represent about 8.4 per cent of hospitalizations for all Manitobans, the percentages vary by age group. The chart below shows injury hospitalizations as a percentage of total hospitalizations by age group, during the fiscal year 21/22. During this year, injuries were the leading cause of hospitalization among males aged ten to 39 years of age. 6 Pregnancy and childbirth was the leading cause of hospitalization among teenage girls and adult females aged 15 to 39 years of age, accounting for 66 per cent (18,755) of their total hospitalizations(27,848). Injuries were the fifth leading cause of hospitalizations among girls and females aged 15 to 39 years, accounting for 4.2 per cent of their hospitalizations, following diseases of the digestive system (6.2 per cent), mental disorders (4.9 per cent) and diseases of the genitourinary system (4.8 per cent). 5 Manitoba Health Report, Decision Support Services, Regional Health Authority Utilization Data 21/22. 6 Manitoba Health, Decision Support Services, Regional Health Authority Hospital Utilization Data by Age Break 21/22. iv

7 Injury Hospitalizations as a Percentage of All Hospitalizations Manitoba Percentage Total Age Males Females All % % % , , , ,146 1,157 1, ,39 1,425 1,52 v

8 Hospitalizations Due to All Injuries Three-year Rolling Average Manitoba 1992 to 21 1,4 1,2 per 1, 1, Males Females Manitoba 1,28. 1,169. 1,166. 1,128. 1,88. 1,52. 1, , , , ,373. 6, , , , ,52. 1,27. 1,24. 1,17. 1, ,64.3 5, , , , , , ,52. 1,129. 1,97. 1,94. 1,72. 1,51. 1,24. 1, , , , , ,26. 11, , ,117.7 As illustrated by the Chart below, from 1992 to 21, the rate of hospitalizations due to all injuries decreased by 13.5 per cent. There was a 17.3 per cent decrease in injury hospitalizations among males and a 9.3 per cent decrease in injury hospitalizations among females. This decrease may in part be the result of changing hospital admitting practices during this time. The Manitoba Centre for Health Policy found that from 1992 to 1996, inpatient hospitalizations for all causes in Winnipeg decreased by nine per cent. 7 The leading causes 8 of injury hospitalizations in Manitoba from 1992 to 1999 were: 1. Falls unintentional 2. Motor Vehicle Traffic Injuries unintentional 9 3. Self-inflicted Injuries 4. Assault 5. Struck By/Against an Object The risks of hospitalization and death from injuries vary over the life cycle. Chapter 5 of this Report contains detailed information about injury deaths and hospitalizations by age. 7 Monitoring the Winnipeg Hospital System: 199/91 through 1996/97, Figure 3. 8 Leading causes of injury hospitalizations are defined as those which resulted in the most hospitalizations. 9 This includes pedal cycling and pedestrian injuries where motor vehicle traffic was involved. vi

9 Leading Causes of Injury Hospitalizations Manitoba 1992 to 21 6 per 1, 4 2 Unintentional falls Unintentional motor Self-inflicted Assault Unintentional vehicle traffic struck by/against Males Females All ,919 5,938 3,364 5,861 3, ,527 4,499 5,868 2, ,446 1,437 9,232 7,878 4,287 Seniors Compared with other age groups, seniors aged 75 years and over were at greatest risk of dying as the result of injuries, although injuries accounted for less than four per cent of deaths among those in this age group. As a group, seniors were also at greatest risk of hospitalization as the result of injuries, although injuries accounted for less than 1 per cent of hospitalization among seniors. Children and Youth Injuries were responsible for about 49 per cent of deaths among children aged one to 14 years and about 71 per cent of deaths among young people aged 15 to 24 years. Injuries were also responsible for about 1 per cent of hospitalizations among children aged one to four years; 18 per cent of hospitalizations among children aged five to nine years; 21 per cent of hospitalizations among children aged 1 to 14 years; 16 per cent of hospitalizations among teenagers aged 15 to 19 years; 9 per cent of hospitalizations among young adults aged 2 to 24 years. vii

10 First Nations Manitobans First Nations Manitobans were at increased risk of death and hospitalization due to injuries. While the data available for this Report do not include all First Nations Manitobans (nor all Aboriginal Manitobans), some conclusions can be drawn from the data which are available. First Nations Manitobans had an injury death rate which was almost twice that of other Manitobans (males two times, females 1.5 times). First Nations Manitobans who died due to injuries, lost on average 47.6 potential years of life (males 46.3, females 51.3), compared to an average of 27.1 potential years of life lost for non-first Nations Manitobans (males 3.1, females 21.3). This reflects an average younger age at time of death among First Nations Manitobans, compared to non-first Nations Manitobans who died as the result of injuries First Nations Manitobans had an injury hospitalization rate which was over three times that of other Manitobans (males 3.7 times, females 3.2 times). More detailed information is provided in Chapter 1. Workplace Injuries Included in this Report are data about workplace injuries that resulted in either hospitalization or death. These have been supplemented by analyses of data provided by Manitoba Labour s Workplace Safety and Health Division and the Manitoba Workers Compensation Board. Each year, five to six per cent of workers report time loss work-related injuries. In 21, Manitobans reported over 37, workplace injuries to the Manitoba Workers Compensation Board. Of these, 18,919 involved lost time from work, for a total of over 4, lost work days, an average of 15 days, or three work weeks, per injury. The remaining 18,114 claims were for medical aid only and involved no time loss from work beyond the day of the injury. The highest rate of workplace injury was among young workers, aged 15 to 24 years, particularly for 2 to 24 year olds. Forty percent of their injuries involved the hands. These young workers were concentrated in the restaurant, retail trade and manufacturing sectors. In agriculture, the highest rate of injury was among the senior population, those age 6 and older. Falls from elevation accounted for 12.7 per cent of deaths in provincially-regulated workplaces, yet they are responsible for 5 per cent of the deaths in the construction sector since 199. Falls resulted in 23 per cent of the hospitalizations recorded for non-farm workplace injuries in 21. In addition to falls from elevation, 11.5 per cent of the time loss injuries were due to falls on the same level slips and trips. Socioeconomic Status Although no data were analyzed by socioeconomic status in this report, Chapter 12 summarizes data from other reports. Both injury deaths and injury hospitalizations are strongly related to socioeconomic status, with injury rates generally increasing as socioeconomic status decreases. viii

11 Table of Contents Executive Summary i 1. Introduction What s Included in this Report How to Use This Report 3 2. Injuries in Perspective Injury Deaths Injury Hospitalizations 8 3. Leading Causes of Injuries in Manitoba Injury Deaths Injury Hospitalizations Age as a Factor in Injuries Infants Children One to Four Years Old Children Aged Five to Nine Years Children Aged 1 to 14 Years to 19 Year Olds to 24 Year Olds to 34 Year Olds to 44 Year Olds to 54 Year Olds to 64 Year Olds to 74 Year Olds to 84 Year Olds Years and Older Unintentional Injuries Cutting and Piercing Injuries Drowning and Submersion Falls Fire and Burn Injuries Firearms Injuries Machinery Motor Vehicle Traffic Pedal Cycle Injuries Other Unintentional Pedestrian Injuries Other Unintentional Transportation Injuries Natural and Environmental Injuries Overexertion Poisoning 99 ix

12 5.14 Injuries Due to Being Unintentionally Struck By or Against an Object Suffocation and Choking Unintentional Fractures, Cause Unspecified Intentional Injuries Suicide and Self-inflicted Injuries Assault Regional Groups Injury Deaths Regional Groups Injury Hospitalizations Regional Groups Regional Health Authority Profiles Assiniboine RHA Brandon RHA Burntwood RHA Central RHA Churchill RHA Interlake RHA Nor-Man RHA North Eastman RHA Parkland RHA South Eastman RHA Winnipeg RHA The Injury Experience of First Nations Manitobans Introduction Injury Deaths Injury Hospitalizations Occupational Injuries Overview of Manitoba Workplace Injuries Manitoba Workplace Fatalities Manitoba Workplace Injuries Manitoba Health Hospital Separation Data for Work Injuries Injuries and Socioeconomic status 211 Acknowledgements 217 Appendix 1: Data Sources 219 Appendix 2: Comparability Between ICD-9 and ICD-1 for Injury Deaths 221 Appendix 3: ICD-9 Injury Codes in Detail 223 Appendix 4: Provincial Injuries Data 243 x

13 1 Introduction This Report examines injuries in Manitoba from 1992 to 21. Tragically, during this time 5,72 Manitobans died as a result of injuries. As well, there were 12,611 hospitalizations for injuries in the province. Deaths and hospitalizations due to injuries are preventable. This Report is designed to show the details of the burden of injury in our province to assist policy makers and service providers with planning for injury prevention. Because this is a surveillance report, it is descriptive rather than prescriptive. 1.1 What s Included in this Report The data used in this Report include all Manitobans. These data come from three sources. The data on injury deaths come from the Manitoba Vital Statistics Deaths Database. The population data come from Manitoba Health s Registration System. The data on injury hospitalizations come from Manitoba Health s Hospital Discharge Database. A detailed explanation of these data sets can be found in Appendix 1. The data are presented using the injuries data matrix developed by the US Centre for Disease Control and modified by Health Canada. This matrix includes both the mechanism or cause of injury, as well as the manner or intent of the injury (unintentional, self-inflicted, assault, undetermined and other). All data have been coded using the World Health Organization s International Classification of Diseases E codes. A complete listing of the ICD codes in each category is included in Appendix 4. Readers interested in detailed data may find these in Appendix 3. The unintentional injuries are grouped into the following categories using ICD-9 classifications: Cutting and Piercing Drowning and Submersion Falls Fires and Burns Firearms Machinery Motor Vehicle Traffic Pedal Cyclist, Other (not involving motor vehicle traffic) Pedestrian, Other (not involving motor vehicle traffic) Transport, Other (not involving motor vehicle traffic) Natural and Environmental Overexertion Poisoning Struck By or Against Suffocation and Choking Other Specified, Classifiable Other Specified, Not Elsewhere Classified Unspecified 1

14 The intentional injuries are grouped into two categories from this matrix: Self-inflicted Injuries/Suicide Assault Information about the mechanism or cause of injury is included in the discussion of both self-inflicted injuries/suicide and assault, using the ICD classifications. All injury hospitalizations were coded using ICD-9-CM. Data about injury hospitalizations are presented for the 1-year period from April 1, 1992 to March 31, 21. Data about injury deaths are presented for the eight-year period from January 1, 1992 to December 31, These different reporting periods were chosen because of the change in classification systems used for recording data about deaths. Until December 31, 1999, Manitoba recorded data about deaths using the ICD-9 classification system. On January 1, 2, Manitoba began recording all provincial deaths data using the new ICD-1 system. Unfortunately, there is no bridge to allow direct comparability of data between the two systems. In all charts in this Report which present three-year rolling average data about injury deaths, the first six data points each cover a three-year period using the ICD-9 classifications, while the last data point covers only two years and uses the ICD1 classification. Because of the lack of direct comparability between the ICD-9 and ICD-1 systems, the data for 2-1 are shown separately. More information about the ICD-9 to ICD-1 change can be found in Appendix 2. Six types of data are presented in this Report: 1. The number of people who died and the number of hospitalizations that occurred as the result of a particular type of injury or group of injuries per year. 2. The rate per 1, that is, the number who have been hospitalized or who have died as a result of the particular type of injury or injuries, for every 1, people. If the data presented are for males, then the rate per 1, is calculated for 1, males. If the data presented are for females aged 15 to 19, then the rate per 1, is calculated for females in that age group. These data are presented to show the differences and similarities in risks faced by different groups of Manitobans. It is important to note that the rates presented in this Report are crude rates, not adjusted to compensate for changes in age structure. Notably, the population of Manitoba has aged over the 1-year period under review. 3. The injury rate per 1, expressed as a three-year rolling average. The first data point shows rates for 1992, 1993 and 1994 combined. The second shows 1993, 1994 and The third shows 1994, 1995 and 1996, etc. Combining years of data helps to smooth out random fluctuations so that injury trends over time can be examined. 4. The potential years of life lost (PYLL) due to injuries. PYLL is calculated as the years of life lost before the age of 75. These data are presented as one measure of the impact of injury. 5. The average length of stay, expressed as days in hospital. These data are presented as a measure of the impact of injuries on the hospital system. 6. The total number of hospital days. These data are presented as another measure of the impact of injuries on the hospital system. Where individuals could potentially be identified due to small numbers, data are suppressed for reasons of confidentiality. For this reason, detailed information about deaths and injuries in the Churchill RHA have been excluded. 2

15 This Report includes data about injuries, which are a subset of the data about hospitalizations and deaths due to external causes. The other external causes captured by the ICD system are the adverse effects of medical care and surgical care and the adverse effects of drug treatments. These issues are within the mandate of the Manitoba Health Patient Safety Advisory Committee. Unless specifically stated, this Report includes only data about injuries. 1.2 How To Use This Report Chapter 3 (Injuries in Perspective) and Chapter 4 (Leading Causes of Injuries in Manitoba) of this Report provide general information about injuries in Manitoba. Readers interested in particular age groups (such as children and seniors) will find information about the impact of injuries on different age groups in Chapter 5 (Age as a Factor in Injuries). Some readers have a particular interest in certain types of injuries and they will find this information in Chapters 6 (Unintentional Injuries) and 7 (Intentional Injuries). Readers interested in the impact of injuries at the regional level will find this information in Chapters 8 (Regional Groups) and 9 (Regional Health Authority Profiles). Chapter 1 (The Injury Experience of First Nations Manitobans) contains specific information about the impact of injuries on First Nations Manitobans. Two chapters of this Report have been contributed by experts outside of Manitoba Health. Norma Alberg of the Workplace Health and Safety Division of Manitoba Labour has contributed Chapter 11 (Occupational Injuries) and Marni Brownell of the Manitoba Centre for Health Policy has contributed Chapter 12 (Injuries and Socioeconomic Status). More detailed data are available on the CDs included with this Report. 3

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17 2 Injuries in Perspective 2.1 Injury Deaths For the 1-year period from 1992 to 21, 5,72 Manitobans died as a result of injuries. For the eight years from 1992 to 1999, injury deaths represented 125,619 potential years of life lost, an average of 28.4 years of lost life for each person fatally injured. In 21, approximately seven per cent of Manitoba deaths were the result of external causes. External causes includes injuries and adverse effects of medical treatment. Injuries account for over 96 per cent of the deaths in this category. The causes of all deaths in Manitoba during 21 are illustrated in Chart 1 below. Chart 1. Deaths from All Causes Manitoba 21 Digestive system disorders 383 4% All other codes External causes* 1,487 15% 649 7% Neoplasms 2,581 27% Endocrine, metabolic and immune disorders 457 5% Respiratory system disorders 73 7% Circulatory system disorders 3,373 35% Source: Decision Support Services, Manitoba Health, Provincial Deaths by Diagnosis Data Source: Vital Statistics 21 * External causes includes injuries and adverse effects of medical treatment. Injuries account for over 96 per cent of the deaths in this category. In 21, external causes were the most frequent cause of death for Manitobans aged one to 24. For males aged 25 to 54, injuries remained the most frequent cause of death. Females in this age group were most likely to die of cancers; injuries represented their second most frequent cause of death. 7 7 Manitoba Health, Decision Support Services, Provincial Deaths by Diagnosis, Data Source: Vital Statistics 21. 5

18 Chart 2. Deaths from External Causes as a Percentage of All Deaths Manitoba Per cent of Deaths Total Age Males Females All % % % Source: Manitoba Health, Decision Support Services, Provincial Deaths by Diagnosis Data Source: Vital Statistics 21 * External causes includes injuries and adverse effects of medical treatment. Injuries account for over 96 per cent of the deaths in this category. 6

19 Trends in injury deaths from 1992 to 21 are illustrated by Chart 3 below. From 1992 to 1999, on average, injury deaths among all Manitobans increased by 21.3 per cent. Deaths among males increased 12.5 per cent. Deaths among females increased 42. per cent during this period. 8 Some of this increase is attributable to the aging of the population, as seniors are more likely to die from injuries, and there were more seniors at the end of the study period than at the beginning. 9 A recent report by the Manitoba Centre for Health Policy found that even after adjusting for changes in the age structure of the population, there was still a 12 per cent increase in injury mortality between 199 to 1994 and 1995 to 1999, with age adjusted injury deaths for females increasing by over 2 per cent over this time. 1 It is important to note that while the rate of injury deaths among females increased, there were about 1.6 injury deaths among males for every injury death among females. 8 Chart 3. Injury Deaths Due to All Injuries Three-year Rolling Averages Manitoba 1992 to 1999 and 2 to per 1, Males Females Manitoba * Numbers shown are the mean for the three years 8 In all charts in this Report which present three-year rolling average data about injury deaths, the first six data points each cover a three-year period using the ICD-9 classifications, while the last data point covers only two years and uses the ICD1 classification. Because of the lack of direct comparability between the ICD-9 and ICD-1 systems, the data for 2-1 are shown separately. See Appendix 2 for more information on the issues involved in comparing data between the two ICD classification systems. 9 In 1992 there were 149,181 seniors 65 years of age and older living in Manitoba. They represented 13.2 per cent of the Manitoba population. This increased to 157,289, or 13.6 per cent of the population in 21. During this same period, seniors aged 75 years of age and older increased from 5.8 per cent of the population to 6.8 per cent (Manitoba Health, Decision Support Services). 1 Martens, P. et al. The Manitoba RHA Indicators Atlas: Population-Based Comparisons of Health and Health Care Use, 23, page 6. 7

20 2.2 Injury Hospitalizations From 1992 to 21, there were 12,611 hospitalizations for injuries in Manitoba. To place this in a larger perspective, in the fiscal year 21/22 preventable hospitalizations for external causes (injuries plus adverse effects of medical treatment) represented 8.4 per cent of hospitalizations and 6.6 per cent of hospital days. 11 In 21, Manitobans spent 143,423 days in hospital because of injuries, an average of 13.3 days per hospitalization. It is important to note that only those injuries which were serious enough to require inpatient admission to hospital (generally at least one night s stay) are included in this Report. Those which resulted only in emergency room visits, day procedures or visits to physicians in their offices are not included in these data. The causes of hospitalization in Manitoba for 21/2, are illustrated in Chart 4 below. Chart 4. Hospitalizations in Manitoba 21 to 22 Congenital anomalies and conditions originating in perinatal period.8% Disease of musculoskeletal system and connective tissue 4,936 4.% Symptoms, signs, ill-defined conditions 7, % Disease of skin and subcutaneous tissue 1, % Pregnancy, childbirth, puerperium 18, % Disease of genitourinary system 6, % Injury and poisoning 1, % Disease of digestive system 13, % Factors influencing health status and contact with health services 8, % Disease of respiratory system 11, % Neoplasms 8, % Infectious and parasitic diseases 1, % Disease of blood, blood-forming organs 1,9.9% Endocrine, metabolic disease and immune disorders Mental disorders 6, % 2, % Disease of nervous system and sense organs 2,513 Disease of 2.% circulatory system 17, % Source: Manitoba Health, Decision Support Services, Regional Health Authority Utilization Data 21/22 While injuries represent about 8.4 per cent of hospitalizations for all Manitobans, the percentages vary by age group and sex. Chart 5 below shows injury hospitalizations as a percentage of total hospitalizations, by age group, during the fiscal year 21/ Manitoba Health Report, Decision Support Services, Regional Health Authority Utilization Data 21/22. 8

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