Measuring transport injuries in a developing country: an application of the capture–recapture method
Francisco Tercero a,b , Ragnar Andersson c,∗
b a Department of Preventive Medicine, National Autonomous University of Nicaragua, León, Nicaragua Department of Public Health Sciences, Karolinska Institute, Division of Social Medicine, Stockholm,Sweden c Department of Social Sciences, Karlstad University, SE-651 88, Karlstad, Sweden
Received 31 January 2002; received in revised form 18 September 2002; accepted 15 October 2002
Abstract The purposes of this study are to provide an estimation of the incidence of transport injuries in a deﬁned local community in Nicaragua by using the capture–recapture method, and to compare resultsusing this method when data at different levels of severity are utilized. Two sources of injury data were used to monitor injuries: hospital data (inpatient and outpatient) and trafﬁc police records. Characteristics available for matching included name, age, sex, and date of occurrence. The methodology of capture–recapture was used to estimate the ascertainment degree of both sources of data and theestimate mortality and incidence rates. Estimates were calculated both when all hospital data were taken into account (inpatient and outpatient combined) and when only inpatient records were matched against police records. First, including police records and all hospital data, the mortality and morbidity estimates were 35.5/100 000 and 43.7/1000 per year, respectively. Second, when outpatientswere excluded from the analysis, the corresponding estimates were 28.6/100 000 and 7.5/1000, respectively. In non-fatal cases, the ascertainment-corrected coverage through police records was 2.6% and through hospital surveillance 19.0% when both inpatients and outpatients were included. In fatal cases, the corresponding rates were 56.1 and 22.8%, respectively. The combined data set pointed outpedestrians and cyclists as the main risk groups. Most fatalities were due to head injuries. Our results show that neither police records nor hospital records nor the aggregate database provided acceptable coverage of transport-related injuries. Combining police and hospital data by means of capture–recapture analysis produces more valid estimates, but caution must be given to the issue of severityheterogeneity between the two sources. © 2003 Elsevier Science Ltd. All rights reserved.
Keywords: Transport; Injuries; Capture–recapture method; Low-income countries; Nicaragua
1. Introduction Road transport accidents (RTA) are a huge public health problem in both developed and developing countries (Jacobs and Sayer, 1983; Baker et al., 1992; Söderlund and Zwi, 1995; Krug, 1999). This group ofinjuries constitutes the ninth leading cause of disease, and it is projected to increase in rank to third place by the year 2020 (Murray and López, 1996). Despite the fact that motor vehicle-related injuries are preventable, they remain the main cause of death among children and young adults, greater in number than any other single cause in the United States. The ratio of emergency departmentvisits to admissions to death is 95:12:1. Many of these survivors are seriously disabled by traumatic brain and
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spinal cord injuries (NCIPC, 1997). Further, motor vehicles account for 29% of the total number of injury deaths, and it is also an important mechanism ofnon-fatal injury, accounting for 22% of injury-related hospitalization and 12% emergency department visits in the USA (MacKenzie, 2000). Most low-income countries are facing an even worse situation, due to rapid urbanization and motorization in combination with poverty. Moreover, such countries normally have poorly developed health information systems including little or no data regarding morbidity,...