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PubMed2006

The economic value of fatal and non-fatal occupational risks in Mexico City using actuarial- and perceived-risk estimates.

Compensating wage differentials are used to estimate marginal rates of substitution between income and both fatal and non-fatal occupational-injury risks in the Mexico City metropolitan area. Data are obtained by in-person survey of almost 600 workers and include workers' perceived risks of fatal and non-fatal occupational injury supplemented by actuarial-risk estimates from government statistics. Results using both actuarial- and perceived-risk estimates are reasonably consistent. Estimates of the value per statistical life are between 235,000 US dollars and 325,000 US dollars and estimates of the value per statistical non-fatal injury are between 3500 US dollars and 11,000 US dollars (2002 US dollars). These values are much smaller than corresponding estimates for higher-income countries but are compatible with the small number of prior estimates for lower-income countries.

Actuarial Analysis↗

PubMed2006

Understanding the effect of deployment on the risk of fatal motor vehicle crashes: a nested case-control study of fatalities in Gulf War era veterans, 1991-1995.

Motor vehicle crashes (MVCs) are an important cause of morbidity and premature loss of life among military personnel during peacetime and particularly following combat. A nested case-control study of fatal MVC occurring between 1991 and 1995 was conducted in a cohort of Gulf War era veterans. Cases were validated MVC deaths in the Fatality Analysis Reporting System. Controls were selected using risk set sampling by gender and year of case ascertainment in a 10:1 ratio. Preliminary results, consistent with previous reports of increased fatal MVC risk among returning combat veterans, showed a crude odds ratio of 1.45 (95% confidence interval 1.27-1.65). Multivariable logistic regression modeling was used to identify important independent predictors, as well as to quantify the influence of deployment on a risk profile for fatal MVC. Because of significant interaction between deployment and inpatient diagnosis of substance abuse, the final model was stratified by deployment status. Results suggest that demographic, military, and behavioral characteristics of deployed healthy warriors are similar to the risk profile for fatal MVC. In addition to young, single, high school-educated, enlisted male personnel, those who served during times of ground combat, particularly in infantry, gun crews, or seamanship occupations, should be targeted for preventive interventions.

Accidents, Traffic↗

PubMed2004

The effects of daylight and daylight saving time on US pedestrian fatalities and motor vehicle occupant fatalities.

This paper analyzes the effects of daylight and daylight saving time (DST) on pedestrian and motor vehicle occupant fatalities in the United States. Multivariate analyses of county level data from the Fatality Analysis Reporting System for 2-week periods in 1998 and 1999 are used. Results show that full year daylight saving time would reduce pedestrian fatalities by 171 per year, or by 13% of all pedestrian fatalities in the 5:00-10.00 a.m. and in the 4:00-9:00 p.m. time periods. Motor vehicle occupant fatalities would be reduced by 195 per year, or 3%, during the same time periods.

Accidents, Traffic↗

PubMed1985

Recurrent myocardial infarction. 1. Natural history of fatal and non-fatal events.

1306 men below 68 years of age who survived a first myocardial infarction (MI) during 1968-1977 were followed up between 2 and 12 years after discharge from hospital. The mean follow-up time was 6.5 years. The patients were unselected and paid regular visits to a Post-MI Clinic where treatment was standardized. The diagnosis of a non-fatal reinfarction was based on conventional clinical criteria, and the diagnosis of a fatal reinfarction on autopsy findings of a recent myocardial injury and/or a fresh coronary thrombus. The autopsy rate was high and the follow-up of endpoints was complete. The total cumulative rate of endpoint free patients was 64% at 5 years and 50% at 10 years follow-up. The total mortality rate was 19% at 5 years and 33% at 10 years follow-up. The total cumulative rate of a first reinfarction was 28% at 5 years and 37% at 10 years follow-up (80% non-fatal and 20% fatal). 63 patients suffered more than one reinfarction. The mortality rate was strongly associated with age. In contrast the rate of non-fatal reinfarctions was independent of age.

Adult↗

PubMed2001

Changes in fatal and near-fatal asthma in an urban area of South Africa from 1980-1997.

Over the past two decades, changes in the health services designed to improve access to and quality of asthma care have occurred in South Africa. The aim of this study was to investigate the incidence of fatal and near-fatal asthma (NFA) from 1980-1997 in an urban part of South Africa. A retrospective analysis of fatal asthma and NFA in the Cape Town City Council area was performed. Mortality data were obtained from death notification records. Data on NFA were obtained from the records of patients admitted for asthma to intensive care units (ICUs) at major academic hospitals serving the area. There were 1,506 deaths (mean age 56 yrs) from asthma reported; 39 and 3% occurred in people under 55 and 15 yrs, respectively. Average annual asthma mortality rate (8.1 +/- 1.9 per 100,000 population) was highest amongst people of mixed race (10.1 +/- 2.0), followed by Blacks (6.8 +/- 3.1) and Whites (5.0 +/- 1.9, p<0.001). Asthma mortality declined by 0.28 deaths per 100,000 population per year; rates decreased in all ethnic groups. Most deaths (72.3%) were outside a health facility and a higher number of deaths occurred on weekends (223 deaths x day(-1)) than weekdays (207 deaths x day(-1), p=0.014). Paediatric asthma ICU admissions declined by 1.81 children yr(-1). The annual number of adults admitted to ICU for asthma, and the proportion requiring intermittent positive pressure ventilation did not change. These results indicate that the incidence of fatal and near-fatal asthma in this area has declined over the period and this may reflect improved asthma management. However, the relatively high asthma mortality rate in people of mixed race and the predominance of deaths outside health facilities and on weekends suggest problems with access to care.

Adolescent↗

PubMed2006

Impact of on-site cardiac catheterization on resource utilization and fatal and non-fatal outcomes after acute myocardial infarction.

BACKGROUND: Patterns of care for acute myocardial infarction (AMI) strongly depend on the availability of on-site cardiac catheterization facilities. Although the management found at hospitals without on-site catheterization does not lead to increased mortality, little it known about its impact on resource utilization and non-fatal outcomes. METHODS: We identified all patients (n = 35,289) admitted with a first AMI in the province of Quebec between January 1, 1996 and March 31, 1999 using population-based administrative databases. Medical resource utilization and non-fatal and fatal outcomes were compared among patients admitted to hospitals with and without on-site cardiac catheterization facilities. RESULTS: Cardiac catheterization and PCI were more frequently performed among patients admitted to hospitals with catheterization facilities. However, non-invasive procedures were not used more frequently at hospitals without catheterization facilities. To the contrary, echocardiography [odds ratio (OR), 2.04; 95% confidence interval (CI), 1.93-2.16] and multi-gated acquisition imaging (OR, 1.24; 95% CI, 1.17-1.32) were used more frequently at hospitals with catheterization, and exercise treadmill testing (OR, 1.02; 95% CI, 0.91-1.15) and Sestamibi/Thallium imaging (OR, 0.93; 95% CI, 0.88-0.98) were used similarly at hospitals with and without catheterization. Use of anti-ischemic medications and frequency of emergency room and physician visits, were similar at both types of institutions. Readmission rates for AMI-related cardiac complications and mortality were also similar [adjusted hazard ratio, recurrent AMI: 1.02, 95% CI, 0.89-1.16; congestive heart failure: 1.02; 95% CI, 0.90-1.15; unstable angina: 0.93; 95% CI, 0.85-1.02; mortality: 0.99; 95% CI, 0.93-1.05)]. CONCLUSION: Although on-site availability of cardiac catheterization facilities is associated with greater use of invasive cardiac procedures, non-availability of catheterization did not translate into a higher use of non-invasive tests or have an impact on the fatal and non-fatal outcomes available for study in our administrative database.

Acute Disease↗

PubMed2002

The risk of hospitalization and near-fatal and fatal asthma in relation to the perception of dyspnea.

BACKGROUND: A life-threatening asthma attack is still of major concern. One of the main goals in treating patients with asthma is identification of the patients at risk of having these attacks. It has been shown that patients who have a near-fatal asthma attack have a blunted perception of dyspnea (POD). The purpose of this study is to measure the POD in patients with asthma, and to relate POD to life-threatening attacks within a 24-month follow-up period. METHODS: The POD was scored using the Borg scale during breathing against a progressive load at 1-min intervals, in order to achieve mouth pressure up to 30 cm H(2)O, in 113 consecutive asthmatic patients with stable asthma attending an outpatient clinic. All patients were invited to regular follow-up every 3 months for up to 24 months, and all hospitalizations and near-fatal and fatal asthma attacks were recorded. The prebronchodilator morning peak expiratory flow rate (PEFR), daily regular treatment, and beta(2)-agonist consumption were recorded in a diary card for the first 4 weeks. RESULTS: Seventeen patients (15%) had high POD compared to the normal subjects, 67 patients (59%) had POD within the normal range, and 29 patients (26%) had lower-than-normal POD. In the patients with low POD, there was a tendency for higher age, higher female/male ratio, and a longer duration of disease. The rate of severe asthma was higher in the low-POD group than in the normal-POD group, but did not differ from the rate in the high-POD group. The mean daily beta(2)-agonist consumption in the patients with low POD was significantly lower (p < 0.01) than in the patients with high POD, although the mean PEFR was lower in the low-POD group. During the 2 years of follow-up, the patients in the low-POD group had statistically significantly more emergency department (ED) visits, hospitalizations, near-fatal asthma attacks, and deaths compared to the normal-POD and high-POD groups. CONCLUSIONS: Approximately 26% of the referral subjects with asthma had low POD when compared to healthy matched subjects. Patients with low POD had statistically significantly more ED visits, hospitalizations, near-fatal asthma attacks, and deaths during the follow-up period. Reduced POD may predispose patients to a life-threatening attack.

Adult↗

PubMed2005

The effect of a reduction in heroin supply on fatal and non-fatal drug overdoses in New South Wales, Australia.

OBJECTIVE: To examine the impact of a sudden and dramatic decrease in heroin availability, concomitant with increases in price and decreases in purity, on fatal and non-fatal drug overdoses in New South Wales, Australia. DESIGN AND SETTING: Time-series analysis was conducted where possible on data on overdoses collected from NSW hospital emergency departments, the NSW Ambulance Service, and all suspected drug-related deaths referred to the NSW Coroner's court. MAIN OUTCOME MEASURES: The number of suspected drug-related deaths where heroin and other drugs were mentioned; ambulance calls to suspected opioid overdoses; and emergency department admissions for overdoses on heroin and other drugs. RESULTS: Both fatal and non-fatal heroin overdoses decreased significantly after heroin supply reduced; the reductions were greater among younger age groups than older age groups. There were no clear increases in non-fatal overdoses with cocaine, methamphetamines or benzodiazepines recorded at hospital emergency departments after the reduction in heroin supply. Data on drug-related deaths suggested that heroin use was the predominant driver of drug-related deaths in NSW, and that when heroin supply was reduced overdose deaths were more likely to involve a wider combination of drugs. CONCLUSION: A reduction in heroin supply reduced heroin-related deaths, and did not result in a concomitant increase, to the same degree, in deaths relating to other drugs. Younger people were more affected by the reduction in supply.

Adolescent↗

PubMed1992

The Minnesota Fatal Accident Circumstances and Epidemiology Study. Surveillance of occupational fatalities.

This report describes the Minnesota Fatal Accident Circumstances and Epidemiology Study (MN FACE), a new federally funded initiative to study fatal injuries in the workplace. Its primary objective is to reduce occupational fatalities. Fatalities due to falls, electrocutions, and asphyxiation caused by entry into confined spaces are currently investigated in Minnesota. MN FACE determines risk factors associated with fatalities then develops interventions for their mitigation or elimination. A comprehensive, statewide surveillance system, including state agencies, associations, organized labor, and industry, has been established to reduce the amount of bias in reporting.

Accidents, Occupational↗

PubMed1982

An analysis of fatal and non-fatal head wounds incurred during combat in Vietnam by U.S. forces.

Analysis of data obtained from U.S. military personnel who received either a lethal or non-lethal brain or head wound in Vietnam indicate that: 1. Bullets caused more fatal brain wounds that did fragments. 2. Most bullet wounds were received at close range, 40.9 m average. Most fatal fragment wounds to the brain occurred at a very close range, 2.9 m average. 3. Clinically significant intracranial blood clots occurred in only 7% of all fatal brain wounds. Only one man with a non fatal brain wound had an associated clot, 3.3%. 4. Helmets offered no protection against bullets but gave significant protection against fragments. 5. Men who sustained either fetal or non fatal brain wounds became immediately militarily non effective.

Brain Injuries↗

PubMedDate not supplied

Fatal and non-fatal childhood injuries in Metropolitan Toronto, 1986-1991.

The distribution of the cause, rate and nature of fatal and major non-fatal injuries in children living in Metropolitan Toronto and their trends from 1986 to 1991 were systematically reviewed from hospital discharge records and coroner's records. A total of 11,024 non-fatal injuries, of which falls were the leading cause (45%), and 133 fatal injuries, of which intentional injury (21%) was the principal cause, occurred during the six-year study period. The non-fatal injury rate dropped 23%, from 567 to 436 per 100,000 children. Mortality rates also fell during the study period. However, injuries to motor vehicle occupants and drownings increased considerably. Fractures of various kinds were the most common clinical diagnosis. Protecting children in motor vehicles by promoting the use of proper restraints and preventing injuries caused by falls and drowning should be high priorities for childhood injury prevention in Metropolitan Toronto.

Adolescent↗

PubMed2001

Is it safe on deck? Fatal and non-fatal workplace injuries among Alaskan commercial fishermen.

BACKGROUND: Commercial fishing in Alaska accounts for an occupational fatality rate that is 28 times the rate for all U.S. workers. Most deaths are attributed to vessel sinking or capsizing. However, many deaths and most non-fatal injuries are not related to vessel loss. This paper describes injuries that occur on the dock or on the fishing vessel. METHODS: Data from fishing fatalities and non-fatal injuries between 1991-1998 were analyzed using the Alaska Occupational Injury Surveillance System and the Alaska Trauma Registry. RESULTS: There were 60 workplace deaths unrelated to vessel loss; most from falls overboard, others from trauma caused by equipment on deck. There were 574 hospitalized injuries, often from falls on deck, entanglement in machinery, or being struck by an object. SUMMARY: Fishing boats are hazardous working environments. Further efforts are required to prevent falls overboard and on deck, and to redesign or install safety features on fishing machinery and equipment.

Accidental Falls↗

PubMed1987

Induction of class I and class II transplantation antigens in rat brain during fatal and non-fatal measles virus infection.

Measles virus induced a marked increase in the expression of MHC-coded class I and class II antigens as detected by immunostaining during both fatal and non-fatal brain infections in rats. The distribution of these molecules in the brain was much more widespread than the occurrence of viral antigen suggesting a soluble factor for their induction. In 14-day-old rats with a non-fatal infection there was a marked infiltration of T lymphocytes of 'cytotoxic/suppressor' phenotype in the brain parenchyma, whereas T 'helper' cell phenotypes mainly were located perivascularly. In brains from newborn rats with a fatal infection no or only few lymphocytes were detected.

Animals↗

PubMed1997

Fatal and non-fatal outcome by accidental intoxication with paint thinner.

Although poisonings (fatal and non-fatal) due to intentional or accidental acute exposure to toluene or toluene mixture fumes have been previously reported in the literature, several issues concerning lethal doses or lasting post-exposure neuropathological impairments still remain unclear. Two male painters (18 and 30 years old) were accidentally exposed to toxic concentrations of paint diluent fumes containing toluene (TL), acetone (ACT) and methyl ethyl ketone (MEK) (60:15:15 w/w/w respectively) during their work in an underground reservoir. Both workers were found unresponsive by colleagues and were immediately transferred to the regional hospital. On admission, the younger man was pronounced dead, while the other remained in the intensive care unit for 3 days and then 4 days in the internal medicine ward. TL, ACT and MEK concentrations in blood samples taken from the survivor on admission were 6.3, 30.6 and 40.5 microg/mL. Postmortem toxicology of the dead worker revealed TL, ACT and MEK blood levels of 12.4, 90.8 and 80.4 microg/mL respectively. The solvent levels in the liver, kidney, lung, brain, testis and gland were also quantified and showed a somewhat similar distribution of the chemicals among these tissues with the highest levels found in the brain and the liver. The fatal and the non-fatal outcome that resulted despite similar intoxication conditions, most probably demonstrates the interindividual tolerance among the painters who also had similar body weights. The surviving painter did not develop any neuropsychological impairment in post-exposure time. The reported case strongly emphasizes the necessity to take precautions when using paint diluents in enclosed spaces.

Journal Article↗

PubMed1998

Classical risk factors and their impact on incident non-fatal and fatal myocardial infarction and all-cause mortality in southern Germany. Results from the MONICA Augsburg cohort study 1984-1992. Monitoring Trends and Determinants in Cardiovascular Diseases.

BACKGROUND: The MONICA (Monitoring Trends and Determinants in Cardiovascular Diseases) project in Augsburg provides the first population-based cohort study in Germany to quantify the associations of the risk factors hypertension, hypercholesterolaemia and smoking with incident non-fatal and fatal myocardial infarction and all-cause mortality, and to assess their impact at the population level. METHODS: The cohort comprises 1074 men and 1013 women aged 45-64 years; they were followed over 8 years from 1984-1992. In the men, there were 61 non-fatal and fatal myocardial infarctions and 92 all-cause mortality events over this period; in the women the number of deaths from all causes was 45. Incidence rates, hazard rate ratios, population attributable fractions and rate advancement periods were calculated. RESULTS: Adjusting for confounders, the myocardial infarction hazard rate ratios for men with hypertension, or a total cholesterol/HDL-cholesterol ratio > or =5.5, or smoking > or =20 cigarettes/day, were 2.0 (95% CI 1.2-3.5), 2.9 (95%, CI 1.7-5.0), and 2.7 (95% confidence interval (CI) 1 4-5.0), respectively. The risk factor combination total cholesterol/HDL cholesterol ratio > or = 5.5 and cigarette smoking was particularly hazardous. The three risk factors contributed 65% of the burden of myocardial infarction in the population. The rate advancement period for myocardial infarction associated with hypertension, total cholesterol/HDL cholesterol ratio > or =5.5 or smoking > or =20 cigarettes/day was 8.3, 12.4 and 11.5 years, respectively. In women, these risk factors were similarly predictive of all-cause mortality. Comparing the cohort data from Augsburg with those of two occupational cohorts from Germany reveals higher absolute myocardial infarction risks in the Augsburg population; however, the relative risk estimates in the Augsburg and the two occupational cohorts were very similar. CONCLUSION: Our results confirm the important contribution of the classical risk factors to the risk of myocardial infarction and all-cause mortality in Germany. The results pertaining to the concept of rate advancement periods particularly demonstrate the great potential for prevention.

Cause of Death↗

PubMed2000

Hypothesis: the recent decline in coronary heart disease mortality--mainly a shift from fatal to non-fatal events?

OBJECTIVES: A marked, sequential decline in coronary heart disease (CHD) mortality is established, but not its causes. Does it reflect modern treatment effects or a spinoff of primary prevention? The aim of this study was to explore this issue using a prospective cohort follow-up design. DESIGN: In 1972-1975 and 1980-1982 Cohorts 1 (n = 613) and 2 (n = 667) of identical age (males, mean 56 years) were examined, and thereafter followed closely for 14 years. CHD risk- and treatment patterns, incidence of non-fatal myocardial infarctions (MIs) and total-, cardiovascular and CHD mortality rates were studied. RESULTS: CHD risk factors were more favourable, medical treatment more aggressive and 14-years CHD mortality, as expected, lower in Cohort 2 (7.7%/4.8%, p = 0.032). However, hospital- and prospective ECG data revealed opposite trends in non-fatal cohort CHD incidence, and aggregated numbers of CHD deaths and non-fatal MI cases were 16.7%/16.0% in Cohort 1/2 (p = 0.90). CONCLUSIONS: A marked, sequential reduction in CHD mortality was followed by a reciprocal increase in non-fatal MIs. This phenomenon may prevail in low CHD-endemic areas, and may call for altered primary preventive measures for reduction in total CHD incidence.

Aged↗

PubMed2006

Serum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28,838 middle-aged men and women.

AIMS: Serum gamma-glutamyltransferase (GGT) concentration may be involved in atherosclerosis. This study examined if serum GGT predicted coronary heart disease (CHD), especially differentiating non-fatal myocardial infarction (MI) and fatal CHD event, among the general population or participants with type-2 diabetes. METHODS AND RESULTS: A prospective study of 28,838 Finnish men and women aged 25-74 years was performed (1467 incident CHD cases; a median follow-up time of 11.9 years). Serum GGT cutpoints were the 25th, 50th, 75th, and 90th sex-specific percentiles. After adjustment for known cardiovascular risk factors, compared with the lowest GGT category, hazard ratios (HR) were 1.15, 1.25, 1.27, and 1.57 among men and 1.03, 1.22, 1.32, and 1.44 among women in other four GGT categories (P for trend <0.01, respectively). However, stronger associations were observed among subjects aged <60 and among alcohol drinkers. The strength of association was similar for non-fatal MI and for fatal CHD. Among subjects with type-2 diabetes, the corresponding adjusted HRs were 1.29, 1.57, 1.88, and 1.78 (P trend=0.03, men and women combined). CONCLUSION: This study suggests an independent mechanism linking serum GGT to CHD among general population. Even though the strength of association appeared to be modest among all subjects, stronger associations were observed among subjects aged <60 and among alcohol drinkers. Especially, measurement of serum GGT among type-2 diabetics may be helpful to predict the future risk of CHD.

Adult↗

PubMed1997

Drugs taken in fatal and non-fatal self-poisoning: a study in south London.

This study compared the number and type of substances taken in deliberate self-poisoning with fatal (n = 127) and non-fatal (n = 521) outcome. The aims were (i) to describe substances typically involved in self-poisoning in England and Wales, (ii) to examine the role of drug "cocktails' and (iii) to examine whether toxic substances are over-represented in cases with fatal outcome. Over-the-counter (OTC) analgesics, minor tranquillizers and antidepressants accounted for about 70% of substances taken, irrespective of outcome. Compared with survivors, cases who died had taken a higher mean number of substances. Among self-poisonings with a single substance, antidepressants and paracetamol-opiate combinations were over-represented in fatal-outcome cases. This report emphasizes the role of OTC analgesics and antidepressants in overdose-related mortality in England and Wales.

Adult↗