in the European Union Injuries

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Injuries

Working together to make Europe a safer place

in the European Union

Summary 2003-2005

ISSUE II

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INJURIES IN THE EUROPEAN UNION

Statistics summary 2003 – 2005

featuring the EU Injury Database (IDB) https://webgate.ec.europa.eu/idb

Vienna, October 2007

Supported by the European Commission / Health and Consumer Protection (DG Sanco)

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ABOUT THIS REPORT

The second edition of “Injuries in the European Union” is an up-to-date summary of the main results of current injury statistics and surveys at the EU level. European injury data made publicly accessible through international data providers such as Eurostat or the World Health Organization (WHO) is combined with recent hospital-based data of the EU Injury Database (IDB) on home and leisure accidents in order to give a comprehensive view of injuries in Europe at a glance.

As a standard, data is used from the years 2003 to 2005 (in most cases a 3 year average) of the 27 EU Member States.

Exceptions and information about the data sources are stated in the Annex. Data were extracted May 2007.

More information on European injury statistics can be found at:

- Home and Leisure: https://webgate.ec.europa.eu/idb/

- Work Place, Road Traffic, General: http://epp.eurostat.ec.europa.eu/

Editorial

Authors: Andrea Angermann, Robert Bauer, Georg Nossek, Nina Zimmermann Kuratorium für Verkehrssicherheit (Austrian Road Safety Board)

Schleiergasse 18, 1100 Vienna, Austria www.kfv.at, freizeit@kfv.at

Reviewers: Saakje Mulder (Consumer Safety Institute, Amsterdam), Nadia Minicuci (ULSS20, Verona) ISBN: 978-3-7070-0081-8

Layout: Rafael Budka; Melanie Musseg Printed in Austria

Supported by the European Commission / Health and Consumer Protection (DG Sanco)

1Quoted from “Health in Europe”, Eurostat Pocket Books, EC 2006

Please note that despite the harmonisation efforts undertaken by the respective data centres and data providers in the Member States, injury statistics may not always be comparable and may overlap. There are many reasons for this, ranging from differences in the organisation of the national health care systems to cultural differences in the reporting of injury causes. ¹

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INJURIES IN THE EUROPEAN UNION

PREFACE

Providing health information at the community level is one of the core responsibilities of the European Union in the field of public health. One part of this task is to provide information on injuries (intentional and unintentional) with specific information about circumstances and causes, such as settings, activities, products and services involved.

In June 2006 the first report on “Injuries in the European Union” was published. It was a first attempt to give a comprehensive view of injuries in Europe at a glance and to combine the majority of the available injury data and statistics at an EU level. It was very well received by the community working in the field of injury research, prevention and health policy makers. The main findings of this report were part of a

Communication from the Commission to the European parliament and the Council on ‘Actions for a Safer Europe’ (June 2006) and a consequent Council Recommendation on ‘The prevention on injury and the promotion of safety’ (May 2007).

These findings are increasingly alarming health administrations that are seeking opportunities to ensure the health and safety of their citizens.

This second report “Injuries in the European Union” provides updated figures and additional information not previously published, such as pilot data on intentional injuries.

In summary:

t

Injuries in the European Union account for about 250 000 fatalities.

t

Injuries are the fourth most common cause of death in the community.

t

In children, adolescents and young adults injuries due to accidents and violence are the leading cause of death.

t

The risk of an injury is unequally distributed in Member States and in social groups, and varies by age and gender as well. The risk of dying from an injury is five times greater in the Member State with the highest injury rate then in the one with the lowest rate.

The report is based on the tremendous work of members in the EuroSafe network on injury data and the IDB network, the strong support of DG Sanco units, and the dedicated team in my institute: Robert Bauer, Nina Zimmermann, Andrea Angermann, Georg Nossek and the international reviewers Saakje Mulder and Nadia Minicuci. Thanks are also due to Joanne Vincenten, Justin Cooper and Jagruti Haas from EuroSafe. Also, I express my gratitude to the many other colleagues who assisted with organisational and scientific support.

This report has become a valuable instrument for placing injury prevention higher on the health policy agenda of the European Union.

Rupert Kisser

Head of Division Home, Leisure & Sports in the Austrian Road Safety Board (Kuratorium für Verkehrssicherheit) Chairman of the European Association for Injury Prevention and Safety Promotion (EuroSafe)

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LIST OF FIGURES AND TABLES

Figure 1: Injury death rates and injury deaths by country, EU27 7

Figure 2: Unintentional and intentional fatal injuries, EU27 9

Figure 3: Unintentional fatal injuries by sector, EU27 9

Figure 4: Fatal injuries by causes of death, all ages, EU27 10

Figure 5: Fatal injuries by causes of death, 1 – 4 years, EU27 10

Figure 6: Fatal injuries by causes of death, 15 – 24 years, EU27 11

Figure 7: Fatal injuries by causes of death, 65+ years, EU27 11

Figure 8: Selected causes of fatal injuries, Standardised Death Rates (1995 – 2004, Index = 1995), EU27 12

Figure 9: Injury deaths per 100 000 by sex and age group, EU27 12

Figure 10: Hospital discharges due to injuries, EU27 13

Figure 11: Injury Pyramid – overall injury counts, EU27 14

Figure 12: Road fatalities and injured road users, EU27 15

Figure 13: Fatalities by road user type 15

Figure 14: Fatalities and injured due to work-related accidents, EU27 16

Figure 15: Fatalities at work by economic activity (according to NACE branches), EU15 16

Figure 16: Fatalities and injured due to home and leisure accidents by country, EU27 17

Figure 17: Non fatal Home & Leisure Accidents by activity at the time of injury 17

Figure 18: Home & leisure accidents by age group and sex 18

Figure 19: Home & leisure accidents by injured body part 19

Figure 20: Home & leisure accidents by type of injury 19

Figure 21: Home & leisure accidents by injury mechanism 20

Figure 22: Injured in home & leisure accidents by activity at time of injury and age group 21 Figure 23: Injured in home & leisure accidents by activity at time of injury and sex 21

Figure 24: Play and leisure activity by injury mechanism 22

Figure 25: Domestic work by injury mechanism 23

Figure 26: Do-it-yourself work by injury mechanism 24

Figure 27: Sports practiced at the time of injury 25

Figure 28: Sports practiced at the time of injury by age group 25

Figure 29: Sports practiced at the time of injury by sex 26

Figure 30: Sports practiced at the time of injury by injured body part 26

Figure 31: Home & leisure accidents by place of occurrence at the time of injury 27 Figure 32: Place of occurrence of home & leisure accidents at the time of injury by age group 27

Figure 33: Intentional and unintentional injuries in IDB pilot countries 28

Figure 34: Unintentional injuries by activity (IDB, all injuries - pilot data) 28

Figure 35: Injuries by activity and place of occurrence (IDB, all injuries - pilot data) 29

Table 1: Injury deaths in % of all causes of death by age group, EU27 7

Table 2: Leading causes of death by age group, EU27 8

Table 3: Fatal injuries by causes of death, all ages, EU27: Minimum and maximum values by country 10 Table 4: Hospital discharges due to injuries, EU27: Minimum and maximum values by country 13

Table 5: Comprehensive view of injuries by sector, EU27 14

Table 6: Top 10 consumer products involved in home and leisure accidents and most reported injury type 20 Table 7: Top 10 consumer products involved in play and leisure activity and most reported injury type 22 Table 8: Top 10 consumer products involved in domestic work activity and most reported injury type 23 Table 9: Top 10 consumer products involved in do-it-yourself activity and most reported injury type 24

Table 10: Data providers and data sources 30

Table 11: Time reference - Injury data used in this report to compile a comprehensive view of injuries by country 32

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INTRODUCTION 6

1. INJURIES IN THE EUROPEAN UNION – MORTALITY 7

2. BURDEN OF DISEASE IN THE EUROPEAN UNION – MORBIDITY 13

3. COMPREHENSIVE VIEW OF INJURIES 14

3.1 TRANSPORT 15

3.2 WORK PLACE 16

3.3 HOME AND LEISURE 17

4. HOME AND LEISURE ACCIDENTS – SELECTED IDB RESULTS 18

4.1 IDB - OVERALL OUTCOMES 18

4.2 ACTIVITY AT THE TIME OF INJURY 21

4.2.1 PLAY AND LEISURE 22

4.2.2 DOMESTIC WORK 23

4.2.3 DO-IT-YOURSELF WORK 24

4.3 SPORTS 25

4.4 PLACE OF OCCURRENCE 27

5. IDB “ALL INJURY” PILOT DATA 28

ANNEX 30

A1 – DATA PROVIDERS AND SOURCES 30

A2 – AVAILABILITY OF DATA SOURCES BY COUNTRY AND YEAR 32 A3 – DATA SOURCES OF FIGURES AND TABLES 33

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INTRODUCTION

Firstly, this report quantifies the detrimental impact of injuries on the public’s health within the EU:

t

injuries in the EU are killing over 250 000 people each year

t

injuries are the leading cause of death in children, adolescents and young adults

t

injury mortality greatly varies between EU Member States

t

injuries consume almost 10% of hospital resources

This information is not entirely new, but has not been regularly reported at the EU level thus far. Whereas these “superficial” key figures are useful for overall country benchmarking and monitoring changes, they are not sufficient for guiding injury prevention.

Secondly, this report and its underlying database provide unique information for assisting injury prevention - numbers about what injuries occur, when, where, how, why, and to whom – especially for the growing domain of home and leisure injuries. This kind of detailed information is new and provided only by the Injury Database (IDB) - publicly and online accessible since June 2006.

Did you know, for instance, that in terms of injuries:

t

homes are quite unsafe places?

t

unpaid work – housekeeping and do it yourself activities - yield more hospital admissions than paid work?

t

sports injuries are mainly affecting males?

t

football (soccer) is the most injury prone type of sports?

Thirdly, this report introduces a cross-sectoral approach (“comprehensive view”) to injury reporting. This is new. Traditionally, injury prevention in EU Member States was separated into independent sectors – traffic, work, consumers, violence - and so were the data sources on injuries. The comprehensive view of injuries in this report allows for a comparison of major injury outcomes by injury sector, providing added value for public health and cross-sector injury prevention. For example:

t

one fatal injury is accompanied by over 200 non-fatal cases, comprising a rising number of disabled persons;

t

traffic injuries account for approximately 20% of fatal injuries but only for 6% of non-fatal injuries;

t

“home and leisure” is the setting in which happen most injuries by far, but provides the lowest insurance cover for its victims;

t

EU-wide, two thirds of all injuries are treated in hospitals, making them an important setting for injury surveillance;

Roughly 60 million out of 500 million EU citizens are medically treated for injuries each year. This report shall contribute to raising awareness about this epidemic and to facilitate the reduction of these injuries.

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Source: Eurostat, 3 year average of latest available years (mostly 2003-2005). Data presentation: Kuratorium für Verkehrssicherheit (KfV), 2007

Values for CY were derived from WHO Health for all Database (no values available at Eurostat). For a detailed explanation of the sources, please see Annex.

Huge disparities among EU Member States – well known, well accepted?

There are huge disparities among EU Member States in the number of injuries: the risk of dying from an injury in Lithuania is over five times higher than in the Netherlands. These differences indicate a high potential for reducing injury mortality that has not yet been adequately addressed. If every country in the EU27 equaled the performance of those reporting the lowest mortality rate, almost 100 000 lives could be saved each year in the Community. Solely reducing the injury mortality rate in the new EU Member States to the EU15 average would save more than 20 000 lives a year in these countries. These inequalities are ethically unacceptable taking into account the strong evidence that prevention works (Figure 1 and Table 1).

Accidents and injuries place a huge burden on societies and individuals globally and also in the EU. One of the main contributing factors to that record is the enormous human cost of premature death. During the years 2003 to 2005 accidents and injuries accounted “only”

for 5% of all deaths, but for 18% of all deaths before the age of 60, and for an alarming two thirds of all deaths in the 15 to 24 year-olds (Table 1 and Table 2).

All ages < 1 year* 1 - 4 years* 5 - 14 years* 15 - 24 years 25 - 44 years 45 - 64 years 65+

All countries EU27 5% 3% 27% 37% 65% 34% 8% 3%

Minimum 3.5% (UK) 0.7% (DK) 16.8% (IT) 29.1% (IE) 39.3% (CY) 26.2% (BG) 5.4% (UK) 1.4% (BG ,EL)

Maximum 12.6% (LT) 12.0% (EE) 51.9% (LV) 65.7% (CY) 77.4% (EE) 51.6% (LT) 21.2% (LT) 5.0% (FR)

* MT and LU were excluded as the data is only available for the age group of 0-14 years Values for CY were derived from WHO Health for all Database (no values available at Eurostat)

Table 1: Injury deaths in % of all causes of death by age group, EU27

INJURIES IN THE EUROPEAN UNION – MORTALITY

1. INJURIES IN THE EUROPEAN UNION – MORTALITY

Figure 1: Injury death rates and injury deaths by country, EU27

Injury deaths in % of all causes of death

<5%

5-8%

>8%

Country Standardised Injury Death Rate

Injury deaths in

% of all causes of death

LT 149.0 12.6%

LV 132.4 10.1%

EE 123.4 9.9%

HU 74.8 6.6%

FI 69.2 8.8%

SI 65.8 8.0%

CZ 64.2 6.3%

RO 63.6 5.2%

PL 62.3 6.8%

PT 57.6 5.0%

SK 56.0 5.9%

BE 54.9 6,1%

FR 52.7 7.6%

DK 48.7 5.7%

LU 46.1 6.3%

BG 45.4 3.5%

AT 43.6 5.7%

CY 41.1 6,2%

SE 40.9 5.2%

IT 34.1 4.7%

EL 33.0 3.9%

IE 32.9 4.9%

ES 32.7 4.4%

DE 31.9 4.0%

UK 28.6 3.5%

MT 28.3 4.1%

NL 27.7 3.8%

EU25 43.9 5.3%

EU27 45,4 5.2%

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Source:

Rank

All ages < 1 year 1 - 4 years 5 - 14 years

Cause ICD-10 Code Absolute number

Fatalities per 100 000 Cause

ICD-10 Code Absolute number

% on all causes of death

% on all causes of

death Cause ICD-10 Code Absolute number

death

% on all causes of death

1

Diseases of the circulatory system

I00-I99 n=2 113 088

431 Certain conditions originating in the perinatal period

P00-P96 n=13 046

48%

External causes of injury and poisoning

V01-Y89 n=1 508

27%

V01-Y89 n=3 186

37%

43%

2

Neoplasms C00-D48 n= 1 244 590

254 Congenital malformations and chromosomal abnormalities Q00-Q99 n=7 121

26%

Congenital malformations and chromosomal abnormalities Q00-Q99 n=862

15%

Neoplasms C00-D48 n=1 834

22%

25%

3

Diseases of the respiratory system

J00-J99 n=368 198

75 Symptoms, signs, abnormal findings, ill-defined causes R00-R99

n=2 007

7%

Neoplasms C00-D48 n=801

14%

Diseases of the nervous system and the sense organs G00-H95

n=877

10%

8%

4

V01-Y89 n= 257 252

53 Diseases of the respiratory system

J00-J99 n=1 722

6%

n=579

10%

7%

5%

5

Diseases of the digestive system

K00-K93 n=226 023

46 External causes of injury and poisoning

V01-Y89 n=782

3%

J00-J99 n=471

8%

I00-I99 n=474

6%

5%

6

Symptoms, signs, abnormal findings, ill-defined causes R00-R99

n=163 012

33 Diseases of the nervous system and the sense organs G00-H95

n=729

3%

Infectious and parasitic diseases

A00-B99 n=328

6%

J00-J99 n=405

5%

3%

7

Endocrine, nutritional and metabolic diseases E00-E90 n=130 731

27 Infectious and parasitic diseases

A00-B99 n=615

2%

n=297

5%

A00-B99 n=355

4%

3%

All causes of death n=4 913 837

1003 All causes of death n=27 292

All causes of death n=5 620

All causes of death n=8 536 100%

Rank

15 - 24 years 25 - 44 years 45 - 64 years 65 + years

% on all causes of death

% on all causes of death

death Cause ICD-10 Code Absolute number

death

1

V01-Y89 n=21 938

65%

V01-Y89 n=59 057

34%

41%

I00-I99 n=1 862 718

48%

2

10%

21%

I00-I99 n=220 204

29%

23%

3

I00-I99 n=1 835

6%

I00-I99 n=27 204

16%

V01-Y89 n=63 900

8%

J00-J99 n=329 196

8%

4

n=1 480

4%

K00-K93 n=12 910

7%

K00-K93 n=60 074

8%

K00-K93 n=152 265

4%

5

n=1 422

4%

n=8 874

5%

J00-J99 n=30 758

4%

n=126 927

3%

6

J00-J99 n=789

2%

A00-B99 n=6 990

4%

n=23 211

3%

7

2%

n=5015

3%

2%

V01-Y89 n=106 866

3%

All causes of death n=3 892 463

Injury is the leading cause of death in children, adolescents and young adults

Every year more than 250 000 inhabitants of the European Union die due to external causes of injuries and poisoning. This equates to more than 700 fatalities a day. Moreover, injuries are the most common cause of death in the age group 1 to 44 years, resulting in an enormous sum of years of life lost and an overall reduced life expectancy. All age groups taken together, injuries are the fourth leading cause of death after cardiovascular diseases, cancer and diseases of the respiratory system (Table 2).

Table 2: Leading causes of death by age group, EU27

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Unintentional injuries are more common than intentional injuries and are often preventable

Distinguished by intent, unintentional injuries are responsible for about two thirds of injury deaths and intentional injuries (mainly suicide and homicide) for about one third (Figure 2).

Distinguished by sector, work place accidents account for 4% of unintentional fatalities, transport accidents for 33%, and almost two thirds of fatalities are attributed to the “residual category” of home, leisure and sports accidents. This categorisation is not completely clear-cut but provides a useful orientation for cross-sector injury prevention by linking the strong vertical sectors of work place and road safety with the horizontal WHO approach to injury prevention (Figure 3).

Figure 2: Unintentional and intentional fatal injuries, EU27

Intentional injuries incl. injuries of undetermined intent 32%

Unintentional injuries 68%

Source: WHO Mortality Database, 3 year average of latest available years (mostly 2002-2004). Data presentation: Kuratorium für Verkehrssicherheit (KfV), 2007

Figure 3: Unintentional fatal injuries by sector, EU27

Transport 33% Home, Leisure and Sports 63%

Work Place 4%

Source: WHO Mortality Database (Transport Area and Home, Leisure and Sports), 3 year average of latest available years (mostly 2002-2004); WHO Health for all Database (Work Place area), 3 year average of latest available years (mostly 2003-2005). Data presentation: Kuratorium für Verkehrssicherheit (KfV), 2007

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Suicide, Traffic, Falls – clear priorities for the prevention of fatal injuries

Distinguished by cause of death, suicides are the main cause of injury mortality in the EU27 (24% of all cases; almost 61 000 persons a year), followed by motor vehicle traffic accidents (21%; 51 000) and accidental falls (19%; 50 000). These three causes make up two thirds of all injury fatalities (Figure 4).

Similar to the overall number of fatal injuries (Figure 1) there are also wide disparities among EU Member States in individual causes of fatal injuries: e.g. the share of accidental falls ranges from 7% of all injury deaths in Bulgaria to 44% in Malta (Table 3).

Suicide

Motor vehicle traffic

accidents

Accidental falls Accidental poisoning

Accidental drowning and

submersion

Homicide

Other transport accidents

Accidents caused by fire

and flames

Other causes

EU27 excl. CY 24% 21% 19% 4% 3% 2% 2% 2% 23%

Minimum 8.6% (EL) 9.3% (FI) 7.2% (BG) 0.6% (AT) 1.1% (UK) 1.2% (FR) 0.7% (FR) 0.6% (SI) 9.9% (EL)

Maximum 35.2% (SI) 45.2% (EL) 44.2% (MT) 15.8% (EE) 9.4% (EL) 7.2% (EE) 5.7% (MT) 8.1% (EE) 36.5% (FR)

Table 3: Fatal injuries by causes of death, all ages, EU27: Minimum and maximum values by country Figure 4: Fatal injuries by causes of death, all ages, EU27

Accidental falls 19%

Other causes 23%

Accidental poisoning 4%

Accidental drowning and submersion 3%

Accidents caused by fire and flames 2%

Homicide and injury purposely inflicted by other persons 2%

Other transport accidents 2%

Suicide and selfinflicted injuries 24%

Motor vehicle traffic accidents 21%

Figure 5: Fatal injuries by causes of death, 1 – 4 years, EU27

Accidental falls 7%

Accidental drowning and submersion 21%

Accidents caused by fire and flames 9%

Other causes 25%

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Two good reasons for focussing on children and elderly

The share of fatal injuries is highest in very young ages (Table 1). Deaths of children and teenagers are a catastrophe, both for the families and the aging EU societies. Motor vehicle accidents, drowning and accidents caused by fire and flames are the top three causes of injury deaths in children (Figure 5).

In absolute numbers, most of the fatal injuries in the EU affect the elderly (Table 1). At an advanced age “simple falls” often trigger a sequence of lengthy and costly treatments, and often lead to death. Thus, the main cause of injury death in the elderly are falls. The demographic development in the EU adds further relevance to fall prevention measures (Figure 7).

Figure 6: Fatal injuries by causes of death, 15 – 24 years, EU27

Accidental poisoning 4%

Suicide and selfinflicted injuries 21%

Accidental falls 3%

Other causes 11%

Figure 7: Fatal injuries by causes of death, 65+ years, EU27

Motor vehicle traffic accidents 10% Suicide and selfinflicted injuries15%

Other causes 31%

Accidental falls 36%

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Figure 8: Selected causes of fatal injuries, Standardised Death Rates (1995 – 2004, Index = 1995), EU27

0.60 0.70 0.80 0.90 1.00 1.10

1995 1996 19999 7 19999 8 19999 9 20000 0 20000 1 20000 2 20000 3 20000 4

All injn uries Home and leie surerr * Work

Trarr ffff iffc Suicide Homicide

Figure 9: Injury deaths per 100 000 by sex and age group, EU27

0 50 100 150 200 250 300 350 400 450 500 550 600

<1 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ A ll

Injury deaths per 100 000 - male Injury deaths per 100 000 - female Source: WHO Health for all Database. Data presentation: Kuratorium für Verkehrssicherheit (KfV), 2007

*Estimation of the standardised death rate for home and leisure accidents is calculated as the remainder to all external causes of injury and poisoning minus the defined injury sectors.

EU Injury mortality declines – but not as fast as possible

Recent trends indicate that injury mortality in the 27 Member States of the European Union is on the decline. Over the last ten years (given data availability) the standardised death rate for all injuries in the EU experienced a reduction of 20%. This decrease can be reported for all injury areas except for home and leisure, mostly falls in the elderly. This shows that further prevention efforts are required in elderly fall prevention in order to save more lives from injury death and to accelerate the decline of injury mortality (Figure 8).

Males at risk

When looking at gender, injuries affect males and females disproportionately. The risk of dying from an injury is almost twice as high for males (72 injury deaths per 100 000 males) than it is for females (35 per 100 000 females). As a result, 66% of EU injury fatalities are male, 34% female (Figure 9).

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BURDEN OF DISEASE IN THE EUROPEAN UNION – MORBIDITY

2. BURDEN OF DISEASE IN THE EUROPEAN UNION – MORBIDITY

Figure 10: Hospital discharges due to injuries, EU27

Hospital discharges due to injurie in % of all

<8%

8-10%

>10%

Hospital discharges, injury and poisoning per 100 000

Hospital discharges due to injuries in

% of all hospital discharges

Hospital days due to injuries in % of

all hospital days Average length of stay due to injuries

EU27 1 452 8.7% 8.3% 7.9 days

Minimum 540 (MT) 5.9% (HU) 5.1% (RO) 5.2 days (EL)

Maximum 2 858 (AT) 15.6% (CY) 13.2% (CY) 11.4 days (FI)

2 Source: “A surveillance based model to calculate the direct medical costs in Europe” – Final Report. DG Sanco Public Health / Consumer Safety Institute, Amsterdam 2004.

Table 4: Hospital discharges due to injuries, EU27: Minimum and maximum values by country

Country Hospital discharges due to injury

In % of all hospital discharges

BE 167 569 9.9%

BG 85 629 7.1%

CZ 189 108 8.1%

DK 83 737 9.1%

DE 1 623 443 10.2%

EE 17 119 6.5%

IE 50 880 10.1%

EL 151 071 9.3%

ES 371 924 8.3%

FR 937 344 8.5%

IT 819 462 9.0%

CY 7 517 15.6%

LV 52 075 10.5%

LT 73 427 8.7%

LU 6 061 7.7%

HU 145 895 5.9%

MT 2 473 6.2%

NL 129 466 8.2%

AT 231 815 10.0%

PL 416 627 7.9%

PT 73 573 7.6%

RO 302 441 6.6%

SI 30 204 9.5%

SK 80 789 7.4%

FI 102 706 8.0%

SE 124 218 8.6%

UK 720 862 9.1%

EU27 6 997 435 8.7%

Millions of injury admissions each year – billions of avoidable health care costs!

Hospital admissions due to accidents and injuries in the EU27 sum up to almost 7 million - which is almost the population of Bulgaria and nearly nine percent of all hospital admissions in the EU (Figure 10).

The cost per capita for an injury admission in the former EU15 has been estimated to be approximately 30 Euros²; a cautious extrapolation of this cost to 490 million inhabitants in the EU27 yields at least 15 billion Euros for the treatment of injury inpatients.

On average about 1 500 hospital discharges due to injuries per 100 000 inhabitants in the EU27 are reported per year. A wide range of discharges exists between Member States, from 540 in Malta to 2 858 in Austria, which reflects differences in national hospital admissions.

Less variation is shown in the share of hospital discharges due to injuries from all hospital discharges: the EU average is about 9% and it ranges from 6% in Hungary to 16% in Cyprus (Table 4).

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3. COMPREHENSIVE VIEW OF INJURIES

Source: WHO Mortality Database, WHO Health for all Database, Eurostat, EU Injury Database (IDB, Home and leisure accidents) and “Comprehensive View of European Injury Data” CVI – Final Report; 3 year average of latest available years (mostly 2003-2005). Data presentation: Kuratorium für Verkehrssicherheit (KfV), 2007

Injuries by numbers – only a weak reflection of the human costs of injuries

The EU injury pyramid indicates that statistically each injury fatality (out of the total of 250 000) corresponds to 28 hospital admissions (7 million in total) and 140 hospital outpatient treatments (34 million in total). Also, 75 injury patients per one injury fatality receive other medical treatment outside the hospital (18 million in total; Figure 11).

Annually in the EU 60 million people – or 12% of the EU27 population - seek medical treatment for an injury. This corresponds to 50 million hospital days annually and a prevalence of more than 3 million disabled people to date, an enormous economic and public health toll (Table 5). No numbers exist so far for the indirect and human costs of injuries.

Source:

Figure 11: Injury Pyramid – overall injuries, EU27

Fatal Injuries 252 000

Hospital Admissions 7 000 000

Hospital Outpatients 34 200 000

Other medical Treatment 18 300 000

» Injuries consume more than 50 million hospital days a year (9% of all hospital days)

» Injuries to date have left more than 3 million persons permanently disabled

Table 5: Comprehensive view of injuries by sector, EU27

Injury counts and outcomes Transport Workplace Home, Leisure, Sports, School

Total of unintentional

injuries

Homicide, assault, other

violence

Suicide (attempt)

Total of intentional

injuries

Total of all injuries

Fatal Injuries 56 412 6 216 109 512 172 140 6 146 61 368 67 514 252 494*

23% 2% 43% 68% 3% 24% 27% 100%*

Hospital Admissions 860 000 310 000 5 200 000 6 370 000 590 000 100 000 690 000 7 000 000

Hospital Outpatients 1 800 000 3 000 000 27 000 000 31 800 000 2 200 000 200 000 2 400 000 34 200 000

Other medical treatment 1 200 000 1 500 000 14 300 000 17 000 000 1 200 000 100 000 1 300 000 18 300 000 All medically treated cases 3 860 000 4 810 000 46 500 000 55 170 000 3 990 000 400 000 4 390 000 59 560 000

6.5% 8.1% 78.1% 92.6% 6.7% 0.7% 7.4% 100%

Disabled (prevalence 16-64) 750 000 1 300 000 900 000 2 950 000 – – – > 3 000 000

Hospital bed days 7 200 000 2 400 000 39 000 000 48 600 000 3 000 000 600 000 3 600 000 52 200 000

* incl. injuries of undetermined intent, not displayed

Source: WHO Mortality Database, WHO Health for all Database, Eurostat, EU Injury Database (IDB, Home and Leisure Accidents) and “Comprehensive View of European Injury Data” CVI – Final Report; 3 year average of latest available years (mostly 2003-2005). Data presentation: Kuratorium für Verkehrssicherheit (KfV), 2007

Table 5 combines hospital data (e. g. admissions and outpatients by sector) of the European Injury Database (IDB) with routine hospital discharge and cause of death data into a

“comprehensive view of injuries in the EU” by different sectors of injury prevention. Projections of national surveys to EU level in this overview anticipate also the incidence information that will be available in future through the EU Health Interview Surveys for injuries treated outside the hospital (“All medically treated cases”). Also indicators of health care consumption (hospital bed days) and long term consequences (prevalence of injury disability) of injuries by sector are given.

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COMPREHENSIVE VIEW OF INJURIES - TRANSPORT

3.1 TRANSPORT

Figure 12: Road fatalities and injured road users, EU27

Road fatalities per 100 000 inhabitants

< 8 8-12

>12

Figure 13: Fatalities by road user type

Unknown traffic participation 0,23%

Pedestrians 17%

Motorcycles and Scooters 12%

Other road users excluding unknown 7%

Mopeds and Mofas 4%

Bicyclists 7% Passenger cars 53%

Country Road fatalities

Injured road users

Road fatalities per 100 000 inhabitants

Injured road users per

100 000 inhabitants

BE 1 155 65 066 11 624

BG 953 – 12 –

CZ 1 372 33 968 13 332

DK 377 7 515 7 139

DE 5 939 445 246 7 540

EE 167 – 12 –

IE 370 9 230 9 227

EL 1 630 20 988 15 190

ES 4 864 140 609 11 329

FR 5 642 110 911 9 178

IT 5 728 328 538 10 565

CY 105 – 14 –

LV 497 – 21 –

LT 740 – 22 –

LU 50 1 047 11 231

HU 1 300 26 703 13 264

MT 15 – 4 –

NL 861 34 043 5 209

AT 859 55 324 11 677

PL 5 599 63 251 15 166

PT 1 361 52 172 13 497

RO 2 431 – 11 –

SI 258 16 858 13 844

SK 603 10 551 11 196

FI 375 8 954 7 171

SE 483 26 715 5 297

UK 3 454 286 698 6 479

EU27 47 187 1 744 386* 10 356*

The toll of mobility– almost 50 000 road fatalities in the EU per year

Road transport is one of the most complex and most dangerous systems people have to deal with on a daily basis. According to police records, almost 50 000 road fatalities and 1.7 million injured road users are the recent toll of road traffic in the EU. Road fatalities in the EU27 range from 4 per 100 000 inhabitants in Malta to 22 in Lithuania which indicates the potential for further reduction of road traffic mortality in some Member States (Figure 12).

Source: European Commission / Directorate-General Energy & Transport in cooperation with Eurostat and IRTAD (International Road Traffic and Accident Database), 3 year average of latest available years (2003-2005). Data presentation: Kuratorium für Verkehrssicherheit (KfV), 2007 * excl. BG, EE, CY, LV, LT, MT, RO due to missing/data in IRTAD

Source: IRTAD (International Road Traffic and Accident Database), 3 year average of latest available years (mostly 2003-2005). Data presentation: Kuratorium für Verkehrssicherheit (KfV), 2007

Detailed information about circumstances and external causes of road accidents can be obtained from the European Road Accident Database (CARE) and International Road Traffic and Accident Database (IRTAD), and in the future also from the EU Injury Database, (see Chapter 4 and Annex). For example, more than half of road fatalities are passengers or drivers of cars, but vulnerable road users (pedestrians, cyclists and motorcyclists) account for at least 40% of road fatalities (Figure 13).

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3.2 WORK PLACE

Figure 15: Fatalities at work by economic activity (according to NACE branches), EU15

Manufacturing 20%

Agriculture, hunting and forestry 14%

Transport, storage and communication 18%

Wholesale and retail trade; repair of motorvehicles, motorcycles and personal and household goods 9%

Financial intermediation; real estate, renting and business activities 7%

Hotels and restaurants 1% Electricity, gas and water supply 1%

Construction 30%

Figure 14: Fatalities and injured due to work-related accidents, EU27

Work related fatalities per 100 000

<1 1-2

>2

Country

Deaths due to work

related accidents

Injured due to work related accidents

Work related fatalities

per 100 000 inhabitants

Work related injured per

100 000 inhabitants

BE 114 173 526 1.1 1 673

BG 122 5 448 1.6 69

CZ 183 82 250 1.8 805

DK 62 47 167 1.2 884

DE 1 016 1 179 406 1.2 1 430

EE 30 3 285 2.2 243

IE 59 22 967 1.5 578

EL 103 16 529 0.9 151

ES 734 895 310 1.8 2 133

FR 692 740 261 1.2 1 241

IT 947 586 595 1.6 1 019

CY 12 2 149 1.5 282

LV 53 1 405 2.3 61

LT 97 2 657 2.8 77

LU 6 25 139 1.4 5 547

HU 143 25 031 1.4 248

MT 10 4 256 2.5 1 061

NL 73 82 667 0.4 510

AT 118 136 741 1.5 1 673

PL 492 79 561 1.3 208

PT 323 230 112 3.2 2 249

RO 423 5 994 1.9 28

SI 27 40 149 1.4 2 009

SK 83 14 573 1.5 271

FI 41 57 437 0.8 1 104

SE 60 32 291 0.7 359

UK 192 162 139 0.3 273

EU27 6 216 4 655 044 1.5 970

Source: WHO Health for all Database, 3 year average of the latest available years (mostly 2003-2005). Data presentation: Kuratorium für Verkehrssicherheit (KfV), 2007

Work place safety progresses – still 6 000 occupational fatalities in the EU remain

According to data aggregated by WHO more than 6 000 work place fatalities are recorded per year in the EU27. They range from 0.3 per 100 000 inhabitants in United Kingdom to 3.2 in Portugal. Also the rate of non-fatal work place accidents shows a significant variation between Member States due to differences in national definitions and registration practices (Figure 14).

Source: Eurostat / ESAW (European statistics on accidents at work), 3 year average of 2002 – 2004. Data presentation: Kuratorium für Verkehrssicherheit (KfV), 2007

Detailed information about the socio-demography and circumstances of work place accidents can be found in the European statistics on accidents at work (ESAW) and WHO Health for all databases (HFA-DB). Half of all work place fatalities occur in two branches: the construction (30%) and manufacturing branch (20%). These two “leading”

branches are followed by the transport sector (18%

of all work place fatalities) which indicates the need for a close cooperation of work place and traffic safety (Figure 15).

COMPREHENSIVE VIEW OF INJURIES - WORK PLACE

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COMPREHENSIVE VIEW OF INJURIES - HOME AND LEISURE

3.3 HOME AND LEISURE

Figure 16: Fatalities and injured due to home and leisure accidents by country, EU27

Fatalities per 100 000

<=15

>15-30

>30 no data available

Country

Fatal injured in home and leisure

accidents

Hospital treated injuries due

to home and leisure

accidents

Fatalities per 100 000 inhabitants

Hospital treated injuries per 100 000 inhabitants

BE 2 156 – 21 –

BG 1 402 – 18 –

CZ 3 285 – 32 –

DK 1 748 449 000 32 8 300

DE 12 214 – 15 –

EE 967 – 72 –

IE 469 – 12 –

EL 1 623 – 15 –

ES 6 060 – 14 –

FR 21 685 3 815 000 35 5 000

IT 12 579 – 22 –

CY* – – – –

LV 1 654 – 72 –

LT 2 192 – 64 –

LU 111 – 25 –

HU 4 421 – 44 –

MT 77 – 19 –

NL 2 406 604 000 15 4 000

AT 1 723 577 000 21 7 100

PL 9 204 – 24 –

PT 1 431 608 000 14 5 800

RO 6 255 – 29 –

SI 521 – 26 –

SK 1 097 – 20 –

FI 2 340 – 45 –

SE 2 310 516 000 26 5 700

UK 9 594 5 569 000 16 9 400

EU27* 109 512 32 200 000** 22 6 471**

Source: Eurostat, WHO Mortality Database, WHO Health for all Database, EU Injury Database (IDB, Home and Leisure Accidents), 3 year average of latest available years. Data presentation:

Kuratorium für Verkehrssicherheit (KfV), 2007 * Value for Cyprus for V00-X59 is not available ** Estimation based on the available IDB data.

Over 100 0000 home and leisure fatalities in the EU – a reason to bother

The average rate of fatal home and leisure accidents in the EU27 is 22 per 100 000 inhabitants, this is more than twice the rate of fatal road traffic accidents (10 per 100 000) and more than ten times the rate of fatal work place accidents (1.5 per 100 000). Every year more than 100 000 EU citizens die from home and leisure injuries (Figure 16).

Other specified activity 18%

Do-it-yourself work 3%

Unspecified activity 16%

Vital (basic) activity 4%

Sports, athletics, exercise 18%

Domestic work 4%

Play and leisure activity 36%

Educational activity 1%

Source: EU Injury Database (IDB, Home and Leisure Accidents - https://webgate.ec.europa.eu/idb/), data of latest available years (mostly 2003-2005). Data presentation: Kuratorium für Verkehrssicherheit (KfV), 2007

Figure 17: Non fatal home and leisure accidents by activity at the time of injury Injury surveillance in the home and leisure area is still neglected in most EU Member States. The EU Injury Database (IDB) aims at closing this gap by providing unique information about the external causes of home and leisure accidents.

For the participating IDB countries the rate of hospital treated home and leisure accidents ranges from 4 000 per 100 000 inhabitants (Netherlands) to 9 400 (United Kingdom; Figure 16).

Sport injuries account for about 18% of this injury sector (Figure 17).

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4. HOME AND LEISURE ACCIDENTS – SELECTED IDB RESULTS

Almost all European countries use the official cause of death statistics according to the WHO International Classification of Diseases to mo- nitor fatal injuries (Figure 4). Also, in most EU countries official data systems for recording causes of traffic and occupational injuries are in place (Figures 12 and 14). These statistics provide important key figures but not for all injuries. A prevention-oriented „all injury“ surveillance system in the form of the EU Injury Database (IDB) is currently operated by only twelve European countries. This is surprising as the establish- ment of specially designed injury surveillance systems is widely advocated as a prerequisite for the development and evaluation of injury prevention strategies. The IDB provides a variety of indicators on hospital treated injuries - for both inpatients and outpatients - solely for the purpose of injury prevention. The IDB focus is still on home and leisure accidents but first data on „all injuries“ are already available for some IDB countries.

An EU-wide implementation of the IDB would provide detailed and comparable injury information across all sectors of injury prevention - work, school, traffic, home and leisure, and violence and suicide - for all countries. Currently, only an EU estimate can be produced based on projections from the available „all injury“ IDB pilot data (Table 5).

4.1 IDB - OVERALL OUTCOMES

The IDB data contains unique details on the mechanism of the accident, the activity of the victim, the place of occurrence and involved products. These details can be analysed in relation to type and severity of the actual injury for each record.

Source: EU Injury Database (IDB, Home and Leisure Accidents), data of latest available years (mostly 2003-2005). Data presentation: Kuratorium für Verkehrssicherheit (KfV), 2007

Distribution of injuries in males and females

Overall, males and females are almost equally distributed among the hospital treated injuries. However, more males sustain an injury in child- hood and adolescence whereas the situation is inverted in older age groups (50+; Figure 18).

Figure 18: Home and leisure accidents by age group and sex

0%

2%

4%

6%

8%

10%

12%

14%

16%

00-04 05-09 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+

Male Female

in the European Union Injuries

Injuries

Working together to make Europe a safer place