How To Calculate Sprts Related Injuries

Transcription

1 U.S. CONSUMER PRODUCT SAFETY COMMISSION WASHINGTON, D.C Sprts-Related Injuries t Persns 65 Years f Age and Older April 1998

2 U.S. CONSUMER PRODUCT SAFETY COMMISSION WASHINGTON, D.C Sprts-Related Injuries t Persns 65 Years f Age and Older Gerge W. Rutherfrd Jr., M.S. Thmas J. Schreder, M.S. April 1998

3 CONTENTS HIGHLIGHTS...i INTRODUCTION...1 METHODOLOGY...2 RESULTS...4 SPECIFIC SPORT RELATED HAZARDS...8 COSTS ASSOCIATED WITH SPORTS RELATED INJURIES...12 DISCUSSION...12 REFERENCES...14

4 HIGHLIGHTS Frm 1990 t 1996, sprts-related injuries t persns 65 years f age and lder increased significantly, frm 34,000 t 53,000. This is an increase f 54% in that 7-year perid. The increased incidence f injury ccurred nt nly amng the yungest f the 65 and ver ppulatin, but als amng thse 75 years and lder. Sprts-related injuries t persns 75 and lder increased by 29%. Sprts-related injuries increased much mre t persns 65 and ver than t any ther age grup. By cntrast, they increased 18% t persns age (vs. 54% fr 65 and lder). Sprts-related injuries have increased mre than ther cnsumer-prduct related injuries treated in hspital emergency rms fr persns 65 and ver. The increase in sprts-related injuries is greater than the increase in the ppulatin 65 and ver, s it cannt be explained slely by the increase in ppulatin f this age grup. Frm 1990 t 1996, the ppulatin 65 and ver increased by just ver 8%, whereas sprts-related injuries t this age grup increased 54%. Injuries t lder persns have increased the mst in cnnectin with mre active sprts, such as bicycling, exercise activity (with and withut equipment), weight training, and skiing. The highest number f sprts injuries t persns 65 and lder were assciated with bicycles and bicycling. Bicycling injuries increased 75% frm 1990 t Of bicycling injuries t lder persns, 30% were t persns 75 years f age and lder. Mst injuries resulted frm falls, and head injuries were 21% f the ttal. Virtually nne f the fall victims was wearing a bike helmet. The number f injuries related t exercise activity (with and withut equipment) increased 173% frm 1990 t The 75 and lder grup accunted fr 40% f thse injured in 1996 in this categry. The mst cmmn injuries were falls, tripping and strains in nrmal exercise activity. Injuries frm less active sprts, such as fishing, glf, bwling and shufflebard, increased nly mderately r nt at all frm 1990 t Fr example, fishing injuries increased 6%. i

5 Fr the first time in 1996 we find a small number f injuries amng the 65 and ver ppulatin in very active and physically challenging sprts such as snwbarding and in-line skating. In bth 1990 and 1996, abut 60% f the 65 and lder victims f sprts injuries were males. In bth f these years, males were abut 40% f the ppulatin 65 and lder. The hspitalizatin rate fr persns 65 and ver with sprtsrelated injuries is 10%. This is lwer than the 18% hspitalizatin rate fr injuries with all cnsumer prducts fr persns in this age grup. The average cst per injury fr sprts-related injuries treated in emergency rms has declined since While mre injuries are ccurring, they appear, n the average, t be less cstly and severe. CONCLUSIONS The increase in injuries is mst likely attributable t increasingly active lifestyles and t increased participatin in sprts activities by lder Americans. Especially ntable is the increased participatin by peple 65 and ver in mre active sprts, such as bicycling, exercise (with and withut equipment), weight training, and skiing. Americans are remaining physically active int their 70's, 80's and even int their 90's. The lwer hspitalizatin rate fr sprts-related injuries suggests that the ppulatin participating in sprts activities is healthier verall than thse wh are nt participating in sprts. Persns invlved in activities such as bicycling can reduce their risk f injury by using bike helmets. Bicycle helmets reduce the risk f serius head injury. Individuals shuld use safety gear and take apprpriate safety precautins, especially in active sprts such as inline skating and use f exercise equipment and weights. All frms f exercise, frm walking and gardening t swimming, tennis and biking, cntribute t imprved health and well-being. By getting regular exercise -- and ding it safely -- lder Americans can enjy a healthier life. ii

6 INTRODUCTION Since 1990, the U.S. ppulatin 65 years f age and lder has increased by apprximately 2.63 millin peple. 1 Such a ppulatin increase culd be expected t have an impact n the verall injury frequency in this age chrt, including injuries related t cnsumer prducts. Cnsumer prduct related injuries t persns aged 65 years and lder were examined using the Natinal Electrnic Injury Surveillance System (NEISS), an injury surveillance netwrk perated by the U.S. Cnsumer Prduct Safety Cmmissin, which tracks cnsumer prduct related injuries frm a natinal statistical sample f hspital emergency rms. NEISS data fr the years 1990 thrugh 1996 were reviewed and injury estimates fr the 65 and lder age grup calculated fr each year. These estimates shw an increase in cnsumer prduct related injuries fr each year during this time perid. In 1990, there were an estimated 979,000 cnsumer prduct related emergency rm (ER) treated injuries t persns 65 years f age and lder. This estimate increased in 1996 t 1,322,200 cnsumer prduct related injuries. By cmparisn, verall frequencies f emergency rm treated cnsumer prduct related injuries t thse under 65 years ld declined between 1990 and Between 1990 and 1996, ppulatin based injury rates als declined in every age grup except the ppulatin 65 years and lder. The rate f emergency rm treated injuries per 1,000 ppulatin in the age 65 and lder grup increased frm in 1990 t in In 1996, the injury rate in this age grup was higher than that fr persns years f age r persns years f age. By cntrast, data frm analyses perfrmed in the late 1980s 2 indicated that the ppulatin age 65 and lder at that time had a lwer verall injury rate than ther segments f the ppulatin. One pssible explanatin fr this increase in cnsumer prduct related injuries is that thse ver age 65 are maintaining increasingly active lifestyles, resulting in greater expsures t the risk f injury. This paper lks at NEISS data n sprts related injuries as a ptential indicatr f activity level in the ppulatin age 65 and lder and describes sprts related injuries seen in this grwing ppulatin. 1

7 METHODOLOGY This analysis was prepared using data frm the Natinal Electrnic Injury Surveillance System (NEISS), which cnsists f a natinal prbability sample f 101 hspitals, drawn frm the ver 5,000 hspitals with 24 hur emergency departments, natinwide. The sample includes hspitals f differing sizes and lcatins, as well as children's hspitals and trauma centers. The sampling frame is divided int fur size strata based n the annual number f emergency department visits reprted by each hspital, and a stratum fr children's hspitals. Since its inceptin in the 1970's, the NEISS sample has been updated several times t maintain its statistical validity. Fr in-scpe cases, the cder at each NEISS hspital abstracts infrmatin n as many as furteen different variables. These variables include date f treatment, case recrd number, age, sex, injury diagnsis, bdy part injured, cnsumer prducts invlved (up t tw prducts may be specified), indicatr fr third prduct invlved, dispsitin f the case (i.e. treated and released, hspitalized, dead n arrival) accident lcale, whether fire r a mtr vehicle was invlved, and up t tw lines f narrative t prvide a brief descriptin f the incident. Because f the statistical design f the NEISS, sampling errrs assciated with NEISS estimates can be calculated. 3 A variance cmputatin prgram that accunts fr the stratified sample design was used t calculate variances f estimates and the assciated cvariance between estimates acrss annual time perids. T determine if the difference in annual estimates was statistically significant, student t tests (adjusting fr the cvariance between years) were perfrmed. 4 Because activities such as skiing (limited t a few hspitals), and bicycling (in the 65 and lder age grup, reprted mstly frm warm weather hspitals), had high variances assciated with the recent injury estimates, the "t" test did nt indicate significant change. A nnparametric test based n Spearman's rank crrelatin cefficient was used t test fr trends in these sprts, fr which the cnsistency f the year-t-year increases, ver the seven year perid, led us t believe that there may in fact have been an increase. 5 A significance level f 0.05 was used fr all statistical testing. Injury cst estimates were based n the Injury Cst Mdel develped by the U.S. Cnsumer Prduct Safety Cmmissin, Directrate fr Ecnmic Analysis. The Injury Cst Mdel is structured t measure eleven different types f csts separately, ne cmpnent at a time, and then t add them tgether t establish the ttal cst f an injury. A variety f techniques 2

8 METHODOLOGY (Cntinued) are used t estimate the eleven cst cmpnents including regressin analysis, sample means frm large databases, and direct analytic slutin. The cst cmpnents include: medical csts, the csts f insurance, fregne earnings, pain and suffering caused by the injury, and disability csts. 3

9 RESULTS NEISS data n prduct related injuries frm 1990 were cmpared with thse frm Figure 1 shws an increase in the ttal estimated cnsumer prduct related injuries between 1990 and 1996 fr the ppulatin 65 years f age and lder, frm 979,000 (1990) t 1,322,200 (1996), a 35% increase. Figure 1. Estimated Prduct-Related Injuries t Persns 65 Years f Age and Older, Treated in Hspital Emergency Departments, There was an even greater increase in sprts related injuries ver that same time perid. Figure 2 illustrates that in 1990, there were an estimated 34,400 sprts related injuries t persns 65 years f age and ver, while in 1996, the estimate increased by 54% t 53,000 injuries (p <.05). The rate f injury assciated with sprts activities in this ppulatin als increased frm 1.10 per 1,000 ppulatin in 1990, t 1.57 per 1,000 ppulatin in The injury rate seen with all cnsumer prducts increased frm in 1990 t in

10 RESULTS (Cntinued) While there is scant data n the number f lder adults participating in sprts activities, ne can speculate frm the rising injury rate, that the increase in sprts related injuries in the age 65 and lder grup is mre likely t be due t an increased participatin level than an increase in the risk f any f the sprts activities themselves. Figure 2. Estimated Sprts-Related Injuries t Persns 65 Years f Age and Older, Treated in Hspital Emergency Departments, T further explre sprts-related injuries in the ver 65 ppulatin, incidence f injury was analyzed fr tw subgrups cmprising that ppulatin: years f age; 75 years and lder. Table 1 shws that within the 65 and lder ppulatin, the age distributin shifted between 1990 and In 1996, there were relatively fewer injuries in the age grup than in 1990 (75.3% in 1990, 70.9% in 1996), and relatively mre injuries in the 75 and lder grup than in 1990(24.7% in 1990, 29.1% in The prprtin f the ppulatin in the age 75 and lder grup als increased between the tw time perids frm 42.1% in 1990 t 44.9% in 1996, but nt enugh t accunt fr the increase in injuries. This finding suggests that sprts participatin is nt limited t the yungest senirs, and that as the ver age 65 chrt ages, they may remain active int their 70's, 80's and perhaps even 90's. 5

11 Table 1. Estimated Sprts-Related Injuries t Persns 65 and Older. Estimated U.S. Ppulatin Ages 65 and Older, in (000s). By Year and Age Grup Age Grup 1990 Injuries 1990 Pp. (1,000s) 1990 Percent Injuries 1990 Percent Pp. Ttal 34,400 31, % 100.0% Years 75+ Years 25,899 18, % 57.9% 8,501 13, % 42.1% 1996 Age Grup 1996 Injuries 1996 Pp. (1,000s) 1996 Percent Injuries 1996 Percent Pp. Ttal 53,000 33, % 100.0% Years 75+ Years 37,566 18, % 55.1% 15,434 15, % 44.9% TE: Ppulatin estimates are runded and may nt add t ttal. 6

12 RESULTS (Cntinued) The types f sprts activities in which senirs were injured changed smewhat between 1990 and The number f emergency rm treated injuries related t active sprts such as bicycling, exercise activity, and snw skiing increased significantly between 1990 and 1996, while injuries frm less active sprts, such as glf and fishing increased less r nt at all ver that time perid. It is interesting t nte that there were a small number f injuries seen fr the first time in 1996 invlving "extreme" r mre physically challenging sprts such as snwbarding and inline skating. We examined the leading grups f sprts fr the distributin by sex f victim. We fund that almst 60% f the injuries were t males in bth 1990 and Males represented abut 40% f the 65 and lder ppulatin in bth f these years. HIGHLIGHTS OF SPECIFIC SPORT RELATED INJURY HAZARDS Figure 3 illustrates the distributin f sprts activities assciated with the highest number f injuries t the ppulatin 65 and lder in 1996, and the change in distributin f injuries between 1990 and The sprts activities with the largest increases in injuries in 1996 frm 1990 were bicycling, exercise activity/exercise equipment/weightlifting, and snw skiing. Glf injuries als increased between 1990 and 1996, but nt significantly. The smallest change in the number f injuries between 1990 and 1996 was seen in tennis and fishing. Table 2 presents 1996 data which summarizes thse sprts activities in which persns age 65 and lder are mst ften injured. The injuries are brken ut fr the fur age grups cmprising the age 65 and lder ppulatin. Figure 3. Estimated Emergency Rm Treated Injuries t Persns 65 Years f Age and Older, Tp Sprts Activities, A mre detailed descriptin f the injuries assciated with the tp sprts activities fllws. 7

13 Table 2. Estimated Sprts Activity Related Injuries t Persns 65 Years f Age and Older. Specific Activities by 10 Year Age Grups, 1996 Sprt Ttal Ttal 53,033* 37,566 12,818 2, Bicycles 11,002 7,747 2, ** Exercise Activity/Equipment/ Weightlifting 8,197 4,926 2, ** Glf & Glf Carts 8,127 5,983 2,093 ** 0 Snw Skiing 5,432 4,372 1,026 ** ** Fishing 5,268 3,648 1,552 ** 0 Tennis 2,818 2, Swimming/Diving Swimming Pls 2,623 1, ** ** Bwling 2,326 1, ** 0 Skating 1,460 1,325 ** ** 0 Baseball & Sftball 1,364 1,056 ** ** 0 All Terrain Vehicles Hrseback Riding ** 0 0 Basketball 532 ** ** ** 0 * Several additinal prducts were als reprted, and are included in the ttal, fr which the ttal 1996 estimate was less than 500. These prducts were: Snwmbiles, Persnal watercraft, Squash/racketball, Vlleyball, Sccer, Minibikes/Trailbikes, Ball sprts nt elsewhere classified, Gymnastics, G carts, Ftball, Billiards, Shufflebard, Water skiing, Handball, and Sleds. ** Estimate less than 500. Sample size t small t include estimate. 8

14 SPECIFIC SPORTS (Cntinued) Bicycles/Bicycling The highest number f injuries t the age 65 and lder ppulatin were assciated with bicycles and bicycling, with an estimated 11,000 emergency rm treated injuries in The estimated number f injuries increased significantly between 1990 and by 75% r apprximately 4,700 injuries. Thirty percent f the injuries in 1996 ccurred in persns ver 75 years f age. Apprximately 13% f the injured persns 65 and ver were hspitalized fr their bicycle related injuries. Falls frm the bike were the mst frequent pattern f injury, abut 60% f the ttal. Head injuries frm either falls r mtr vehicle cllisins were 21% f the ttal injuries, and when helmet use was mentined, virtually nne f the victims were wearing helmets. Exercise Activity with r withut Equipment/ Weightlifting Estimated injuries assciated with these activities increased 173% frm 3,007 in 1990 t 8,197 in (p =.0001). Frty percent f thse injured in 1996 were 75 years f age r lder, with nine percent f all thse injured being hspitalized. The mst frequent patterns f injury assciated with these activities were falling, r strains frm nrmal exercise activity. Smaller numbers f injuries resulted frm falls against the equipment and frm prduct-related prblems such as sharp parts r equipment failures. Snw Skiing Skiing injuries t persns 65 and lder increased by 217% frm 1,716 in 1990 t 5,432 in This difference between the 1990 and 1996 estimates was nt significant. Because variance f NEISS estimates is strngly influenced by the number f hspitals reprting, and because the skiing cases are reprted mstly frm just a few hspitals, this is nt an unexpected finding. When we applied the nn-parametric test fr cnsistency f year t year changes, the pattern fr skiing was statistically significant. Persns 65 and ver wh were injured while skiing were hspitalized fr their injuries in 8% f the cases. The mst frequent pattern f skiing injury was a fall. Glf The estimated number f glf related injuries t persns 65 and lder increased by 2,139, abut 36%, frm 1990 t Hwever, this change was nt fund t be significant at the.05 level. Glf injuries were virtually all t persns under 85 years ld; 26% were t persns between 75 and 84 years f age. Just under 6% f glf injury victims 65 and ver were hspitalized. Glf related injuries were mst frequently strains and sprains and ther minr injuries. Hwever, there were sme fractures, 9

15 primarily t ankles, mstly frm falls. Other Sprts Injuries In additin t the fur sprts activities which were assciated with the highest number f injuries t the ver age 65 chrt, Table 3 als shws a number f ther sprts activities and the injury incidence assciated with them. There was an unexpectedly high prprtin f hspitalizatin cases with bwling (abut 20%)(nt shwn in table). Brken hips r femurs were the mst frequent reasn given fr these hspitalizatins. 10

16 TABLE 3. Summary f Findings. Sprts Injuries t Persns 65 and Older. Estimated Emergency Rm Treated Injuries,1996 fr Tp Seven Sprting Activities Sprts Activity Difference 90 t 96 Significance (p = <.05) Adjusted "t" test Nn-parametric test 1996 Age 75+ Mst Frequent Bdy Part Injured Mst Frequent Diagnsis Mst Frequent Pattern Percent Hspitalized 1996 Overall +18, % YES YES 15,433 29% n/a n/a n/a 10% Bicycles + 4, % YES 3,255 30% shulder & trunk fractures falls 13% Exercise Activity & Equip. Weightlifting +5, % YES YES 3,271 40% leg & ft shulder and trunk fractures and dislcatins falls, tripping, strains in nrmal activity 9% Glf & Glf Carts +2, % 2,144 26% leg & ft mstly ankle strains and sprains nrmal play f the game 6% Snw Skiing +3, % YES 1,060 20% shulder and trunk strains and sprains falls 8% Fishing % 1,620 31% fingers punctures hks in fingers 12% Tennis % evenly distributed, except head & face are very lw strains and sprains falls, strains and strains in nrmal play -- Swimming/ Diving/ Swimming Pls +1, % 1,281 49% shulder and trunk fractures and dislcatins falls n pl decks 8%

17 COSTS ASSOCIATED WITH SPORTS RELATED INJURIES The csts assciated with sprts related injuries t persns 65 years f age and ver als were examined. In 1990, sprts related emergency rm treated injuries fr the ppulatin 65 years and lder, cst sciety abut $364 millin; in 1996, they cst abut $516 millin, an increase f abut 42% (bth expressed in 1996 dllars). 5 When the increase in sprts injuries and the increase in the cst f thse injuries are cnsidered tgether, the average cst per injury declined frm 1990 t That is, while there are mre injuries ccurring, n the average, they appear t be less cstly and pssibly less severe. The hspitalizatin rate fr sprts injuries in this ppulatin als declined frm abut 13% in 1990 t abut 10% in Because f the changes in the health care system and the increasing emphasis n cst cutting measures and reduced hspital stays, hwever, it is difficult t draw any firm cnclusins abut the changes since 1990 in the cst and severity f these sprts related injuries. When the sprts injury hspitalizatin rates f the age 65 and lder ppulatin are cmpared with hspitalizatin rates fr all cnsumer prduct related injuries fr that same age grup, it is apparent that the sprts hspitalizatin rate is lwer. When all prduct related injuries are cnsidered fr 1996, members f this ppulatin were hspitalized n average abut 18% f the time fr their injuries, while fr sprts activities, they were hspitalized apprximately 10% f the time. This data hints that the ppulatin participating in sprts activities might be healthier verall that the rest f the same age chrt, a subject that deserves further study. DISCUSSION Estimates f sprts related injuries t persns 65 years f age and lder have increased frm 1990 t They have increased mre than ther prduct related injuries treated in hspital emergency rms, and mre than can be explained slely by the increase in ppulatin. These increases are mst likely explained by greater activity and participatin in sprts activities amng senirs. The increased incidence f sprts related injuries is ccurring nt nly amng the yungest f the 65 and lder ppulatin, but amng the year ld and year ld age grups. There is sme indicatin in the data that there may als be a tendency tward increased participatin in mre active sprts. The size f the ppulatin in the 65 and ver age grup has increased. Hwever, less active sprts such as fishing and glf, had nly small increases in the injury estimates, while injuries assciated with mre active sprts like bicycling, exercise equipment, and snw skiing, increased, nt nly in frequency, but in their share f the ttal f sprts related injuries t this age 12

18 grup. Persns age 65 and ver wh suffer sprts related injuries were hspitalized abut 10% f the time. Hwever, when all prduct related injuries are cnsidered, this grup is hspitalized abut 18% f the time. Frm this finding, it appears that, in general, sprts injuries may be less severe than many ther prduct related injuries. This may be because the activities themselves are less dangerus, r because the ppulatin participating is healthier than thse injured in ther ways. Valid data is needed n participatin in sprts activities by the age 65 and ver ppulatin. Based n day t day bservatins and discussins with senirs, it appears that this ppulatin is mre active and is likely t participate mre in sprts activities. Examined in cmbinatin with the injury data, sprts participatin data culd help explain better the reasn fr the increase in these injuries. Individuals shuld use the apprpriate prtective gear fr the activity, such as bicycle helmets fr bicycling and helmets and wrist guards fr skating. It is very imprtant t read and understand the instructins which cme with any cmplex piece f equipment, and t maintain the equipment which yu use fr the activity in gd perating cnditin. 13

19 REFERENCES 1. U.S. Bureau f the Census, U.S. Ppulatin Estimates by Age, Sex, Race, and Hispanic Origin: 1990 t 1996, March U.S. Cnsumer Prduct Safety Cmmissin. Prducts Assciated with Injuries and Deaths t Persns 65 Years f Age and Older. Unpublished Reprt. Rutherfrd, Gerge W. Jr. M.S., Meadws, Susan, Brwn, Victria 3. U.S. Cnsumer Prduct Safety Cmmissin. The NEISS Sample (Design and Implementatin), Washingtn, D.C., U.S. Cnsumer Prduct Safety Cmmissin; July Kish, Leslie, Survey Sampling, Jhn Wiley and Sns, Inc., Sectin 12.4 "Crrelatins frm Overlaps in Repeated Surveys". 5. Blalck, Hubert m, Jr. Scial Statistics, Secnd Editin, McGraw-Hill Bk Cmpany, Chapter 18, pp Office f the Surgen General f the United States, Physical Activity and Health: A Reprt f the Surgen General,