Patterns in Domestic Injuries and how COVID-19 Lockdown Measures Changed Their Incidence in Mexico

doi:10.21203/rs.3.rs-3332191/v1

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Patterns in Domestic Injuries and how COVID-19 Lockdown Measures Changed Their Incidence in Mexico

https://doi.org/10.21203/rs.3.rs-3332191/v1

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Domestic accidents occur worldwide. From small burns and bruises to significant wounds and injuries from dangerous falls, not all of them reach clinical care; so to measure the toll of these hardships on society, we surveyed three major cities in Mexico to better understand the problem and how coronavirus disease 2019 (COVID-19) lockdown measures changed the incidence rate.

We conducted an analytical cross-sectional study using Microsoft Forms, with a digital survey distributed among the Mexican population from October 2021 to November 2021, during lockdown. The incidence of all injuries surveyed increasedduring the first year of the COVID-19 pandemic. A comparison of the time spent inside the house before and during the pandemic showed that only burns increased. The number of wounds and musculoskeletal injuries decreased as people spent more time at home. Women were shown to be the most vulnerable group.

This study offers an unprecedented perspective on home-related trauma, as past literature has mainly examined trauma injuries treated in hospitals. The types of wounds have morphed depending on the percentage of time spent in the house, which has undergone a remarkable transformation since the lockdown was enacted.

domestic injury

trauma

COVID-19

burn

wound

musculoskeletal

Domestic accidents are unintentional physical injuries that happen inside the house. They occur every day worldwide. From small burns and bruises to significant wounds and injuries from dangerous falls, even in the safest spaces, first-aid care is required. This study aimed to set the epidemiological precedent for prehospital domestic trauma. Moreover, show variations in the rate of home-based injuries between the period preceding and the first year of the COVID-19 pandemic.

COVID-19 poses immense challenges and has affected a wide range of economic outcomes ^1–3. This high risk of infection was linked to the scarcity of respiratory devices and skilled personnel in medical centers ⁴. In response, governments worldwide adopted drastic steps to impede transmission. Some measures taken included maintaining physical distance, shunning close contact with people in public areas, and donning face masks ^5,6. In Mexico, a national safe-distance campaign (in Spanish, jornada nacional de la sana distancia) was established by the government on March 23rd, 2020. In addition to the actions previously mentioned, this campaign sought to impede the propagation of SARS-CoV-2 by suspending nonessential activities ⁷.

The increased time spent inside residences by the general population due to the lockdown is clear; it resulted in a decline in pedestrian and vehicle movement ⁸, a surge in weight gain ⁹, and a reduction in emergency-department visits ^10,11. This was further demonstrated by a recent Google study showing that Mexico experienced an increase of + 13.19 percentual points (pp) in the time spent in residential zones in 2020 ^12,13.

Domestic accidents are a serious public health problem for all age groups ^14,15. Injuries at home such as trauma or burns may require hospital or emergency-center treatment, and numerous studies have concluded that countermeasures against the pandemic had a huge effect on the number of hospital admissions ^11,15–18.

Injuries have traditionally been defined as physical damage caused by the transfer of energy or sudden absence of heat or oxygen that disrupt a tissue integrity ^19,20. They significantly affect the quality of life of those who have them and the world’s health systems ²¹. In 2010, unintentional injuries caused the most injury-related deaths (69%) ¹⁹, as harsh external environments often result in skin injuries ²².

Burn injuries are underestimated wounds that can cause serious ailments and death. Most burn injuries originate from heat from hot liquids, solids, or fire ^23,24.

Fractures are the most common large-organ traumatic injuries in humans ^19,25,26, and falls are the second most common cause of death related to unintentional injuries worldwide ¹⁹. Sprain is also one of the most common musculoskeletal injuries ^27–29. All the injuries mentioned represent a heavy toll on the economy for both the public and government; as well as the quality of life of individuals ¹⁹.

In Mexico, mortality due to unintentional injuries decreased from 1990 to 2017, whereas the incidence of nonfatal incidents increased. However, unintentional injuries continue to cause considerable mortality and morbidity, with patterns that vary according to the state, age, sex, and year ³⁰. A previous study indicated that most hospital discharges after injuries due to external causes were for patients with fractures (51.4%), the second most common was for patients with wounds of all kinds (21.9%), and the third most common was for patients with trauma (17.2%) ³¹. Another study collected data from a survey conducted in 2018 on 20,356 people, of which 15% reported having suffered an accidental injury during the year before the survey; injuries due to falls and traffic were the most frequently reported, followed by burns, poisoning, drowning by submersion, and other asphyxiation ³².

Some injuries are treated with first aid and are not treated in the hospital ³³, which leaves the question: How many people are injured and not receiving hospital care? This study aimed to evaluate the epidemiology of domestic injuries and the effect of the COVID-19 pandemic on their incidence.

We conducted an analytical cross-sectional study using Microsoft Forms with a digital survey distributed to the Mexican population from October 2021 to November 2021. After they provided informed consent, participants were questioned about demographics (age, sex, socioeconomic class) and the events concerning lesions sustained previously and during the pandemic under the government’s “stay at home” policy.

The sample size required to estimate the proportion of people who had experienced domestic accidents before and during the COVID-19 pandemic was 385. We chose three of the more populated cities in the country (Mexico City, Guadalajara, and Monterrey) and received 1,004 responses. This was based on a 5% margin of error, 95% confidence interval, and 50% prevalence rate. We could not find a previous study with a significant sample size evaluating domestic accidents during the lockdown for COVID-19 among the Mexican population; therefore, the prevalence rate was fixed to a statistical assumption of 50%. Responses from other cities were also accepted for analysis to gain a better understanding of the Mexican population. Our questionnaire was proposed based on the literature and validated, reaching a statistical Cronbach’s alpha value of > 0.7.

There were questions about the number of lesions experienced the year before the pandemic and during the first year of the pandemic, which ranged from 0 to > 15. For analysis, subjects were divided into two groups: those who had lesions and those who did not. The average time spent inside the house, both pre-pandemic and during the first year of it, was divided into four options for the statistical analysis: “less than 6 hours”, “6–12 hours”, “13–18 hours” and “19–24 hours”.

The sample was tested using the Kolmogorov-Smirnov test, which showed that the variables did not follow a normal distribution, D (1004) = 0.302, p < 0.005.

A comparative analysis was performed to examine the relationships between gender and previous injury and injury during the “stay-home” policy” using the chi-square test or Fisher’s exact test for qualitative variables. To determine the correlation between the different injuries the year before and the first year of the pandemic, Spearman’s rank correlation coefficient was used based on the non-normal sample distribution. We also compared the medians between lesions using the Wilcoxon signed-rank test. Statistical analysis was performed using the SPSS v25 program, and a value of p ≤ 0.05 was interpreted as statistically significant.

The demographic information of the participants is presented in Table 1. The targeted participants for this survey were young Mexicans. Originally, 1291 answers were received. From those, 11 did not consent to continue with the questionnaire, 9 did not finish it, and 267 answers were eliminated because the age of the participants was below 18. The collected sample (1,004 participants) was composed of 459 (45.7%) men and 545 (54.3%) women between 18 and 75 years of age, with a mean of 28.7 SD ± 12.94; most of the participants were younger than 30 years of age (66.7%). Most participants in the collected sample were educated (45.1%) and had a bachelor’s degree or higher.

Table 1

Demographic information of the participants.
Age	(years)	Male (%)	Female (%)	%	p
	18–30	292 (29)	376 (37.5)	66.5
	31–40	74 (7.4)	60 (6.0)	13.3
	41–50	42 (4.2)	62 (6.2)	10.4
	51–60	39 (3.9)	37 (3.7)	7.6
	61–70	9 (0.9)	11 (1.1)	2
	71–80	2 (0.2)	0 (0.0)	0.02
Total		458 (45.6)	546 (54.4)	100%	< .001
Education
	No education	4 (0.4)	4 (0.4)	0.8
	Primary School	10 (1.0)	21 (2.1)	3.1
	Secondary School	47 (4.7)	53 (5.3)	10.0
	Highschool	97 (9.7)	112 (11.2)	20.9
	University degree	206 (20.5)	247 (24.6)	45.1
	Postgraduate	94 (9.4)	109 (10.9)	20.3
					.669
Socioeconomic status
	Extreme lower class	3 (0.3)	3 (0.3)	0.6
	Lower class	5 (0.5)	7 (0.7)	1.2
	Working class	23 (2.3)	28 (2.8)	5.1
	Middle class	52 (5.2)	58 (5.8)	11.0
	Upper-middle class	129 (12.8)	138 (13.7)	26.6
	Upper class	312 (31.1)	246 (24.5)	55.6
					.910
Time spent inside the house before the pandemic
11.93 (SD ± 4.19) h					< .001
Time spent inside the house during the pandemic
19.14 (SD ± 4.44) h					< .001

Answers to the questionnaire registered an average of 11.93 (SD ± 4.19) hours spent at home the year before the pandemic and 19.14 (SD ± 4.44) hours during the pandemic, which represents a 60.4% augment on the time spent at home (Fig. 1). The frequency of injuries also changed between the year before and the first year of the pandemic: the average numbers of wounds per participant were 0.81 SD ± 1.37 and 1.05 SD ± 1.82, respectively, with an increase of 29.69% (Fig. 2). The average numbers of burns were 0.41 SD ± 0.97 and 0.68 SD ± 1.53, respectively, increasing by 66.18% (Fig. 3). The average numbers of musculoskeletal injuries were 1.03 SD ± 1.77 and 1.19 SD ± 2.01, respectively, increasing by 15.36% between the 2 years analysed (Fig. 4).

As the time spent at home increased a 60.4% (7.21 ± 0.25 h), when compared to wounds per participant, these decreased their incidence by 30.71% in the function of time spent at home. Musculoskeletal injuries also decreased in 45.05% in the function of time spent at home. However, the incidence of burns increased a 5.78% when compared to the increase of time spent at home.

The results of the 1,004 responses to the survey showed that, in Mexico, women spent more time at home than men in both periods analysed. Similarly, women had 31.67% more injuries, 66.92% more burns, and 60.74% more musculoskeletal injuries than men during the pandemic when compared to the year before.

A chi-square test of independence was performed to examine the relationships between sex and the three types of domestic injuries in the years before and in the first year of the pandemic. The relationship between them was found to be significant, with a p-value of < .001. The incidences of lesions obtained from the 1,004 surveys in a female:male ratio were as follows: wounds, 291:221; burn injuries, 217:130; and musculoskeletal injuries 344:214, proving women were more likely to suffer from domestic injuries than men. Education and socioeconomic status were found not significant.

Among the population surveyed, a positive Spearman correlation was found between sex and the incidence of wounds in both the year before and the first year of the pandemic (r [510] = .319 p < .001). Burn injuries (r [345] = .314, p < .001), and musculoskeletal injuries (r (556) = .374, p < .001) were also found to be significant when the same variables were compared.

A Wilcoxon signed-rank test showed a significant (p < .001) increment in the following data: time spent at home in the year before (median = 11) and in the first year of the pandemic (median = 20) (T = 246,576, Z = -17.458); wounds in the year before (n = 2) and in the first year of the pandemic (n = 2, T = 26,417.5, Z = -5.520); burns between the year before (median = 1) and the first year of the pandemic (median = 2) (T = 9,707.5, Z = -8.655); and musculoskeletal injuries between the year before (median = 2) and the first year of the pandemic (median = 2) (T = 40,886.5, Z = -3.729).

We observed that changes in the incidence of injuries were related to the amount of time individuals were inside their homes. The purpose of these results was to determine which lesions were more prevalent at home and which increased in incidence over extended periods. The incidence of these injuries according to age, sex, and socioeconomic status was also analysed to determine whether any of these factors altered the probability of suffering a domestic injury.

The findings showed that the incidence of all injuries surveyed increased during the first year of lockdown for the COVID-19 pandemic. When compared with the time spent inside the house, only burns increased more than the time spent, while wound and musculoskeletal injury rates diminished as people spent more time in their house. From the answers we collected, it is safe to conclude that the risk of burn injuries increases as time is spent inside the house, whereas the risk of other injuries decreases as we remain inside. In addition, women are more prone to domestic injuries than men.

Other studies have analysed trauma patterns in non-COVID-19 periods versus lockdown periods in third-level trauma centres and found that men were more often injured than women ^11,18; monocentric studies reported that orthopaedic admissions and emergency surgery decreased after the first wave of COVID-19 ^16,17,34, while some reported an increase in specific musculoskeletal injuries ¹⁴. Previous multicentre surveys that assessed trauma were conducted in Germany in clinical trauma centres to determine the impact of the COVID-19 pandemic on the number of trauma patients ¹⁷. Increments in pediatric emergency-department admissions for domestic accidents between March and April (2020) compared to the corresponding date during the previous year, before lockdown measurements (2021), were reported in a monocentric study ³⁵. Women were shown to be at risk of domestic injuries, such as hand lacerations, sprains, contusions, and burns ³⁶.

This study provides unprecedented insights into domestic trauma among individuals who may or may not end up in a clinic, as most previous literature only considers trauma injuries registered as hospital admissions. We also found changes in the patterns of these injuries according to the time spent at home, which has changed drastically since the lockdown.

More attention should be paid to injury patterns inside the house, as they represent a heavy economic toll for people and governments. Domestic accidents are considered a public health problem, especially in vulnerable groups such as older adults and children ^37–39; studies aimed at this population to determine with more precision the most common domestic injuries and what preventive measures are being taken, as well as identifying other risk groups, such as low-income, less educated, and rural, may help to enlighten and redirect efforts.

Prevention plays an important role in mitigating the effects of demographic changes on wound prevalence. Education about harms at home, dangerous activities and first aid training could play a major role in lowering the incidence of accidents and their impact on the people’s lives. Public healthcare system should focus on patient education, especially in risk groups. As well as early and widespread first aid training ⁴⁰.

A broader investigation that includes activities and in-house locations could further consider the safety of current domestic activities and how much attention should be paid to the safety of those activities.

Self-awareness of risk and first-aid training were the variables of interest. The knowledge of first aid in developing countries has been previously studied ^41,42. Research on the relationships among risk self-awareness, the incidence of injuries, and first-aid knowledge could help determine the focus and priorities of first-aid training and injury-preventive care.

We identified limitations to our study, such as using only social media to share the questionnaire; therefore, the population reached mostly included people active on Facebook, Twitter, WhatsApp, and Reddit, reflecting on the age and most importantly on the socioeconomic status of the people who answered our questionnaire. Also, although we provided multiple ways for participants to elucidate when their injuries happened, some might have recalled injuries as more recent than what they were.

This is the first study in Mexico and Latin America to identify in-house lesions during the COVID-19 lockdown and to provide useful information for differentiating at-risk populations. The frequency of domestic injuries increased notably during the COVID-19 lockdown. From the three types of injuries analysed, we conclude that, while the risk of wounds and musculoskeletal injuries decreases as people spent more time inside their houses, burn injuries become more frequent. This emphasized the importance of examining house activities, as they shouldn’t be taken as “low risk” just because of the common conception of our homes being a “safe place”. Our findings also highlight the need for more research on injuries and trauma that do not reach hospital care, how people's risk perception affects their activities, especially in-house activities, and how decision-making should be made to take preventive measures to reduce these kinds of incidents. These results also implicate that groups that spend more time inside the home, such as the elderly, might have a higher risk of suffering an insult. Domestic injuries should be a public health concern and measures should be taken to prevent them; especially when in-house time patterns change as with the COVID-19 lockdown.

The current project was approved by the Research Ethics Committee of the University Hospital “Dr. José Eleuterio González” at the Nuevo León Autonomous University (UANL).

6 Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

7 Author Contributions

Garcia-Gonzalez and Muñoz-Maldonado conceptualized and designed the study. Garcia-Gonzalez organized the database and performed the statistical analysis. Garcia-Gonzalez wrote the literature review, methodology, results, and Muñoz-Maldonado the discussion, both wrote the conclusion. All authors contributed to the manuscript revision, read, and approved the submitted version.

8 Funding

The nature of the study required no funding.

9 Acknowledgments

Department of Preventive Medicine and Public Health, University Hospital “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, México.

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Patterns in Domestic Injuries and how COVID-19 Lockdown Measures Changed Their Incidence in Mexico

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1 Introduction

2 Materials and Methods

3 Results

4 Discussion

5 Conclusion

Declarations

6 Conflict of Interest

7 Author Contributions

8 Funding

9 Acknowledgments

References

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