|Year : 2015 | Volume
| Issue : 1 | Page : 54-57
Sociodemographic determinants of traumatic musculoskeletal injuries: A register-based study from North-west India
Bhanu Awasthi1, Sunil Kumar Raina2, Naveen Kumar1, Vipin Sharma1
1 Department of Orthopaedics, Dr. RP Govt. Medical College, Tanda, Kangra, Himachal Pradesh, India
2 Department of Community Medicine, Dr. RP Govt. Medical College, Tanda, Kangra, Himachal Pradesh, India
|Date of Web Publication||13-Jan-2015|
Sunil Kumar Raina
Department of Community Medicine, Dr. RP Govt. Medical College, Tanda, Kangra, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
Introduction: Globally, about 16,000 people die of injuries every day. It is estimated that 5.8 million people die each year as a result of some form of injury corresponding to an annual mortality rate of 97.9/100,000 populations. The study aimed to arrive at sociodemography of traumatic musculoskeletal injuries. Materials and Methods: A prospective, descriptive hospital-based study was conducted on 1272 patients presenting with musculoskeletal injuries to the Department of Orthopedics in a tertiary care hospital in rural North-west India, for a period of 1 year from January 1, 2012 to December 31, 2012. Results: Age group 16-30 was the most common (25.2%) age to suffer from injuries with a male preponderance. Students and farmers suffered more commonly. The most common place for the occurrence of injury was outside home (69.9%). Fall was the most common cause of injury (74.6%), followed by road traffic crash (14.6%). Discussion and Conclusion: The study defines the profile of traumatic musculoskeletal injuries and demonstrates the utility of development of a trauma registry.
Keywords: Determinants, musculoskeletal injuries, register, sociodemographic, traumatic
|How to cite this article:|
Awasthi B, Raina SK, Kumar N, Sharma V. Sociodemographic determinants of traumatic musculoskeletal injuries: A register-based study from North-west India. Int J Health Allied Sci 2015;4:54-7
|How to cite this URL:|
Awasthi B, Raina SK, Kumar N, Sharma V. Sociodemographic determinants of traumatic musculoskeletal injuries: A register-based study from North-west India. Int J Health Allied Sci [serial online] 2015 [cited 2020 Feb 17];4:54-7. Available from: http://www.ijhas.in/text.asp?2015/4/1/54/149276
| Introduction|| |
Globally, about 16,000 people die of injuries every day. ,, It is estimated that 5.8 million people die each year as a result of some form of injury. ,, This corresponds to an annual mortality rate of 97.9/100 000 population. , It is estimated that by the year 2020, 8.4 million people will die every year from injury.  Mortality due to injury is only the tip of the iceberg as millions of people require hospital treatment for every death. 
Out of the total the injuries in the world 30.3% of the burden of injuries and 28.7% of mortality occur in the South-east Asian Region. , For every death due to injury nearly 10-20 victims are hospitalized, 50-100 receive emergency care in hospitals and 100 victims sustain minor injuries.  The toll of injuries on the lives and health of people around the world far exceeds the number who dies. Statistics on health are inadequate in many countries worldwide. Road traffic injuries (RTIs) are an important component of injuries in general. A report on a nationally representative survey on RTI mortality and mechanism was published in 2013. According to the survey report, 2299 RTI deaths in the survey correspond to an estimated 183,600 RTI deaths or about 2% of all deaths in 2005 in India, of which 65% occurred in men between the ages 15 and 59 years. The age-adjusted mortality rate was greater in men than in women, in urban than in rural areas. 
The current study was planned with the objective to identify sociodemographic determinants of traumatic musculoskeletal injuries.
| Materials and Methods|| |
All patients of traumatic musculoskeletal injuries attending the Department of Orthopedics and including outpatient department, emergency and indoor patients in a tertiary care center located in a rural area of Himachal Pradesh, a sub-Himalayan state of India were included in the study. The center caters to a largely rural population of Himachal Pradesh. Patients with nontraumatic collapse of vertebra, soft tissue injury without fracture, dislocation, strain and sprain, pathological fractures, head injury patient, patients with nontraumatic back pain, patient with overuse syndrome and stress-related injuries and patients who denied consent were excluded from this study. The exclusion was based on opinions provided by two orthopedic surgeons independent of each other. The independent opinion was used to establish the eligibility for inclusion based on the criteria as mentioned above.
The study was a prospective, descriptive hospital-based, conducted over a period of 1 year. For the purpose of the study, a hospital-based register was established in the Department of Orthopedics. Patients of all age groups presenting to Department of Orthopedics with musculoskeletal injuries secondary to trauma were included in the register. Sociodemographic variables such as age, sex, occupation, education, type of family and income, relating to the patient were entered in the register after eliciting information on the same from the patient on a structured performa. The information was gathered after conducting an interview in person on a structured Performa by a M.B.B.S doctor (NN). In the case of disoriented and minor patients history on injury and sociodemography variables was collected from guardian/parent of the patient through an in-person interview at the time of registration. Each interview lasted about 15-20 min. A detailed survey was conducted on each patient and to establish the diagnosis, X-ray of part of interest (fracture site) was performed.
The results have been expressed as percentages and analyzed using Statistical Package for Social Sciences (IBM SPSS) version 11.5.
| Results|| |
A total of 1290 cases with musculoskeletal injuries presented within the study period. However, 18 of them refused to participate give us a response rate of 98%. Therefore, a total of 1272 cases were registered and included in this study. There were 853 males and 419 females.
Data of six cases were incomplete as they were not reported after primary survey; hence excluded from the study. It was seen that traumatic musculoskeletal injuries were common among age group 16-30 years (n = 319/1272; 25.2%). Fall was the commonest cause of injury (74.6%), followed by road traffic crash (14.6%).
The most common injury was fractures (n = 874/1272; 69%) [Table 1]. The difference in distribution of musculoskeletal injuries among different age group was found to be statistically significant with P < 0.05. A significant difference was found in the proportion of traumatic musculoskeletal injuries between males and females (male: n = 847/1272, 66.9, female n = 419/1272, 33%) with a sex ratio 2.02:1 [Table 2]. Injuries were common among student (n = 357/1272, 27.73%) followed by farmer (n = 250/1272, 19.74%) [Table 3]. Education did not seem to influence occurrence of injuries as injuries were more or less uniformly distributed across various education groups. Musculoskeletal injuries were common among joint family (n = 739/1272, 58.37%) as compared with nuclear families (n = 437/1272, 34.5%). This could be because a higher number of individuals presenting with musculoskeletal injuries belonged to joint families. A joint family was defined as one which consisted of a number of married couples with all men related by blood and the women of the household their wives. However, the difference was not significant statistically. Further, traumatic musculoskeletal injuries were common among individual from higher income groups (n = 1113, 87.9%) when compared to low-income groups (n = 153, 12.08%). Again the reason for this may lie in the fact that a higher number of individuals presenting with musculoskeletal injuries belonged to higher income groups. Traumatic musculoskeletal injuries were common outside home (n = 885, 69.9%) followed by at home (n = 345, 27.25%).
|Table 3: Occupation wise distribution of traumatic musculoskeletal injuries|
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| Discussion|| |
It is important to understand the sociodemographic profile of injuries to know the considerable strain that they put on the health care system. This study provides an overview of all traumatic musculoskeletal injuries in terms of the total number, basic demographic characteristics and their specific diagnosis.
In an epidemiological study conducted in the municipal corporation area of Delhi the number of injuries were highest among the age group of 5-25 years (48%) followed by 25-45 age group (28%).  The data is almost similar to our study in that the commonest age group for injury in our study was 16-30 years. However, in a hospital-based study conducted in the hilly region of Northeast India the most common age group involved was fourth decade followed by third decade.  In an epidemiological study conducted in Delhi on skeletal injuries following unintentional fall from height the peak age of fall was seen between 11 and 30 years, almost similar to our study and almost 75% of patients were in their first four decades.  The similarity may also be because our study reports falls as a major cause of musculoskeletal injuries. A study conducted in South India on all the road traffic accident (RTA) the most common age group of 5-25 years (48%) was followed by 25-45 age group.  A retrospective review of hospital charts of all patients admitted as a result of RTA injuries between October 2001 and December 2005 in a teaching hospital in Nigeria observed that total of 47.3% trauma admissions were in the third and fourth decade of life. 
In our study, injuries were almost equally distributed in age groups up to 60 years with a mean age as 34.74 ± 20.04 years. The male to female ratio was 2.02:1. The most common age group involved was 0-15 years (24.34%) followed by 31-45 years (22.3%). Different studies in different parts of world and India reports male preponderance. ,,,,, Although RTI as cause of musculoskeletal injuries was less common than falls as a cause of injuries in our study; data on RTI provides some insight into the injury pattern in India. The million death study (MDS) data reveals that much of the deceased due to musculoskeletal trauma resulting from RTI were men between ages 15 and 59 years. Further men had a four-fold higher cumulative risk of RTI death compared with women before the age of 70.  MDS estimates on the number of RTI deaths is more than 50% greater than reported in the official police statistics of the National Crime Records Bureau (NCRB) in 2005. Existing regional population-based injury surveys in India support the findings of MDS with higher crude RTI death rates than NCRB statistics. ,
Our study corroborated this trend with male to female ratio of 2.02:1. This difference could be due to more active involvement of the male population in social and other outdoor activities making them more prone to injuries. A study conducted in Delhi observed that a person with primary education had higher injury incidence as compared to postgraduate group.  In our study maximum, cases of injuries were seen in those educated up to middle standards followed by those educated up to secondary standards. This difference could be attributed to higher school enrollment in Himachal as compared to Delhi.  In a study conducted in Delhi observed that business group were reported to have a higher incidence of injury followed by labor class and the housewives have least incidence rate of injuries. 
In our study, maximum numbers of cases involved were students (27.73%) followed by farmers (19.74%). The reason for this may be the difficult terrain that students have to follow for education. Furthermore, Himachal Pradesh being predominantly rural, and students being involved in other outdoor activity like farm works, forest activities etc., unlike their counterparts in urban areas may contribute to higher percentages of injuries in them. This is also the reason for higher injuries in farmers. Extensive literature review revealed no information on agricultural injuries in India. Adarsh et al. revealed an incidence rate of 28% in phase 1 and 49% in phase 2 in a sample of 2635 workers from 9 villages of Uttar Pradesh and 30 villages of Haryana.  In a review of equipment-related injuries in Indian agriculture, it was observed that 5% and 46% of injuries are caused by tractors and hand-held equipment. 
The extensive literature search reveals no data on the association of traumatic musculoskeletal injuries with different type of family involved. In our study involvement of members of joint family outnumbered patients from the nuclear family. This could be because joint family norms are still predominantly prevalent form of the family system in Himachal. A role for joint family norm in preventing musculoskeletal injuries needs to be explored further, more so in our context where fall is the commonest cause of injuries.
An injury affects people of all socioeconomic status. Available literature has not mentioned about the association of traumatic musculoskeletal injuries with socioeconomic status. In our study people above poverty line had a higher prevalence of traumatic musculoskeletal injuries. This could be because low poverty rate in Himachal Pradesh compared to national poverty rate.  The study on skeletal injuries following unintentional fall from height conducted in Delhi reported that the majority of the injuries (90%) were sustained in households and only 10% at places of work.  In another study conducted in Delhi, it was observed that most of the injuries occurred at home (41.26%) followed by road (39.8%).  However, other studies indirectly support the fact that roadside accidents as most common cause of injury. ,,
In our study, most injuries were inflicted outside home while doing outdoor activities in all age groups. This could be because most of the injuries occur while being involved in outdoor activities related to farming and forestry. Also, the fact people have to travel long distance to perform daily chores predisposing them to injuries outside home with difficult geographical terrain contributing to fall.
| Conclusion|| |
Preventing traumatic musculoskeletal injuries offers a cost-effective approach. A multifaceted, interdisciplinary effort is required requiring collaboration of legislators, planners, law enforcement agencies, automobile manufactures, engineers and health professionals among others. The key message from this study conceptualizes an injury prevention framework based on education of the general public on injury prevention combined with environmental modifications.
| References|| |
Krug EG, Sharma GK, Lozano R. The global burden of injuries. Am J Public Health 2000;90:523-6.
Holder Y, Peden M, Krug E, Lund J, Gururaj G, Kobusingye O. Injury Surveillance Guidelines. Geneva, Switzerland: World Health Organization WHO Publications; 2001.
Verma PK, Tewari KN. Injury Prevention and Control. WHO Project No. ICP DPR 001. WHO; 2003. p. 1-13.
Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global burden of disease study. Lancet 1997;349:1498-504.
Mock C, Cherian MN. The global burden of musculoskeletal injuries: Challenges and solutions. Clin Orthop Relat Res 2008;466:2306-16.
Hsiao M, Malhotra A, Thakur JS, Sheth JK, Nathens AB, Dhingra N, et al.
Road traffic injury mortality and its mechanisms in India: Nationally representative mortality survey of 1.1 million homes. BMJ Open 2013;3:e002621.
Meena RK, Singh AM, Singh CA, Chishti S, Kumar AG, Langshon R. Pattern of fractures and dislocations in a tertiary hospital in North East India. Int J Epidemiol 2013;11:13-5.
Gulati D, Nat A, Kumar S, Agarwal A. Skeletal injuries following unintentional fall from height. Turk J Trauma Emerg Surg 2012;18:141-6.
Jha N, Srinivasa DK, Roy G, Jagadish S. Injury pattern among road traffic accident cases: A study from South India. Indian J Community Med 2003;28:85-90.
Akinpelu OV, Oladele AO, Amusa YB, Adeolu AA, Kolofe EO. Review of road traffic accident admissions in a Nigerian tertiary hospital. East Cent Afr J Surg 2007;12:63-7.
Swarnkar M, Singh P, Dwivedi S. Pattern of trauma in central India - An epidemiological study with special reference to mode of injury. Int J Epidemiol 2010;9:1.
Tandon T, Shaik M, Modi N. Paediatric trauma epidemiology in an urban scenario in India. J Orthop Surg (Hong Kong) 2007;15:41-5.
Bradley C, Harrison J. Descriptive epidemiology of traumatic fractures in Australia. Injury Research and Statistics Series Number 17. Adelaide: AIHW; 2004. [AIHW cat No. INJCAT 57].
WHO. Injury Prevention and Control: An Epidemiological Study of Injuries in the Area of Municipal Corporation of Delhi. Regional Office for South-east Asia; 2003. p. 1-18.
Dandona R, Kumar GA, Ameer MA, Ahmed GM, Dandona L. Incidence and burden of road traffic injuries in urban India. Inj Prev 2008;14:354-9.
Kumar A, Mohan D, Mahajan P. Studies on tractor related injuries in Northern India. Accid Anal Prev 1998;30:53-60.
Adarsh K, Varghese M, Mohan D. Equipment-related injuries in agriculture: An international perspective. Inj Control Saf Promot 2000;7:1-12.
[Table 1], [Table 2], [Table 3]