Introduction: Fire and rescue services Syd, in the south of Sweden, started to conduct home fire and safety checks on a large scale in 2010. The goal was to reduce the damages from residential fires. Method: We estimate the effects of the intervention on the incidence of residential fires and evaluate its economic effect. We use a difference-in-kinks design to analyze time-varying intervention effects and conduct a cost–benefit analysis for the economic evaluation. Results: The results demonstrate that fires and developed fires decrease by a maximum of approximately 6% and 8% per year (assuming 100% causality)and that the intervention has positive economic effects, with the benefits estimated to be maximum 8–11 times higher than the costs. Practical applications: The results should be valuable as input when deciding whether to implement home fire and safety checks elsewhere.

We study the effects of a studded footwear subsidy program in Gothenburg, Sweden, where a free pair of anti-slip devices was distributed to all residents aged over 65 years as a pedestrian falls prevention measure. Using a difference-in-differences approach with internal age-based controls, we find evidence of a short-term effect on emergency department visits due to slips on snow and ice during the first year of the intervention ( -45% [95% CI: - 54, - 9] in 2013), which equates to 21.8 injuries prevented (95% CI: 3.34, 39.4). A cost-benefit analysis based on this result suggests that the short-term benefits outweigh the total costs of the intervention (benefit-cost ratio: 6.9 [95% CI: 1.05-12.46]), indicating that this type of subsidy program may be an important tool for the prevention of pedestrian falls among older adults during icy weather conditions. However, replication at other sites is recommended before drawing any strong and general conclusions.

Background: Unintentional injuries are the leading cause of death among adolescents. Adolescents with disabilities may be particularly vulnerable with an increased risk of unintentional injuries. Objective: To study the association between a set of disabilities and unintentional injury risks among adolescents, accounting for comorbidity, subjective disability severity and sex. Method: Cross-sectional data from a Swedish national school survey including 4,741 students (15 and 17-year olds) conducted in 2016 was analyzed using log-binomial generalized linear models. Results: We found a 33% increased risk of injury the last 12 months and a 53% increased risk of injury leading to hospitalization for adolescents with any disability compared to their peers with no disability. The differences in injury risk were greater for girls than boys. There was a dose-response relationship between disability severity and injury risk. In analyses adjusted for sociodemographic factors and comorbidity, attention-deficit/hyperactivity disorder (ADHD) and epilepsy were associated with an increased risk of injury the last 12 months, risk ratios [RR] were 1.41 (95% Confidence Interval [CI] 1.08–2.97) and 1.79 (95% CI 1.10–1.81) respectively. Autism spectrum disorder was associated with a decreased injury risk the last 12 months (RR = 0.43, CI 0.2–0.92). ADHD, mobility impairment and visual impairment were associated with hospitalization due to injury during lifetime. Conclusions: There was an increased risk of unintentional injuries for adolescents with disabilities compared to their non-disabled peers, specifically for individuals with ADHD, epilepsy, visual impairment and mobility impairment. Injury prevention strategies may include adapting the physical environment and medical treatment.

Background

Fall injuries affect the lives of older people to a substantial degree. This quasi-experimental observational study investigates the potential fall injury reducing effect of a compliant flooring in a residential care setting.

Methods

The allocation of the compliant flooring was non-random. Data on fall-events and individual characteristics were collected in a residential care unit during a period of 68 months. The primary outcome was the fall injury rate per fall, and a logistic regression analysis was used to test for the effect of complaint flooring. Falls per 1000 bed days was the secondary outcome, used to measure the difference in fall risk on compliant flooring versus regular flooring.

Results

The event dataset is an unbalanced panel with repeated observations on 114 individuals, with 70% women. The mean age was 84.9 years of age, the average Body Mass Index (BMI) was 24.7, and there was a mean of 6.57 (SD: 15.28) falls per individual. The unadjusted effect estimate showed a non-significant relative risk injury reduction of 29% per fall (RR 0.71 [95% CI: 0.46–1.09]) compared to regular flooring. Re-estimating, excluding identified outliers, showed an injury risk reduction of 63% (RR 0.37 [95% CI: 0.25–0.54]). Falls per 1000 bed days showed that individuals living in apartments with compliant flooring had a fall rate of 5.3 per 1000 bed days compared to a fall rate of 8.4 per 1000 bed days among individuals living in regular apartments. This corresponds to an incidence rate ratio (IRR) of 0.63 (95% exact Poisson CI: 0.50–0.80).

Conclusion

The results of this non-randomized study indicate that compliant flooring has the potential to reduce the risk of fall injury without increasing the fall risk among older people in a Swedish residential care setting.

OBJECTIVE: To estimate the effects of fire safe cigarette laws on fire mortality and cigarette-related fires in the USA.

METHODS: We examined the gradual implementation of the laws to identify their average effects, using difference-in-differences analysis to account for common year effects, time-invariant state effects, state-specific trends and observable time-varying state-level covariates.

RESULTS: We found no statistically significant effects on all-cause fire mortality, residential fire mortality or cigarette-caused fire rates. The estimates for cigarette-caused fire deaths were significant under some specifications, but were not robust to the inclusion of state-specific trends or comparisons to effects on other cause-determined fires.

CONCLUSIONS: Given the mixed state of our results, we conclude that previous claims regarding the effects of fire safe cigarette laws may be premature.

Introduction This paper discusses the application of the synthetic control method to injury-related interventions using aggregate data from public information systems. The method selects and determines the optimal control unit in the data by minimising the difference between the pre-intervention outcomes in one treated unit (eg, a state) and a weighted combination of potential control units. Method I demonstrate the synthetic control method by an application to Florida's post-2010 policy and law enforcement initiatives aimed at bringing down opioid overdose deaths. Using opioid-related mortality data for a panel of 46 states observed from 1999 to 2015, the analysis suggests that a weighted combination of Maine (46.1%), Pennsylvania (34.4%), Nevada (5.4%), Washington (5.3%), West Virginia (4.3%) and Oklahoma (3.4%) best predicts the preintervention trajectory of opioid-related deaths in Florida between 1999 and 2009. Model specification and placebo tests, as well as an iterative leave-k-out sensitivity analysis are used as falsification tests. Results The results indicate that the policies have decreased the incidence of opioid-related deaths in Florida by roughly 40% (or -6.19 deaths per 100.000 person-years) by 2015 compared with the evolution projected by the synthetic control unit. Sensitivity analyses yield an average estimate of -4.55 deaths per 100.000 person-years (2.5th percentile: -1.24, 97.5th percentile: -7.92). The estimated cumulative effect in terms of deaths prevented in the postperiod is 3705 (2.5th percentile: 1302, 97.5th percentile: 6412). Discussion Recommendations for practice, future research and potential pitfalls, especially concerning low-count data, are discussed. Replication codes for Stata are provided.

Background: Worldwide, about 5.8 million people die each year due to injuries. In Sweden, the corresponding number amounts to 3000. There are large differences among injury types regarding the age-profile of the fatalities and as most of them occur in older age groups, counting the absolute number of injury fatalities does not fully reflect the size of the burden of injury. Methods: Using age-and sex-specific life expectancy tables in combination with data on external causes of injury, the number of injury fatalities in Sweden for the time period 1972-2014 is converted to a sum of potential years of life lost (PYLL). We then fit cause and group-specific spline regression models to the data to estimate temporal trends in both fatality counts and PYLL. Results: There has been a steady reduction in the number of injury fatalities and in the sum of PYLL from the early 1970s to around the year 2000. Since then, there has been an increase in the number of injury fatalities and in the sum of PYLL. The upward trend is mainly explained by an increasing number of deaths due to poisonings and suicide, specifically among younger men. Conclusions: The increases in suicide and poisoning mortality offset the reductions in downward trending causes of injury mortality during the last decades. The share of PYLL is larger than the share of fatalities for both suicides and poisonings implying that an aging population does not cause the increase.

As dog bite injuries are a considerable problem in modern society, in order to reduce such injuries, breed-specific legislation has been introduced in a number of countries. Whilst many studies have shown a lack of effect with such legislation, the commonly used methodology is known to be flawed. Therefore, the aim of this study is to investigate the effect of the Danish breed-specific legislation on the number of dog bite injuries using more credible methods. A time series intervention method was used on a detailed dataset from Odense University Hospital, Denmark, regarding dog bite injuries presented to the emergency department. The results indicate that banning certain breeds has a highly limited effect on the overall levels of dog bite injuries, and that an enforcement of the usage of muzzle and leash in public places for these breeds also has a limited effect. Despite using more credible and sound methods, this study supports previous studies showing that breed-specific legislation seems to have no effect on dog bite injuries. In order to minimise dog bite injuries in the future, it would seem that other interventions or non-breed-specific legislation should be considered as the primary option.