Epidemiology of burn-related fatalities in Australia and New Zealand, 2009–2015

doi:10.1016/j.burns.2019.07.003

Burns

Volume 45, Issue 7, November 2019, Pages 1553-1561

https://doi.org/10.1016/j.burns.2019.07.003 Get rights and content

Highlights

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From 2009 to 2015, 310 burn-related fatalities occurred in Australia and New Zealand.
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41% of these fatalities occurred in a pre-hospital setting.
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One quarter of all fatalities were a consequence of self-inflicted harm.
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A majority of fatalities were male, and were aged 41–80 years.
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The population incidence of fatalities in NSW decreased over the study period.

Abstract

Background

Knowledge of the epidemiology of burn-related fatalities is limited, with most previous studies based on hospital and burn centre data only.

Aims

To describe the epidemiological characteristics of all burn-related fatalities in Australia and New Zealand, and to identify any trends in burn-related fatality incidence over the study period.

Methods

Data from the National Coronial Information System, including data for pre-hospital and in-hospital burn-related fatality cases, was used to examine the characteristics of burn-related fatalities occurring in Australia and New Zealand from 2009 to 2015. Burn-related fatality rates per 100,000 population were estimated, and incidence trends assessed using Poisson regression analysis.

Results

Of the 310 burn-related fatalities that occurred in Australia and New Zealand, 2009–2015, 41% occurred in a pre-hospital setting. Overall, most burn-related fatality cases were fire related, occurred at home, and were of people aged 41–80 years. One quarter of all burn-related fatalities were a result of intentional self-harm. The population incidence of all burn-related fatalities combined, and for NSW, decreased over the study period.

Conclusions

This study has identified the importance of examining all burn-related fatalities. If this is not done, vulnerable population subgroups will be missed and prevention efforts poorly targeted.

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

References (38)

C.T. Brewster et al.
Trends in hospital admissions for burns in England, 1991–2010: a descriptive population-based study
Burns
(2013)
T.J. Cassidy et al.
Transfer time to a specialist burn service and influence on burn mortality in Australia and New Zealand: a multi-centre, hospital based retrospective cohort study
Burns
(2015)
S.P. Pegg
Burn epidemiology in the Brisbane and Queensland area
Burns
(2005)
A.E. Waller et al.
Adult thermal injuries in New Zealand resulting in death and hospitalization
Burns
(1998)
C. Ye et al.
Ten-year epidemiology of chemical burns in western Zhejiang Province, China
Burns
(2016)
E. Åkerlund et al.
Burns in Sweden: an analysis of 24538 cases during the period 1987–2004
Burns
(2007)
M.D. Peck
Epidemiology of burns throughout the world. Part I: distribution and risk factors
Burns
(2011)
B.A. Pruitt et al.
An historical perspective on advances in burn care over the past 100 years
Clin Plast Surg
(2009)
J.A. Haagsma et al.
The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013
Inj Prev
(2016)
World Health Organization. Burns; 6 March 2018. https://www.who.int/news-room/fact-sheets/detail/burns. [Accessed 13...

Mason S.A et al.

Trends in the epidemiology of major burn injury among hospitalized patients: a population-based analysis

J Trauma Acute Care Surg

(2017)

N. Bell et al.

Does direct transport to provincial burn centres improve outcomes? A spatial epidemiology of severe burn injury in British Columbia, 2001–2006

Can J Surg

(2012)

N.P. Sharma et al.

Descriptive epidemiology of unintentional burn injuries admitted to a tertiary-level government hospital in Nepal: gender-specific patterns

Asia Pac J Public Health

(2015)

J. Wasiak et al.

The epidemiology of burn injuries in an Australian setting, 2000–2006

Burns

(2009)

B.J. Gabbe et al.

Profile, transport and outcomes of severe burns patients within an inclusive, regionalized trauma system

ANZ J Surg

(2011)

H.J. Cleland et al.

The Burns Registry of Australia and New Zealand: progressing the evidence base for burn care

Med J Aust

(2016)

Australian Government Geoscience Australia. Area of Australia — States and territories, land areas of states and...

Australian Bureau of Statistics

Australian demographic statistics

(2018)

Statistics New Zealand. Population, estimated resident population of New Zealand. www.ststs.govt.nz/topics/population....

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View full text

Epidemiology of burn-related fatalities in Australia and New Zealand, 2009–2015

Highlights

Abstract

Background

Aims

Methods

Results

Conclusions

Introduction

Section snippets

Study design and setting

Results

Discussion

Conclusion

Funding sources

Declarations of interest

Acknowledgements

Burns

Burns

Burns

Burns

Burns

Burns

Burns

An historical perspective on advances in burn care over the past 100 years

Clin Plast Surg

The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013

Inj Prev

Trends in the epidemiology of major burn injury among hospitalized patients: a population-based analysis

J Trauma Acute Care Surg

Does direct transport to provincial burn centres improve outcomes? A spatial epidemiology of severe burn injury in British Columbia, 2001–2006

Can J Surg

Descriptive epidemiology of unintentional burn injuries admitted to a tertiary-level government hospital in Nepal: gender-specific patterns

Asia Pac J Public Health

The epidemiology of burn injuries in an Australian setting, 2000–2006

Burns

Profile, transport and outcomes of severe burns patients within an inclusive, regionalized trauma system

ANZ J Surg

The Burns Registry of Australia and New Zealand: progressing the evidence base for burn care

Med J Aust

Australian demographic statistics