Fatal injuries of US citizens abroad.
BACKGROUND
US citizens are increasingly traveling, working, and studying abroad as well as retiring abroad. The objective of this study was to describe the type and scope of injury deaths among US citizens abroad and to compare injury death proportions by region to those in the United States.


METHODS
A cross-sectional design using reports of US citizen deaths abroad for 1998, 2000, and 2002 on file at the US State Department was employed. The main outcome measures were the frequencies of injury deaths and proportional mortality ratios (PMRs) comparing deaths abroad to deaths in the United States.


RESULTS
Two thousand eleven injury deaths were reported in the 3 years, comprising 13% of all deaths. The overall age-adjusted PMR for injury fatalities abroad compared to the United States was 1.6 (95% confidence interval 1.6-1.7). The highest age-adjusted PMRs for motor vehicle crashes were found in Africa (2.7) and Southeast Asia (1.6). The proportion of drowning deaths was elevated in all regions abroad.


CONCLUSIONS
Injuries occur at a higher proportion abroad than in the United States. Motor vehicle crash and drowning fatalities are of particular concern. Improved data quality and surveillance of deaths would help government agencies create more evidence-based country advisories.
Guse
Clare E
CE
Injury Research Center, Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA. cguse@mcw.edu
Cortés
Leslie M
LM
Hargarten
Stephen W
SW
Hennes
Halim M
HM
D000059:Accidents / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004332:Drowning / Q000401:mortality; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention / Q000458:organization & administration; D016016:Proportional Hazards Models; D017751:Safety Management / Q000458:organization & administration*; D014195:Travel / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality*