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Injury-Related Deaths Among Finnish Children, 1971-2001
To the Editor: Injuries are a major public health problem worldwide, and are by far the leading cause of death and disability for children from early childhood through adolescence.1-4 We sought to explore temporal trends in the incidence of traumatic death among children in Finland.
Methods
We obtained from the Finnish Official Cause-of-Death Statistics the data for children aged 0 to 14 years who died from an injury between 1971 and 2001. This statutory register has been computer-based since 1971, and it has been updated and quality-controlled by the Cause-of-Death Bureau at Statistics Finland since its inception.5 The main categories of death from unintentional injury are road traffic injuries, water traffic injuries, falls, drownings, and poisonings.5-6 For deaths from intentional injury, the main categories are suicides and homicides. The Finnish Official Cause-of-Death Statistics are 100% complete, since each death, its certificate, and the corresponding personal information in our computerized population register are cross-checked. The accuracy of the data is, in turn, maximized by a 3-phase process in which each code of the death certificate is confirmed by the physician who certified the death.5-6 In injury-based deaths, the accuracy of the Finnish death certificates and their cause-of-death codes are verified further by autopsies performed in 94% to 97% of these deaths.5-6 The mortality data were drawn from the entire childhood population of Finland, which was 1 107 280 in 1971 and 933 962 in 2001. Thus, the absolute numbers and incidences of deaths were not cohort-based estimates but true descriptions of the population.
Results
During the entire study period, injuries were the leading cause of death in children aged 1 to 14 years, but not in infants. In 1971, 54% of all deaths of Finnish children aged 1 to 14 years were attributable to intentional or unintentional injuries; by 2001, this figure had decreased to 40%. During the 30-year follow-up period, the incidence (per 100 000 persons) of unintentional and intentional fatal injuries in Finnish children decreased considerably in all age groups and in both sexes (in girls, from 20.1 in 1971 to 2.8 in 2001; in boys, from 36.7 in 1971 to 7.1 in 2001). The reduction was almost entirely due to the decreasing number of unintentional injuries (Figure 1). In 2001, 38% of all the injury deaths among Finnish children aged 0 to 14 years were caused by motor vehicle injuries, 17% by drowning, and 21% by intentional injuries.
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Figure. Annual Incidence (per 100 000 Persons) of Fatal Injuries Among Finnish Girls and Boys Aged 0 to 14 Years, 1971-2001.
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Comment
Our population data show that most of the fatal injuries of children are preventable. The reasons for the decline in such deaths are multifactorial, but the most likely explanation is improved traffic safety, perhaps the result of the multifaceted traffic safety program conducted in Finland since the late 1960s. The program has included road and traffic planning and legislation, more comprehensive traffic supervision and control (particularly controlling speeds and driving under the influence of alcohol or illicit drugs), improved vehicle safety (car body, seats, seat belts, and child safety-seat restraints), and intense promotion of the use of bicycle helmets. Also, increased general awareness of children's high-risk situations (for example, increased supervision when the child is commuting to school or when the child is near water), safer playgrounds, and keeping poisonous substances out of reach of children are among other possible explanations, although there is good evidence from the reports in the United States and some other countries that policy and law enforcement interventions are more effective than educational programs in reducing injury death rates.7 An additional factor that may relate to the above-noted positive time trend in fatal injuries is more rapid access to emergency services and improved trauma care.
Funding/Support: This study was financially supported by the Medical Research Fund of Tampere University Hospital, Tampere, Finland.
Jari Parkkari, MD, PhD;
Ville Mattila, MSc
Tampere Research Center of Sports Medicine
UKK Institute for Health Promotion Research
Tampere, Finland
Seppo Niemi
Accident & Trauma Research Center
UKK Institute for Health Promotion Research
Pekka Kannus, MD, PhD
Department of Surgery
Tampere University Medical School and University Hospital
Tampere
1. Scheidt PC, Harel Y, Trumble AC, Jones DH, Overpeck MD, Bijur PE. The epidemiology of nonfatal injuries among US children and youth. Am J Public Health. 1995;85:932-938.
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2. Bartlett SN. The problem of children's injuries in low-income countries: a review. Health Policy Plan. 2002;17:1-13.
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3. Parkkari J, Kannus P, Niemi S, et al. Childhood deaths and injuries in Finland in 1971-1995. Int J Epidemiol. 2000;29:516-523.
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4. Anderson M, Kaufman J, Simon TR, et al for the School-Associated Violent Deaths Study Group. School-associated violent deaths in the United States, 1994-1999. JAMA. 2001;286:2695-2702.
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5. Official Statistics of Finland. Official Cause-of Death Statistics 2001. Helsinki: Statistics Finland; 2002.
6. Kannus P, Parkkari J, Koskinen S, et al. Fall-induced injuries and deaths among older adults. JAMA. 1999;281:1895-1899.
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7. Rivara FP, Grossman DC, Cummings P. Injury prevention. N Engl J Med. 1997;337:543-548.
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Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.
JAMA. 2003;289:702-703.
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