Economic development and injury mortality : Studies in global trends from a health transition perspective

Globally, injury is a major public health problem. The extent of the problem varies considerably by demographic subgroups, regions and national income. The overall objective of this thesis is to examine the relationship between injury mortality and economic development, and to discuss its role in the changing patterns of mortality as described in health transition theory. By cross-sectional analysis between cause-specific injury-related mortality and income per capita, studies included in this thesis indicated that while unintentional injury mortality (UIM) and homicide rates correlated negatively with GNP per capita for total populations with varying patterns for age-specific mortality, suicide rates increased slightly by nations’ income per capita, especially among women. In age- and cause-specific injury mortality differentials between low-income, middle-income and high-income countries, ageing and injury interplay mutually with regard to health transition; declining rates in child UIM by income level contributes to the ageing process, while increasing UIM among the elderly, in combination with ageing populations boosts the absolute number of injury deaths in this segment. Between the income-based country groups, both cross-sectional and longitudinal analyses show that injury mortality for all three major causes (i.e. unintentional injury, suicide and homicide) first increase and then decrease with rising income per capita, following an inverted U-shaped curve. These results illustrate that injury is not a homogeneous public health phenomenon from a health transition perspective. While child unintentional mortality clearly agrees with ‘diseases of poverty’, unintentional injury in the elderly agrees with ‘diseases of affluence’. Patterns for homicide and suicide are more complex and uncertain. Generally, the strength and direction of injury mortality by economic development vary considerably by age, sex and type of injury. Further research on causations, mechanisms, broader indicators and data quality, as well as theoretical developments on health transition taking new findings and parallel frameworks into account, is needed to fully understand the complex relationship between economic development and injury mortality