Epidemiology of burn-related fatalities in Australia and New Zealand, 2009–2015
Introduction
Despite major advances in the prevention and treatment of burn injuries over recent decades, burns resulting in death still occur, contributing substantially to the global burden of injury [1,2]. The World Health Organization (WHO) has reported that an estimated 180,000 deaths occur worldwide as a consequence of burn injuries each year, with most of these occurring in low and middle income countries [3]. Although recognised as a major public health issue, knowledge of the epidemiology of burn-related fatalities is limited.
Studies reporting on burn-related fatalities vary greatly regarding study population and data source, making comparisons and generalisations difficult. Many studies have restricted their analyses to fatalities that have occurred in hospitals [4,5] or in specialist burn centres [6]. Others have excluded specific population and clinical subgroups, including individuals injured through intentional self-harm [7,8], children [9,10], individuals without valid health care cards [5], and deaths occurring in emergency departments [5], or have restricted analyses to fatalities of a specific cause [11]. Studies set in Australia and New Zealand have examined prevalence and characteristics of burn-related fatalities using administrative records of hospital admissions and emergency department presentations [12], and of patients hospitalised at specialist burn units [6,9,13,14].
The reliance on hospital and specialist burn centre data, and a focus on specific sub-groups, has resulted in an incomplete picture of burn-related deaths. Exclusive use of hospital and specialist burn centre data can introduce bias as not all burns cases will survive to reach hospital. This is particularly pertinent to countries such as Australia and New Zealand, where specialist burn centres are centralised to major cities, and patients may require transportation over large distances and difficult terrain to receive optimal care. A more comprehensive picture of burns-related deaths is needed to better monitor the effectiveness of prevention strategies, and to inform prevention policies and effective resource allocation. Accordingly, the aims of this study were to describe the demographic and injury event characteristics of all burn-related fatalities in Australia and New Zealand, and where possible, to identify any trends in burn-related fatality incidence.
Section snippets
Study design and setting
This study used a national repository of coronial data to examine the characteristics of burn-related fatalities occurring in Australia and New Zealand from 2009 to 2015. Australia, covering an area of nearly 7.7 million square kilometres (km2), had a population of 24.9 million at June 2018, and is divided into eight State and Territory jurisdictions of varying size and population [15,16] (Fig. 1). New Zealand, located approximately 2000 km from the east coast of Australia, consists of two main
Results
There were 310 reportable deaths determined to be burn-related by Australian and New Zealand Coroners between 1 July 2009 and 30 June 2015; of these 51 occurred in New Zealand and 259 in Australia. The largest proportions of burn-related fatalities occurred in the Australian jurisdiction of NSW (Fig. 2).
The annual incidence of burn-related fatalities for the Australian and New Zealand population combined decreased over the study period (IRR, 0.92; 95% CI: 0.87, 0.99; P = 0.02) from 0.26 per
Discussion
This study, the first of its kind, has highlighted the extent of the burden of burn-related fatalities, and has highlighted the population subgroups most vulnerable to this type of injury in the Australian and New Zealand region. By using coronial data, which includes both pre-hospital and in-hospital burn-related fatality cases, it has presented data describing all burn-related fatalities in this region, rather than just those treated in hospitals and specialist burn centres. Of the 301 deaths
Conclusion
This study has identified the importance of examining all burn-related fatalities, wherever they occur along the trajectory of burn incident to eventual death. If this is not done, specific population subgroups will be missed and prevention efforts poorly targeted. Further research to characterise pre-hospital and in-hospital burn-related characteristics and circumstances is warranted.
Funding sources
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Declarations of interest
None.
Acknowledgements
The authors wish to thank Ms Katherine Dartnell and Mr Thomas Burgess for extracting and collating the NCIS data, and for answering queries about the data. The National Coronial Information System (NCIS) is a data repository containing information about deaths reported to a coroner in Australia and New Zealand. The NCIS is managed by the Victorian Department of Justice and Community Safety, 65 Kavanagh Street, Southbank VIC 3006, Australia.
Belinda Gabbe was supported by an Australian Research
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