Q&A: Trends on injury burden in the ASEAN region

In a new study examining the burden of injuries in the ASEAN region, we examined 17 distinct causes of injury, including road injuries, falls, drowning, and self-harm and interpersonal violence. Road injuries were the leading cause of mortality and morbidity in most ASEAN countries.

Lead author Dr. Marie Ng, Affiliate Associate Professor at IHME and Associate Professor at National University of Singapore’s Yong Loo Lin School of Medicine, discusses the findings.

Video transcript

This transcript has been lightly edited for clarity

What are ‘Injuries’ in a health context, and how significant are they in the ASEAN region?

In the Global Burden of Disease, injury is defined as death or disability caused directly or indirectly by physical force, immersion, or exposure, whether accidental or intentional, or resulting from war, conflict, violence, or natural disaster. In this study, we examined 17 distinct causes of injury, including road injuries, falls, drowning, and self-harm and interpersonal violence. Road injuries have long been a major public health issue in the ASEAN region, ranking seventh in 2021 for disease burden among all Level 3 GBD causes.

In addition to road injuries, this study offers a broader examination of other emerging causes of injury.

What are the key findings of your research?

Road injuries were the leading cause of mortality and morbidity in most ASEAN countries. In 2021, there were an estimated 120,000 deaths caused by road injuries. The disease burden of road injuries is the highest in Thailand and Malaysia. Falls have the highest number of incident cases and resulted in the second-highest mortality in the region. The third-leading cause of injury-related mortality is self-harm.

Map A shows the age-standardized mortality rates for all injuries across the 10 ASEAN countries. Darker red indicates a higher rate, whereas darker blue indicates a lower death rate. Overall injury mortality rate ranged from a low of 13.4 per 100,000 in Singapore to a high of 68.5 per 100,000 in Vietnam. Cambodia and Thailand also had high age-standardized mortality rates, exceeding 65 per 100,000.

Map B shows the geographical variation in DALY rates, which reflect both mortality and disability resulting from injuries. The highest age-standardized DALY rate was observed in Thailand, estimated at 3,800 per 100,000, followed by Myanmar with the estimate of 3,500 per 100,000. Cambodia, Vietnam, and Laos all had DALY rates about 3,000 per 100,000. The lowest DALY rate was observed in Singapore at 1,200 per 100,000.

This figure shows the share of disease burden contributed by different injury causes relative to the total injury DALYs. Each color represents an injury cause. The left side shows males, and the right side shows females. The vertical axis indicates age groups. Drowning constitutes the largest share of injury among children. For adolescents and much of young and mid-adulthood, road injuries are the primary cause of injury burden. Falls account for the largest share from age 65 onward.

How can the burden of injuries be reduced?

Over the past 30 years, there has been remarkable progress in some areas of injury prevention, with the burden of road injuries decreasing by 40% across the ASEAN, and as much as 78% in Singapore. However, progress remains uneven across different causes of injury. To further reduce road injuries in high-burden countries, ongoing investment is needed not only in improving road design and vehicle standards, but also to strengthen enforcement of road safety regulations, such as improving helmet and seatbelt use and imposing stricter penalties for drunk driving.

To prevent falls, effort must go beyond enhancing environmental safety to also address lifestyle factors such as obesity and physical inactivity. These factors increase the risk of fall-related injuries. To address self-harm, which is a concerning problem in several upper-middle- and high-income ASEAN countries, there is an urgent need to proactively tackle mental health issues, destigmatize and decriminalize suicide attempts, and improve transparency in surveillance and reporting of self-harm incidents. These steps are critical for monitoring trends and informing effective policy changes.