| 11. |
- Bergström, Monica Frick, et al.
(author)
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Extent and consequences of misclassified injury diagnoses in a national hospital discharge registry
- 2011
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In: Injury Prevention. - : BMJ. - 1353-8047 .- 1475-5785. ; 17:2, s. 108-113
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Journal article (peer-reviewed)abstract
- Background Classification of injuries and estimation of injury severity on the basis of ICD-10 injury coding are powerful epidemiological tools. Little is known about the characteristics and consequences of primary coding errors and their consequences for such applications. Materials and methods From the Swedish national hospital discharge register, 15 899 incident injury cases primarily admitted to the two hospitals in Uppsala County between 2000 and 2004 were identified. Of these, 967 randomly selected patient records were reviewed. Errors in injury diagnosis were corrected, and the consequences of these changes were analysed. Results Out of 1370 injury codes, 10% were corrected, but 95% of the injury codes were correct to the third position. In 21% (95% CI 19% to 24%) of 967 hospital admissions, at least one ICD-10 code for injury was changed or added, but only 13% (127) had some change made to their injury mortality diagnosis matrix classification. Among the cases with coding errors, the mean ICD-based injury severity score changed slightly (difference 0.016; 95% CI 0.007 to 0.032). The area under the receiver operating characteristics curve was 0.892 for predicting hospital mortality and remained essentially unchanged after the correction of codes (95% CI for difference -0.022 to 0.013). Conclusion Errors in ICD-10-coded injuries in hospital discharge data were common, but the consequences for injury categorisation were moderate and the consequences for injury severity estimates were in most cases minor. The error rate for detailed levels of cause-of-injury codes was high and may be detrimental for identifying specific targets for prevention.
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| 12. |
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| 13. |
- Bonander, Carl, 1988-, et al.
(author)
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Are fire safe cigarettes actually fire safe? : Evidence from changes in US state laws
- 2018
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In: Injury Prevention. - : BMJ Publishing Group Ltd. - 1353-8047 .- 1475-5785. ; 24:3, s. 193-198
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To estimate the effects of fire safe cigarette laws on fire mortality and cigarette-related fires in the USA.METHODS: We examined the gradual implementation of the laws to identify their average effects, using difference-in-differences analysis to account for common year effects, time-invariant state effects, state-specific trends and observable time-varying state-level covariates.RESULTS: We found no statistically significant effects on all-cause fire mortality, residential fire mortality or cigarette-caused fire rates. The estimates for cigarette-caused fire deaths were significant under some specifications, but were not robust to the inclusion of state-specific trends or comparisons to effects on other cause-determined fires.CONCLUSIONS: Given the mixed state of our results, we conclude that previous claims regarding the effects of fire safe cigarette laws may be premature.
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| 14. |
- Bonander, Carl, 1988-, et al.
(author)
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Can the provision of a home help service for the elderly population reduce the incidence of fall-related injuries?
- 2016
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In: Injury Prevention. - : BMJ. - 1353-8047 .- 1475-5785. ; 22:Suppl.2, s. A181-A181
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Journal article (peer-reviewed)abstract
- Background Fall-related injuries are a global public health problem, especially in elderly populations. In this study, the effect of an intervention aimed at reducing the risk of falls in the homes of community-dwelling elderly persons was evaluated. The intervention, which involves home hazards reduction by providing a minor home help service, is provided in the majority of Swedish municipalities.Methods Intention-to-treat effect estimates were derived using quasi-experimental time series intervention (ITS) analysis for immediate effects and a difference-in-discontinuity (RD) design for long term effects, and community-level estimates were pooled using meta-analysis. The outcome measure was the incidence of fall-related hospitalizations in the treatment population, the age of which varied by municipality (≥65 years, ≥67 years, ≥70 years or ≥75 years).Results We found no statistically significant reductions in injury incidence in the ITS (IRR 1.01 [95% CI: 0.98–1.05]) or RD (IRR 1.00 [95% CI: 0.97–1.03]) analyses. The results are robust to several different model specifications, including segmented panel regression analysis with linear trend change and community fixed effects parameters.Conclusions It is unclear whether absence of an effect is due to a low efficacy of the home hazards modifications provided, or a result of low utilisation. Additional studies of the effects on other quality of life measures are recommended before conclusions are drawn regarding the cost-effectiveness of the provision of home help services
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| 15. |
- Bonander, Carl, 1988-, et al.
(author)
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Can the provision of a minor home help service for the elderly population reduce the incidence of fall-related injuries? : A quasi-experimental study of the community-level effects on hospital admissions in Swedish municipalities
- 2016
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In: Injury Prevention. - : BMJ Publishing Group Ltd. - 1353-8047 .- 1475-5785. ; 22:6, s. 412-419
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Journal article (peer-reviewed)abstract
- BackgroundFall-related injuries are a global public health problem, especially in elderly populations. The effect of an intervention aimed at reducing the risk of falls in the homes of community-dwelling elderly persons was evaluated. The intervention mainly involves the performance of complicated tasks and hazards assessment by a trained assessor, and has been adopted gradually over the last decade by 191 of 290 Swedish municipalities. MethodsA quasi-experimental design was used where intention-to-treat effect estimates were derived using panel regression analysis and a regression-discontinuity (RD) design. The outcome measure was the incidence of fall-related hospitalizations in the treatment population, the age of which varied by municipality (≥65 years, ≥67 years, ≥70 years or ≥75 years).ResultsWe found no statistically significant reductions in injury incidence in the panel regression (IRR 1.01 [95% CI: 0.98-1.05]) or RD (IRR 1.00 [95% CI: 0.97-1.03]) analyses. The results are robust to several different model specifications, including segmented panel regression analysis with linear trend change and community fixed effects parameters.ConclusionsIt is unclear whether the absence of an effect is due to a low efficacy of the services provided, or a result of low adherence. Additional studies of the effects on other quality of life measures are recommended before conclusions are drawn regarding the cost-effectiveness of the provision of home help service programs.
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| 16. |
- Bonander, Carl, 1988-
(author)
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Compared with what? : Estimating the effects of injury prevention policies using the synthetic control method
- 2018
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In: Injury Prevention. - : BMJ Publishing Group Ltd. - 1353-8047 .- 1475-5785. ; 24, s. I60-I66
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Journal article (peer-reviewed)abstract
- Introduction This paper discusses the application of the synthetic control method to injury-related interventions using aggregate data from public information systems. The method selects and determines the optimal control unit in the data by minimising the difference between the pre-intervention outcomes in one treated unit (eg, a state) and a weighted combination of potential control units. Method I demonstrate the synthetic control method by an application to Florida's post-2010 policy and law enforcement initiatives aimed at bringing down opioid overdose deaths. Using opioid-related mortality data for a panel of 46 states observed from 1999 to 2015, the analysis suggests that a weighted combination of Maine (46.1%), Pennsylvania (34.4%), Nevada (5.4%), Washington (5.3%), West Virginia (4.3%) and Oklahoma (3.4%) best predicts the preintervention trajectory of opioid-related deaths in Florida between 1999 and 2009. Model specification and placebo tests, as well as an iterative leave-k-out sensitivity analysis are used as falsification tests. Results The results indicate that the policies have decreased the incidence of opioid-related deaths in Florida by roughly 40% (or -6.19 deaths per 100.000 person-years) by 2015 compared with the evolution projected by the synthetic control unit. Sensitivity analyses yield an average estimate of -4.55 deaths per 100.000 person-years (2.5th percentile: -1.24, 97.5th percentile: -7.92). The estimated cumulative effect in terms of deaths prevented in the postperiod is 3705 (2.5th percentile: 1302, 97.5th percentile: 6412). Discussion Recommendations for practice, future research and potential pitfalls, especially concerning low-count data, are discussed. Replication codes for Stata are provided.
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| 17. |
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| 18. |
- Bonander, Carl, 1988-, et al.
(author)
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Model-based economic evaluation of ice cleat distribution programmes for the prevention of outdoor falls among adults from a Swedish societal perspective
- 2021
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In: Injury Prevention. - : BMJ Publishing Group Ltd. - 1353-8047 .- 1475-5785.
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Journal article (peer-reviewed)abstract
- Background: Slipping on snow or ice poses a significant health risk among older adults in Sweden. To combat this problem, about 80 Swedish municipalities have distributed ice cleats to older citizens (65+ years old) over the last decade. This paper details a cost-benefit analysis of such programmes. Materials and methods: We developed a decision-analytical model to estimate the costs and benefits of ice cleat programmes in Swedish municipalities compared with a business-as-usual scenario. The modelled benefits of the programme were based on effect estimates from previous research, data from population and healthcare registers and a survey of attitudes to and actual ice cleat use. The modelled costs of the programme were based on resource use data collected from 34 municipalities with existing ice cleat programmes. We assessed heterogeneity in the potential impact and benefit-to-cost ratios across all Swedish municipalities as a function of the average number of days with snow cover per year. Uncertainty in the cost-benefit results was assessed using deterministic and probabilistic sensitivity analyses. Results: The average benefit-to-cost ratio was 87, ranging from about 40 in low-risk municipalities to 140 in high-risk municipalities, implying that the potential benefits of ice cleat programmes greatly outweigh their costs. Probabilistic and deterministic sensitivity analyses support the robustness of this conclusion to parameter uncertainty and large changes in assumptions about the magnitude of the impact on ice cleat use and injuries. Conclusion: The benefits of distributing ice cleats to older adults appear to outweigh the costs from a Swedish societal perspective.
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| 19. |
- Cryer, C, et al.
(author)
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Empirical validation of the New Zealand serious non-fatal injury outcome indicator for 'all injury'
- 2018
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In: Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention. - : BMJ. - 1475-5785. ; 24:4, s. 300-304
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Journal article (peer-reviewed)abstract
- Our purpose was to empirically validate the official New Zealand (NZ) serious non-fatal ’all injury' indicator. To that end, we aimed to investigate the assumption that cases selected by the indicator have a high probability of admission. Using NZ hospital in-patient records, we identified serious injury diagnoses, captured by the indicator, if their diagnosis-specific survival probability was ≤0.941 based on at least 100 admissions. Corresponding diagnosis-specific admission probabilities from regions in Canada, Denmark and Greece were estimated. Aggregate admission probabilities across those injury diagnoses were calculated and inference made to New Zealand. The admission probabilities were 0.82, 0.89 and 0.90 for the regions of Canada, Denmark and Greece, respectively. This work provides evidence that the threshold set for the official New Zealand serious non-fatal injury indicator for ’all injury' captures injuries with high aggregate admission probability. If so, it is valid for monitoring the incidence of serious injuries.
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| 20. |
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