Skip to main content
SpringerLink
Log in

Quantifying the Iceberg Effect for Injury

Using Comprehensive Community Health Data

  • Published:
Canadian Journal of Public Health Aims and scope Submit manuscript

An Erratum to this article was published on 01 January 2006

Abstract

Background

Injury is the leading cause of preventable morbidity and mortality in Canada. The “iceberg” effect in injuries was proposed to address the injury statistics that are often poorly documented. The aim of this investigation was to quantify the severity and magnitude of iceberg effect in Ontario, Canada.

Methods

Data from Vital Statistics (1999, mortality), Canadian Institute for Health Information (2001, hospitalizations), Census (2001, demographic information), National Ambulatory Care Reporting System (2001, emergency department visits), and the Canadian Community Health Survey (2000/01, other injuries) were used to construct the Ontario injury iceberg for ages 12 years and older.

Results

There were 79,577 fatalities in Ontario in 1999; 2,645 were attributable to injuries (crude rate: 2.3 per 10,000). Of the 913,540 hospitalizations (2001), 67,301 were caused by injuries. There were 3,520,253 emergency department (ED) visits (2001) and 959,278 were attributable to injuries. For injuries treated elsewhere, the most common treatment site was the physician’s office (23.3%). The most common cause of injuries (CCHS) was falls (37.4%) and exertion/movement (20.5%). There were 1,928,000 injuries causing functional impairment (one injury to five individuals in the population).

Interpretation

The high ratio of injury-related ED visits to deaths illustrated the high volume of injuries that present to the ED. The ratio of injuries resulting in functional impairment to the population demonstrates that such injuries can be problematic, even if not resulting in hospitalization. Constructing the injury iceberg using valid data should assist researchers and decision-makers in priority setting.

Résumé

Contexte

Les blessures corporelles constituent la principale cause de morbidité et de mortalité au Canada. On a proposé la théorie de l’effet « iceberg » pour mieux comprendre les données statistiques relatives aux blessures, souvent peu documentées. Cette étude vise à quantifier la gravité et l’importance de l’effet iceberg dans la province de l’Ontario, au Canada.

Méthodes

Les statistiques de l’état civil (1999, mortalité), de l’Institut canadien d’information sur la santé (2001, hospitalisations), et du recensement (2001, données démographiques), du Système national d’information sur les soins ambulatoires (2001, nombre de visites aux services d’urgence) et de l’Enquête sur la santé dans les collectivités canadiennes (ESCC) (2000–2001, autres blessures) ont servi à la construction de l’effet iceberg en Ontario, pour les personnes de 12 ans et plus.

Résultats

En 1999, on a signalé 79 577 décès en Ontario, dont 2 645 attribuables à des blessures (taux brut: 2,3 pour 10 000). Des 913 540 hospitalisations relevées (2001), 67 301 étaient attribuables à des blessures. De même, des 3 520 253 visites des services d’urgence (SU) (2001), 959 278 étaient dues à des blessures. Les blessures qui ne sont pas traitées dans les services d’urgence l’étaient de façon prédominante dans un cabinet de médecin (23,3 %). Les chutes représentaient la principale cause de blessures (ESCC) (37,4 %), suivie de la fatigue et des mouvements (20,5 %). On constate que 1 928 000 blessures ont entraîné une invalidité fonctionnelle (dans la population, une personne sur cinq a subi des blessures).

Interprétation

Le taux élevé de visites aux services d’urgence pour cause de blessures et de mortalité témoignent du nombre important de blessures traitées par les services d’urgence. Le taux de blessures entraînant des invalidités fonctionnelles permet de conclure que les blessures peuvent poser problème et ce, même si elles ne donnent pas lieu à une hospitalisation. La construction de l’effet iceberg, à l’aide de données valides, devrait aider les chercheurs et les décideurs dans l’établissement des priorités.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Northern Health Information Partnership. Injuries and Poisonings in Northern Ontario–2000. Sudbury, ON: NHIP, 2000.

    Google Scholar 

  2. Queen’s Printer for Ontario. Provincial Health Planning Database. Health Planning Branch, Ontario Ministry of Health and Long-Term Care, 2000.

    Google Scholar 

  3. Northern Health Information Partnership. An overview of health status in Northern Ontario, 2004.

    Google Scholar 

  4. Health Canada. Economic burden of injury in Canada, 1998. 2002.

    Google Scholar 

  5. McClure R, Douglas R. The public health impact of minor injuries. Accid Anal Prev 1996;28(4):443–51.

    Article  CAS  PubMed  Google Scholar 

  6. Loimer H, Driur M, Guarnier M. Accidents and acts of God: A history of the terms. Am J Public Health 1996;86(1):101–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Davis R, Pless B. BMJ bans “accidents”: Accidents are not unpredictable. BMJ 2001;322(7298):1320–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Last, JM. The iceberg: Completing the clinical picture in general practice. Lancet 1963;6:28–31.

    Article  Google Scholar 

  9. World Health Organization. International Classification of Diseases, Injuries, and Causes of Death, 9th Revision. Geneva, Switzerland, 1977.

    Google Scholar 

  10. Northern Health Information Partnership. Injuries and Poisonings in Northern Ontario–2004. Sudbury, ON: NHIP, 2004.

    Google Scholar 

  11. Burt CW, Fingerhut, LA. Injury visits to hospital emergency departments: United States, 1992–95. Vital Health Statistics 1998;13(131):1–76.

    Google Scholar 

  12. Pickett W, Hartling L, Brison, RJ. A populationbased study of hospitalized injuries in Kingston, Ontario, identified via the Canadian Hospitals Injury Reporting and Prevention Program. Chron Dis Can 1997;18(2):61–69.

    CAS  Google Scholar 

  13. Wadman MC, Muelleman RL, Coto JA, Kellerman, AL. The pyramid of injury: Using ecodes to accurately describe the burden of injury. Ann Emerg Med 2003;42(4):468–78.

    Article  PubMed  Google Scholar 

  14. Centers for Disease Control and Prevention. Leads from the Morbidity and Mortality Weekly Report, Atlanta, GA: Deaths resulting from firearm- and motor-vehicle-related injuries— United States, 1968–1991. JAMA 1994;271(7):495–96.

    Article  Google Scholar 

  15. Sahai VS, Pitblado JR, Bota GW, Rowe BH. Factors associated with seat belt use: An evaluation from the Ontario Health Survey. Can J Public Health 1998;89(5):320–24.

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Irvine A, Rowe BH, Sahai V. Bicycle helmetwearing variation and associated factors in Ontario teenagers and adults. Can J Public Health 2002;93(5):368–73.

    PubMed  PubMed Central  Google Scholar 

  17. Demorest RA, Posner JC, Osterhoudt KC, Henretig, FM. Poisoning prevention education during emergency department visits for childhood poisoning. Pediatric Emerg Care 2004;20(5):281–84.

    Article  Google Scholar 

  18. Reeson C, Wafer M. Falls in accident and emergency departments. Nursing Standard 2001;15(50):33–37.

    Article  CAS  PubMed  Google Scholar 

  19. Leigh JP, Markowitz SB, Fahs M, Shin C, Landrigan, PJ. Occupational injury and illness in the United States: Estimates of costs, Morbidity, and mortality. Arch Intern Med 1997;157(14):1557–68.

    Article  CAS  PubMed  Google Scholar 

  20. Bastida JL, Aguilar PS, Gonzalez, BD. The economic costs of traffic accidents in Spain. J Trauma: Injury, Infection, Critical Care 2004;56(4):883–89.

    Article  Google Scholar 

  21. Northern Health Information Partnership. Northern Ontario Child and Youth Health Report. Sudbury, ON: NHIP, 2003.

    Google Scholar 

  22. MacMillan HL, MacMillan AB, Offord DR, Dingle, JL. Aboriginal health. CMAJ 1996;155(11):1569–78.

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Scott J. Homelessness and mental health. Br J Psychiatry 1993;162:314–24.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Northern Health Information Partnership, Sudbury, ON, Canada

    Vic S. Sahai MSc & Mary S. Ward MSc

  2. Northeastern Ontario Medical Education Corporation, Canada

    Vic S. Sahai MSc & Tim Zmijowskyj MD, CCFP

  3. Northern Ontario Medical School, University of Ottawa, Sudbury, Canada

    Vic S. Sahai MSc, Mary S. Ward MSc & Tim Zmijowskyj MD, CCFP

  4. Departments of Emergency Medicine and Public Health Sciences, Faculty of Medicine and Dentistry, University of Alberta, 1G1.43 WMC, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada

    Brian H. Rowe MD, MSc, CCFP(EM), FCCP

Authors
  1. Vic S. Sahai MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mary S. Ward MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tim Zmijowskyj MD, CCFP
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Brian H. Rowe MD, MSc, CCFP(EM), FCCP
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Brian H. Rowe MD, MSc, CCFP(EM), FCCP.

Additional information

Acknowledgements: The work of Vic Sahai and Mary Ward is supported and funded by the Ministry of Health and Long-Term Care (Ontario, Canada). Dr. Rowe’s research is supported by the Canadian Institute of Health Research (CIHR, Ottawa, ON) as a Canada Research Chair.

Funding: Northern Health Information Partnership is supported by the Ministry of Health and Long- Term Care–Ontario and the Canadian Institute of Health Research Canada Chairs program. Dr. Rowe holds a Canada Research Chair in Emergency Airway Diseases from the Canadian Institutes of Health Research (CIHR).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sahai, V.S., Ward, M.S., Zmijowskyj, T. et al. Quantifying the Iceberg Effect for Injury. Can J Public Health 96, 328–332 (2005). https://doi.org/10.1007/BF03404025

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03404025

MeSH terms

Search

Navigation