Injury Prevention最新文献

{"title":"Do sports utility vehicles (SUVs) and light truck vehicles (LTVs) cause more severe injuries to pedestrians and cyclists than passenger cars in the case of a crash? A systematic review and meta-analysis.","authors":"Elsa Robinson, Phil Edwards, Anthony Laverty, Anna Goodman","doi":"10.1136/ip-2024-045613","DOIUrl":"https://doi.org/10.1136/ip-2024-045613","url":null,"abstract":"<p><strong>Questions: </strong>In the case of a road traffic crash, do sports utility vehicles (SUVs) and light truck vehicles (LTVs) cause more severe injuries to pedestrians and cyclists than passenger cars? Does any effect differ between adults and children?</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Data sources: </strong>MEDLINE, TRID and Global Index Medicus were searched up to September 2024, with no restrictions by setting or language.</p><p><strong>Inclusion criteria: </strong>Eligible studies had to compare injury severity between pedestrians and/or cyclists hit by an SUV or LTV versus a passenger car. Only sources using real-world crash data were included.</p><p><strong>Main outcome measure: </strong>Injury severity, defined either as 'fatal versus non-fatal injury' or as 'killed or seriously injured (KSI) versus slight injury'.</p><p><strong>Results: </strong>24 studies were included in the meta-analysis. The results were similar between pedestrians and cyclists. When combining pedestrians and cyclists, the pooled odds of KSI versus slight injury if hit by an SUV/LTV versus a passenger car were higher among adults/all-age samples by 1.24 (95% CI 1.15, 1.34) and higher among children by 1.28 (95% CI 1.19, 1.37). The odds of fatal versus non-fatal injury if hit by an SUV/LTV versus a passenger car increased among adults/all-age samples by 1.44 (95% CI 1.33, 1.56) and among children by 1.82 (95% CI 1.57, 2.11; p=0.006 for heterogeneity by age).</p><p><strong>Conclusion: </strong>In the case of a crash, SUVs and LTVs cause more severe injuries to pedestrians and cyclists than passenger cars. This effect is larger for fatalities than for KSIs, and the fatality effect is particularly large for children.<b>PROSPERO registration number</b> CRD42024597283.</p>","PeriodicalId":13682,"journal":{"name":"Injury Prevention","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining fall-related mortality in registries and surveillance systems in sub-Saharan Africa: a systematic review.","authors":"Alissa Renz, Samuel Mayeden, Silvia Runge-Ranzinger, Valerie R Louis, Andreas Deckert, Peter Dambach, Volker Winkler, Olaf Horstick, Michael Lowery Wilson","doi":"10.1136/ip-2024-045467","DOIUrl":"https://doi.org/10.1136/ip-2024-045467","url":null,"abstract":"<p><strong>Objective: </strong>Fall-related injuries are a global public health concern, and trauma registries aid in collecting data to develop measures to reduce their burden on individuals and communities. The aim of this review was to provide a comprehensive overview of the reporting of fall-related mortality in trauma registries and surveillance systems in sub-Saharan Africa.</p><p><strong>Methods: </strong>A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched eight electronic databases, and studies set in countries of sub-Saharan Africa were included if the reported data originated from a trauma registry or surveillance system and contained a measurement of fall-related mortality. Results were synthesised in a descriptive manner.</p><p><strong>Results: </strong>Of the 3574 records found, we included 21 studies in the analysis. Different definitions were inconsistently used in reporting fall-related mortality: studies reported either a percentage of fall deaths by total falls or of fall deaths by total deaths. Deaths due to falls by total falls ranged from 0.01% to 2.4% in studies with paediatric patient populations, and from 0.03% to 60% among studies not restricted to a specific age group. Reporting on other variables in relation to injury and trauma care was also inconsistent.</p><p><strong>Conclusions: </strong>The findings of this review were heterogeneous, and variables were collected irregularly among trauma registries. This led to a broad range of results and made comparisons and deductions difficult. A more standardised data collection across registries would heighten the intercomparability of results from different studies and, therefore, facilitate usage in data-based efforts for implementing prevention and optimising care.</p>","PeriodicalId":13682,"journal":{"name":"Injury Prevention","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is legislation effective in reducing risks of all-terrain vehicle-related injuries? A systematic review.","authors":"Natalie L Yanchar, Olutayo Toriola, Suzanne Beno, Alison K Macpherson, Ioana Bratu, Mary E Brindle","doi":"10.1136/ip-2024-045576","DOIUrl":"https://doi.org/10.1136/ip-2024-045576","url":null,"abstract":"<p><strong>Background: </strong>Over decades, governments have enacted policies and legislation mandating strategies to reduce the incidence and severity of all-terrain vehicle (ATV)-related injuries. We performed a systematic review to determine the efficacy of laws and policies in reducing these injuries.</p><p><strong>Methods: </strong>Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 20 articles from the peer-reviewed literature were systematically selected. Associations between legislation/policy and changes or differences in injury numbers, rates or severity were queried.</p><p><strong>Results: </strong>Data were available to examine age restrictions or child/youth-directed safety measures, use of helmets and vehicle-specific/engineering policies. Legislating age restrictions was associated with limited paediatric injury reduction in five of nine studies; sustained efficacy may require concurrent socialisation through media or regulated riding environments. Mandated helmet use was associated with reduced ATV-related mortality in five of six studies. However, the concurrent presence of other safety legislation precludes concluding the efficacy of helmet laws, alone. Legislation targeting vehicle design/engineering is limited, as are studies of their efficacy. A US federal decree for large-scale vehicle-related and industry-related changes was associated with a brief but dramatic decrease in ATV-related deaths; this reversed once the decree was lifted.</p><p><strong>Conclusions: </strong>With the possible exception of helmet legislation, many laws aimed at reducing ATV-related injuries demonstrate little association with actual injury reduction. Most target changing individual behaviours and may be unsuccessful due to personal perceptions of low risk of injury. Enacting policies directed to industry, to address design and engineering interventions that can reduce risk during operation of these products, is more likely to result in substantive and sustained change.</p>","PeriodicalId":13682,"journal":{"name":"Injury Prevention","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preparing for a meta-analysis of rates: extracting effect sizes and standard errors from studies of count outcomes with person-time denominators.","authors":"Matthew Spittal","doi":"10.1136/ip-2024-045610","DOIUrl":"https://doi.org/10.1136/ip-2024-045610","url":null,"abstract":"<p><strong>Background: </strong>Formulas for the extraction of continuous and binary effect sizes that are entered into a meta-analysis are readily available. Only some formulas for the extraction of count outcomes have been presented previously. The purpose of this methodological article is to present formulas for extracting effect sizes and their standard errors for studies of count outcomes with person-time denominators.</p><p><strong>Methods: </strong>Formulas for the calculation of the number of events in a study and the corresponding person time in which these events occurred are presented. These formulas are then used to estimate the relevant effect sizes and standard errors of interest. These effect sizes are rates, rate ratios and rate differences for a two-group comparison and rate ratios and rate differences for a difference-in-difference design.</p><p><strong>Results: </strong>Two studies from the field of suicide prevention are used to demonstrate the extraction of the information required to estimate effect sizes and standard errors. In the first example, the rate ratio for a two-group comparison was 0.957 (standard error of the log rate ratio, 0.035), and the rate difference was -0.56 per 100,000 person years (standard error 0.44). In the second example, the rate ratio for a difference-in-difference analysis was 0.975 (standard error of the log rate ratio 0.036) and the rate difference was -0.30 per 100,000 person years (standard error 0.42).</p><p><strong>Conclusions: </strong>The application of these formulas enables the calculation of effect sizes that may not have been presented in the original study. This reduces the need to exclude otherwise eligible studies from a meta-analysis, potentially reducing one source of bias.</p>","PeriodicalId":13682,"journal":{"name":"Injury Prevention","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantifying rip current-related drowning deaths and exposure on Australian beaches.","authors":"Sean Kelly, Jessica Ledger, William Koon, Robert Brander, Amy E Peden, Shane Daw, Jasmin C Lawes","doi":"10.1136/ip-2024-045565","DOIUrl":"https://doi.org/10.1136/ip-2024-045565","url":null,"abstract":"<p><strong>Background: </strong>Rip currents are the leading coastal hazard on Australian beaches and a significant contributor to coastal drowning. This comprehensive study explored the long-term epidemiology and exposure-based mortality rates of Australian rip current drowning deaths, with the purpose of informing rip-related education efforts to reduce coastal drowning risk.</p><p><strong>Methods: </strong>A retrospective descriptive analysis of rip current drowning deaths between 1 July 2004 and 30 June 2023 was conducted, and rip current involvement was determined using data triangulation methods (incident narrative, beach imagery and expert opinion). Temporal trends were examined using Joinpoint regression, while Australian population and coastal participation data were used to calculate mortality rates.</p><p><strong>Results: </strong>407 rip current drowning deaths were identified (21 deaths/year); an exposure-based mortality rate of 0.11/1 million coastal visits. Incidents predominantly involved males (85%), 20-34 years (38%), occurred in regional/remote areas (59%) and in the presence of others (80%). For every rip current drowning death, an estimated 2449 people were rescued by someone else and 8171 individuals self-rescued.</p><p><strong>Discussion: </strong>Despite small reductions in the rate of rip current drowning among males, little overall progress has been seen in attempts to decrease the mortality burden. Future efforts will require an expanded approach, beyond traditional means.</p><p><strong>Conclusions: </strong>Rip currents remain a significant public health threat and the number one coastal hazard contributing to preventable mortality along Australia's coastline.</p><p><strong>Implications for public health: </strong>Improved rip current education approaches, development and evaluation are needed to direct effective messaging to at-risk groups.</p>","PeriodicalId":13682,"journal":{"name":"Injury Prevention","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Injuries from falling out of bed in infants under 1 year of age: a systematic review.","authors":"Camile Lima Barros Ourem Campos, Gabriela Carneiro de Farias Evangelista, Lucas Victor Alves, Joao Guilherme Alves","doi":"10.1136/ip-2025-045660","DOIUrl":"https://doi.org/10.1136/ip-2025-045660","url":null,"abstract":"<p><strong>Context: </strong>Falls from beds are a leading cause of unintentional injuries in infants under 1 year of age. While most cases result in mild outcomes, the potential for severe injuries, such as skull fractures or intracranial haemorrhages, exists. Despite the prevalence of these incidents, no systematic review has focused specifically on injuries from bed falls in this specific age.</p><p><strong>Objective: </strong>To evaluate the risk and severity of injuries caused by falls from beds in infants under 1 year of age through a systematic review.</p><p><strong>Data sources: </strong>We searched in PubMed, Embase, Cochrane Library and Lilacs Scielo for studies published between 1984 and December 2024.</p><p><strong>Study selection: </strong>We included observational studies that reported injuries from falls from beds in infants under 1 year.</p><p><strong>Data extraction: </strong>We extracted the relevant data from the included study details, recruitment setting, study design, sample size and outcome measures. We conducted a quality assessment using the Newcastle-Ottawa Scale.</p><p><strong>Results: </strong>Out of 297 initially identified studies, three met inclusion criteria, comprising a total of 2034 infants under 1 year of age. Most falls resulted in minor or no injuries. Warrington <i>et al</i> reported <1% of cases leading to concussion or fractures. Samuel <i>et al</i> identified two cases of intracranial haemorrhage and linear skull fractures without intervention. Kolulu <i>et al</i> observed significant injuries, including skull fractures and cerebral contusions, in 10.2% of infants.</p><p><strong>Conclusions: </strong>Falls from beds are frequent in infants under 1 year, with most resulting in minor outcomes. However, serious injuries occur in around 5% of infants below 1-year old, emphasising the need for prevention strategies and clinical guidelines for managing post-fall assessments. Further research is required to refine understanding and improve prevention and management practices.</p><p><strong>Prospero registration number: </strong>CRD42024626255.</p>","PeriodicalId":13682,"journal":{"name":"Injury Prevention","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-sectional survey to investigate bicycle riders' knowledge and experience of structural weakness in bicycles in Australia.","authors":"Julie Hatfield, Soufiane Boufous, Andrew Roman Novak","doi":"10.1136/ip-2024-045518","DOIUrl":"https://doi.org/10.1136/ip-2024-045518","url":null,"abstract":"<p><strong>Background: </strong>Structural weakness may occur within bicycles (eg, during manufacture or impact) and may result in sudden failure and serious injuries. While some indicators of structural weakness may be detected by visual inspection, others require more advanced non-destructive tests. Available research is yet to adequately examine bicycle riders' awareness and experience of the structural weakness in bicycles, or their knowledge and use of testing methods.</p><p><strong>Methods: </strong>An online cross-section survey of 298 bicycle riders was conducted to address these knowledge gaps.</p><p><strong>Results: </strong>11.4% of respondents had experienced at least one crash that they suspected was due partly to structural weakness, with just over half resulting in injury and just under half involving costs greater than $A500. About 25% of respondents had a component replaced because of 'failure during normal use'. More than one third did not think it was necessary to test for indicators or weaknesses when buying a used bicycle, or after a crash. Testing was most likely following motor vehicle collisions and for bicycles with carbon components. Visual inspection was the most reported form of testing and only 42% of respondents reported being aware of any non-destructive methods of testing.</p><p><strong>Discussion and conclusions: </strong>11.4% of respondents had experienced at least one crash that they suspected was due partly to structural weakness, with just over half resulting in injury and just under half involving costs greater than $A500. About 25% of respondents had a component replaced because of 'failure during normal use'. More than one-third did not think it was necessary to test for indicators or weaknesses when buying a used bicycle or after a crash. Testing was most likely following motor vehicle collisions and for bicycles with carbon components. Visual inspection was the most reported form of testing, and only 42% of respondents reported being aware of any non-destructive methods of testing.Results suggest that structural weakness in bicycles is fairly common while awareness of the issue, and methods of testing for it, is limited. Public education about when and how to test for weakness (eg, after any crash), and improvement in production standards and quality assurance, may reduce injuries due to bicycle failure.</p>","PeriodicalId":13682,"journal":{"name":"Injury Prevention","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic review of the impact of interventions changing access to lethal means on suicide attempts and deaths.","authors":"Lisa M Shank, Derek J Smolenski, Courtney Boyd, Dawn M Bellanti, Reshmi Nair, Kiriana Cowansage, Salvatore Libretto, Kamaria Frazier, Daniel P Evatt, Marija S Kelber","doi":"10.1136/ip-2024-045611","DOIUrl":"https://doi.org/10.1136/ip-2024-045611","url":null,"abstract":"<p><strong>Objective: </strong>The study objective was to examine if interventions changing access to lethal means are associated with changes in suicide deaths and/or attempts by conducting a systematic review of controlled intervention studies.</p><p><strong>Methods: </strong>Authors searched key databases (PubMed, PsycInfo, CINAHL) from inception to March 2024 for longitudinal controlled intervention studies with at least one contemporaneous comparator group evaluating the impact of interventions changing access to lethal means on suicide attempts and/or deaths in a primarily adult population. Reviewers dually screened articles, then extracted study characteristics and assessed methodological quality.</p><p><strong>Results: </strong>Researchers screened 8522 studies and 36 articles met eligibility for inclusion. Most studies evaluated the impact of population-level firearm interventions on suicide deaths and found that stricter regulations were associated with a small reduction, if any, in total and/or firearm-specific suicide deaths. The ecological level of analysis precluded individual-level causal inference. Findings within interventions targeting methods other than firearms were limited, mixed and/or inconclusive. Notably, no high-quality randomised controlled trials (RCTs) were identified that met our eligibility criteria.</p><p><strong>Conclusion: </strong>Future studies should use an RCT design or advanced statistical causal inference techniques to further elucidate the effectiveness of these interventions on suicide deaths and/or attempts.</p><p><strong>Prospero registration number: </strong>CRD42022364775.</p>","PeriodicalId":13682,"journal":{"name":"Injury Prevention","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Home and injury location discordance patterns in paediatric trauma: trends by mechanism, age and childhood opportunity level.","authors":"Erin E Ross, MaKayla L O'Guinn, Shadassa Ourshalimian, Ryan G Spurrier, Pradip P Chaudhari","doi":"10.1136/ip-2024-045554","DOIUrl":"https://doi.org/10.1136/ip-2024-045554","url":null,"abstract":"<p><strong>Background/aims: </strong>Understanding how injury mechanisms, demographics and neighbourhood characteristics differ based on injury location can improve data-driven injury prevention efforts. Our objective was to describe the association between mechanism of injury (MOI), patient age, neighbourhood characteristics and home and injury location discordance.</p><p><strong>Methods: </strong>We performed a retrospective, multicentre study of children transported by emergency medical services to 15 trauma centres in the county trauma registry from 2010 to 2021. Home-injury discordance (discordance between home and injury zip code) and neighbourhood opportunity discordance (more than one level difference across Childhood Opportunity Index (COI) levels) were trended by age and MOI. COI discordance by home COI for each MOI was also explored.</p><p><strong>Results: </strong>Among 13 020 paediatric traumas, home-injury discordance occurred in 48% of injuries, and was highest in sports/recreation (72%) and motorised travel (69%). COI discordance (27% overall) was frequent in sports/recreation (34%) and rarer in assault (22%). Assault and assault and motorised travel injuries occurred closer to home and with less COI discordance.</p><p><strong>Conclusion: </strong>Unique patterns of injury risk and COI discordance by home COI level demonstrate that injury prevention efforts may require differential focus on factors affecting residents versus visitors of a neighbourhood depending on the MOI.</p>","PeriodicalId":13682,"journal":{"name":"Injury Prevention","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fentanyl-xylazine overdose deaths in the USA, 2018-2023.","authors":"David T Zhu, Manuel Cano","doi":"10.1136/ip-2024-045596","DOIUrl":"https://doi.org/10.1136/ip-2024-045596","url":null,"abstract":"<p><strong>Background: </strong>Xylazine, a veterinary sedative and analgesic, has emerged as a novel adulterant in the US illicit drug supply, frequently co-occurring with fentanyl. This study examines trends in fentanyl-xylazine overdose death rates from 2018 to 2023.</p><p><strong>Methods: </strong>This serial cross-sectional study examined death certificates from the CDC WONDER database to identify International Classification of Diseases, 10th Revision codes for overdose deaths likely coinvolving fentanyl (T40.4) and xylazine (T42.7 or T46.5). Crude mortality rates per 100 000 were calculated overall and by sex, race/ethnicity, US Census Divisions and state to examine demographic and geographical trends.</p><p><strong>Results: </strong>Fentanyl-xylazine deaths increased from 99 in 2018 to 6020 in 2023. Crude mortality rates rose from 0.03 (95% CI 0.02 to 0.04) to 1.80 (95% CI 1.75 to 1.84) per 100 000. In 2023, rates were higher among males than females (2.63 (95% CI 2.55 to 2.71) vs 0.99 (95% CI 0.93 to 1.03) per 100 000), and higher among black than white individuals (3.21 (95% CI 3.04 to 3.38) vs 1.86 (95% CI 1.80 to 1.92) per 100 000). The Middle Atlantic and New England Census Divisions had the highest regional rates at 5.72 (95% CI 5.49 to 5.95) and 4.32 (95% CI 3.99 to 4.65) per 100 000, respectively.</p><p><strong>Discussion and conclusions: </strong>The sharp increase in fentanyl-xylazine deaths, particularly among black individuals, highlights both the growing infiltration of xylazine into the illicit drug supply and persistent structural disparities in addiction treatment. Addressing this escalating epidemic requires routine toxicological testing for xylazine and expanded access to trauma-informed care, harm reduction services and interventions such as naloxone, opioid agonist therapies and wound care.</p>","PeriodicalId":13682,"journal":{"name":"Injury Prevention","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}