Epidemiology

Beth Mueller, DrPH
Section Head

	HIPRC Overview Overview Injury Prevention at Work Acute Care Biomechanics Epidemiology Rehabilitation Collaborative Efforts

Applying state-of-the-art research tools to better understand the risk of injury

A 6-year-old chases a ball into the street and is struck by a car. A grandmother, wearing slippers, falls in her living room and breaks her hip. A marital dispute over household finances escalates from verbal abuse to physical battering. A truck driver lies injured after a crash on a backwoods logging road - until the next passerby happens along, hours later.

These disparate injury scenarios come together in the Epidemiology Section of the Harborview Injury Prevention and Research Center. The physicians who treat these victims in the hospital also see firsthand the underlying patterns of behavior and circumstance behind the injuries. When joined with the analytical tools of epidemiology, this insight paves the way for researchers to define and describe an injury problem, measure its incidence, determine who is most at risk, and explore the ways to intervene. This important work by the HIPRC Epidemiology Section is the foundation for all other efforts at the Center.

Non-intentional injury findings

Injuries caused by falls in older Washington state residents cost more than $53 million annually in hospital care. These findings came from a HIPRC study which also found that nearly half of patients hospitalized for fall-related injuries were discharged to nursing care, rather than to their homes. These results emphasize the importance of fall-prevention efforts, and led to a collaboration with researchers in the HIPRC Biomechanics Section to evaluate footwear function and design.

The HIPRC has placed much of its research emphasis into studying motor vehicle-related injury. One such study, done with Group Health Cooperative (GHC), evaluated which drivers aged 65 or older are at high risk for motor-vehicle collision injury, and, given particular attention to medical conditions, why sensory impairment or use of medications that can influence driving ability. The results showed that only two conditions - diabetes and hearing loss - pose a significant risk among older drivers. The study also demonstrated that physician advice is influential in elderly patients' decisions to continue driving. These conclusions can help physicians better evaluate their older patients' driving fitness and more effectively counsel them about safe driving.

The HIPRC also examined the effectiveness of seat belts in preventing injury to pregnant women and their unborn fetuses. They found that women drivers involved in motor vehicle collisions who are not wearing seat belts are more likely to deliver within 48 hours of the crash, and to deliver a stillborn or low-birth weight infant. The risk remained even after adjusting for other differences such as age and smoking. Because more than half of the women in the study were not restrained at the time of the crash, the HIPRC launched a major public service campaign to educate the public about the need to buckle up during pregnancy and to encourage obstetricians to counsel patients about its importance.

Domestic violence

Because many people are reluctant to report domestic violence as the underlying cause of many of their problems (such as depression, chronic pain syndrome or injury) a new effort teams HIPRC and GHC researchers in a project aimed at helping primary care providers identify and treat victims of domestic violence. The project will also explore ways to improve the overall management of cases involving domestic violence and provide cost information to other health care providers interested in implementing a similar undertaking.

Suicide among Native American Youth

Work targeted at minority populations is a major emphasis of the HIPRC. In an effort to better understand the risk factors for and prevention of suicide among Native American adolescents, HIPRC researchers used information from the Indian Health Service Adolescent Health Survey. A history of mental health problems, a sense of alienation from family and community, the attempted suicides of friends or family members, and hard liquor drunk on a weekly basis all significantly increased the risk for suicide among Indian youth.

Safe Storage

In addition to providing scientific information to policy makers and the public, HIPRC investigators are searching for ways physicians can help stem the tide of gun-related violence. One strategy they have studied is counseling patients on firearm safety, including the safe storage of guns. Pediatricians and family physicians in Washington state rarely speak with patients about firearms and injuries, the HIPRC study found, largely because they aren't sure what to say and don't expect their advice to be heeded. Conversely, 80 percent of parents surveyed in four public pediatric clinics would find it "helpful" to get information regarding safe ways to store guns.

"Such advice should be incorporated into our standard 'package,' just as we discuss immunization information, bike helmets, or the dangers of smoking," says Dr. David Grossman, a pediatrician and HIPRC director, who authored the study. "I see firearm counseling in the same light today as alcohol and tobacco counseling were 20 years ago."

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