The burden of injury in Central, Eastern, and Western European sub-region: a systematic analysis from the Global Burden of Disease 2019 Study
Authors: Haagsma Juanita A. , Charalampous Periklis , Ariani Filippo , Gallay Anne , Moesgaard Iburg Kim , Nena Evangelia , Ngwa Che Henry , Rommel Alexander , Zelviene Ausra , Abegaz Kedir Hussein , Al Hamad Hanadi , Albano Luciana , Liliana Andrei Catalina , Andrei Tudorel , Antonazzo Ippazio Cosimo , Aremu Olatunde , Arumugam Ashokan , Atreya Alok , Aujayeb Avinash , Ayuso-Mateos Jose Luis , Engelbert Bain Luchuo , Banach Maciej , Winfried Bärnighausen Till , Barone-Adesi Francesco , Beghi Massimiliano , Bennett Derrick A. , Bhagavathula Akshaya S. , Carvalho Félix , Castelpietra Giulio , Caterina Ledda , Chandan Joht Singh , Couto Rosa A. S. , Cruz-Martins Natália , Damiani Giovanni , Dastiridou Anna , Demetriades Andreas K. , Dias-da-Silva Diana , Francis Fagbamigbe Adeniyi , Fereshtehnejad Seyed-Mohammad , Fernandes Eduarda , Ferrara Pietro , Fischer Florian , Fra.Paleo Urbano , Ghirini Silvia , Glasbey James C. , Glavan Ionela-Roxana , Gomes Nelson G. M. , Grivna Michal , Harlianto Netanja I. , Haro Josep Maria , Hasan M. Tasdik , Hostiuc Sorin , Iavicoli Ivo , Ilic Milena D. , Ilic Irena M. , Jakovljevic Mihajlo , Jonas Jost B. , Jerzy Jozwiak Jacek , Jürisson Mikk , Kauppila Joonas H. , Kayode Gbenga A. , Khan Moien A. B. , Kisa Adnan , Kisa Sezer , Koyanagi Ai , Kumar Manasi , Kurmi Om P. , La-Vecchia Carlo , Lamnisos Demetris , Lasrado Savita , Lauriola Paolo , Linn Shai , Loureiro Joana A. , Lunevicius Raimundas , Madureira-Carvalho Aurea , Mechili Enkeleint A. , Majeed Azeem , Menezes Ritesh G. , Mentis Alexios-Fotios A. , Meretoja Atte , Mestrovic Tomislav , Miazgowski Tomasz , Miazgowski Bartosz , Mirica Andreea , Molokhia Mariam , Mohammed Shafiu , Monasta Lorenzo , Mulita Francesk , David Naimzada Mukhammad , Negoi Ionut , Neupane Subas , Oancea Bogdan , Orru Hans , Otoiu Adrian , Otstavnov Nikita , Otstavnov Stanislav S. , Padron-Monedero Alicia , Panda-Jonas Songhomitra , Pardhan Shahina , Patel Jay , Pedersini Paolo , Pinheiro Marina , Rakovac Ivo , Rao Chythra R. , Rawaf Salman , Rawaf David Laith , Rodrigues Violet , Ronfani Luca , Sagoe Dominic , Sanmarchi Francesco , Santric-Milicevic Milena M. , Sathian Brijesh , Sheikh Aziz , Shiri Rahman , Shivalli Siddharudha , Dora Sigfusdottir Inga , Sigurvinsdottir Rannveig , Yurievich Skryabin Valentin , Aleksandrovna Skryabina Anna , Smarandache Catalin-Gabriel , Socea Bogdan , Sousa Raúl A. R. C. , Steiropoulos Paschalis , Tabarés-Seisdedos Rafael , Roberto Tovani-Palone Marcos , Tozija Fimka , Van de Velde Sarah , Juhani Vasankari Tommi , Veroux Massimiliano , Violante Francesco S. , Vlassov Vasiliy , Wang Yanzhong , Yadollahpour Ali , Yaya Sanni , Sergeevich Zastrozhin Mikhail , Zastrozhina Anasthasia , Polinder Suzanne , Majdan Marek 
Published: May 2022

Abstract
Background
Injury remains a major concern to public health in the European region. Previous iterations of the Global Burden of Disease (GBD) study showed wide variation in injury death and disability adjusted life year (DALY) rates across Europe, indicating injury inequality gaps between sub-regions and countries. The objectives of this study were to: 1) compare GBD 2019 estimates on injury mortality and DALYs across European sub-regions and countries by cause-of-injury category and sex; 2) examine changes in injury DALY rates over a 20 year-period by cause-of-injury category, sub-region and country; and 3) assess inequalities in injury mortality and DALY rates across the countries.

Methods
We performed a secondary database descriptive study using the GBD 2019 results on injuries in 44 European countries from 2000 to 2019. Inequality in DALY rates between these countries was assessed by calculating the DALY rate ratio between the highest-ranking country and lowest-ranking country in each year.

Results
In 2019, in Eastern Europe 80 [95% uncertainty interval (UI): 71 to 89] people per 100,000 died from injuries; twice as high compared to Central Europe (38 injury deaths per 100,000; 95% UI 34 to 42) and three times as high compared to Western Europe (27 injury deaths per 100,000; 95%UI 25 to 28). The injury DALY rates showed less pronounced differences between Eastern (5129 DALYs per 100,000; 95% UI: 4547 to 5864), Central (2940 DALYs per 100,000; 95% UI: 2452 to 3546) and Western Europe (1782 DALYs per 100,000; 95% UI: 1523 to 2115). Injury DALY rate was lowest in Italy (1489 DALYs per 100,000) and highest in Ukraine (5553 DALYs per 100,000). The difference in injury DALY rates by country was larger for males compared to females. The DALY rate ratio was highest in 2005, with DALY rate in the lowest-ranking country (Russian Federation) 6.0 times higher compared to the highest-ranking country (Malta). After 2005, the DALY rate ratio between the lowest- and the highest-ranking country gradually decreased to 3.7 in 2019.

Conclusions
Injury mortality and DALY rates were highest in Eastern Europe and lowest in Western Europe, although differences in injury DALY rates declined rapidly, particularly in the past decade. The injury DALY rate ratio of highest- and lowest-ranking country declined from 2005 onwards, indicating declining inequalities in injuries between European countries.