KFL&A Public Health BURDEN OF INJURY IN KINGSTON, FRONTENAC, LENNOX & ADDINGTON

Transcription

1 KFL&A Public Health BURDEN OF INJURY IN KINGSTON, FRONTENAC, LENNOX & ADDINGTON DECEMBER 213

2 Authors: Suzanne Fegan, Epidemiologist, Research and Evaluation Division, KFL&A Public Health Suzanne Biro, Foundational Standard Specialist, Health Eating and Physical Activity, KFL&A Public Health Contributors: KFL&A Public Health s Ontario Public Health Standards Cross Team Injury Prevention & Substance Misuse Working Group An-Qi Shen, Research Assistant, Research and Evaluation Division, KFL&A Public Health Reviewers: Kathleen O Connor, Director, Research and Evaluation Division, KFL&A Public Health Kimberley Shaw, Manager, Health Eating and Physical Activity, KFL&A Public Health Janine Monahan, Manager, School Health, Chronic Disease and Injury Prevention, KFL&A Public Health Susan Stewart, Director, Chronic Disease and Injury Prevention, KFL&A Public Health Daphne Mayer, Manager, Substance Misuse and Injury Prevention, KFL&A Public Health Special Acknowledgement A special thanks goes out to Ottawa Public Health, and in particular, to Katherine Russell, Epidemiologist, Epidemiology Unit, of Ottawa Public Health, for their considerable help, support and collaborative effort in the production of this report. For more information contact: Suzanne Fegan Epidemiologist, Research and Evaluation Division KFL&A Public Health 221 Portsmouth Ave., Kingston, ON K7M 1V5 Tel: , ext suzanne.fegan@kflapublichealth.ca Recommended Citation: Research and Evaluation Division of Kingston, Frontenac and Lennox & Addington Public Health. The Burden of Injury Report. Kingston: Author; 213 Kingston Cloyne Napanee Sharbot Lake 221 Portsmouth Ave., P.O. Box Dundas Street, P.O. Box 149 Kingston, ON K7M 1V5 Cloyne, ON Napanee, ON Sharbot Lake, ON Tel: (613) KH 1K K7R 1Z5 KH 2P Or Tel: (613) Tel: (613) Tel: (613) Fax: (613) Fax: (613) Fax: (613) Fax: (613) Working together for better health

3 Table of Contents Executive Summary...1 Falls... 1 Motor Vehicle Collisions... 1 Poisoning... 2 Chapter 1 Introduction...3 Injury Prevention within KFL&A Public Health... 5 Chapter 2 Unintentional Injuries...7 Highlights... 7 Introduction... 7 Self-Reported Injuries... 7 Emergency Department Visits and Hospitalization for All Unintentional Injuries... 7 Diagnosis of Unintentional Injuries Leading Causes of Unintentional Injury Resulting in an Emergency Department Visit Leading Causes of Unintentional Injury Resulting in Hospitalization Deaths Resulting from Unintentional Injuries Potential Years of Life Lost Chapter 3 Falls Highlights Introduction Self-Reported Falls Emergency Department Visits and Hospitalizations for Falls Diagnosis of Fall-Related Injuries Place of Falls Types of Falls... 3 Types of Falls Among Seniors Types of Falls Among Children Falls on Same Level Due to a slip, trip or Stumble Falls On and From Stairs and Steps Falls Involving Snow and Ice Falls Involving a Bed, Chair, or Other Furniture Falls On and From a Ladder or Scaffolding Falls Involving Wheelchairs, Strollers, and Other Types of Walking Devices Falls Resulting in Death Chapter 4 Motor Vehicle Collisions... 4 Highlights... 4 Introduction... 4 Reportable Collisions... 4 Motor Vehicle Collision-Related Emergency Department Visits and Hospitalizations... 4 Diagnosis of Motor Vehicle Collision-Related Injuries Types of Collisions Car Occupants Pedestrians Motorcyclists Pedal Cyclists... 5 Deaths Resulting from Motor Vehicle Collisions Collision Prevention Awareness and Behaviour KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington i

4 Impaired Driving Cell Phone Use While Driving Car Seats and Booster Seats Chapter 5 Unintentional Poisoning and Substance Misuse Highlights Introduction Unintentional Poisoning and Substance Misuse-Related Emergency Department Visits and Hospitalizations Location of Unintentional Poisoning and Substance Misuse Resulting in Emergency Department visits and Hospitalizations Types of Poisoning Substances Deaths Related to Unintentional Poisoning and Substance Misuse Chapter 6 Sports and Recreation Injuries Highlights Introduction Sport and Recreation-related Emergency Department Visits and Hospitalizations Types of Sport and Recreation Injuries Cycling Injuries... 7 Hockey Injuries... 7 Skiing and Snowboarding Injuries Playground Equipment-Related Injuries ATV/Snowmobile Injuries Other Team Sports Injuries Including Football, Rugby, Soccer and Baseball Injuries In-Line Skating, Skateboarding and Scooter Fall Injuries Ice Skating Injuries Tobogganing Injuries Use of Protective Equipment in Youth and Adults Sport and Recreation Injury Deaths Chapter 7 Pedestrian Injuries Highlights Introduction Pedestrian-related Emergency Department Visits and Hospitalizations Diagnosis of Pedestrian Injuries Types of Pedestrian Injuries Pedestrian Deaths Chapter 8 Cycling Injuries Summary Introduction Cycling-Related Emergency Department Visits and Hospitalizations Diagnosis of Cycling Injuries Cycling-related head injuries Types of Cycling Injuries Cycling Deaths Bike Helmet Use Chapter 9 Burns... 9 Summary... 9 Introduction... 9 Burn-Related Emergency Department Visits and Hospitalizations... 9 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington ii

5 Place of Occurrence of Burns Causes of Burns Scalds Burn-Related Deaths Chapter 1 Drowning Highlights Introduction Near-drowning-Related Emergency Department Visits and Hospitalizations Place of Occurrence of Near-Drowning... 1 Types of Near-Drowning Events... 1 Near-Drowning Involving Watercraft Swimming Pool-Related Near-Drowning Drowning Deaths Chapter 11 Intentional Injuries Highlights Introduction Emergency Department Visits and Hospitalizations for Self-Harm Types of Self-Harm Injuries Self-Harm by Drugs or Alcohol Suicide Deaths Violence Violence Acts Deaths from Violence Chapter 12 Summary and Discussion Appendix 1 Glossary of Terms Appendix 2 Data Sources Appendix 3 External Cause of Injury Codes Appendix 4 Nature of Injury Codes Reference List KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington iii

6 EXECUTIVE SUMMARY Executive Summary This report provides data and trends for injury in the Kingston, Frontenac and Lennox & Addington Public Health (KFL&A Public Health) region, and outlines current local practices and partners related to areas of intentional and unintentional injury prevention. The report provides individuals, program planners and policy makers with the information needed to address injury prevention priorities in the KFL&A region. Injuries are not accidents. Injuries are predictable and preventable; they arise out of a series of events and interconnected factors related to unsafe environments, conditions and behaviours. The greatest burden of injury arises from those whose health, wellbeing, and life potential are directly diminished or destroyed by injury. In the KFL&A area, an average of 63 residents die each year due to unintentional injury. It is recognised that alcohol was an important risk factor associated with injury-related deaths between 2 and 29. In terms of potential years of life lost (PYLL), unintentional injuries in the KFL&A area were second only to ischemic heart disease as a cause of PYLL. Fourteen percent of all admissions to emergency departments (ED) were due to unintentional injuries. The ED visit rate for unintentional injury in the KFL&A area was considerably higher than the provincial rate. However, hospital admission rates in the KFL&A area, as a result of unintentional injury, were lower than the Ontario rate. Though the emotional and social consequences of injury cannot be measured in dollars, it was estimated that $3.1 billion was spent in 24 in Ontario on the indirect costs of injury, such as reduced productivity due to hospitalization, disability and premature death; and $3.7 billion was spent on direct costs related to injury, such as hospitalization, outpatient care, nursing home care, home care, and services of physicians and other health professionals. The following are trends noted from local data on some specific injuries: Falls Falls affect seniors older than 65 years more than any other age group; they are the age group with the highest rate of emergency department visits and hospitalizations resulting from falls. Children under five years of age are also predominantly affected by falls. Motor Vehicle Collisions Young adults aged 15 to 24 years have the highest rate of motor-vehicle collision (MVC)-related emergency department visits and hospitalizations. Although both men and women (all ages) have similar MVC-related emergency department visits, males have almost double the rate of MVC-related hospitalizations. Car occupants, including both drivers and passengers, represented most of the MVC-related emergency department visits and hospitalizations. On average, 11 KFL&A residents die annually as a result of a MVC. Two percent of all collisions involved a driver who had consumed alcohol, while 9 % were due to inattentive drivers. KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 1

7 EXECUTIVE SUMMARY Poisoning There were a total of 92 deaths related to unintentional poisoning and substance misuse in the KFL&A area between 23 and 211. The highest rate of emergency department visits related to unintentional poisoning and substance misuse were for children under age 5; the highest rates of hospitalizations were for children under age 5 and seniors older than 65 years. The most common poisonings resulting in emergency department visits and hospitalizations were psychotherapeutic drugs, narcotics and hallucinogens. The Burden of Injury in KFL&A report will enable KFL&A Public Health and community partners to work collaboratively to develop a coordinated, evidence-based approach to injury prevention in our region. KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 2

8 CHAPTER 1 INTRODUCTION Chapter 1 Introduction Kingston, Frontenac, and Lennox & Addington Public Health (KFL&A Public Health) is pleased to present the report, Burden of Injury in KFL&A. The aim of this report is to understand the extent of injuries in our region by identifying important trends and detailing who is affected by injury, and in what contexts. The information will enable KFL&A Public Health and community partners to work collaboratively to develop effective injury prevention strategies. It has been recognized for some time that injuries are not accidents over which we have little control. Injuries are predictable and preventable; they arise out of a series of events and interconnected factors related to unsafe environments, conditions and behaviours. 1 The greatest burden of injury arises from those whose health, wellbeing, and life potential are directly diminished or destroyed by injury. 2 Indirect costs of injury, such as costs related to reduced productivity due to hospitalization, disability and premature death may therefore be considered conservative estimates; nevertheless, in 24, indirect costs of injury in Canada were $9.7 billion. 2 Direct costs related to injury, such as hospitalization, outpatient care, nursing home care, home care, services of physicians, and other health professionals, pharmaceuticals, rehabilitation, as well as the costs of prostheses, appliances, eyeglasses, hearing aids, and speech devices necessary to help patients overcome the impairments associated with major injury, were $1.72 billion. 2 In Ontario, these numbers were $3.1 billion and $3.7 billion respectively. 2 While injuries are indeed costly, the impact of injuries on individuals, their families and our communities exact significant emotional, and social consequences that cannot be measured in dollars. Injury is defined as damage or harm to the body resulting in impairment or destruction of health 3 all the ways that people can be physically hurt, impaired or killed. 1 To distinguish whether or not an injury was meant to harm a person, injury is divided into two categories, intentional and unintentional. 1 Examples of unintentional injuries include sports injuries, falls, or injuries resulting from motor vehicle crashes. Intentional injuries are those that result from violence, abuse, neglect, self-harm or suicide. The Ministry of Health and Long Term Care s goal for the Prevention of Injury and Substance Misuse program is to reduce the frequency, severity and impact of preventable injury and substance misuse. 4 Similarly, the Ontario Ministry of Health Promotion s Injury Prevention Strategy: Working Together For A Safer, Healthier Ontario outlines a comprehensive, coordinated approach that uses community partnerships and mobilization, public education and engagement, safe environments and healthy public policy. 1 This report portrays a current view of the burden of injuries in the KFL&A area, providing evidence to inform injury prevention programs and policies, as well as addressing the epidemiologic analysis and surveillance requirements of the Ontario Public Health Standards. This report also highlights injury prevention programs and services provided by KFL&A Public Health and partners in the community. KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 3

9 CHAPTER 1 INTRODUCTION This report is divided into twelve chapters. An executive summary provides the key highlights and trends from the data collected and analyzed from injuries resulting in emergency department (ED) visits, hospitalizations, and deaths in the KFL&A area. This first chapter outlines the framework for injury prevention, best practices and the mandate of KFL&A Public Health s injury prevention programs based on the requirements of the Ontario Public Health Standards. The following chapters focus on nine injury categories, including what the data reveal about the most prevalent types of injuries in our region: all unintentional injuries, falls, motor vehicle collisions (MVC), unintentional poisoning and substance misuse, self-harm and suicide, sport and recreation injuries, pedestrian injuries, cycling injuries, burns, and drowning. The final chapter of the report highlights the burden of injuries at different ages and stages across the lifespan to identify groups of people in this region who are at increased risk of injury Injury prevention in the workplace is not included as a separate sub-category in this report as it is a wellestablished field governed by occupational health and safety legislation with a high level of involvement from the private sector. While these injuries are not specifically highlighted, some of them are related to unintentional injuries and may be incorporated into coordinated programs that address a range of different needs and situations. In the spirit of what gets counted, counts we offer this report as an important information source for developing priorities for action in our community that will build upon the rich and varied injury prevention efforts in our region. We also acknowledge the limitations that not everything that counts can be counted and this report serves to highlight some gaps in available data. Societal Transportation investments and regulations, legislation and regulation for safe play, safety policies, car design, crossing environments, health care policies Community Speed control and law enforcement, neighbourhood walkability, zoning codes, Complete Streets Policies, safety signage Interpersonal supervision, walking in groups Individual/ Intrapersonal Demographic, biological, safe pedestrian crossing skills, perceived environment Figure 1. Socio-ecological model for prevention with examples for walking and pedestrian injury prevention. 5 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 4

10 CHAPTER 1 INTRODUCTION Injury Prevention within KFL&A Public Health Under the requirements outlined in the Ontario Public Health Standards, public health units in Ontario are required to promote safety and prevent injuries. KFL&A Public Health s injury prevention objectives and strategies include, but are not limited to: promoting the health and safety of children and youth in the home, and in the community, reducing the rate of fall-related injuries in the elderly, reducing harmful drinking, and conducting surveillance of health-related information that identifies priority populations and contributes to effective public health program planning, delivery and management. To achieve the Board of Health outcomes related to injury and substance misuse prevention, all OPHS Foundational Standard and Prevention of Injury and Substance Misuse Standard requirements must be met. This environmental scan will assist with meeting the requirement of the Foundational Standard for this program. The purpose of this report is to provide data and trends for injury in our region, and outline current local practices and partners related to the areas of intentional and unintentional injury prevention. Data Sources This report provides a descriptive analysis of the burden of injuries in the KFL&A area and profiles current public health injury prevention programming. Only those injury incidents captured through emergency department (ED) visits, hospitalizations, and deaths are included in this report. This report provides a current comparison between the KFL&A area and Ontario. Where detailed injury data could not be reported from one year of data, five years of data were pooled and presented as a five-year average. In instances where even five years of data represents small and unstable numbers, all available years of data were pooled and presented as an average. Multiple data sources were used in the report s preparation. The most recently available data files were used; however, the most recent year that data are available is not consistent across data sources. Mortality data (Calendar years: 2-29) came from the Vital Statistics database (from the Office of the Registrar General). ED visit data from the National Ambulatory Care Reporting System (Canadian Institute of Health Information) for fiscal years (March through April) 23/24 to 211/212 were used. In this report, the National Ambulatory Care Reporting System was also used for information on hospitalizations. A patient can be admitted as an inpatient after being seen in the emergency department for an unscheduled visit. Fiscal years (March through April) 23/24 to 211/212 were used for hospitalization data. Mortality data uses the International Statistical Classification of Diseases and Related Health Problems, 1th Revision (ICD-1) to code cause of death and external causes of injury. 6 Emergency department visits and hospitalizations uses ICD-1-CA, an enhanced Canadian version of ICD-1 developed by the Canadian Institute for Health Information (CIHI) for morbidity classification in Canada. 7 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 5

11 CHAPTER 1 INTRODUCTION Behavioural data were obtained from the Canadian Community Health Survey (CCHS 29, 21) of Statistics Canada and the Rapid Risk Factor Surveillance System (RRFSS 25, 27-21) of the KFL&A area. For further details on the data sources, see Appendix 2: Data Sources. To protect the confidentiality of all the KFL&A area residents, small numbers that would make it possible to identify any individual were suppressed. Data Limitations/Considerations The data captured in this report (ED visits, hospitalization and mortality) under-represent the true burden of injuries in the KFL&A area because many injuries go unreported. The data represent injuries sustained by the KFL&A area residents who visited an ED or were hospitalized within Ontario. The injury event may have taken place outside of the KFL&A area, but it is captured if the patient was a resident of the KFL&A area and presented to an ED within KFL&A. ED and hospitalization data prepared for this report are counted as diagnoses rather than unique visits. A person may have multiple reasons (external causes of injury) for visiting the ED or being hospitalized. For example, a pedestrian involved in a motor vehicle collision (MVC) also may have fallen. Instead of counting the person as one visit to the ED, the person is counted once for the MVC and once for the fall. As the sequence of events leading to the ED visit cannot be distinguished, both external cause diagnoses have been counted. For simplicity of terminology, external cause diagnoses are referred to as visits for ED data and hospitalizations for hospital admissions in this report. The coding used for these external causes of injury is outlined in Appendix 3. The types of data in this report should be considered separately. Persons who are admitted to hospital from the ED or who die in the ED are not removed from the ED data. Similarly, those who die while in hospital are not removed from the hospitalization data. Thus, it would not be appropriate to add together the ED, hospitalization and death data as presented in this report. Data on the place that the injury occurred are available for all injuries in the report, with the exception of MVCs, pedestrian injuries, and cycling injuries. Abbreviations ATV CCHS ED ICD KFL&A Public Health MVC NACRS PYLL RRFSS all-terrain vehicle Canadian Community Health Survey emergency department International Classification of Diseases Kingston, Frontenac and Lennox & Addington Public Health motor vehicle collision National Ambulatory Care Reporting System potential years of life lost Rapid Risk Factor Surveillance System KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 6

12 CHAPTER 2 MOTOR VEHICLE COLLISIONS Chapter 2 Unintentional Injuries Highlights Approximately 63 the KFL&A area residents die each year due to an unintentional injury. The death rate for unintentional injuries has been higher in males than in females. Falls are the leading cause of unintentional injury death across all ages, followed by motor vehicle collisions (MVCs) and poisoning. Falls are the leading cause of unintentional injury emergency department (ED) visits and hospitalizations across all ages. The rates of ED visits and of hospitalizations for all unintentional injuries in the KFL&A area have been higher than the Ontario rates. Introduction This chapter examines the issue of unintentional injuries and focuses on a selected number of causes. Unintentional injuries are those where there is no evidence of predetermined intent. Intentional injuries, such as intentional self-harm, are not included in this chapter. Please refer to Chapter 11 for data on self-harm. The types of injuries included in chapters are not mutually exclusive; for example, cycling injuries are included and covered as part of MVCs and of sports and recreation injuries. Self-Reported Injuries According to the Canadian Community Health Survey, in 29/21, 17.4% (95%CI: ) of the KFL&A area residents aged 12 and older reported that they had suffered an injury serious enough to limit normal activities (for example a broken bone, a bad cut or burn or a poisoning) in the previous year. Emergency Department Visits and Hospitalization for All Unintentional Injuries Unintentional injuries caused a substantial burden on the KFL&A area s EDs, accounting for an average of 24,841 visits per year from 23 to 211. In 211, there were 26,38 visits, which accounted for about 14% of all ED visits. The rate of ED visits for unintentional injuries was 13,918.3 per 1, population in the KFL&A area (211). This rate is considerably higher than the Ontario rate of 9,73.6 per 1, population. (Figure 2.1) In 211 in the KFL&A area, 739 hospitalizations occurred because of an unintentional injury. The hospitalization rate was per 1, population, which is slightly lower than the provincial rate of per 1, population (211). (Figure 2.2) KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 7

13 Rate per 1, population Number of Hospitalizations Rate per 1, population Number of ED Visits CHAPTER 2 UNINTENTIONAL INJURIES Figure 2.1 All unintentional injury-related ED visits. KFL&A area and Ontario KFL&A Rate Ontario Rate KFL&A # of ED visits Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Data note: Rates are age standardized to the 1991 Canadian Population Figure 2.2 All unintentional injury-related hospitalizations. KFL&A area and Ontario , KFL&A Rate Ontario Rate KFL&A # of Hospitalizations Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Data note: Rates are age standardized to the 1991 Canadian Population KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 8

14 Age group CHAPTER 2 UNINTENTIONAL INJURIES In the KFL&A area from , for both males and females, the highest average number of all unintentional injury ED visits occurred in those aged 15 to 19 years, closely followed by those aged 2 to 24 years old. (Figure 2.3) For males in the KFL&A area, the highest rates of all unintentional injury ED visits occurred in those aged 1 to 19 years (25,785 per 1, population in 211), followed by those under age 1 (16,46 per 1, population). (Figure 2.4) For females, those aged 1-19 also have the highest unintentional injury ED visit rate, 22,213 per 1, population in 211. (Figure 2.4) Also for females, the rates of unintentional injury ED visits for all age groups are lower than those of males, except in the age group 65 and older where the unintentional injury ED visits of females is higher, (12,661 per 1, population), than males (1,588 per 1, population). (Figure 2.4) In the KFL&A area from , females aged 75 and older had the highest average number of all unintentional injury hospitalizations for both males and females. (Figure 2.5) The average hospitalization rate for all unintentional injuries for the KFL&A area was highest in senior females aged 65 and over (1518 per 1, population), almost twice that of their senior male counterparts aged 65 and over. (Figure 2.6) Figure 2.3 All unintentional injury-related ED visits by age group and sex. KFL&A area average Average # Female ED Visits per year from Average # Male ED Visits per year from ED Visits Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 9

15 Age group Rate per 1, Age-specific population CHAPTER 2 UNINTENTIONAL INJURIES Figure 2.4 All unintentional injury-related ED visits by age group and sex. KFL&A area and Ontario KFL&A Ontario KFL&A Ontario Females Males Source: National Ambulatory Care Reporting System 211, Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Figure 2.5 All unintentional injury-related hospitalizations by age group and sex. KFL&A area average Average # Female Hospitalizations per year from Average # Male Hospitalizations per year from Hospitalizations Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 1

16 Rate per 1, Age-specific population CHAPTER 2 UNINTENTIONAL INJURIES Figure 2.6 All unintentional injury-related hospitalizations by age group and sex. KFL&A area and Ontario KFL&A Ontario KFL&A Ontario Females Males Source: National Ambulatory Care Reporting System 211, Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Diagnosis of Unintentional Injuries Almost one-third of all unintentional injury ED visits and almost three-quarters of all unintentional injury hospitalizations in the KFL&A area from 27 to 211 were related to a musculoskeletal injury (i.e., fracture, dislocation, sprain, or strain). (Figures 2.7 and 2.8) Figure 2.7 All unintentional injury-related ED visits by diagnosis. KFL&A area Open Wound, including Traumatic Amputation Superficial 2.6% 23.7% 15.5% Other and unspecified 5.5% Internal Organ Musculoskeletal 31.3% 1.7% Poisonings 1.6% Burns Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Nov. 9, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 11

17 CHAPTER 2 UNINTENTIONAL INJURIES Figure 2.8 All unintentional injury-related hospitalizations by diagnosis. KFL&A area % 1.5% 3.2% 3.2% Burns Superficial Open Wound, including Traumatic Amputation Poisonings 4.5% Other and Unspecified 12.7% Internal Organ 73.9% Musculoskeletal Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Nov. 9, 212 Leading Causes of Unintentional Injury Resulting in an Emergency Department Visit In the KFL&A area for 211, the top five causes of unintentional injury ED visits were falls, struck by or against, overexertion, cut or pierce, and motor vehicle collisions. These top five causes accounted for nearly 75% of unintentional injury ED visits. Across all age groups from 27 to 211, falls were the leading cause of unintentional injury ED visits. As well, the same top five causes of ED visits appear in all age groups. (Tables 2.1 and 2.2) In both of these tables, there is a special mention of a sports and recreation category, which helps to capture injuries that occurred when a person was engaging in sports or recreational activities. This category consists of codes from other areas such as falls and struck by or against, and thus cannot be included in the main part of the table as a mutually exclusive category. For example, a person may have a fall while playing soccer. They would be included in the falls category as well as the sports and recreation category. In another example, a person may be struck by a hockey stick while playing hockey. This person would be included in the struck by and against category as well as the sports and recreation category. Sports and Recreation accounts for a quarter of injuries in those 19 and under and 12.6% of those aged (Tables 2.1 and 2.2) KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 12

18 CHAPTER 2 UNINTENTIONAL INJURIES Table 2.1 Leading causes of unintentional injury-related ED visits, all ages. KFL&A area Rank Type of Unintentional Injury Number % 1 Falls Struck by or against Overexertion Cut or pierce Motor vehicle collisions Foreign body in eye or natural orifice Caught or pinched between two objects Bitten by dog or other mammal Other land transport collisions Nonvenomous insect bites Poisoning Fires and burns Contact with bees, wasps or hornets Water transport incidents Suffocation Hyperthermia Hypothermia Exposure to ultraviolet light Contact with plant thorn, spines, or sharp leaves Contact with electric current Contact with agricultural machinery Discharge from firearms Near drowning 22.2 Other and unspecified* Total for all unintentional injuries Sports and Recreation *The Other and unspecified category is not included in the ranking as it includes multiple causes of injury, as opposed to a single cause. The Sports and Recreation category is a special mention category in this table as it consists of ICD-1-CA codes from other categories such as Falls and Struck by or against. Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept 18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 13

19 CHAPTER 2 UNINTENTIONAL INJURIES Table 2.2 Leading causes of unintentional injury-related ED visits by age group. KFL&A area Type of Unintentional Injury -19 years 2-44 years years 65 and over years # % # % # % # % Falls Struck by or against Cut or pierce Overexertion Motor vehicle collisions Foreign body in eye or natural orifice Bitten by dog or other mammal Poisonings Nonvenomous insect bites Caught or pinched between two objects Contact with bees, wasps or hornets Fires and burns Suffocation Other land transport Water transport incidents Hypothermia Hyperthermia Contact with plant thorn, spines, or sharp leaves Contact with agricultural machinery Near drowning Exposure to ultraviolet light Contact with electric current Discharge from firearms Other and unspecified Total for all unintentional injuries Sports and Recreation *The Other and unspecified category is not included in the ranking as it includes multiple causes of injury, as opposed to a single cause. The Sports and Recreation category is a special mention category in this table as it consists of ICD-1-CA codes from other categories such as Falls and Struck by or against. Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept 18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 14

20 CHAPTER 2 UNINTENTIONAL INJURIES Table 2.2b Leading causes of unintentional injury-related ED visits by age group for those under 19. KFL&A area Type of Unintentional Injury -4 years 5 to 9 years 1 to 14 years 15 to 19 years # % # % # % # % Falls Struck by or against Overexertion Cut or pierce Motor vehicle collisions Foreign body in eye or natural orifice Other land transport collisions Caught or pinched between two objects Nonvenomous insect bites Bitten by dog or other mammal Poisoning Fires and burns Contact with bees, wasps or hornets Water transport incidents Suffocation Hyperthermia Near drowning Hypothermia Exposure to ultraviolet light Contact with plant thorn, spines, or sharp leaves Contact with electric current Contact with agricultural machinery Discharge from firearms Other and unspecified* Total for all unintentional injuries Sports and Recreation *The Other and unspecified category is not included in the ranking as it includes multiple causes of injury, as opposed to a single cause. The Sports and Recreation category is a special mention category in this table as it consists of ICD-1-CA codes from other categories such as Falls and Struck by or against. Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept 18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 15

21 CHAPTER 2 UNINTENTIONAL INJURIES Leading Causes of Unintentional Injury Resulting in Hospitalization Similar to ED visits, falls were the leading cause of unintentional injury hospitalization across all age groups in the KFL&A area. However, the top five causes of injury resulting in hospitalization differ slightly from ED visits. The top five causes of injury resulting in hospitalization for all ages included falls, motor vehicle collisions, struck by or against, poisoning, and other land transport collisions. (Table 2.3) In each age group, three causes of unintentional injury hospitalization ( falls, motor vehicle collisions, and struck by or against ) were included in the top five causes of unintentional injury hospitalizations. In addition, falls and motor vehicle collisions were consistently the top two causes across all age groups. For to 19 years and 45 to 64 years, other land transport collisions was also included in the top five causes, and for age groups 2 to 44 and 65 and over, overexertion, was included in the top five causes. Children aged to 19 had the highest number of hospitalizations due to sports and recreation. (Table 2.4) It should be noted that alcohol use is an important risk factor for injury-related hospitalizations. It is estimated that between 22 and 21 in the KFL&A area, an estimated 1145 injury-related hospitalizations attributable to alcohol consumption occurred among 15 to 69 year olds. For more information on injuries attributable to alcohol, please see the report titled It Starts Here: A conversation about alcohol in the City of Kingston available at KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 16

22 CHAPTER 2 UNINTENTIONAL INJURIES Table 2.3 Leading causes of unintentional injury-related hospitalizations, all ages. KFL&A area Rank Type of Unintentional Injury Number % 1 Falls Motor vehicle collisions Struck by or against Poisoning Other land transport collisions Overexertion Cut or pierce Foreign body in eye or natural orifice Bitten by dog or other mammal Fires and burns Suffocation Hypothermia Water transport incidents Caught or pinched between two objects Drowning Nonvenomous insect bites Excessive heat Contact with bees, wasps or hornets Other and unspecified* Total for all unintentional injuries Sports and Recreation *The Other and unspecified category is not included in the ranking as it includes multiple causes of injury, as opposed to a single cause. The Sports and Recreation category is a special mention category in this table as it consists of ICD-1-CA codes from other categories such as Falls and Struck by or against. Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 17

23 CHAPTER 2 UNINTENTIONAL INJURIES Table 2.4 Leading causes of unintentional injury-related hospitalization visits by age group. KFL&A area Type of Unintentional Injury -19 years 2-44 years years 65 and over years # % # % # % # % Falls Motor vehicle collisions Struck by or against Poisoning Other land transport collisions Overexertion Cut or pierce Foreign body in eye or natural orifice Bitten by dog or other mammal Fires and burns Suffocation Hypothermia Water transport incidents Caught or pinched between two objects Drowning Nonvenomous insect bites Excessive heat Contact with bees, wasps or hornets Other and unspecified* Total for all unintentional injuries 371 1% 566 1% 89 1% % Sports and Recreation *The Other and unspecified category is not included in the ranking as it includes multiple causes of injury, as opposed to a single cause. The Sports and Recreation category is a special mention category in this table as it consists of ICD-1-CA codes from other categories such as Falls and Struck by or against. Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 18

24 Rate per 1, population Number of Deaths CHAPTER 2 UNINTENTIONAL INJURIES Deaths Resulting from Unintentional Injuries In the KFL&A area from 2 to 29, the average rate of unintentional injury death was 63 per year. In 29, the death rate was 21.8 per 1,. It should be noted that alcohol use is an important risk factor for injuryrelated deaths. It is estimated that between 2 and 27 in the KFL&A area, an estimated 74 injury-related deaths attributable to alcohol consumption occurred among 15 to 69 year olds. The number of unintentional injury deaths has remained fairly consistent over the years, as had been the death rate. (Figure 2.9) Overall, from 2 to 29, the unintentional injury death rate was higher for males than females. (Figure 2.1) The cumulative number of unintentional deaths from 2 to 29 was highest among seniors aged 65 and over, and in particular, in senior females. (Figure 2.11) From 2 to 29, the leading cause of unintentional injury death in the KFL&A area was falls, followed by MVCs and poisoning. (Table 2.5) Figure 2.9 Deaths resulting from unintentional injuries. KFL&A area and Ontario KFL&A Rate Ontario Rate KFL&A # of deaths Source: Ontario Mortality Database 2-29, Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted August 15, 212 Data note: Rates are age standardized to the 1991 Canadian Population KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 19

25 Rate per 1, Age-specific population Average # Deaths per year Rate per 1, population Number of Deaths CHAPTER 2 UNINTENTIONAL INJURIES Figure 2.1 Deaths resulting from unintentional injuries by sex. KFL&A area Male Death Rate Female Death Rate # Male Deaths # Female Deaths Source: Ontario Mortality Database 2-29, Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted August 15, 212 Data note: Rates are age standardized to the 1991 Canadian Population Figure 2.11 All unintentional injury deaths by age group and sex. KFL&A area Male Death Rate Female Death Rate Ave. # Male Deaths Ave. # Female Deaths Age Group Source: Ontario Mortality Database 2-29, Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted August 15, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 2

26 CHAPTER 2 UNINTENTIONAL INJURIES Table 2.5 Leading causes of deaths resulting from unintentional injuries, all ages. KFL&A area 2-29 Rank Type of Unintentional Injury Number % 1 Falls Motor vehicle collisions Poisoning Suffocation Fires and Burns Drowning Struck by or against Other land transport collisions Hypothermia Water transport incidents Cut or pierce Bitten by dog or other mammal Contact with bees, wasps or hornet 1.2 Other and unspecified* Total for all unintentional injuries deaths *The Other and unspecified category is not included in the ranking as it includes multiple causes of injury, as opposed to a single cause. Note: Number of deaths is too small to show Table 2.5 by age group. Source: Ontario Mortality Database 2-29, Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted August 15, 212 Potential Years of Life Lost Potential years of life lost (PYLL) is a measure of premature mortality. This measure represents the number of years not lived by an individual who died before age 75 thereby highlighting causes of premature death. Deaths among elderly have little effect on these values. Males typically have higher rates of premature mortality than females because they are more likely to die before the age of 75. In the KFL&A area from 2 to 29, suicides and motor vehicle collisions are some of the leading causes of potential years of life lost. (Figures 2.12) From 2 to 29, unintentional injury was second only to ischemic heart disease as a cause of PYLL for both males and females. (Figure 2.13) KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 21

27 PYLL per 1 population PYLL per 1 population CHAPTER 2 UNINTENTIONAL INJURIES Figure 2.12 Potential years of life lost due to selected unintentional injury or suicide by type of injury and sex (Age to 74 years). KFL&A area Males Females Total Burns Falls Drowning Pedestrian Sports and Recreation Poisoning MVCs Suicide All unintentional Males Females Total Source: Ontario Mortality Database 2-29, Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted August 15, 212 Figure 2.13 Potential years of life lost due to selected causes by cause and sex (Age to 74 years). KFL&A area Cervical Cancer Males Females Total Prostate Cancer Colorectal Cancer Breast Cancer Stroke Suicide Lung Cancer All unintentional Ischemic Heart Disease Males Females Total Note: Blank cells indicate a Total PYLL per 1 population is not applicable given the particular disease in question only affects one sex. Source: Ontario Mortality Database 2-29, Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted August 15, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 22

28 CHAPTER 3 FALLS Chapter 3 Falls Highlights Falls accounted for about 8, visits in 21 and 211 to the KFL&A area emergency departments (EDs). The most common type of fall for seniors aged 65 and over was falls on the same level due to a slip, trip, or stumble. For children under age five, the most common type of fall was from a bed, chair, or other furniture. Elderly women are most likely to be hospitalized for a fall. On average, 17 people die annually in the KFL&A area from a fall. Most of these are seniors. Introduction Falls were the leading cause of unintentional injury resulting in an ED visit and hospitalization across all age groups in the KFL&A area from 27 to 211. Falls affect seniors 65 and over more than any other age group; they are the age group with the highest rate of ED visits and hospitalizations resulting from falls. For the elderly, most falls happen at home, often due to slips, trips, or stumbles involving stairs. Muscle weakness and reduced physical fitness, particularly in the lower body, are important factors in falls among the elderly. 8 Age-related changes in the musculoskeletal, neural, and sensory systems can lead to limited ability to maintain upright balance. Vision changes and eye conditions including glaucoma and cataracts can change perception and make a person more at risk of falling. Chronic illnesses such as arthritis, stroke, Parkinson s disease, cardiovascular disease are also key factors leading to falls among the elderly. 8 Poor nutrition and medications that affect alertness, judgment, perception, and coordination also put seniors at greater risk of falls. Osteoporosis may also make fractures more likely when falls do occur. Environmental factors come into play as well, with poorly designed stairs and handrails, inadequate lighting, and weather conditions involving ice and snow leading to many falls among the elderly. Young children are also a predominant age group affected by falls. Children under five years of age account for the second highest rate of ED visits due to falls, with most injuries involving beds, chairs, or other furniture. Alcohol use is also an important risk factor for causing falls. It is estimated that between 22 and 21 in the KFL&A area, an estimated 334 fall-related injury hospitalizations and 4 fall-related deaths attributable to alcohol consumption occurred among 15 to 69 year olds. Self-Reported Falls The Canadian Community Health Survey, Cycle 5.1, found that in 29/21, 5.7*% (95%CI: ) of the KFL&A area adults reported having a fall that was serious enough to limit their daily activities. 9 Another source, the Rapid Risk Factor Surveillance System, found that in 21, 7.7% (96%CI: ) of the KFL&A area adults reported having a fall that was serious enough to limit their daily activities. 1 *use with caution due to high variability KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 23

29 Rate per 1, population Number of ED Visits CHAPTER 3 FALLS Emergency Department Visits and Hospitalizations for Falls Falls represent a tremendous burden on EDs, accounting for about 8 ED visits in the KFL&A area in 211; this is to almost one third of all ED visits due to unintentional injuries. (Figure 3.1 and Table 2.1) In 211, the KFL&A area rate for fall-related ED visits is much higher than the Ontario rate (the KFL&A area: per 1, population, Ontario: per 1, population). (Figure 3.1) Figure 3.1 Fall-related ED visits. KFL&A area and Ontario KFL&A Rate Ontario Rate KFL&A # of ED visits Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Over 45 hospitalizations occurred because of a fall in 211. Hospitalization rates due to falls in the KFL&A area were stable between 23 and 211. In 211, per 1, the KFL&A area residents were hospitalized due to falls compared with a provincial rate of per 1, Ontario residents. (Figure 3.2) KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 24

30 Rate per 1, population Number of Hospitalizations CHAPTER 3 FALLS Figure 3.2 Fall-related hospitalizations. KFL&A area and Ontario KFL&A Rate Ontario Rate KFL&A # of Hospitalizations Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Younger children and the elderly (65 and over) were most likely to visit the ED for a fall. (Figures 3.3 and 3.5) In the KFL&A area, females 65 and over had a higher rate of ED visits than their male counterparts (27-211). (Figure 3.5) Seniors were more likely to be seriously injured from a fall, resulting in hospitalization. (Figures 3.4 and 3.6) Males had higher rates of hospitalizations for falls for all age groups under 65, whereas female hospitalization rates were higher for those aged 65 and over. (Figure 3.6) In 211, women accounted for 57% percent of all ED visits and 61% percent of all hospitalizations resulting from a fall (data not shown). KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 25

31 Age group Age group CHAPTER 3 FALLS Figure 3.3 Fall-related ED visits by age group and sex. KFL&A area Average # Female ED Visits per year from Average # Male ED Visits per year from ED Visits Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Figure 3.4 Fall-related hospitalizations by age group and sex. KFL&A area Average # Female ED Hospitalizations per year from Average # Male Hospitalizations per year from Hospitalizations Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 26

32 Rate per 1, Age-specific population Average # of Hospitalizations per year Rate per 1, Age-specific population Average # of ED visits per year CHAPTER 3 FALLS Figure 3.5 Fall-related ED visits by age group and sex. KFL&A area Rate per 1, Total Rate per 1, Males Rate per 1, Females Average # of ED visits per year Total Average # of ED visits per year Males Average # of ED visits per year Females Age Group Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Figure 3.6 Fall-related hospitalizations by age group and sex. KFL&A area Rate per 1, Total Rate per 1, Males Rate per 1, Females Average # of Hospitalizations visits per year Total Average # of Hospitalizations visits per year Males Average # of Hospitalizations visits per year Females Age Group Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 27

33 CHAPTER 3 FALLS Diagnosis of Fall-Related Injuries Many different types of injuries can result from a fall; from minor injuries such as cuts, scrapes, and bruises to serious injuries such as concussions, sprains, dislocations, and fractures. Serious injuries such as fractures can result in lifelong functional impairments and can lead to a loss of independence. Over 4% of all people who visited the ED for falls were treated for a musculoskeletal injury (i.e., fracture, dislocation, sprain or strain), while close to a quarter were treated for superficial injuries and approximately 13% were treated for open wound injuries. (Figure 3.7) Approximately 75% of the serious falls leading to hospitalization were diagnosed primarily with musculoskeletal injury. In particular, fractures were the most frequent type of injury resulting from a serious fall. Almost half of the falls requiring hospitalization were diagnosed with hip (femur) fractures and one-fifth were fractures of the lower leg and ankle. Figure 3.7 Fall-related ED visits by diagnosis. KFL&A area % 11.7% 13.4% 23.9% Internal Organ Other and Unspecified Open Wound, including Traumatic Amputation Superficial 42.5% Musculoskeletal Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Place of Falls Between 27 and 211, 18.4% of the falls resulting in an ED visit took place at home. Over half (56.7%) of all fall-related ED visits did not specify where the fall took place. (Figure 3.8) During the same period, 45.9% of the falls resulting in hospitalization occurred at home, while 17.% took place in a residential institution. (Figure 3.9) KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 28

34 Place of Occrrence Place of Occurrence CHAPTER 3 FALLS Figure 3.8 Fall-related ED visits by place of fall. KFL&A area Unspecified or Missing Home Other specified places* Sports and athletics area Schools Residential Institution Street and Highway Trade and service area Industrial and contruction area Farm ED Visits - Percent (%) *Other specified places may include beach, campsite, forest and amusement park Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept.18, 212 Figure 3.9 Fall-related hospitalizations by place of fall. KFL&A area Home Unspecified or Missing Residential Institution Schools Other specified places* Trade and service area Street and Highway Sports and athletics area Industrial and contruction area Farm Hospitalizations - Percent (%) *Other specified places include beach, campsite, forest and amusement park Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept.18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 29

35 CHAPTER 3 FALLS Types of Falls Falls on the same level due to a slip, trip, or stumble (3.8%) represented the most common type of fall resulting in an ED visit for all ages from 27 to 211. This was followed by falls on and from stairs and steps (14.8%). (Table 3.1 and Figure 3.1) For falls resulting in hospitalization, the most common type of a fall was on the same level due to a slip, trip, or stumble (26.8%), followed by falls on and from stairs and steps (1.5%). (Table 3.1 and Figure 3.11) Table 3.1 Average annual number and proportion of fall-related ED visits and hospitalizations, all ages. KFL&A area Type of Fall Average # of ED Visits per year % of ED Visits Average # of Hospitalizations per year % of Hospitalizations On same level due to a slip, trip or stumble 2, On and from stairs and steps 1, On same level involving ice and snow Involving bed, chair or other furniture Involving skates, skis, snowboards, and in-line skates Involving playground equipment On and from ladder or scaffolding Involving wheelchairs and other types of walking devices While being carried or supported by other persons On same level due to collision with, or pushing by, another person Other types of falls* 2, *Other types of falls include falls from, out of or through buildings or structures, falls from trees or cliffs, falls from diving or jumping into water causing injury other than drowning or submersion, falls from one level to another, other falls on same level, and unspecified falls. Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept.18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 3

36 CHAPTER 3 FALLS Figure 3.1 Types of falls resulting in ED visits. KFL&A area Other 27.3%.2%.5% On same level due to collision with, or pushing by, another person While being carried or supported by other persons On same level due to a slip, trip or stumble On and from stairs and steps 3.8% 14.8% 1.5% 2.5% On and from ladder or scaffolding 2.9% Involving playground equipment 5.2% Involving wheelchairs and other types of walking devices Involving skates, skis, snowboards, and in-line skates 5.9% Involving bed, chair or other furniture 8.3% On same level involving ice and snow Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept.18, 212 Figure 3.11 Types of falls resulting in hospitalizations. KFL&A area % While being carried or supported by other persons Other 38.7% 1.2% 1.4% Involving playground equipment Involving skates, skis, snowboards, and in-line skates On same level due to a slip, trip or stumble On and from stairs and steps 26.8% 1.5% 3.6% 4.5% 6.2% On and from ladder or scaffolding Involving wheelchairs and other types of walking devices On same level involving ice and snow 6.8% Involving bed, chair or other furniture Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept.18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 31

37 CHAPTER 3 FALLS Types of Falls Among Seniors Seniors, particularly those aged 85+, accounted for the second highest rate of ED visits and highest rate of hospitalizations for falls. (Figures 3.5 and 3.6) The two most common types of falls requiring a visit to the ED or hospitalization from 27 to 211 were: Falls on the same level due to a slip, trip, or stumble (41.2% of ED visits and 3.4% of hospitalizations) (Table 3.2) Falls involving a bed, chair, or other furniture (9.7% of ED visits and 9.3% of hospitalizations) (Table 3.2) For ED visits, falls on and from stairs and steps (6.2%) were the third most common type, and for hospitalizations, it was falls involving wheelchairs and other types of walking devices, (7.8%). (Table 3.2) Many falls were unspecified or were in an other category (34.6% of ED visits and 46.3% of hospitalizations). Table 3.2 Average annual number and proportion of fall-related ED visits and hospitalizations, seniors aged 85 years and older. KFL&A area Type of Fall Average # of ED Visits per year % of ED Visits Average # of Hospitalizations per year % of Hospitalizations On same level due to a slip, trip or stumble Involving bed, chair or other furniture On and from stairs and steps Involving wheelchairs and other types of walking devices On same level involving ice and snow Other types of falls *Other types of falls include falls from, out of or through buildings or structures, falls from trees or cliffs, falls from diving or jumping into water causing injury other than drowning or submersion, falls from one level to another, other falls on same level, and unspecified falls. Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept.18, 212 Types of Falls Among Children The highest rate of fall-related ED visits was among children under five, and they present a different pattern of falls from seniors and the rest of the population. Between 27 and 211, the most common type of fall resulting in an ED visit for children aged to 4 years was a fall from a bed, chair, or other furniture (25.3%), followed by falling on the same level due to a slip, trip, or stumble (19.8%) and falling on and from stairs and steps (13.4%). (Table 3.3) Injuries involving skates, skis, snowboards, in-line skates and playground equipment are captured in Chapter 7 (Sports and Recreation Injuries). KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 32

38 CHAPTER 3 FALLS Table 3.3 Average annual number and proportion of fall-related ED visits, children aged to 4 years. KFL&A area Type of Fall Average # of ED % of ED Visits visits per year Involving bed, chair or other furniture On same level due to a slip, trip or stumble On and from stairs and steps Involving playground equipment While being carried or supported by other persons Involving wheelchairs and other types of walking devices On same level involving ice and snow Involving skates, skis, snowboards, and in-line skates 4.7 On same level due to collision with, or pushing by, another person 2.3 On and from ladder or scaffolding 1.2 Other types of falls *Other types of falls include falls from, out of or through buildings or structures, falls from trees or cliffs, falls from diving or jumping into water causing injury other than drowning or submersion, falls from one level to another, other falls on same level, and unspecified falls. Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept.18, 212 Falls on Same Level Due to a Slip, Trip or Stumble Seniors aged 65 and over had the highest rate of ED visits in 27 to 211 ( per 1, population) and of hospitalizations (39.5 per 1, population) for falls due to a slip, trip, or stumble. (Figures 3.12 and 3.13) KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 33

39 Rate per 1, Age-specific population Average # of Hospitalizations per year Rate per 1, Age-specific population Average # of ED visits per year CHAPTER 3 FALLS Figure 3.12 ED visit rates for falls due to a slip, trip or stumble on same level by age. KFL&A area KFL&A Rate Average # of ED visits per year Age Group Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept.18, 212 Figure 3.13 Hospitalization rates for falls due to a slip, trip or stumble on same level by age. KFL&A area KFL&A Rate Average # of Hospitalizations per year Age Group Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept.18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 34

40 Rate per 1, Age-specific population Average # of Hospitalizations per year Rate per 1, Age-specific population Average # of ED visits per year CHAPTER 3 FALLS Falls On and From Stairs and Steps Falls on and from stairs and steps was the second leading type of fall resulting in a visit to the ED. Many of the falls on and from stairs and steps resulting in an ED visit occurred in infants and children under the age of five (898.5 per 1, population from 27 to 211) and older adults 65 and over (711.5 per 1, population). Seniors also had the highest rate of falls on and from stairs and steps requiring hospitalization (87.3 per 1, population from 27 to 211). (Figures 3.14 and 3.15) Figure 3.14 ED visit rates for falls on and from stairs by age. KFL&A area KFL&A Rate Average # of ED visits per year Age Group Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept.18, 212 Figure 3.15 Hospitalization rates for falls on and from stairs by age. KFL&A area KFL&A Rate Average # of Hospitalizations per year Age Group Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept.18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 35

41 Rate per 1, Age-specific population Average # of Hospitalizations per year Rate per 1, Age-specific population Average # of ED visits per year CHAPTER 3 FALLS Falls Involving Snow and Ice In 27 to 211, there was an annual average of 643 falls on the same level involving snow and ice that resulted in an ED visit. Falls of this type resulting in a visit to the ED or hospitalization are infrequent for children under five years of age. Hospitalizations for falls involving ice and snow occur most frequently among seniors aged 65 and over. (Figures 3.16 and 3.17) Figure 3.16 ED visit rates for falls on same level involving ice and snow by age. KFL&A area KFL&A Rate Average # of ED visits per year Age Group Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept.18, 212 Figure 3.17 Hospitalization rates for falls on same level involving ice and snow by age. KFL&A area KFL&A Rate Average # of Hospitalizations per year Age Group Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept.18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 36

42 Rate per 1, Age-specific population Average # of Hospitalizations per year Rate per 1, Age-specific population Average # of ED visits per year CHAPTER 3 FALLS Falls Involving a Bed, Chair, or Other Furniture Falls from a bed, chair, or other furniture represent the most common type of fall for children under the age of five years. (Table 3.3) Children under age five are the age group with the highest rate of ED visits for falls from a bed, chair, or other furniture ( per 1, population). (Figure 3.18) However, seniors have the highest hospitalization rates for falls from a bed, chair or other furniture. (Figure 3.19) These types of falls were the second most common type for the most elderly (those aged 85+). (Table 3.2) Figure 3.18 ED visit rates for falls from bed, chair or other furniture by age. KFL&A area KFL&A Rate Average # of ED visits per year Age Group Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept.18, 212 Figure 3.19 Hospitalization rates for falls from bed, hair or other furniture by age. KFL&A area KFL&A Rate Average # of Hospitalizations per year Age Group Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept.18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 37

43 Rate per 1, Age-specific population Average # of Hospitalizations per year Rate per 1, Age-specific population Average # of ED visits per year CHAPTER 3 FALLS Falls On and From a Ladder or Scaffolding Falls from ladders or scaffolding are common in the home or at work. Between 27 and 211, males accounted for about 75% of the ED visits and hospitalizations for falls from a ladder or scaffolding. Visits to the ED for falls from a ladder or scaffolding had the highest rate among adults aged 45 to 64 years, followed by seniors aged 65 and over and those aged 2 to 44. (Figure 3.2) Falls from ladders and scaffolding resulting in hospitalization had the highest rate among adults aged 45 to 64 and seniors aged 65 and over. (Figure 3.21) Figure 3.2 ED visit rates for falls from ladder or scaffolding by age. KFL&A area KFL&A Rate Average # of ED visits per year Age Group Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept.18, 212 Figure 3.21 Hospitalization rates for falls from ladder or scaffolding by age. KFL&A area KFL&A Rate Average # of Hospitalizations per year Age Group Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept.18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 38

44 Rate per 1, population Number of falls resulting in death CHAPTER 3 FALLS Falls Involving Wheelchairs, Strollers, and Other Types of Walking Devices In children under the age of five years, an average of 1 visits to the ED were made annually from 23 to 211, in the KFL&A area, for falls involving baby walkers, strollers or carriages, shopping carts and other types of walking devices. For seniors aged 85+, an average of 35 visits to the ED and 9 hospitalizations occurred annually from 23 to 211 in the KFL&A area for a fall involving wheelchairs and other types of walking devices. Falls Resulting in Death In the KFL&A area from 2 to 29, an average of 18 people died annually from a fall. In Ontario, from 2 to 29, the rate 1, has almost doubled from 4.9 falls resulting in death in 2, to 9.6 per 1, in 29. (Figure 3.22) From 2 to 29 in the KFL&A area, 92% of people who died as a result of a fall were 65 and over (data not shown). In the KFL&A area in 29, the mortality rate from falls for people aged 65 and over was 58. deaths per 1, age-specific population. Figure 3.22 Falls resulting in death. KFL&A area and Ontario KFL&A Rate Ontario Rate KFL&A # of deaths Source: Ontario Mortality Database 2-29, Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted August 15, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 39

45 CHAPTER 2 MOTOR VEHICLE COLLISIONS Chapter 4 Motor Vehicle Collisions Highlights On average, 11 deaths per year in the KFL&A area result from motor vehicle collisions (MVCs). The rate of MVC-related emergency department (ED) visits has been stable in the KFL&A area and consistently higher than the Ontario rate. Males are more likely to be hospitalized than females for a MVC-related injury. Young adults aged 15 to 24 represent the highest rate of MVC-related ED visits, followed closely by adults aged 25 to 44. Young adults aged 15 to 24 also had the highest rate of MVC-related hospitalizations, followed by seniors aged 65 and over. Introduction A MVC is an incident where a vehicle collides with an object (such as another vehicle or pedestrian), causing damage to the vehicle or personal injury. A motor vehicle can be a car, truck or van, motorcycle, bus, or allterrain or off-road vehicle, including ATVs and snowmobiles. Collision injuries include those sustained by someone as a driver, passenger, motorcyclist, pedestrian, or bicyclist. Motor vehicle safety has been addressed by numerous laws throughout the years to reduce the number and severity of collisions. These laws address mandatory seatbelt use, drinking and driving, cell phone use while driving, as well as car seats and booster seats for children Reportable Collisions From 27 to 29, a total of 14,622 reportable* collisions were reported in the KFL&A area. One-fifth of these collisions (2992 collisions) resulted in at least one person being injured. In total, 3759 people were injured in collisions during this time period. Of these 14,622 collisions, 57.4% of the drivers were male. 15 There were 59 fatalities from collisions from 27 to Overall, the rate of MVC-related fatalities in the KFL&A area is 4. per 1. However, in Frontenac County, the fatality rate is only 2.3 per 1, collisions, whereas in Lennox & Addington County the fatality rate is 1.7 per 1, collisions. Motor Vehicle Collision-Related Emergency Department Visits and Hospitalizations From 23 to 211, an average of 1475 visits per year were made to the KFL&A area EDs because of a MVC. During that same time period, the rate of MVC-related ED visits was stable in the KFL&A area and consistently higher than the Ontario rate. In 211, the age-standardized rate for MVC-related ED visits was per 1, population, which was significantly higher than the Ontario rate of visits per 1, population. (Figure 4.1) *Reportable collisions are those defined by the Ontario Highway Traffic Act as collisions having damage of $1 or more or where injury results. 16 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 4

46 Rate per 1, population Number of ED Visits CHAPTER 4 MOTOR VEHICLE COLLISIONS Figure 4.1 Motor vehicle collision-related ED visits. KFL&A area and Ontario KFL&A Rate Ontario Rate KFL&A # of ED visits Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept.18, 212 Data note: Rates are age standardized to the 1991 Canadian Population MVC-related hospitalization rates are slightly higher in the KFL&A area than provincial rates, although in most years this difference was not significant. In 211, there were 42.1 MVC-related hospitalizations per 1, population in the KFL&A area. MVC-related hospitalization rates declined in Ontario from 49.5 per 1, in 23 to 34.6 per 1, in 211. (Figure 4.2) KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 41

47 Rate per 1, population Number of Hospitalizations CHAPTER 4 MOTOR VEHICLE COLLISIONS Figure 4.2 Motor vehicle collision-related hospitalizations. KFL&A area and Ontario KFL&A Rate Ontario Rate KFL&A # of Hospitalizations Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept.18, 212 Data note: Rates are age standardized to the 1991 Canadian Population Young adults aged 2 to 24 years accounted for the highest average number (male mean = 11 per year; female mean = 99 per year) of MVC-related ED visits per year. (Figure 4.3) Although, for all ages, males and females have similar MVC-related ED visit rates, males have almost double the rate of MVC-related hospitalizations than females (27 to 211: 61. per 1, and 34.2 per 1,, respectively). (Figure 4.4) KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 42

48 Age group Age group CHAPTER 4 MOTOR VEHICLE COLLISIONS Figure 4.3 Motor vehicle collision-related ED visits by age group and sex. KFL&A area Average # Female ED Visits per year from Average # Male ED Visits per year from ED Visits Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept.18, 212 Figure 4.4 Motor vehicle collision-related hospitalizations by age group and sex. KFL&A area Average # Female Hospitalizations per year from Average # Male Hospitalizations per year from Hospitalizations Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept.18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 43

49 Rate per 1, Age-specific population Average # of Hospitalizations per year Rate per 1, Age-specific population Average # of ED visits per year CHAPTER 4 MOTOR VEHICLE COLLISIONS Young adults aged 15 to 24 years accounted for the highest rate of MVC-related ED visits ( per 1, population in 27 to 211), followed by those aged 25 to 44 years (923.6 per 1, population). (Figure 4.5) Those aged 15 to 24 also had the highest rate of MVC-related hospitalizations (68.5 per 1, population in 27 to 211), followed by seniors aged 65 and over (67.4 per 1, population). (Figure 4.6) Figure 4.5 Motor vehicle collision-related ED visits by age group. KFL&A area KFL&A Rate Average # of ED visits per year Age Group Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept.18, 212 Data note: Rates are age standardized to the 1991 Canadian Population Figure 4.6 Motor vehicle collision-related hospitalizations by age group. KFL&A area KFL&A Rate Average # of Hospitalizations per year Age Group Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept.18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 44

50 CHAPTER 4 MOTOR VEHICLE COLLISIONS Diagnosis of Motor Vehicle Collision-Related Injuries MVCs can cause both internal and external wounds. From 27 to 211, musculoskeletal (33.8%) and superficial (26.8%) injuries were the leading diagnoses seen in MVC-related ED visits. (Figure 4.7) Figure 4.7 Motor vehicle collision-related ED visits by diagnosis. KFL&A area % 9.2% 24.2% 26.8% Open Wound, including Traumatic Amputation Internal Organ Other and Unspecified Superficial 33.8% Musculoskeletal Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept.18, 212 Data note: Rates are age standardized to the 1991 Canadian Population Types of Collisions From 27 to 211, 7,335 people visited an emergency department due to being injured in a motor vehicle collision. Fifty-eight percent of the MVC-related ED visits involved car occupants injured in collisions, 13.2% involved occupants of all-terrain vehicles (including ATVs and snowmobiles), 6.9% involved motorcyclists, 5.9% involved pedestrians, and 5.5% involved occupants of pick-up trucks or vans. (Figure 4.8) Of the 461 people injured in MVCs requiring hospitalization from , 43.5% were car occupants, 18.8% were all-terrain vehicle occupants (including ATVs and snowmobiles), 13.% were motorcyclists, and 12.6% were pedestrians. (Figure 4.9) KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 45

51 Type of Victum/Occupant Type of Victum/Occupant CHAPTER 4 MOTOR VEHICLE COLLISIONS Figure 4.8 Motor vehicle collision-related ED visits by type of victim/occupant. KFL&A area Car occupant All-terrain vehicles* Motorcyclist Pedestrian Occupant of pick-up truck or van Pedal Cyclist Other land transport** Bus occupant Occupant of heavy transport vehicle Occupant of three-wheeled vehicle Motor vehicle collisions - Percent (%) *All-terrain vehicles include ATVs, snowmobiles, and other motor vehicles designed primarily for off-road use. **Other land transport collisions include occupants of animal-drawn vehicles, occupants of vehicles used on industrial premises or in agriculture or construction, and other unspecified motor vehicle collisions. Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept.18, 212 Data note: Rates are age standardized to the 1991 Canadian Population Figure 4.9 Motor vehicle collision-related hospitalizations by type of victim/occupant. KFL&A area Car occupant All-terrain vehicles* Motorcyclist Pedestrian Occupant of pick-up truck or van Pedal Cyclist Bus occupant Occupant of heavy transport vehicle Other land transport** Hospitalizations - Percent (%) *All-terrain vehicles include ATVs, snowmobiles, and other motor vehicles designed primarily for off-road use. **Other land transport collisions include occupants of animal-drawn vehicles, occupants of vehicles used on industrial premises or in agriculture or construction, and other unspecified motor vehicle collisions. Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept.18, 212 Data note: Rates are age standardized to the 1991 Canadian Population KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 46

52 Rate per 1, Age-specific population Average # of ED visits/hopitalizations per year CHAPTER 4 MOTOR VEHICLE COLLISIONS Car Occupants Car occupants, including both drivers and passengers, represented most of the MVC-related ED visits and hospitalizations. (Figures 4.8 and 4.9) For the period 23 to 211, young adults aged 15 to 24 years had the highest ED visit rate (91.9 per 1, population) and the highest average hospitalization rate (39.5 per 1, population). Seniors aged 65 and over followed closely with the second highest average hospitalization rate (38.6 per 1, population). (Figure 4.1) Figure 4.1 Car occupants involved in motor vehicle collision-related ED visits and hospitalizations by age group. KFL&A area ED visit rate Hospitalization rate Average # ED visits Average # Hospitalizations Age Group Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept.18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 47

53 Rate per 1, population Average # of ED visits/hopitalizations per year CHAPTER 4 MOTOR VEHICLE COLLISIONS Pedestrians Young adults aged 15 to 24 had the highest rate of ED visits from 23 to 211 for pedestrian injuries from traffic collisions (91.4 per 1, population). Those aged 5 to 14 had the highest hospitalization rate for pedestrian injuries from traffic collisions (9. per 1, population), followed by seniors aged 65 or more (8.9 per 1,). (Figure 4.11) Figure 4.11 Pedestrians involved in motor vehicle collision-related ED visits and hospitalizations by age group. KFL&A area ED visit rate Hospitalization rate Average # ED visits Average # Hospitalizations Age Group Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept.18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 48

54 Rate per 1, population Average # of ED visits/hopitalizations per year CHAPTER 4 MOTOR VEHICLE COLLISIONS Motorcyclists From 23 to 211, males accounted for 75.9% of all motorcycle collisions resulting in an ED visit. On average, motorcycle collision-related ED visit rates were highest among adults aged 25 to 44 (66.7 per 1, population) and young adults aged 15 to 24 (66.5 per 1, population). Motorcycle collision-related hospitalization rates were highest among adults aged 45 to 64 years (8.8 per 1, population). (Figure 4.12) Figure 4.12 Motorcyclists Involved in motor vehicle collision-related ED visits and hospitalizations by age group. KFL&A area ED visit rate Hospitalization rate Average # ED visits Average # Hospitalizations Age Group Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept.18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 49

55 Rate per 1, population Average # of ED visits/hopitalizations per year CHAPTER 4 MOTOR VEHICLE COLLISIONS Pedal Cyclists From 23 to 211, males represented 69.1% of pedal cyclists injured in MVCs resulting in a visit to the ED. Young adults aged 15 to 24 had the highest rates of ED visits for pedal cycle injuries involved in MVCs (66.5 per 1, population). (Figure 4.13) Other types of pedal cyclist injuries and information on bicycle helmet use are covered in Chapter 9. Figure 4.13 Pedal cyclists involved in motor vehicle collision-related ED visits and hospitalizations by age group. KFL&A area ED visit rate Hospitalization rate Average # ED visits Average # Hospitalizations Age Group Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept.18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 5

56 Rate per 1, Age-specific population CHAPTER 4 MOTOR VEHICLE COLLISIONS Deaths Resulting from Motor Vehicle Collisions From 2 to 29, an average of 11 the KFL&A area residents died annually as a result of a MVC. The agegroups showing the highest MVC-related mortality rates per 1, are ages 15-24, and 65 and over. (Figure 4.14). Age-standardized MVC-related mortality rates have remained stable over this time period. From 2 to 29, 31.% of the KFL&A residents who died in a MVC were car, pickup truck or van occupants, 17.7% were all-terrain vehicle occupants (including ATVs and snowmobiles), 13.3% were pedal cyclists, and 6.2% were motorcyclists. Figure 4.14 Motor vehicle collision mortality rates. KFL&A area Death Rate Age Group Source: Ontario Mortality Database 2-29, Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted August 15, 212 Collision Prevention Awareness and Behaviour Seatbelts Seatbelt use has been mandatory in Ontario since Since Ontario's seatbelt law first came into effect, the number of people killed and injured in motor vehicle collisions has steadily dropped and it is estimated that seatbelt use has saved over 8, lives. 12 However, there are motor vehicle drivers and passengers who do not always wear their seatbelt. Despite the fact that only five percent of Ontario vehicle occupants do not use seatbelts, 22.5% of fatalities were people who were not using seatbelts at the time of the crash. 16 In 21 in the KFL&A area, 5.9% of occupants who visited the ED due to a MVC did not wear a seatbelt at the time of the collision. (Figure 4.15) Those aged were most likely not to have been wearing their seatbelts. (Figure 4.16) In 29 in Ontario, 88 vehicle occupants were killed while not wearing a seatbelt down from 97 in KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 51

57 Percentage Rate per 1, population CHAPTER 4 MOTOR VEHICLE COLLISIONS Figure 4.15 Of occupants who visited the ED due to a motor vehicle collision, percentage who were not wearing seatbelts. KFL&A area Not wearing seatbelt Source: National Ambulatory Care Reporting System 23-21, Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Figure 4.16 Of occupants who visited the ED due to a motor vehicle collision, percentage who were not wearing seatbelts by age group. KFL&A area Not wearing seatbelt 7.5* Age Group *Use with caution due to high sampling variability Source: National Ambulatory Care Reporting System 23-21, Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 52

58 CHAPTER 4 MOTOR VEHICLE COLLISIONS Impaired Driving From 27 to 29, two percent of all collisions (14,622 reportable collisions which includes collisions that cause fatalities, personal injury and/or property damage) involved a driver who had consumed alcohol. 15 Of that two percent; 4.9% of drivers (122 drivers) had consumed alcohol but were not legally impaired, that is, their blood alcohol concentration level was below.8 grams of alcohol per 1 millilitres of blood, 37.2% of drivers (111 drivers) had consumed alcohol and upon testing were found to have a blood alcohol level in excess of.8 grams of alcohol per 1 millilitres of blood, and 21.8% of drivers (65 drivers) had consumed sufficient alcohol (exact blood alcohol concentration levels could not be determined but the driver was deemed sufficiently impaired by the police officer) to warrant being charged with a drinking and driving offence. However, 1.2% of all fatalities involved a driver who had consumed alcohol. 15 Eighty percent of the drivers involved in those fatal collisions were considered legally impaired from alcohol consumption. In Ontario, the number of drinking and driving fatalities decreased from 145 in 28 to 129 in 29 (down 11%). 16 In 29, Ontario s drinking and driving fatality rate was.14 per 1, licensed drivers, down from.16 in 28. Out of 828 drivers involved in fatal collisions in Ontario in 29, 115 were drinking drivers and 79 drivers were coded as inattentive. Nine percent of collisions were due to inattentive drivers. 15 Cell Phone Use While Driving Driver distraction and inattention are important driving safety issues. Cell phone use while driving can cause driver distraction and can increase the risk of collision. In 29, Ontario passed legislation banning the use of hand-held wireless communications devices such as cell phones, smart phones, and electronic entertainment devices while driving. 11 In 29 to 21, 32.2% of all drivers in the KFL&A area reported ever using a cell phone while driving. However, prevalence of ever talking on a cell phone was significantly higher for daily drivers (42.1%) than non-daily drivers (24.1%). (Figure 4.17) Frequency of talking on a cell phone every time or most times while driving was higher among daily drivers (1.5%) than among all drivers (7.%). Approximately half of drivers never use hands-free mode when talking on the phone while driving, but around one third of drivers report using hands-free mode every time or most times. (Figures 4.18 and 4.19) KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 53

59 Percentage (%) Percentage (%) CHAPTER 4 MOTOR VEHICLE COLLISIONS Figure 4.17 Percentage of drivers ever talking on a cell phone while driving by driving frequency. KFL&A area All Drivers Daily Drivers Non-daily drivers Note: All drivers are those who drove a motor vehicle in the previous 12 months. Non-daily drivers are those who did not drive daily, but drove in the previous 12 months Source: Rapid Risk Factor Surveillance System, Figure 4.18 Frequency of talking on a cell phone while driving by driving frequency. KFL&A area All drivers Daily Drivers Every time/most times when you drive Sometimes when you drive Seldom when you drive Never Note: All drivers are those who drove a motor vehicle in the previous 12 months. Source: Rapid Risk Factor Surveillance System, KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 54

60 Percentage (%) CHAPTER 4 MOTOR VEHICLE COLLISIONS Figure 4.19 Frequency* of using a hands-free mode when talking on a cell phone while driving. KFL&A area Every time/most times when driving 7.6 All drivers Daily Drivers Sometimes Seldom when when driving driving Never (Do not use 'hands-free' devices) * this question was only asked of those who indicated that they have ever talked on a cell phone while driving Note: All drivers are those who have driven a motor vehicle in the last 12 months. Source: Rapid Risk Factor Surveillance System, Car Seats and Booster Seats Properly used child seats and booster seats can significantly reduce the chance of children being hurt and/or killed in collisions. 13 Newborn babies and infants require special protection while in a vehicle and should always sit in a properly installed rear-facing car seat until they are a minimum of 2 pounds (9 kilograms). In 28 in KFL&A, 93.1% ( ) of infants under one year of age, travel all of the time, in a rear facing car seat. 17 A child can face forward while riding starting when he or she is at least 9 kg (2 lb.), although it is recommended to continue to use a rear-facing seat until the child is at least one year old or has reached either the maximum height or weight limits of the rear-facing seat. 13 In 28 in the KFL&A area, 97.1% ( ) of children aged 1 to 3 years always rode in a car seat in the back seat of the vehicle. 17 On September 1, 25, new legislation came into effect requiring all children in Ontario to be transported in an appropriate booster seat while riding in a motor vehicle. 13 After a child no longer requires a car seat and is still too small for a regular seat belt, the law requires that a booster seat must be used until the child meets one or more of the following criteria: Is over eight years old; or Weighs more than 36 kg (8 lbs); or Has a standing height of more than 145 cm (4 9 ). Note: if a child does not meet the height and weight requirements, it is safer for the child to continue to use a booster seat. KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 55

61 Percentage (%) Percentage (%) CHAPTER 4 MOTOR VEHICLE COLLISIONS Booster seats raise the child up so that the adult seatbelt works more effectively. Booster seats protect against serious injury 3 ½ times better than seatbelts alone. 13 A lap and shoulder combination belt must be used with all booster seats, and all children under 13 years of age are safest in the back seat. The KFL&A area data suggest that booster seat usage among households with at least one child aged 4 to 7 years increased following the legislation from 84.% in 25 to 93.2% in 27 and remained steady at 92.8% in 28, although the change is not statistically significant. (Figure 4.2). Figure 4.2 Percentage of households with a child aged 4 to 7 years where the child usually travels in a booster seat (or car seat) and always in the back of the vehicle. KFL&A area 25, Total Source: Rapid Risk Factor Surveillance System, 25, Seatbelts are designed for older children, and it is recommended to use a seatbelt with a lap and shoulder belt. 13 The KFL&A area data on households with at least one child aged 8 to 11 years show that more than 9% of children are consistently using a seat belt with a lap and shoulder belt. (Figure 4.21) Figure 4.21 Percentage of households with a child aged 8-11 years where the child usually uses a seat belt with lap and shoulder belt. KFL&A area 25, Total Source: Rapid Risk Factor Surveillance System, 25, KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 56

62 CHAPTER 5 UNINTENTIONAL POISONING AND SUBSTANCE MISUSE Chapter 5 Unintentional Poisoning and Substance Misuse Highlights There were a total of 92 deaths (63 males and 29 females) related to unintentional poisoning and substance misuse in the KFL&A area from 23 to 211. The highest rate of unintentional poisoning and substance misuse-related emergency department (ED) visits was for children under age five with a rate of ED visits per 1,, or an average of 44 ED visits per year in the KFL&A area. Children under age five and seniors 65 and over had the highest rates of hospitalizations for unintentional poisoning and substance misuse. Introduction This chapter includes information on poisoning injuries and exposure to noxious substances caused by an unintentional overdose of drugs, being given or taking the wrong drug in error, or taking a drug inadvertently. 6 It excludes the administration of drugs with suicidal or homicidal intent, the correct administration of drugs with adverse effects, and contact with venomous animals or plants. Information on intentional self-harm and suicide is provided in Chapter 11. The most common types of poisoning resulting in an ED visit or hospitalization were for psychotherapeutic drugs, (335 ED visits and 52 hospitalizations from 23 to 211), and narcotics and hallucinogens, (253 ED visits and 45 hospitalizations from 23 to 211). Unintentional poisoning and substance misuse affects several age groups, with males having had the highest death rate. Seniors and children under the age of five had the highest rates of unintentional poisoning and substance misuse-related hospitalizations. Children under the age of five also had the highest rate of ED visits, most often caused by ingestion of non-opioid analgesics, antipyretics, and antirheumatics, which include antiinflammatory drugs and pain and fever relievers such as acetaminophen, aspirin, and ibuprofen. Excessive alcohol use is also an important risk factor for poisoning-related injuries. Between 22 and 21 in the KFL&A area, an estimated 53 poisoning-related injury hospitalizations and 9 poisoning-related deaths attributable to alcohol consumption occurred among 15 to 69 year olds. Unintentional Poisoning and Substance Misuse-Related Emergency Department Visits and Hospitalizations In 211, the rate of visits to the KFL&A area EDs for unintentional poisoning and substance misuse (also referred to poisoning in this chapter) was per 1, population. (Figure 5.1) For most years between 23 and 211, poisoning-related hospitalization rates were significantly lower than provincial rates. In 211, there were 14.3 poisoning-related hospitalizations per 1, population in the KFL&A area. (Figure 5.2) KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 57

63 Rate per 1, population Number of Hospitalizations Rate per 1, population Number of ED Visits CHAPTER 5 UNINTENTIONAL POISONING AND SUBSTANCE MISUSE Figure 5.1 Unintentional poisoning and substance misuse-related ED visits. KFL&A area and Ontario KFL&A Rate Ontario Rate KFL&A # of ED visits Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Data note: Rates are age standardized to the 1991 Canadian Population Figure 5.2 Unintentional poisoning and substance misuse-related hospitalizations. KFL&A area and Ontario KFL&A Rate Ontario Rate KFL&A # of Hospitalizations Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Data note: Rates are age standardized to the 1991 Canadian Population KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 58

64 Age group CHAPTER 5 UNINTENTIONAL POISONING AND SUBSTANCE MISUSE The highest number of unintentional poisoning and substance misuse-related ED visits in 23 to 211 in the KFL&A area were among males and females under age five, (489.4 per 1, population), followed by males and females aged 2-24 (293.8 per 1, population, data not shown). (Figures 5.3 and 5.4) Those aged to 4 and seniors 65 and over had the highest unintentional poisoning and substance misuse-related hospitalizations rates during the same time period (Figures 5.5) Figure 5.3 Unintentional poisoning and substance misuse-related ED Visits. KFL&A area, Average # Female ED Visits per year from Average # Male ED Visits per year from ED Visits Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 59

65 Rate per 1, Age-specific population Average # of Hospitalizations per year Rate per 1, Age-specific Population Average # of ED visits per year CHAPTER 5 UNINTENTIONAL POISONING AND SUBSTANCE MISUSE Figure 5.4 Unintentional poisoning and substance misuse-related ED visits by age group. KFL&A area, Rate per 1, age-specific population Average # ED visits per year Age Group Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Figure 5.5 Unintentional poisoning and substance misuse-related hospitalizations. KFL&A area, Rate per 1, age-specific population Average # Hospitalizations per year Age Group Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 6

66 Place of Occurrence Place of Occurrence CHAPTER 5 UNINTENTIONAL POISONING AND SUBSTANCE MISUSE Location of Unintentional Poisoning and Substance Misuse Resulting in Emergency Department visits and Hospitalizations Of poisonings that resulted in an ED visit, 44.1% took place in the home and 6.% took place in a trade or service area. Of the poisonings that resulted in a hospitalization, 47.6% took place in the home and 7.4% took place in a residential institution. (Figures 5.6 and 5.7) Figure 5.6 Location of unintentional poisoning and substance misuse resulting in ED visits. KFL&A area Home Unspecified or Missing Trade and service area Other specified places* Schools Residential Institution Industrial and contruction area Sports and athletics area Street and Highway Farm ED visits - Percent (%) *Other specified places include beach, campsite, forest, and amusement park Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Figure 5.7 Location of unintentional poisoning and substance misuse resulting in hospitalizations. KFL&A area Home 47.6 Unspecified or Missing 4.7 Residential Institution 7.4 Schools Other specified places* Trade and service area Hospitalizations - Percent (%) *Other specified places include beach, campsite, forest, and amusement park Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 61

67 Other Drugs and Alcohol CHAPTER 5 UNINTENTIONAL POISONING AND SUBSTANCE MISUSE Types of Poisoning Substances Forty-nine percent of the ED visits and 88.8% of the hospitalizations for poisoning incidents from 23 to 211 were drug or alcohol related. (Table 5.1) Table 5.1 Type of poisoning substance that resulted in ED visits and hospitalizations, all ages. KFL&A area Type of Substance Average # of ED visits per year % of ED visits Average # Hospitalizations per year % of Hospitalizations Psychotherapeutic drugs Narcotics and Hallucinogens Nonopioid analgesics, antipyretics, antirheumatics Other drugs acting on the autonomic nervous system Other/unspecified drugs and medicaments Alcohol Drugs and Alcohol subtotal Other gases and vapours Organic solvents and halogenated hydrocarbons and their vapours Pesticides Unspecified chemicals and noxious substances Other subtotal TOTAL Includes antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs 2 Includes cannabis, cocaine, codeine, heroin, LSD, methadone, morphine and opium 3 Includes anti-inflammatory drugs and pain and fever relievers such as acetaminophen, aspirin, ibuprofen and other antipyretics 4 Includes anticholinergics and cholinergics, antimuscarinics, antiadrenergics and adrenergics 5 Category used to classify incidents attributed to drugs/medications not mentioned in the above categories and incidents attributed to more than one of the other drug categories 6 Includes carbon monoxide, sulphur dioxide, nitrogen oxides, and vehicle exhaust 7 Includes corrosives, glues and adhesives, metals, paints and dyes, plant food and fertilizer, soaps and detergents, poisonous plants, and non-specific poisons Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 62

68 CHAPTER 5 UNINTENTIONAL POISONING AND SUBSTANCE MISUSE For children under five years of age, 63.5% of the poisoning-related ED visits were due to drugs (23-211). About a quarter of the children visiting the ED for a poisoning incident had ingested non-opioid analgesics, antipyretics, and antirheumatics, which include anti-inflammatory drugs and pain and fever relievers such as acetaminophen, aspirin, and ibuprofen. (Figure 5.8) Figure 5.8 Type of poisoning-related ED visits for children (-4 Years). KFL&A area Unspecified chemicals 26.3% 24.% Nonopioid analgesics, antipyretics, antirheumatics Pesticides 3.8% 8.3% Psychotherapeutic drugs Other gases and vapours 3.3% 1.5% Narcotics and Hallucinogens Organic solvents and halogenated hydrocarbons and their vapours Alcohol 2.8%.5% 2.3% 27.5% Other drugs acting on the autonomic nervous system Other/unspecified drugs and medicaments Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Deaths Related to Unintentional Poisoning and Substance Misuse From 2 to 29, there were a total of 92 deaths resulting from poisonings, 63 of which were males, doubling the number female deaths (29 deaths). Twenty-eight of the male deaths and eleven female deaths were due to exposure to narcotics and hallucinogens, while another 23 male and eight female deaths were due to exposure to other and unspecified drugs. KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 63

69 CHAPTER 6 SPORTS AND RECREATION INJURIES Chapter 6 Sports and Recreation Injuries Highlights On average, three deaths occur annually in KLF&A area due to sport and recreation-related injuries. Males aged 1 to 19 years have the highest rates of emergency department (ED) visits and hospitalizations for sport and recreation-related injuries in the KFL&A area. The three most common activities for all ages resulting in sport and recreation injury-related ED visits were hockey, cycling, and being hit by a ball. The three most common activities for all ages resulting in sport and recreation injury hospitalizations involve ATV/snowmobiles, cycling, and playground equipment. Using playground equipment is the most common activity leading to sport and recreation injury in children aged five to nine years. Introduction People of all ages participate in sport and recreation activities. Regardless of the level of involvement or skill, sport and recreation injuries remain common, and safe play is an important component of these activities. For the purpose of this chapter, sport and recreation injuries include those occurring while participating in hockey, baseball, soccer, football and rugby, as well as those sustained while cycling, skating, skiing, snowboarding, tobogganing, in-line skating, riding a scooter, skateboarding, swimming and diving, riding an ATV or snowmobiling, playing on playground equipment, participating in recreational non-powered boating and injuries while engaged in other sports or using other sports equipment. In addition, if a person was struck by a ball or a bat, it was presumed that this injury was sustained while being involved in some kind of sport and recreation activity and thus was included in the analysis. KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 64

70 Rate per 1, population Number of ED Visits CHAPTER 6 SPORTS AND RECREATION INJURIES Sport and Recreation-related Emergency Department Visits and Hospitalizations Between 23 and 211, there was an average of 363 sport and recreation-related ED visits per year. The rate of ED visits in the KFL&A area declined from 23 to 25 and increased slightly from 25 to 211. For all years, the rates of sport and recreation-related ED visit rates were higher in KFL&A than Ontario. (Figure 6.1) Figure 6.1 Sport and recreational activity-related ED visits. KFL&A area and Ontario KFL&A Rate Ontario Rate KFL&A # of ED visits Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Data note: Rates are age standardized to the 1991 Canadian Population KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 65

71 Rate per 1, population Number of Hospitalizations CHAPTER 6 SPORTS AND RECREATION INJURIES Severe sport and recreation injuries can result in hospitalization. In the KFL&A area in 211, the sport and recreation-related hospitalization rate was 28.4 per 1, population. (Figure 6.2) Figure 6.2 Sport and recreation-related hospitalizations. KFL&A area and Ontario KFL&A Rate Ontario Rate KFL&A # of Hospitalizations Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Data note: Rates are age standardized to the 1991 Canadian Population KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 66

72 Rate per 1, Age-specific Population Average # of ED visits per year CHAPTER 6 SPORTS AND RECREATION INJURIES Males aged 1 to 19 years have the highest rate of ED visits and hospitalizations for sport and recreation injuries. (Figures 6.3 and 6.4) Males in this age group are typically very active in sports and recreation activities. Females aged 1 to 19 have about half the rate of sport and recreation-related ED visits of males. In all age groups, females have lower rates of sport and recreation-related ED visits. Figure 6.3 Sport and recreational activity-related ED visits and rates by age group and sex. KFL&A area, Male Rate Female Rate Male Average # of ED visits Female Average # of ED visits Age Group Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 67

73 Rate per 1, Age-specific Population Average # of Hospitalizations pedr year CHAPTER 6 SPORTS AND RECREATION INJURIES Figure 6.4 Sport and recreational activity-related hospitalizations and rates by age group and sex. KFL&A area Male Rate Female Rate Male Average # of Hospitalizations Female Average # of Hospitalizations Age Group Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Types of Sport and Recreation Injuries The most common type of sport and recreation injury resulting in an ED visit was an injury sustained while playing hockey. Other common sport and recreation injuries resulting in ED visits were cycling and being hit by a ball. The most common activities resulting in hospitalization were ATV or snowmobiling and cycling. (Table 6.1) From , for children aged zero to nine years old, falls from playground equipment was the most common type of sport and recreation activity that resulted in an ED visit. (Table 6.2) For youth aged 1 to 14, the top three types of sport and recreation activities resulting in an ED visit were hockey, being hit by a ball and cycling. For youth aged 15 to 19, the top three types of sport and recreation activities resulting in an ED visit were hockey, football/rugby and cycling. For young adults aged 2 to 24, the top three types of sport and recreation activities resulting in an ED visit were hockey, cycling and being hit by a ball. KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 68

74 Rank Rank CHAPTER 6 SPORTS AND RECREATION INJURIES Table 6.1 Type of sport and recreation activity resulting in an ED visit or hospitalization, all ages, KFL&A area Sport or Recreation Activity Average # of ED visits per year % of ED visits Sport or Recreation Activity Average # of Hospitalizations per year % of Hospitali zations 1 Hockey ATV/snowmobile Cycling Cycling Hit by ball Playground Equipment Football/rugby Hockey Playground Equipment Ice Skates Soccer Fall involving rollerblade/scooter/ skateboard ATV/Snowmobile Ski/snowboard Fall involving rollerblade/scooter/ Recreational boating skateboard 9 Ski/snowboard Football/rugby Ice Skates Soccer Recreational boating Tobogganing Baseball Pool and natural water 1 2. swimming and diving 13 Tobogganing Hit by ball Pool and natural water 14 Baseball swimming and diving 15 Hit by bat Hit by bat.2 Other sports related Other sports related injuries injuries Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 69

75 CHAPTER 6 SPORTS AND RECREATION INJURIES Table 6.2 Type of sport and recreation activity resulting in an ED visit for ages 24 and under, KFL&A area Sport or Recreation Activity Number of ED visits, , by Age Group Hockey Cycling Hit by ball Football/rugby Soccer Playground Equipment ATV/Snowmobile Fall involving rollerblade/scooter/ skateboard Ski/snowboard Ice Skates Recreational boating Baseball Tobogganing Pool and natural water swimming and diving Hit by bat Other sports Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Cycling Injuries Cycling was the second leading sport and recreation activity resulting in an ED visit or hospitalization. Cycling injuries are covered in Chapter 9. Hockey Injuries Hockey is a popular sport that can be played both indoors and outdoors. It is a sport in which protective equipment such as helmets, face shields and padding can be worn to help decrease the risk of injury. Data in this chapter include injuries sustained while playing ice, field and ball hockey, which cannot be differentiated. From 23 to 211, males accounted for 88.4% of the hockey-related ED visits and 91.1% of the hospitalizations. In particular, males aged 1 to 19 years had the highest rate of hockey injuries followed by those aged 2 to 24 years. Contact with another person accounted for 36.2% of hockey-related ED visits and 27.4% of hospitalizations, while hockey sticks and hockey pucks/balls each accounted for about 18% of hockey-related ED visits. KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 7

76 CHAPTER 6 SPORTS AND RECREATION INJURIES Skiing and Snowboarding Injuries Skiing and snowboarding are popular winter sports; however, both sports carry a risk of injury from falling or collision. According to SMARTRISK, the highest incidence of injuries on ski hills is in children aged Collisions and falls account for most of their injuries, and speed, loss of control and not wearing proper safety gear are key risk factors. 18;19 SMARTRISK Foundation, in partnership with the Canadian Ski Patrol System and Canada Snowboard, have launched a program called SNOWSMART. 19 This project will increase awareness among children and youth about ski and snowboard safety and protect younger children from collisions on ski hills. The highest rates of hospitalizations and ED visits for skiing and snowboarding injuries occur in males and females, aged 1 to 19. From 23 to 211, males aged 1 to 19 had a rate of ED visits per 1, population and females had a rate of 23.1 ED visits per 1, population. The average number of ED visits per year is over 69 ED visits per year for children aged 1 to 19, and 147 ED visits per year for all ages. Falls were the most common skiing (42.9%) and snowboarding (44.7%) injuries resulting in ED visits. Another ten percent of ED visits were a result of a person colliding with or being struck by an object and only 2.1% were due to colliding or bumping into another person. Similar proportions were observed for hospitalizations. Playground Equipment-Related Injuries Playground equipment is designed as an area for children to play freely. Structure, height and surfacing are important design aspects that can affect the risk of injury during play. Children who are developing balance skills are at increased risk of falling from playground structures, as are children who like to experiment or challenge their abilities by jumping on and from equipment or using it in ways for which it was not designed. In the KFL&A area, children aged five to nine experienced the highest rate of playground equipment-related injuries (132 ED visits per 1, population and 34 hospitalizations per 1, population from 23 to 211) followed by those four years of age and younger (492 ED visits per 1, population and 11 hospitalizations per 1, population from 23 to 211). ATV/Snowmobile Injuries ATVs and snowmobiles have become popular recreational vehicles. The risk of injury involving ATVs and snowmobiling is influenced by several factors, including speed, riding at night, travelling in unsafe areas (e.g., on lakes) and consuming alcohol. The number of ATV-related ED visits seems to be increasing over the years, while the number of snowmobile visits has remained fairly stable and might even be decreasing slightly. (Figure 6.5) Males accounted for over three-quarters of the ATV and snowmobile-related ED visits and hospitalizations from 23 to 211. During that period, rates of ATV and snowmobile-related injuries were highest among males aged 1 to 29 years, and in particular, for males aged 15 to 19. For males aged 1 to 29, there was an average 75 ATV and snowmobile-related ED visits and 7 hospitalizations per year (292.7 ED visits per 1, population and 25.8 hospitalizations per 1, population). KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 71

77 Rate per 1, population Number of ED visits CHAPTER 6 SPORTS AND RECREATION INJURIES Figure 6.5 ATV and snowmobile-related ED visits. KFL&A area ATV Rate Snowmobile Rate # of ATV ED visits # of Snowmobile ED visits Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Other Team Sports Injuries Including Football, Rugby, Soccer and Baseball Injuries Males accounted for 72.7% of ED visits and 84.4% of hospitalizations for injuries from other team sports between 23 to 211. During that period, rates of other team sports injuries were highest among males aged 1 to 24 years, and in particular, for males aged 15 to 19. For males aged 1 to 24, there was an average of 281 ED visits and 2 hospitalizations per year (146.9 ED visits per 1, and 11.6 hospitalizations per 1,). For males aged 15 to 19, there was an average of 147 ED visits and 1.4 hospitalizations per year. KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 72

78 Rate per 1, population Number of ED visits CHAPTER 6 SPORTS AND RECREATION INJURIES In-Line Skating, Skateboarding and Scooter Fall Injuries From 23 to 211 in the KFL&A area, there was an average of 154 ED visits per year for in-line skating, skateboarding and scooter fall injuries. Skateboard injuries accounted for 58.5% of these injuries, while roller skates or in-line skate accounted for 23.6%. Eighteen percent were classified as other specified and includes non-motorized scooters. Males accounted for 72.% of ED visits and 69.2% of hospitalizations for in-line skating, skateboarding and scooter fall-related injuries between 23 to 211. Males aged 1 to 14 had the highest rate of ED visits, per 1, population (an average of about 33 visits per year), followed by males aged 15 to 19, per 1, population (an average of about 37 visits per year). (Figure 6.6) Figure 6.6 Roller skates/in-line skates and skateboard fall-related ED visits. KFL&A area Roller skates/in-line skates Rate Skateboard Rate # of Roller skates/in-line skates ED visits # of Skateboard ED visits Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 73

79 Rate per 1, population Number of ED visits CHAPTER 6 SPORTS AND RECREATION INJURIES Ice Skating Injuries Injury due to falling while ice skating causes a considerable morbidity during the winter months. Rates of ice skating-related ED visits from 23 to 211 were highest for youth aged 1 to 14 years, per 1, for males and per 1, for females. For both sexes, there was an average of 136 ED visits and 4 hospitalizations per year. Although the number of ED visits seems to be increasing slightly over the last few years, ice skating-related hospitalization rates are decreasing. (Figure 6.7). For years 24 to 27 there were 2 ice skating-related hospitalizations, compared to only 6 hospitalizations for years 28 to 211 (hospitalization data not shown). Figure 6.7 Ice skate fall-related ED visits. KFL&A area Male Rate Female Rate # Male ED visits # Female ED visits Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Tobogganing Injuries An average of 3 visits to the ED were made annually for an injury sustained while tobogganing. Injuries sustained while tobogganing were most common in children aged 5 to 14, for both sexes, with a rate of 81.9 visits per 1, population. Eighty-four percent of these ED visits were due to a collision with an object such as a tree, rock, fence or being thrown from a toboggan and 16% of the tobogganing-related ED visits were associated with a collision with another person. Over the period of 23 to 211, there were only 13 tobogganing-related hospitalizations. KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 74

80 * * * * * * 43.5 NR 3.3 NA NA 55.8* 69.4 CHAPTER 6 SPORTS AND RECREATION INJURIES Use of Protective Equipment in Youth and Adults Sports and recreational activities are important for the health and development of children and youth, but they also carry a risk of injury. 2 For nearly 28% of youth aged 1-19, emergency department visits in KFL&A from were due to sports and recreation injuries. Fortunately, sports and recreational activityrelated injuries can be reduced or prevented for children, youth and adults by using the right protective equipment. In in Ontario, the two sports for which people were least likely to wear helmets while participating were skateboarding and in-line skating or rollerblading. The KFL&A area shows similar results but caution must be used when interpreting many of the KFL&A area estimates due to high variability. (Figures 6.8) Figure 6.8. Percentage of the population who rarely or never wear a helmet by age group and sport. KFL&A area and Ontario, Percentage of the population who 'rarely' or 'never' wear a helmet Biking In-line skating or rollerblading Ages 12+ KFL&A area Ages 12+ Ontario Ages 12 to 19 KFL&A area Ages 12 to 19 Ontario Skiing Snowboarding Skateboarding *Use with caution due to high variability NR data not releasable, NA data not available Source: Canadian Community Health Survey 29/1, Statistics Canada, Share File, Ontario MOHLTC In in the KFL&A area and Ontario, the majority of the population were not likely to wear wrist guards while participating in in-line skating or rollerblading, snowboarding or skateboarding, nor elbow pads while in-line skating, rollerblading or skateboarding. In addition, majority of the population were not likely to wear knee pads while in-line skating or rollerblading. It is encouraging, though, that about half of hockey players aged wear mouth guards in Ontario and the KFL&A area. (Figures 6.9, 6.1 and 6.11) KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 75

81 * 87.6 NA NA * * NA NA 82.6* 9.7 CHAPTER 6 SPORTS AND RECREATION INJURIES Figure 6.9. Percentage of the population who rarely or never wear wrist guards by age group and sport. KFL&A area and Ontario, Percentage of the population who 8. 'rarely' or 'never' wear wrist guards 6. Ages 12+ KFL&A area Ages 12+ Ontario Ages 12 to 19 KFL&A area Ages 12 to 19 Ontario In-line skating or rollerblading Snowboarding Skateboarding *Use with caution due to high variability NA data not available Source: Canadian Community Health Survey 29/1, Statistics Canada, Share File, Ontario MOHLTC Figure 6.1. Percentage of the population who rarely or never wear elbow pads by age group and sport. KFL&A area and Ontario, Percentage of the population who 'rarely' or 'never' wear elbow pads Ages 12+ KFL&A area Ages 12+ Ontario Ages 12 to 19 KFL&A area Ages 12 to 19 Ontario. In-line skating or rollerblading Skateboarding *Use with caution due to high variability NA data not available Source: Canadian Community Health Survey 29/1, Statistics Canada, Share File, Ontario MOHLTC KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 76

82 Percentage of the population * * * CHAPTER 6 SPORTS AND RECREATION INJURIES Figure Usage of other forms of protective equipment by age group and sport. KFL&A area and Ontario, Ages 12+ KFL&A area Ages 12+ Ontario Ages 12 to 19 KFL&A area Ages 12 to 19 Ontario Rarely' or 'never' wear knee pads while In-line skating or rollerblading Always' or 'Most of the time' wear a mouth guard while playing hockey *Use with caution due to high variability Source: Canadian Community Health Survey 29/1, Statistics Canada, Share File, Ontario MOHLTC Sport and Recreation Injury Deaths From 2-29 in the KFL&A area, there were 36 deaths (an average of four per year) due to sport and recreation injuries, with 32 of these being males. As there are few deaths from sport and recreation injury in the KFL&A area each year, descriptive data cannot be published. KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 77

83 CHAPTER 7 PEDESTRIAN INJURIES Chapter 7 Pedestrian Injuries Highlights Nineteen pedestrian deaths occurred in the KFL&A area between 23 and 211. Pedestrian-related emergency department (ED) visit rates in the KFL&A area were similar to Ontario rates. Pedestrian injuries resulting in an ED visit were highest for youth aged 1 to 19 years. Children aged 5-9 years and seniors aged 65 and over had the highest hospitalization rates. The majority of pedestrian injuries were due to a collision with a car, pickup truck, or van. Introduction Pedestrians are physically vulnerable to injury in the presence of motor vehicle traffic. Many people walk recreationally or use walking as a mode of transportation to work and school and for errands. In fact, 9.6% of Kingston s CMA* workforce, or about 67 residents, reported that walking was their primary mode of transportation to work in Creating a safe walking environment can substantially reduce the risk of pedestrian injuries. Risk factors for pedestrian injuries include: high traffic volume, a road speed limit of greater than 4 kilometres per hour, high average vehicle speed, darkness, and rainy weather. 22 This chapter covers pedestrian injuries that are transport-related. Pedestrian - Related Emergency Department Visits and Hospitalizations From 23 to 211, there was an average of 93 pedestrian-related ED visits per year. The ED visit rates for pedestrian injuries were similar to the Ontario rates (the KFL&A area: 54.9 per 1, population in 211; Ontario: 52.8 per 1, population in 211). (Figure 7.1) In 211, in the KFL&A area, there were 16 hospitalizations for pedestrian injuries (8 hospitalizations per 1, population). From 23 to 211, hospitalization rates in the KFL&A area and Ontario remained steady. (Figure 7.2) * CMA = Census metropolitan area, which is defined as an area consisting of one or more neighbouring municipalities situated around a core. 21 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 78

84 Rate per 1, population Number of Hospitalizations Rate per 1, population Number of ED Visits CHAPTER 7 PEDESTRIAN INJURIES Figure 7.1 Pedestrian-related ED visits. KFL&A area and Ontario KFL&A Rate Ontario Rate KFL&A # of ED visits Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Data note: Rates are age standardized to the 1991 Canadian Population Figure 7.2 Pedestrian-related hospitalizations. KFL&A area and Ontario KFL&A Rate Ontario Rate KFL&A # of Hospitalizations Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Data note: Rates are age standardized to the 1991 Canadian Population KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 79

85 Rate per 1, age-specific population Average # of ED visits per year Age group CHAPTER 7 PEDESTRIAN INJURIES Males were slightly more likely than females to visit an ED or to be hospitalized for a pedestrian-related injury. Youth aged 1 to 19 years had the highest rates of pedestrian-related ED visits (females: 91.3 visits per 1, population; males: 1.4 visits per 1, population). (Figures 7.3 and 7.4) Figure 7.3 Pedestrian-related ED visits by age group and sex. KFL&A area Female Visits Male Visits ED Visits Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Figure 7.4 Pedestrian-related ED visits by age group and sex. KFL&A area Male Rate Female Rate Male Average # of ED visits Female Average # of ED visits Age Group Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 8

86 Rate per 1, age-specific Population Average # of Hospitalizations per year CHAPTER 7 PEDESTRIAN INJURIES Children aged 5 to 9 years had the highest rates of hospitalizations for pedestrian injuries, 11.4 hospitalizations per 1, population, followed by seniors aged 65 and over, 8.9 hospitalizations per 1, population. (Figure 7.5) Due to low numbers, data could not be analyzed by sex. Figure 7.5 Pedestrian-related hospitalizations by age group and sex. KFL&A area Rate per 1, age-specific population Average # Hospitalizations per year Age Group Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Diagnosis of Pedestrian Injuries The most common diagnoses in the ED visits for pedestrian injuries from 23 to 211 were superficial injuries (29.2%), and musculoskeletal injuries (26.6%), followed by internal organ injuries (9.9%). Musculoskeletal diagnoses accounted for 7.9% of the pedestrian injury hospitalizations, followed by internal organ diagnoses (23.6%). Types of Pedestrian Injuries About 82% (82.4%) of ED visits for pedestrian injuries from 23 to 211 resulted from a collision with a car, pickup truck, or van; 4.9% resulted from a cyclist collision; 3.1% resulted from a collision with a heavy transport vehicle or bus; and 1.3% resulted from a collision with a two- or three-wheel motor vehicle (8.3% were other types). The most common types of pedestrian injuries leading to hospitalization were similar during this period, with 91.1% due to a collision with a car, pickup truck, or van; 1.8% due to a collision with heavy transport vehicle or bus; 1.8% due to a collision with a two- or three-wheel motor vehicle; and.9% due to a collision with a cyclist (6.3% were other types). Pedestrian Deaths From 23 to 211, there were 19 pedestrian injury-related deaths. Thirteen of these deaths were a result of a collision with a car, pickup truck or van and four of these deaths were due to a collision with a railway train or vehicle. KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 81

87 CHAPTER 8 CYCLING INJURIES Chapter 8 Cycling Injuries Summary An average of 451 visits to the emergency department (ED) are made each year for cycling injuries in the KFL&A area. The rate of ED visits for cycling injuries in the KFL&A area have been consistently higher than in Ontario for several years. Males are more likely than females to visit the ED for a cycling injury. Young males aged 1 to 19 years have the highest rates of ED visits for cycling injuries, followed by male children aged five to nine. The most common type of cycling injury involves falling or being thrown from a bicycle, followed by a collision with a motor vehicle. Introduction Cycling is a popular form of recreation and a mode of transportation for some commuters. In 26, 2.4% of Kingston s CMA* workforce, or about 1655 residents, reported that cycling was their primary mode of transportation to work. 21 Cycling offers health, social, and environmental benefits. However, the design and maintenance of transportation infrastructure and the interaction with motor vehicle traffic can pose safety risks to cyclists. The cycling-related injuries included in this chapter are acute injuries sustained by a person riding on a bicycle, tricycle, or attached trailer during transportation or recreational activity. Chronic injuries related to cycling ergonomics and overuse are not included. Cycling-Related Emergency Department Visits and Hospitalizations Cycling injuries accounted for an average of 451 ED visits per year from 23 to 211. In 211, the ED visit rate for cycling injuries in the KFL&A area was visits per 1, population. The rates of ED visits for cycling injuries have been consistently higher in the KFL&A area than in Ontario. (Figure 8.1) There was an annual average of 13 hospitalizations for cycling injuries from 23 to 211. In 211, the KFL&A area rate was 6.2 hospitalizations per 1, population, and the Ontario rate was 8.2 hospitalizations per 1, population. (Figure 8.2) *CMA = Census metropolitan area, which is defined as an area consisting of one or more neighbouring municipalities situated around a core. 21 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 82

88 Rate per 1, population Number of Hospitalizations Rate per 1, population Number of ED Visits CHAPTER 8 CYCLING INJURIES Figure 8.1 Cycling-related ED visits. KFL&A area and Ontario KFL&A Rate Ontario Rate KFL&A # of ED visits Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Data note: Rates are age standardized to the 1991 Canadian Population Figure 8.2 Cycling-related hospitalizations. KFL&A area and Ontario KFL&A Rate Ontario Rate KFL&A # of Hospitalizations Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Data note: Rates are age standardized to the 1991 Canadian Population KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 83

89 Age group CHAPTER 8 CYCLING INJURIES From 27 to 211, ED visit rates for cycling injuries were higher for males than females (males: 34. per 1,; females: per 1,). Young males, particularly those aged 1 to 19 years, experienced the highest rate cycling-related ED visits per 1, population from 27 to 211. Children aged five to nine years had the second highest rate of visits to the ED for a cycling injury (27 to 211 males: 66.7 per 1, population; 27 to 211 females: per 1,). (Figures 8.3 and 8.4) Overall, hospitalization rates for cycling injuries for both sexes were highest for ages 1 to 19 (9.3 per 1, population from 23 to 211) followed by ages 5 to 9, with 9.1 per 1, population from 23 to 211. However, most cycling-related injuries occur in males. Hospitalization rates for cycling injuries were highest for males ages 1 to 19 (15.5 per 1, population from 23 to 211) followed by males ages 5 to 9, with 13.2 per 1, population from 23 to 211. Figure 8.3 Cycling-related ED visits by age group. KFL&A area Average # Female ED Visits per year from Average # Male ED Visits per year from ED Visits Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 84

90 Rate per 1, age-specific population Average # of ED visits per year CHAPTER 8 CYCLING INJURIES Figure 8.4 Cycling-related ED visits by age group and sex. KFL&A area Male Rate Female Rate Male Average # of ED visits Female Average # of ED visits Age Group Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Diagnosis of Cycling Injuries Cycling injuries resulting in ED visits from 27 to 211 were most commonly diagnosed as musculoskeletal injuries (33.3%), followed by superficial injuries (23.5%) and open wound injuries (17.2%). (Figure 8.5) The cycling injuries requiring hospitalization were most commonly diagnosed as musculoskeletal injuries (6.5%) followed by injury to internal organs (24.6%). KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 85

91 CHAPTER 8 CYCLING INJURIES Figure 8.5 Cycling-Related ED visits by diagnosis. KFL&A area % Internal Organ 17.2% Open Wound, including Traumatic Amputation 18.1% Other and unspecified 23.5% Superficial 33.3% Musculoskeletal Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Oct. 5, 212 Cycling-related head injuries Table 8.1 displays the number of head injuries and traumatic brain injuries as a percentage of the total number of cycling injuries, as defined by cycling-related visits to the ED. The head injury category includes all minor and major head injuries such as fractures, concussions and superficial injuries, such as cuts/scrapes to face and head. The traumatic brain injury category includes only the most serious of head-related injuries. Please note that many of the traumatic brain injuries are also included in the head injuries category. The younger age groups ( to 4 and 5 to 9) sustained more injuries but fewer traumatic brain injuries than the older age groups. Those aged 15 to 19 were more likely to have a traumatic brain injury than the younger age groups. KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 86

92 CHAPTER 8 CYCLING INJURIES Table 8.1 Head and traumatic brain injuries as a percentage of cycling-related resulting in ED visits for ages -19. KFL&A area and Ontario % (number) 5-9 % (number) Age Group 1-14 % (number) % (number) KFLA area 48.6% (53) 24.5% (119) 15.8% (135) 21.1% (133) All Head* Injuries All Traumatic Brain** Injuries Total Number of Cycling Injuries Ontario 54.3% (3413) 34.5% (1169) 17.5% (889) 21.9% (6972) KFLA area.9% (1) 3.3% (16) 2.7% (23) 5.6% (35) Ontario 1.% (6) 1.9% (546) 2.6% (1333) 3.3% (162) KFLA area Ontario *Head injuries include ICD1 codes S-S9. These codes include head injuries such as fractures, concussions and superficial injuries, such as cuts/scrapes to face and head. **Traumatic Brain injuries include more serious brain injuries. ICD1-CA codes included are F7.2 (postconcussional syndrome), S2., S2.1 (fracture of skull), S2.3 (fracture of orbital floor), S2.7 (multiple fractures involving skull and facial bones), S2.8 (fracture of other skull and facial bones), S2.9 (fracture of skull and facial bones, part unspecified), S6 (intracranial injuries), S7.1 (crushing injury of skull), T9.2 (sequelae of fracture of skull and facial bones), and T9.5 (sequelae of intracranial injury). Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Oct. 3, 212 Types of Cycling Injuries The most common type of cycling injury leading to an ED visit was falling or being thrown from a bicycle (78.4% from 27 to 211). Cyclist collisions with motor vehicles ranked second (1.7%). (Figure 8.6) The most common cycling injuries resulting in hospitalization were similar, with 59.8% due to falling or being thrown from a bicycle and 23.5% due to collisions with motor vehicles. (Figure 8.7) The most common type of cycling injury resulting in an ED visit for children aged five to nine years was falling or being thrown from a bicycle (84.4% from 23 to 21). For those aged 1 to 19 years, 82.5% of the cycling injuries resulting in an ED visit were from falling or being thrown from a bicycle, and 7.4% involved a collision with a motor vehicle. KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 87

93 CHAPTER 8 CYCLING INJURIES Figure 8.6 Cycling-related ED visits by type of injury. KFL&A area % 3.4% 5.9% Collision with pedestrian, animal, or other cyclist Collision with object Other and unspecified 1.7% Collision with motor vehicle 78.4% Fall or thrown from bicycle Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Figure 8.7 Cycling-related hospitalizations by type of injury. KFL&A area % 6.1% 7.9% Collision with pedestrian, animal, or other cyclist Collision with object Other and unspecified 25.4% Collision with motor vehicle 57.9% Fall or thrown from bicycle Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 88

94 Perentage CHAPTER 8 CYCLING INJURIES Cycling Deaths There are very few deaths from cycling injuries in the KFL&A area each year. Due to privacy issues, descriptions cannot be published. Bike Helmet Use Effective October 1, 1995, Ontario legislation requires that all persons under the age of 18 wear a bike helmet when bicycling. 23 Roughly half of the population aged 12 and up in both KFL&A area and Ontario rarely or never wore a bike helmet when biking; however, in 29/1, those aged 12 and up were more likely to wear a bike helmet when biking in the KFL&A area Ontario. Figure 8.8 Frequency of bike helmet use when bicycling. KFL&A area and Ontario 29/ Always, almost always Rarely, never * KFL&A area Ontario KFL&A area Ontario Ages 12+ Ages 12 to 19 Source: Canadian Community Health Survey 29/1, Statistics Canada, Share File, Ontario MOHLTC KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 89

95 CHAPTER 9 BURNS Chapter 9 Burns Summary An average of 2.3 residents die annually in the KFL&A area due to burns. Overall, children under age five account for the highest injury burden related to burns. On average, 372 visits to the emergency department (ED) are made each year for burns. The rate of burns requiring an ED visit or hospitalization was consistently higher in the KFL&A area than in Ontario from 23 to 211. Most burns occur at home. Most burns are caused by scalding (4.4% of the burn-related ED visits), followed by exposure to smoke, fire or flames (22.9%). Introduction A burn is damage to body tissue that is caused by exposure to heat (also hot liquids, vapour and steam resulting in scalds), cold, electricity, chemicals, light, the sun, radiation, or friction. 24 Thermal burns are the most common type. Thermal burns occur when hot metals, scalding liquids, steam, or flames come in contact with skin. 24 Burn injuries can be highly variable in terms of the tissue affected, the severity and resultant complications. Burns are classified by severity as first degree (least severe), second degree and third degree (most severe). 24 Burn-Related Emergency Department Visits and Hospitalizations From 23 to 211, there was an average of 372 burn-related ED visits per year in the KFL&A area. The rate of ED visits for burns has remained stable from 23 to 211 and has been consistently higher in the KFL&A area than in Ontario. In 211, the age-standardized rate of ED visits for burns was per 1, population, which was significantly higher than the Ontario rate of visits per 1, population. (Figure 9.1) Burn-related hospitalizations show a slight downward trend in Ontario from 23 to 211. The numbers of burn-related hospitalizations in the KFL&A area have been quite low and variable over the years. (Figure 9.2) KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 9

96 Rate per 1, population Number of Hospitalizations Rate per 1, population Number of ED Visits CHAPTER 9 BURNS Figure 9.1 Burn-related ED visits. KFL&A area and Ontario KFL&A Rate Ontario Rate KFL&A # of ED visits Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Data note: Rates are age standardized to the 1991 Canadian Population Figure 9.2 Burn-related hospitalizations. KFL&A area and Ontario KFL&A Rate Ontario Rate KFL&A # of Hospitalizations Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Data note: Rates are age standardized to the 1991 Canadian Population KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 91

97 Rate per 1, Age-specific population Average # of ED visits per year CHAPTER 9 BURNS The ED visit rates for burns were higher for males than females of all ages. Males and females aged to 4 had the highest rate of ED visits (514.3 and ED visits, respectively, per 1, population). (Figure 9.3) Children under age five also had the highest rates of hospitalization for burns (23.9 per 1, population from 23 to 21). Seniors aged 65 and over had second highest rates of hospitalization (1.1 per 1, population) followed by adults aged 45 to 64 (9.2 per 1, population). (Figure 9.4) Figure 9.3 Burn-related ED visits by age group and sex. KFL&A area Male Rate Female Rate Male Average # of ED visits Female Average # of ED visits Age Group Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 92

98 Place of Occurrence Rate per 1, Age-specific population Average # of Hospitalizations per year CHAPTER 9 BURNS Figure 9.4 Burn-related hospitalizations by age group. KFL&A area Rate per 1, age-specific population Average # Hospitalizations per year Source: National Ambulatory Care Reporting System 23-21, Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Place of Occurrence of Burns On average, from 23 to 211, more than one-third (38.2%) of the burns resulting in an ED visit took place in the home, followed by those occurring in trade and service areas (9.2%). More than one-third of all burnrelated ED visits did not specify where the burn took place. (Figure 9.5) Figure 9.5 Burn-related ED visits by place of occurrence. KFL&A area Unspecified or Missing Home Trade and service area Other specified places Industrial and contruction area Schools Residential Institution Street and Highway Farm Sports and athletics area ED visits - Percent (%) *Other specified places may include beach, campsite, forest and amusement park KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 93

99 CHAPTER 9 BURNS Causes of Burns On average, from 23 to 211, 4.4% of the burns resulting in an ED visit were due to a scalding, approximately one-quarter were due to exposure to smoke, fire or flames, and 13.8% were due to contact with other and unspecified heat and hot appliances. (Figure 9.6) Burns resulting from exposure to smoke, fire or flames (46.6%) and burns due to a scalding (39.7%) were most likely to result in hospitalization than other causes between 23 and 211. (Figure 9.7) Figure 9.6 Causes of burn-related ED visits. KFL&A area % Exposure to electric current, radiation, or man-made heat or cold 11.6% Contact with hot appliances 13.8% Contact with other and unspecified heat and hot appliances 22.9% Exposure to smoke, fire or flames 4.4% Scalding Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 94

100 CHAPTER 9 BURNS Figure 9.7 Causes of burn-related hospitalizations. KFL&A area % Exposure to smoke, fire or flames 1.7% Contact with hot appliances 5.2% Contact with other and unspecified heat and hot appliances 6.9% Exposure to electric current, radiation, or man-made heat or cold 39.7% Scalding Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Scalds A scald is a burn caused by hot liquid or steam. 25 Hot coffee, tea, soup and other hot foods are the most common causes of scalds to young children. Hot tap water is a less common cause, but these scalds are often more severe. 25 However, they are easy to prevent. Most Canadian hot water tanks are pre-set to a temperature of 6 C or 14 F. 26 Water this hot can severely scald a child's skin in seconds, as a child's skin is thinner and more sensitive than an adult's skin. To prevent hot tap water scalds in children, the hot water at a home s tap should be no higher than 49 C or 12 F. 26 Some burns can even happen when children are sitting in bath water that is too hot for them. 26 This can cause a deep burn covering a large portion of the body. Treatment often requires surgeries and painful skin grafts. On average, the highest rate of ED visits and hospitalizations for scalding occurs in children under five years of age (155 ED visits per 1, population from 23 to 211). (Figure 9.8) Scalding was the most common type of burn resulting in an ED visit or hospitalization in children under five years of age. For children under five in the KFL&A area, the number one cause of scalding resulting in an ED visit was contact with hot drinks, food, fats and cooking oils (46.5%). The second leading cause was contact with other hot fluids (including water heated on a stove), (32.3%), which was followed by contact with hot tap water (including hot water in a bath or bucket and from a hose or tap), (15.%). (Figure 9.9) KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 95

101 Rate per 1, Age-specific population Average # of ED visits per year CHAPTER 9 BURNS Across all ages, almost half (47.9%) of the ED visits for scalding were caused by contact with hot drinks, food, fats and cooking oils; just over a third (35.1%) were caused by contact with other hot fluids, including water heated on a stove; 9.7% were caused by contact with hot tap water (including hot water in a bath or bucket and from a tap or hose); and 7.2% were caused by contact with steam or hot vapours. Figure 9.8 Scalding-related ED visits by age group. KFL&A area Rate per 1, age-specific population Average # ED visits per year Source: National Ambulatory Care Reporting System 23-21, Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 96

102 CHAPTER 9 BURNS Figure 9.9 Scalding-related ED visits for children aged -4 years. KFL&A area % Contact with hot drinks, food, fats and cooking oils 6.3% Contact with steam and hot vapours 15.% Contact with hot tap-water 32.3% Contact with other hot fluids Source: National Ambulatory Care Reporting System 23-21, Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Burn-Related Deaths Since 23 in the KFL&A area, there has been an annual average of 2.3 (range of 1 to 4) deaths due to burns. Since there are few deaths from burns in the KFL&A area each year, descriptive data on burn mortality cannot be published for confidentiality reasons. KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 97

103 CHAPTER 1 DROWNING Chapter 1 Drowning Highlights A total of seven KFL&A area residents have died from drowning from 2 to 29. Near-drowning events account for an average of eight emergency department (ED) visits annually and lead to the hospitalization of 1.6 people per year. Children aged zero to nine years had the highest rates of ED visits for near-drowning events. Over half of near-drowning events resulting in an ED visit for children under 5 years take place in a swimming pool. Natural water and swimming pools are the most common locations for near-drowning events resulting in ED visits for children and youth. Introduction Near-drowning and drowning events occur after immersion in water or other liquid, when liquid enters the lungs. 27 Death from drowning occurs when the liquid in the lungs causes suffocation and interruption of the body s natural absorption of oxygen from the air, leading to asphyxia. Near-drowning is survival from a drowning event involving the inhalation of water or other liquid, which can result in unconsciousness and, in some cases, serious long-term effects such as brain injury due to lack of oxygen. 28 Near-drowning can affect the way a child thinks, learns, and plays. 29 Once a child is admitted for near-drowning, the care from the medical and intensive care unit appears to have relatively little impact on the outcome. 3 Common factors that contribute to near-drowning and drowning include lack of or inadequate adult supervision of children; inability to swim or overestimation of swimming capabilities; and risk-taking behaviour, including taking dares from friends or using alcohol or drugs. Environmental strategies, such as installation of fences around the four sides of swimming pools, and behavioural strategies, such as increased supervision of children while around water, are important initiatives to prevent these tragedies. 28 Near-drowning-Related Emergency Department Visits and Hospitalizations From 23 to 211, an average of eight people per year were treated in the ED and 1.6 people per year (14 people in total from 23 to 211) were hospitalized for a near-drowning event in the KFL&A area. In 211, the age-standardized ED visit rate in the KFL&A area was 3.4 per 1, population. (Figure 1.1) During 23 to 211, the two age groups with the highest rate of near-drowning-related ED visits were zero to four years and five to nine years. (Figure 1.2) KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 98

104 Rate per 1, Age-specific Population Total # of ED visits from 23 to 211 Rate per 1, population Number of ED Visits CHAPTER 1 DROWNING Figure 1.1 Near-drowning-related ED visits. KFL&A area and Ontario KFL&A Rate Ontario Rate KFL&A # of ED visits Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Data note: Rates are age standardized to the 1991 Canadian Population Figure 1.2 Near-drowning-related ED visits by age group. KFL&A area KFL&A Rate Total # of ED visits Age Group Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 99

105 CHAPTER 1 DROWNING Place of Occurrence of Near-Drowning During 23 to 211, 45.8% of near-drowning events resulting in ED visits occurred in the home, 4.2% in sports and athletic arenas; and 45.8% in other specified places. Types of Near-Drowning Events Overall, during 23 to 21, 56.2% of all near-drowning events resulting in ED visits involved watercraft, 17.8% were natural water-related, and 9.6% were swimming pool-related. (Figure 1.3) For children under 15 years of age, near-drowning events leading to ED visits for the KFL&A area were most likely to involve swimming pools (33.3%) or natural water (23.8%), followed by those involving watercraft (19.%) or bathtubs (4.8%). (Figure 1.4) Figure 1.3 Types of near-drowning-related ED Visits. KFL&A area % 9.6% 9.6% 17.8% Bathtubs Swimming pools Other, unspecified Natural water 56.2% Incidents involving watercraft Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 1

106 CHAPTER 1 DROWNING Figure 1.4 Types of near-drowning events leading to ED visits for children aged to 14 Years. KFL&A area % 19.% 19.% 23.8% Bathtubs Other, unspecified Accidents involving watercraft Natural water 33.3% Swimming pool Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Near-Drowning Involving Watercraft Over half (56.2%) of the near-drowning events resulting in ED visits involved watercraft. This category includes injuries where there was an incident to the watercraft causing drowning and submersion, such as jumping from compromised watercraft, and incidents causing drowning and submersion without incident to the watercraft itself, such as falling overboard out of the watercraft. Thirty-nine percent of all near-drowning events resulting in ED visits involving watercraft occurred with non-powered watercraft such as sailboats, canoes, kayaks, inflatables, surfboards, and windsurfers, while 48.8% occurred with powered watercraft (including incidents involving water-skis). Twelve point five percent were not specified by type. Neardrowning involving watercraft was most frequent among the KFL&A area residents under 45 years of age. Swimming Pool-Related Near-Drowning Pools are a particular hazard for children under five years of age. Unfenced or inadequately fenced swimming pools are the cause of many drownings in private homes. Safe Kids Canada states that according to researchers, safer pool fencing could prevent 7 out of 1 pool drowning incidents for children under five. 31 According to a report from the Canadian Red Cross, from 1991 to 2, over half of the pool-related drowning incidents in single-unit homes involved children aged one to four years, making pools the most frequent location for the drowning of young children. 32 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 11

107 CHAPTER 1 DROWNING Nearly all of these pools (94%) had inadequate safety gates. Pools with easy access from the home are a particular concern. Constant and close adult supervision of children is necessary around pools at all times. In the KFL&A area from , for children under five years old, over half of near-drowning events resulting in an ED visit took place in a swimming pool. Drowning Deaths In the KFL&A area there have been a total of sixteen drowning-related deaths from 2 to 29. Nine of these deaths were a result of someone drowning while in natural water such as a lake or a river. Three of these deaths occurred after a person fell into natural water, and three of deaths involved incidents while using a non-powered watercraft such as a canoe or kayak, or inflatable craft. KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 12

108 CHAPTER 11 INTENTIONAL INJURIES Chapter 11 Intentional Injuries Highlights There is an average of 2 suicides a year in the KFL&A area. Suicide rates have been decreasing in the KFL&A area and Ontario since 23. Suicide rates among males are consistently higher than among female rates; the highest rate of suicide in males occurs in the group aged 45 to 64. The two most common modes of suicide are 1) hanging, strangulation and suffocation, 34.%, and 2) drugs and alcohol, 24.6%. Drugs and alcohol use contribute to 7.9% of the self-harm related ED visits. Females, particularly those aged 15 to 19 and 2 to 24, have the highest rates of self-harm related emergency department (ED) visits. Rates of ED visits for self-harm have been significantly higher in the KFL&A area than in Ontario. Introduction Self-harm is a broad term used to describe deliberate self-destructive behaviour. Intentional self-harm can encompass both non-suicidal and suicidal behaviours. 33;34 Non-suicidal self-injury (NSSI) can take many forms, but some of the more common include cutting or burning of the skin, scratching, hitting objects or oneself or pulling out one's hair. In general, these behaviours are used as a coping strategy to deal with overwhelming negative emotions or to produce emotion when it is lacking. While many intentional self-harm injuries are not intended as suicide attempts, research shows that those who self-injure are at greater risk of committing suicide later in life. 34 Suicidal behaviour consists of acts focused on taking one's life. Suicidal behaviour includes attempts (suicidal acts unsuccessful in causing death) and gestures (the verbalizing of an actual or potential intent to harm oneself) 35 Suicidal behaviour is an indicator of mental illness. Most mental health professionals consider suicidal behaviours to be a result of irrational mental states (distorted perceptions, impaired judgment, extreme moods, feelings of hopelessness, loss of interest or pleasure) brought on by mental illness. 36;37 Suicidal behaviour is also associated with substance abuse and dependence, and terminal illness. Mental illnesses such as schizophrenia, personality disorder, eating disorders, etc. may also lead to suicidal behaviours. It should be noted that assessing the incidence of attempted suicide is difficult. First of all, the International Classification of Diseases codes utilized to classify the different types of self-harm do not distinguish between suicidal and non-suicidal forms of self-harm. There is an abundance of coding for presumed suicidal behaviours (hanging or strangulation; jumping from high places or lying in front of moving objects; selfdrowning or submersion; and self-injury by firearm), but there are fewer coding options for behaviours considered to be non-suicidal self-injury (such as hitting objects or oneself or pulling out one's hair). KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 13

109 CHAPTER 11 INTENTIONAL INJURIES Therefore, it is difficult to assess the proportion of emergency visits and hospitalizations that are definitively due to suicidal behaviours. In addition to coding issues, the majority of suicide attempts are not serious enough to be seen at an emergency department or be admitted to hospital for treatment; hospitals tend to only admit the most serious attempters. 38;39 Many individuals do not see health professionals, but are helped by family or friends, or perhaps by no one at all. 39 Individuals may also be hospitalized for their own protection or to assess the factors that gave rise to the suicide attempt. Thus, hospitalization data may only provide part of the picture and should be interpreted cautiously. 39 In this chapter, the rate of self-harm-related emergency department visits and hospitalizations might be used as a proxy for the rate of attempted suicides, but caution should be used in interpreting the data given the number of data limitations discussed above. Alcohol use is also an important risk factor for self-harm incidents. It is estimated that between 22 and 21 in the KFL&A area, an estimated 71 self-harm-related injury hospitalizations and 2 self-harm-related deaths attributable to alcohol consumption occurred among 15 to 69 year olds. In the KFL&A area, the data show that adult males and teenage girls (aged 15-19) are at most risk of suicide and self-harm injuries. Men are much more likely than women to commit suicide, particularly men aged 45 to 64, whereas girls aged 15 to 19 have the highest rates of ED visits for self-harm incidents, including suicide attempts with drugs and alcohol. Emergency Department Visits and Hospitalizations for Self-Harm From 23 to 211, individuals aged 1 and up made an average of 329 visits per year to the KFL&A area EDs for self-harm acts. Rates of self-harm-related ED visits were significantly higher in the KFL&A area than in Ontario from 23 to 211, although self-harm related hospitalization rates were lower in the KFL&A area than Ontario. There has been a downward trend in the rate of self-harm-related ED visits in both the KFL&A area and Ontario. (Figure 11.1 and 11.2) From 23 to 211 for individuals aged 1 and up, self-harm related ED visit and hospitalization rates were higher for females than males in most age groups. Young females aged 15 to 19 had the highest rate of selfharm related ED visits, visits per 1,, averaging about 48 ED visits per year. (Figure 11.3 and 11.4) KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 14

110 Rate per 1, population Number of Hospitalizations Rate per 1, population Number of ED Visits CHAPTER 11 INTENTIONAL INJURIES Figure 11.1 Self-harm-related ED visits, ages 1 and up. KFL&A area and Ontario KFL&A Rate Ontario Rate KFL&A # of ED visits Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Data note: Rates are age standardized to the 1991 Canadian Population Figure 11.2 Self-harm-related hospitalizations, ages 1 and up. KFL&A area and Ontario KFL&A Rate Ontario Rate KFL&A # of Hospitalizations Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Data note: Rates are age standardized to the 1991 Canadian Population KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 15

111 Rate per 1, Age-specific population Total number of Hospitalizations from Rate per 1, population Total number of ED visits from CHAPTER 11 INTENTIONAL INJURIES Figure 11.3 Self-harm-related ED visits, ages 1 and up, by age group and sex. KFL&A area Male Rate Female Rate Total # Male Visits Total # Female Visits Age Group Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Figure 11.4 Self-harm hospitalizations, ages 1 and up, by age group and sex. KFL&A area Male Rate Female Rate Total # Male Hospitalizations Total # Female Hospitalizations Age Group Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 16

112 CHAPTER 11 INTENTIONAL INJURIES Types of Self-Harm Injuries From 23 to 211, an average of 7.9% of self-harm acts resulting in an ED visit were due to intentional poisoning or overdose by drugs or alcohol. The second most common mode of self-harm injury was with a sharp object (23.% of ED visits). (Figure 11.5) Figure 11.5 Type of self-harm-related ED visits. KFL&A area % Sharp object 1.9% 1.7% 1.%.9%.3%.2%.2% Other and unspecified means Other and unspecified chemicals Hanging, strangulation and suffocation Blunt object Other gases and vapours Jumping from a high place Firearms 7.9% Drugs and alcohol.3% Drowning and submersion Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Self-Harm by Drugs or Alcohol Drugs and/or alcohol use contribute to 7.9% of the self-harm related ED visits. The most common types of drugs used for self-harm resulting in an ED visit was psychotherapeutic drugs (49.3%), including antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs. Examples of drugs in this category include antidepressants, barbiturates, neuroleptics and tranquilizers. This was followed by anti-inflammatory drugs and pain and fever relievers such as acetaminophen, aspirin and ibuprofen (21.8%). Intentional misuse of narcotics and hallucinogens resulted in 9.7% of ED visits for self-harm acts involving drugs or alcohol, and alcohol misuse accounted for 1.9%. Suicide Deaths One in 11 KFL&A area residents aged 15 and up (9.8% ( ) report that they have considered suicide at some point in their life (27-8). 4 Between 2 and 29, there was an average of 2 suicide deaths per year in the KFL&A area. The rate of suicides in 29 was 7.9 per 1, population. (Figure 11.6) KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 17

113 Rate per 1, population Number of Deaths CHAPTER 11 INTENTIONAL INJURIES Figure 11.6 Suicide mortality. KFL&A area and Ontario KFL&A Rate Ontario Rate KFL&A # of deaths Source: Ontario Mortality Database 2-29, Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted August 15, 212 Data note: Rates are age standardized to the 1991 Canadian Population While the rate of ED visits for intentional self-harm acts are higher among females than males for all age groups (except those 65 and over), the rate of suicides are higher for males than females in the KFL&A area. This trend has been consistent from 2 to 29 and in every age group. The highest rate of male suicide occurs in the group aged 45 to 64 years, where the suicide rate for males was nearly five times higher than the rate for females. (Figures 11.7 and 11.8) The two most common methods of suicide are hanging, strangulation and suffocation, 34.%, followed by drugs or alcohol, 24.6%. This is in contrast to the leading method of intentional self-harm acts resulting in ED visits, which is drug or alcohol use. The third most common method of suicide is firearms, 17.7%. Females are most likely to choose drugs and/or alcohol as their method of suicide, whereas males are most likely to choose hanging, strangulation and suffocation. Also, use of firearms is a method of suicide chosen almost exclusively by males. (Figure 11.9) KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 18

114 Rate per 1, Age-specific Population Total number of suicides from 2-29 Rate per 1, population Number of Suicides CHAPTER 11 INTENTIONAL INJURIES Figure 11.7 Suicide by sex. KFL&A area Male Rate Female Rate # Male Suicides # Female Suicides Age Group Source: Ontario Mortality Database 2-29, Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted August 15, 212 Figure 11.8 Suicide by age group and sex. KFL&A area Male Rate Female Rate Total # Female Suicides Total # Male Suicides Age Group Source: Ontario Mortality Database 2-29, Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted August 15, 212 KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 19

115 CHAPTER 11 INTENTIONAL INJURIES Figure 11.9 Method of suicide. KFL&A area 2-29 Hanging, strangulation and suffication 34.% 1.5% Jumping from a high place 2.% Other and unspecified chemicals 4.4% Sharp object 4.4% Other and unspecified means Drugs and alcohol 24.6% 5.4% 5.9% Drowning and Submersion Other gases and vapours 17.7% Firearms Source: Ontario Mortality Database 2-29, Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted August 15, 212 Violence Violence is of increasing concern for people. Violence can take many forms: physical violence or wounds, neglect, verbal attacks, insults, threats and other psychological abuse. 41 In this part of the chapter, violence is described as physical acts of violence such as by hanging, handgun discharge and violence by bodily force, as well as neglect and abandonment and other forms of violence such as mental cruelty, and sexual violence. From 23 to 211, there was an average of 7 visits per year to the KFL&A area EDs for acts of violence. Rates of violence-related ED visits were significantly higher in the KFL&A area than in Ontario from 23 to 211, although violence-related hospitalization rates were similar. There has been a downward trend in the rate of violence-related ED visits in Ontario, but rates have remained steady in the KFL&A area. (Figure 11.1 and 11.11) KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 11

116 Rate per 1, population Number of Hospitalizations Rate per 1, population Number of ED Visits CHAPTER 11 INTENTIONAL INJURIES Figure 11.1 Violence-related ED Visits. KFL&A area and Ontario KFL&A Rate Ontario Rate KFL&A # of ED visits Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Data note: Rates are age standardized to the 1991 Canadian Population Figure Violence-related Hospitalizations. KFL&A area and Ontario KFL&A Rate Ontario Rate KFL&A # of Hospitalizations Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Data note: Rates are age standardized to the 1991 Canadian Population KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 111

117 Rate per 1, population Total number of ED visits from CHAPTER 11 INTENTIONAL INJURIES Males aged 2-24 years and years had the highest violence-related ED visit rates (298.2 visits and visits per 1, population, respectively). Males had about 3 times the number of violence-related ED visits as females. (Figure 11.12) Figure Violence-related ED visits by age and sex. KFL&A area Male Rate Female Rate Total # Male Visits Total # Female Visits Age Group Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Violence Acts Figure shows the most common acts of violence resulting in an ED visit. Over three-quarters of all ED visits for violence-related injury are caused by violence by bodily force, such as a brawl or fight. The next most common agents of violence are blunt or sharp objects. It should be noted that it is less likely that forms of maltreatment such as mental cruelty will be captured by visits to the ED or hospitalizations. KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 112

118 CHAPTER 11 INTENTIONAL INJURIES Figure Methods of violence leading to ED visits. KFL&A area % 3.5% 5.2% 5.6% 6.2% Sexual assault by bodily force Other maltreatment* Other assault** Assault by sharp object Assault by blunt object 77.6% Assault by bodily force *Other maltreatment includes mental cruelty, physical abuse, sexual abuse and torture. **Other violence includes neglect and abandonment, violence by pushing from a high place, firearm discharge, hanging, violence by fire, steam, drugs, corrosive substances, and other chemicals. Source: National Ambulatory Care Reporting System , Ontario MOHLTC, IntelliHEALTH ONTARIO, extracted Sept. 18, 212 Deaths from Violence From 23 to 211, there were 18 deaths resulting from violence, ten of which were males. Eight of those deaths were caused by a sharp object. KFL&A Public Health Burden of Injury in Kingston, Frontenac, Lennox & Addington 113