Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention · 2026
Epidemiology of external causes of morbidity and mortality in Tabriz, Iran: a multicentre hospital-based study using linked health information system and trauma registry data, 2011-2023, classified by International Classification of Diseases.
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Shahedifar Nasrin, Sadeghi-Bazargani Homayoun, Shokouhi Ghaffar, Hennrich Patrick, Weinert Lina, Posti Jussi P, Lowery Wilson Michael
Аннотация
BACKGROUND: External causes of morbidity and mortality are leading contributors to disability and death. However, epidemiological research on the causes remains limited, mostly in low- and middle-income countries. We aimed to investigate these causes using large-scale data.
METHODS: This retrospective study used International Classification-coded data from health information system and trauma registry at trauma hospitals (2011-2023). Associations were examined using generalised ordered logistic regression.
RESULTS: Among 329 989 patients (mean age: 36.2 years), 58.94% were male. The most common single and multiple injuries were head and wrist/hand injuries, respectively. Deceased patients were younger than those discharged. Severe/fatal limb injuries were linked to shorter hospital stays. Leading causes included falls, mechanical forces, exposure to temperature/poison/nature and road traffic crashes. Females were more likely to be discharged, or survive compared with males. Adults and older adults showed worse outcomes than those ≤17 years. (severe/death, coefficient: 1.43, 95% CI 1.318 to 1.535, p<0.001). A longer stay (≥10 days) was significantly associated with worse outcomes (coefficient: 2.58, 95% CI 2.453 to 2.707, p<0.001). Road traffic crashes showed the strongest association with severe/fatal outcomes (coefficient: 2.66, 95% CI 2.546 to 2.764, p<0.001), followed by assaults, exposure to temperature/poison/nature and falls. The model demonstrated good fit (χ²(8)=7.85, p=0.165; pseudo R2=0.22).
CONCLUSIONS: Falls were the most frequent external cause. Road traffic crashes were most strongly linked to severe outcomes. Mechanical forces and exposure to temperature/poison/nature contributed to the injury burden. Prevention strategies should address fall prevention, residential and occupational safety and road traffic safety and public education, particularly for adult and older males.
METHODS: This retrospective study used International Classification-coded data from health information system and trauma registry at trauma hospitals (2011-2023). Associations were examined using generalised ordered logistic regression.
RESULTS: Among 329 989 patients (mean age: 36.2 years), 58.94% were male. The most common single and multiple injuries were head and wrist/hand injuries, respectively. Deceased patients were younger than those discharged. Severe/fatal limb injuries were linked to shorter hospital stays. Leading causes included falls, mechanical forces, exposure to temperature/poison/nature and road traffic crashes. Females were more likely to be discharged, or survive compared with males. Adults and older adults showed worse outcomes than those ≤17 years. (severe/death, coefficient: 1.43, 95% CI 1.318 to 1.535, p<0.001). A longer stay (≥10 days) was significantly associated with worse outcomes (coefficient: 2.58, 95% CI 2.453 to 2.707, p<0.001). Road traffic crashes showed the strongest association with severe/fatal outcomes (coefficient: 2.66, 95% CI 2.546 to 2.764, p<0.001), followed by assaults, exposure to temperature/poison/nature and falls. The model demonstrated good fit (χ²(8)=7.85, p=0.165; pseudo R2=0.22).
CONCLUSIONS: Falls were the most frequent external cause. Road traffic crashes were most strongly linked to severe outcomes. Mechanical forces and exposure to temperature/poison/nature contributed to the injury burden. Prevention strategies should address fall prevention, residential and occupational safety and road traffic safety and public education, particularly for adult and older males.