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LETTER |
Correspondence: Requests for reprints should be sent to Pekka Kannus, MD, PhD, Accident and Trauma Research Center, President Urho Kaleva Kekkonen Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500 Tampere, FIN-33500, Finland (e-mail: pekka.kannus{at}uta.fi).
Jansson is worried about the effect of possible changes in registration practice on mortality trends. More specifically, he pays attention to changes in the International Classification of Diseases (ICD) and possible changes and differences in coding practice at national statistics agencies that might blur country-to-country comparisons. According to Jansson, these problems may lead to underestimation of fall injury mortality.
For the study that prompted Jansson’s letter,1 we obtained research data from the Finnish official cause-of-death statistics for adults aged 50 years or older who died as a result of a fall-induced injury between 1971 and 2002. In each selected case, the underlying or primary cause of death was a fall that resulted in fatal traumas in the body. Throughout the study years and irrespective and independent of changes in the ICD, the coding system used in these official statistics and the instructions for its use in injury-induced deaths have deliberately been kept unchanged, thus providing a firm basis for analysis of fall-injury mortality trends in Finland. As we reported, the register and its coding system have been quality controlled by the Cause-of-Death Bureau at Statistics Finland since their inception and have excellent coverage and high accuracy for epidemiological purposes.2,3
Thus we have every reason to believe that the observed increases in fall-induced deaths of elderly Finns between 1971 and 2002 were indeed real, reflecting the rising problem of falling among our older adults. Naturally, our Finnish statistics do not allow direct country-to-country comparisons, but they do emphasize the need for nation-specific studies in other countries and locations to speed up implementation of proven fall-prevention interventions.4–6
References
1. Kannus P, Parkkari J, Niemi S, Palvanen M. Fall-induced deaths among elderly people. Am J Public Health.2005;95:422–424.
2. Kannus P, Parkkari J, Koskinen S, et al. Fall-induced injuries and deaths among older adults. JAMA.1999;281:1895–1899.
3. Official Cause-of-Death Statistics 2002. Helsinki: Statistics Finland; 2003.
4. Tinetti ME. Preventing falls in elderly persons. N Engl J Med. 2003;348:42–49.
5. Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH. Interventions for preventing falls in elderly people. Cochrane Database Syst Rev. 2003;(4):CD000340.
6. Chang JT, Morton SC, Rubenstein LZ, et al. Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials. BMJ. 2004;328:680–683.
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