This study found that the majority of injuries in South Eastern Iran were due to road traffic crashes. The next most common injuries were trauma and poisoning. For all injury types, individuals living in urban areas were more likely to be injured compared to rural areas. For most injury types, males were more likely than females to be affected. Males were most likely to be injured in a street, alley or village whereas females were most likely to be injured in or around the home. In urban areas, road traffic related injuries were observed to affect older age groups more than younger age groups. Poisoning was most common in the youngest age group, 0 to 4 years.
The pattern of injuries observed in our study, with road traffic crashes, trauma and poisoning being the most common, differ from fires, drowning, violence and war-related injuries which are the most common injuries in Sub-Saharan Africa; and self-inflicted injuries and traffic-related injuries which are the most common in China and Latin America
]. There are mixed results about the occurrence of injury by urban/rural place of residence in the literature
]. Similar to our findings, the vast majority of previously published studies also show that males are at a higher risk of having an injury than females
]. Previous studies have also shown that most injuries occur in and around home
Our study found the overall injury rate to be 916 per 100,000 individuals. This rate is similar to the injury rate observed in a recent study of nearly 3 million emergency department admissions for injury in Iran; approximately 1% per year in our study and 1.4% in the study by Rasouli et al.
]. However, the rate we observed for injury is much higher than the non-fatal injury rate reported previously in a national study in Iran of 444.3 per 100,000
]. A smaller study in a rural state of Iran found the non-fatal injury rate to be 172 per 100,000 people
]. However, these non-fatal injury rates observed in Iran are still much lower than the 10,000 per 100,000 individuals reported in a study in rural Nigeria
]. The difference in observed rates in our study compared to the previous Iranian study could be due to the studied province truly having increased rates of injury or could also be due to the type of data used to calculate injury rates. The previous study by Soori et al.
] used a retrospective survey of households across Iran, whereas our study used emergency room medical records. Although we would expect a household survey to capture more, rather than less injuries, given household surveys are more likely to include less severe injuries as well as the more severe injuries presenting to emergency departments. The sex differences observed in our study are in keeping with past research internationally as well as in Iran, which demonstrate that males have increased risk of injury compared to females
]. Our study observed an increased injury rate for individuals living in urban, compared to rural, areas at a ratio of about 5 to 1. In comparison, the national Iranian study found injury rates to be approximately equal across urban and rural areas
Our findings regarding road traffic crashes being the most common risk factor for injury mirrors that previously observed in Iran
] and around the world
]. We observed a road traffic injury rate of 308 per 100,000. A previous study found that in Iran, injuries on the road were due mainly to motorized two-wheeler riders, whereas deaths were mainly due to cars
]. In a previous study in Pakistan a road traffic injury rate of 1,500 per 100,000 was observed
]. The study in Pakistan was a nationally representative survey study of households. Similar to our study, the study of injuries in Pakistan also found a male predominance in road traffic crashes and also found young and older adults to be at higher risk (compared to children). A recently published article investigating factors related to road traffic injury severity in Iran found that lack of seat belt use was the most important factor related to injury severity
]. Improper overtaking, speeding, vehicle defects and unauthorized vehicles on freeways, as well as pedestrians and livestock were also factors which increased injury severity
Strengths and limitations
This study provides information from a large dataset comprising over 18,000 injuries from South Eastern Iran. By collecting data at all emergency departments in the province, we are able to provide incidence data for injuries (severe enough to lead to emergency room presentation) and to examine patterns of injury by age, sex and urban/rural status. Data were routinely collected from medical records therefore were standardized across different emergency rooms. However, since this study collected data from emergency departments it was not able to capture less severe injuries, or those treated traditionally in the community. Furthermore, it was not possible to determine the outcome of patients in details due to insufficient data in this case. Data were coded according to the ICD-10 which facilitates comparisons with other regions and countries.