Please note that the pages on this website do not reflect the methods that were used to generate the final set of results for the GBD-2010 study, which was published in December 2012.
-- If you are interested in the methods or results of GBD-2010 and subsequent revisions, please visit the official website of IHME's GBD project (http://www.healthdata.org/gbd). The materials described on the website are now obsolete but these webpages have been retained as an internet archive of the work of the group.
-- Please visit the website www.globalburdenofinjuries.org to find out more about other closely related collaborations of our group members.
Updated April 29 2009
Almost all of the work of this expert group is structured in discussion topics, which are typically lead by one or more core members of the expert group. When a new issue of relevance to the injuries component of the GBD project is identified by the group, it is referred to one of these discussion topics. If the subject is not adequately covered by any of these discussion topics, a new topic is added to the list.
It is expected that most of these discussion topics will become academic research publications. Thus, authorship of these discussions is expected to be based on contribution to the topic as is broadly accepted by the academic community. Furthermore the materials presented in these discussions are the intellectual property of the listed authors.
In addition to authors and co-authors, the listing includes a category called "lurking members". These are people who should be included on all communications about the discussion. The primary purpose of this is to ensure adequate cross-communications between discussion topics. In addition, lurking members are often members who can help guide the topic but may be unable to contribute substantially to the discussion.
Topic 1: Case definition
Lead authors: John Langley (john.langley@ipru.otago.ac.nz)
Additional Authors: Ronan Lyons, Limor Aharonson-Daniel, Tim Driscoll, Caroline Finch
Lurking members: James Harrison, Kavi Bhalla, Lois Fingerhut
Issue: The default case definition (ie as applied in previous GBD work) is cases with ICD codes from the injury or external cause chapters which are recorded in administrative records of death, admission to a hospital or, perhaps, attendance at a hospital emergency department. This is not ideal, especially in light of conceptual developments in the injury prevention research community. Some specific issues warranting attention: conceptual scope (eg Restrict to physical trauma? Why?); severity and severity thresholds; which mild/moderate injury types should be included?; [more?].
Lead authors: Kavi Bhalla (kavi_bhalla@harvard.edu)
Additional authors: Kidist Bartolomeos, Nagesh Borse, Soufiane Boufous, Ronan Lyons, Limor Aharonson-Daniel, Tim Driscoll, Jerry Abraham
Lurking members: James Harrison, Caroline Finch
Issue: The work of the injury group will depend, more than the work of many other groups in the project, on obtaining and analysing morbidity data. To be sufficient for the project, relevant data must be obtained for many parts of the world, including regions for which data are likely to be scanty and difficult to obtain. This paper will compile a lists of sources known at the time of writing. Members are requested to provide information on additional relevant sources of data. The paper will be updated periodically to include these.
Topic 3: Categories and definitions for GBD injury 'sequelae'
Lead authors: James Harrison (james.harrison@flinders.edu.au)
Additional authors: Wendy Watson, Maria Segui-Gomez, Jed Blore, Belinda Gabbe, Fred Rivara, Saeid Shahraz, Phil Edwards, Pablo Perel
Lurking members: Lois Fingerhut , Tim Driscoll, and Kavi Bhalla
Issue: GBD 'disability weights' are required for the estimation of YLD. The reliability of existing weights for injury has been questioned. A most important aspect of the GBD 2005 project is the production of a new set of weights. Expert groups, including the injury group, are able to contribute to this sub-project by advising on the categories for which weights should be provided (ie the list of GBD 2005 'sequelae' and by providing definitions for these. The definitions will be used in the study to generate weights: they will be the basis for the descriptions of conditions that will be used by study subjects to compare hypothetical states. This paper provides a draft list of injury sequelae and some draft examples of definitions for comment by members. Members interested in contributing to this aspect of the work are invited to contribute to the paper.
Topic 4: Dimensions of functioning relevant to injury
Lead authors: Wendy Watson (w.watson@unsw.edu.au) and Maria Segui-Gomez (msegui@unav.es)
Additional authors: Ronan Lyons, Sarah Derrett
Lurking members: James Harrison, Kavi Bhalla
Issue: It is not yet clear which dimensions of functioning will be taken into account in the sub-project to develop new weights for this project. Sets of weights for previous GBD work have not been optimal for injury. For example, cognitive functioning, probably the most important dimension of functioning subject to deficits due to traumatic brain injury, has tended to be overlooked. This paper is intended to provide advice concerning the requirements for injury. Some specific issues warranting attention: should/can PTSD be covered?
Topic 5: Dealing with multiple injuries.
Lead authors: Belinda Gabbe (belinda.gabbe@med.monash.edu.au)
Additional authors: Limor Aharonson-Daniel, Mohsen Naghavi, Theo Vos, Phil Edwards, Pablo Perel, Margaret Warner
Lurking members: James Harrison, Kavi Bhalla, Lois Fingerhut
Issue: Many of the injury cases likely to result in heavy burden involve multiple injuries (e.g. traumatic brain injury plus limb fractures). The ICD provides two ways to record complex and multiple injuries: single codes for certain multiple injuries; and assignment of codes for the several single injuries present in a case. The latter is preferred for coding hospital morbidity in many countries. How should multiple injuries be handled when construction "sequela" categories for GBD? This issue appears not to have been considered in most previous GBD work, the 2003 Australian national study being an exception.
Topic 6: Implications for measurement of injury burden of method chosen to generate weights.
Lead authors: Ronan Lyons (r.a.lyons@swansea.ac.uk)
Additional author: Rebecca Spicer, Juanita Haagsma, Ed Van Beeck, Steven Macey
Lurking members: James Harrison, Kavi Bhalla, Lois Fingerhut, Sarah Derett
Issue: Recent work (e.g. Haagsma et al 2008; UK GBD project in which Lyons is involved) implies potential for large effects on absolute and relative estimates of burden due to injury. This has two main aspects: high-frequency low case-severity conditions; and chronic or intermittent conditions, with sometimes substantial case-specific burden.
J A Haagsma, E F van Beeck, S Polinder, N Hoeymans, S Mulder, and G J Bonsel
Novel empirical disability weights to assess the burden of non-fatal injury
Inj Prev 2008 14: 5-10. doi:10.1136/ip.2007.017178
Topic 7: Dealing with unspecified and poorly specified categories in case data sets
Lead authors: Kavi Bhalla (kavi_bhalla@harvard.edu), James Harrison (james.harrison@flinders.edu.au)
Additional author: Lois Fingerhut, Margaret Warner, Mohsen Naghavi
Lurking members: Saeid Shahraz, Tim Driscoll
Issue: The ICD includes categories that specify causes and conditions well and other categories that are less specific. For example, in ICD-10, R99 means "Other ill-defined and unspecified causes of mortality" and X59 means "Exposure to unspecified factor". Cases assigned such codes should be accounted for in GBD calculations, but to which cause or condition should they be attributed? This does not matter much if a small proportion of cases have such codes, but these codes appear frequently in some datasets. For example, X59 appears as the Underlying Cause of death for about 10% of injury deaths in Mexico. Common practice in previous GBD work has been to re-assign such cases in simple proportion to specifically-coded cases, within age and sex strata. Is this approach sufficiently reliable? This paper examines which poorly specified categories are important for injury, and whether the simple proportionate re-assignment method (within age- sex- strata) is sufficient for the purposes of the GBD 2005 project.
Topic 8: Reporting categories: grouped external causes, grouped injury conditions or both?
Lead authors: Maria Segui-Gomez (msegui@unav.es), James Harrison (james.harrison@flinders.edu.au)
Additional authors: Lois Fingerhut
Lurking members: Kavi Bhalla, Caroline Finch
Issue: Different purposes are best served by reports of DALYs by external causes (e.g. road traffic injury) or by trauma (eg traumatic brain injury). What are the pros and cons of each? Is it feasible to report in terms of more than one list of categories? Can one or more of the lists promulgated by the ICE on Injury Statistics be used in this context?
Topic 9: Recurrent injury
Lead authors: Caroline Finch (c.finch@ballarat.edu.au)
Additional authors: Ronan Lyons, Soufiane Boufous
Lurking members: James Harrison, Kavi Bhalla
Issue: Some conditions that are or might become with in the scope of injury, as defined for the GBD project, can be recurrent, intermittent or fluctuating. Furthermore, repeat hospital visits for the same injury may result in incorrect estimates of incidence. The issue is two-fold: Does this have significant implications for GBD? If so, how can these be managed?
Topic 10: Assumption that burden of a condition is independent of the mechanism that produced it
Lead author: Maria Segui-Gomez (msegui@unav.es)
Additional authors: Belinda Gabbe, Limor Aharanson-Daniel
Lurking members: Tim Driscoll, James Harrison, Kavi Bhalla, Sarah Derett
Issue: A condition such as amputation of a leg below the knee can result from diabetes, a land-mine or other causes. Is it correct to assume that the health burden of the condition is independent of how it cam about?
Topic 11: Mortality data
Lead author: Lois Fingerhut (lafingerhut@gmail.com)
Additional authors: Kavi Bhalla, Mohsen Naghavi, Tim Driscoll
Lurking members: James Harrison
Issue: The Operations manual for the project implies that obtaining and analysing mortality data is a 'central' function, and that the role of Expert Groups will largely be limited to assessment of the results. In practice, the Injury expert group must have a more hands-on approach to mortality data, for several reasons. These include: (1) Doubts about the reliability of the official mortality data for some countries; This has clearly been demonstrated by WHO databases which show poor timeliness and poor coverage for large proportions of the world (See attached papers from Nov 2007 Lancet.(2) the lack of official mortality data for some countries and regions; (related to # 1) (3) the need to analyse mortality data directly in order to come up with and evaluate methods to deal with limitations of the data (e.g. re-allocation of poorly-specified cases); (4) is there a need to search for alternative sources of mortality data (road traffic fatality systems- done by Harvard group? Other than road traffic, what other national sources of injury mortality data might exist (police records of homicide?) ? (5) can we “assume” that injury deaths will have more complete coverage than diseases? If so, where is the evidence?. (6) This paper also overlaps with topic # 7 :Dealing with unspecified and poorly specified categories in case data sets . Even in the “best” of data sets, there is the issue of unspecified and poorly specified codes.
Topic 12: GBD External Cause List and Associated ICD Code Groups
Lead author: James Harrison (james.harrison@flinders.edu.au) and Kavi Bhalla (kavi_bhalla@harvard.edu)
Additional authors: Caroline Finch
Lurking members:
Issue: GBD reports incidence of mortality and burden for a chosen set of external causes. This discussion focuses on identifying the listing of external causes while accounting for (1) policy relevance; and (2) the availability of specific ICD codes for these categories so that estimation is possible.
Topic 13: Disability prevalence
Lead author: Wendy Watson (w.watson@unsw.edu.au)
Additional authors: Sarah Derrett, Maria Segui-Gomez
Lurking members: James Harrison and Kavi Bhalla
Issue: Many routine national data collection activities (e.g. censuses and health surveys) collect information about the prevalence of disabilities in the population. What is the relevance of this information to GBD?
Topic 14: Measuring the burden of musculo-skeletal injuries
Lead author: Caroline Finch (c.finch@ballarat.edu.au)
Additional authors:
Lurking members: James Harrison, Kavi Bhalla, Sarah Derett
Issue: Irrespective of their cause, some musculo-skeletal injuries can have significant impact on a person's well-being. For example, anterior cruciate ligament (ACL) tears that are so severe that the knee needs reconstruction place significant limitations on their sufferer and require quite substantial rehabilitation with resultant short-middle term disability and disruption to quality of life, ability to perform activities of daily living and pain and suffering. Moreover some musculo-skeletal injuries also have the possibility of impacting on future functional capacity and other health conditions, e.g. through predisposing people to the development of osteoarthritis. This discussion will explore the evidence for significant burdens associated with musculo-skeletal injuries and advise if certain specific injuries should be highlighted as key conditions with significant burdens for including in the GBD modelling..
Topic 15: Making optimal use of police reported statistics on national road traffic injuries
Lead author: David Bartels (davidhbartels@gmail.com), Kavi Bhalla (kavi_bhalla@harvard.edu), Pon-Hsiu Yeh (ponpon@gmail.com)
Additional authors: Francisco Lopez-Valdes, Muazzam Nasrullah
Lurking members: James Harrison
Issue: Government statistics websites for most developing countries report national deaths from road traffic injuries. However, the likelihood of severe under-reporting by police, makes this an unreliable source of information. This discussion will explore how police reported data can be made more useful for GBD analysis.
Topic 16: Sports injuries - are we ignoring a significant public health opportunity
Lead author: Caroline Finch (c.finch@ballarat.edu.au)
Additional authors:
Lurking members: James Harrison, Kavi Bhalla, Sarah Derett
Issue: Sports injuries are known to be a common and potentially significant cause of injury morbidity, yet they are largely excluded from the current GBD project. This is because there are very few specific external cause codes that can identify such injuries and the exiting codes, do not cover all cases. To some extent, this has been addressed through the introduction of ICD-10 codes for activity at time of injury.The same problem arises in the context of work-related injury but this category is being handled by the occupational health risk context within GBD. This paper will discuss the burden of sports injuries specifically and the implications for both sports injury (as a public health issue) and the GBD estimates, of current GBD modelling plans which are likely to overlook this significant cause of injury morbidity.
It is possible that this paper could also look at sport as a contributor to other GBD costs as well.