Fatal injuries in rural and urban areas in northern Finland: a 5‐year retrospective study

Abstract

BackgroundFinland has the fourth highest injury mortality rate in the European Union. To better understand the causes of the high injury rate, and prevent these fatal injuries, studies are needed. Therefore, we set out to complete an analysis of the epidemiology of fatal trauma, and any contributory role for alcohol, long suspected to promote fatal injuries. As a study area, we chose the four northernmost counties of Finland; their mix of remote rural areas and urban centres allowed us to correlate mortality rates with ‘rurality’.MethodsThe Causes of Death Register was consulted to identify deaths from external causes over a 5‐year time period. Data were retrieved from death certificates, autopsy reports and medical records. The municipalities studied were classified as either rural or urban.ResultsOf 2915 deaths categorized as occurring from external causes during our study period, 1959 were eligible for inclusion in our study. The annual crude mortality rate was 54 per 100,000 inhabitants; this rate was higher in rural vs. urban municipalities (65 vs. 45 per 100,000 inhabitants/year). Additionally, a greater number of pre‐hospital deaths from accidental high‐energy trauma occurred in rural areas (78 vs. 69%). 42% of all pre‐hospital deaths occurred under the influence of alcohol.ConclusionThe crude mortality rate for fatal injuries was high overall as compared to other studies, and elevated in rural areas, where pre‐hospital deaths were more common. Almost half of pre‐hospital deaths occurred under the influence of alcohol.

Deaths caused by injury among people of working age (18–64) are decreasing, while those among older people (64+) are increasing

“…Suicide has a high incidence of death before admission [6, 22] because of the mechanism of injury, which is designed to be lethal. Injury-related deaths have been reported to be between 45 and 85% in Scandinavia [3–6, 23, 24].…”

Injury mortality in Sweden; changes over time and the effect of age and injury mechanism

“…The lack of prehospital physicians in Swedish medical care could contribute to the high numbers of prehospital deaths. Prehospital death rates are higher in rural areas (5,26) which could also contribute to our findings as a majority of the Swedish population live in rural areas.…”

“…In Scandinavia the numbers of severe trauma (Injury Severity Score, ISS > 15) is between 30 and 54 per 100 000 inhabitants per year (4,5). The trauma picture in Sweden is similar to the rest of Scandinavia which is a result of the similar medical organisations and living situations (4).…”

“…Suicides have high prehospital death rates (5,40) because of the mechanism of injury, i.e., that it is designed to be lethal. Injury related prehospital death has been reported to be in the range of between 45% and 85% in Scandinavia (5,26,33,47,58,65). Wisborg et al (47) found the highest number with 85%, and Kristiansen et al (26) who studied a working age population in Norway found a 78% overall prehospital mortality.…”

Particularities in the Evolution of Mortality by Traumatic Events in the Last 30 Years

“…Factors such as the environment (rural or urban), historical background, geographic area, socio-economic status of a country, age and gender have a major influence on mortality and morbidity through trauma (2,3).…”