The burden of injury in Central, Eastern, and Western European sub-region: a systematic analysis from the Global Burden of Disease 2019 Study
Authors: Charalampous Periklis , Haagsma Juanita A. , Ariani Filippo , Gallay Anne , Iburg Kim Moesgaard , Nena Evangelia , Ngwa Che Henry , Rommel Alexander , Zelviene Ausra , Abegaz Kedir Hussein , Hamad Hanadi Al , Albano Luciana , Andrei Catalina Liliana , Andrei Tudorel , Antonazzo Ippazio Cosimo , Aremu Olatunde , Arumugam Ashokan , Atreya Alok , Aujayeb Avinash , Ayuso-Mateos Jose Luis , Bain Luchuo Engelbert , Banach Maciej , Bärnighausen Till Winfried , 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 , Fagbamigbe Adeniyi Francis , 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. , Jozwiak Jacek Jerzy , 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 , Naimzada Mukhammad David , 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 , Sigfusdottir Inga Dora , Sigurvinsdottir Rannveig , Skryabin Valentin Yurievich , Skryabina Anna Aleksandrovna , Smarandache Catalin-Gabriel , Socea Bogdan , Sousa Raúl A.R.C. , Steiropoulos Paschalis , Tabarés-Seisdedos Rafael , Tovani-Palone Marcos Roberto , Tozija Fimka , de Velde Sarah Van , Vasankari Tommi Juhani , Veroux Massimiliano , Violante Francesco S. , Vlassov Vasiliy , Wang Yanzhong , Yadollahpour Ali , Yaya Sanni , Zastrozhin Mikhail Sergeevich , Zastrozhina Anasthasia , Polinder Suzanne , Majdan Marek 
Published: January 2022

Abstract
Background: Injury remains a major concern to public health in the European region, particularly among adults younger than 49 years. 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 death and DALY rates were highest in Eastern Europe and lowest in Western Europe, although differences in injury DALY rates decline 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.