Στατιστικές μέθοδοι στη διερεύνηση της αιτιολογίας και των παραγόντων κινδύνου των ατυχημάτων

Abstract

This doctoral thesis was part of the research needs of the Centre for Research and Prevention of Injuries (CEREPRI) in order to seek the most appropriate sources of mortality and morbidity data from physical injuries, to perform comparisons between countries and to examine the time trends of indicators of morbidity and to calculate at the national level the incidence indicators and the parameters of the medical cost of health services from physical injuries. Parallel objective was to implement a wide range of statistical methods in different types of studies and designs of explanatory epidemiology in order to investigate factors associated with the occurrence of the injuries in Greece, taking into account the specificities of epidemiology in this area and to highlight the necessity of a detailed database for recording the causes and the circumstances of the injury occurrence and so to identify dangerous consumer products.Analyses were based on data derived from WHO, on the 500000 cases recorded at the CEREPRI Emergency Department Injury Surveillance System (EDISS) database, on household survey of MRB and ad hoc collections. It was also used a simple method for calculating the preventable fraction of the injuries to illustrate the possibilities of using existing data to emerge the burden of the injuries and the need for policy decisions planning prevention interventions tailored to their respective populations.In particular, a nested case control study was performed for highlighting the burden and the causes of the childhood injuries in the town of Velestino. Traditional case control studies as well as the cluster analysis were used to investigate the potential role and to identify risk factors for injuries to specific groups of children. Also, for the first time in our country, a case crossover study was performed with injured children, to study the exposure of the victim in a series of risk factors at different time intervals before the event. Finally, we investigated the role of specific consumer products for infant injuries.From the analysis of available mortality data since 1980 appears that Greece is in a better position than the EU average. The last period it seems that the degree of reduction in mortality in Greece is lower than this of EU average resulting a decline in the advantageous position of Greece in relation to the average of EU countries. Based on EDISS data, it was estimated that in Greece each year are treated in the outpatient hospitals 1.5 million injuries, 18% of which involved children under the age of 15. In an alternative, less objective, approach in which data were collected from a household survey the corresponding estimated size was 0.52 million.Regarding the calculation of the preventable fraction of injuries, it was estimated that up to one in four deaths due to injury could have been avoided if it had been developed appropriate prevention strategies in each region of the U.S. The preventable fraction is particularly high in childhood, where it reaches 42% and similar to that (47%) who had previously calculated by the CEREPRI for the European Union countries.With the studies of this thesis it was presented the magnitude of the problem, indicated a series of risk factors such as intra-familial environment, demographic characteristics of parents, such as age and education or inherent biological parameters such as anthropometric and left-handedness or, designated and described homogeneous groups of individuals who are at increased risk for the same injury type. Confirmation of these findings as well as those of the case crossover study showed that emotional stress or strenuous physical and mental exercise may be associated with a subsequent accident, can provide an incentive to develop new prevention strategies that are aimed at informing and the training of teachers and parents with a view to reducing the injuries in children. Similarly, the example of the study for the injuries caused by the baby bouncers could be a springboard for industry to modify the characteristics of the product resulting an injury and until then, to recommendations for increased vigilance of parents and of the relevant authorities for the risk for injuries from consumer products.In conclusion, in order to assess the effectiveness of prevention efforts and to design targeted programs for the injuries it is necessary an additional database covering detailed description of the external cause of the incident, which is not reflected in the routine collectively data of mortality and morbidity. EDISS was established and operated in line with other databases that were co-funded in the beginning by the European Union and still continue to work with national resources in other countries of the Union. The analysis of the data as presented in this thesis contributed to capture the magnitude of the problem of the injuries in Greece, to identify series of risk factors, to formulate prevention policies, but also to international prominence in the relevant scientific knowledge base, with substantial participation in the scientific developments.