title: Trends in incidence and costs of injuries to the shoulder, arm and wrist in The Netherlands between 1986 and 2008.
abstract: BACKGROUND
  Upper extremity injuries account for a large proportion of attendances to the Emergency Department. The aim of this study was to assess population-based trends in the incidence of upper extremity injuries in the Dutch population between 1986 and 2008, and to give a detailed overview of the associated health care costs.
  
  
  METHODS
  Age-standardized incidence rates of upper extremity injuries were calculated for each year between 1986 and 2008. The average number of people in each of the 5-year age classes for each year of the study was calculated and used as the standard (reference) population. Injury cases were extracted from the National Injury Surveillance System (non-hospitalized patients) and the National Medical Registration (hospitalized patients). An incidence-based cost model was applied in order to estimate associated direct health care costs in 2007.
  
  
  RESULTS
  The overall age-adjusted incidence of upper extremity injuries increased from 970 to 1,098 per 100,000 persons (13%). The highest incidence was seen in young persons and elderly women. Total annual costs for all injuries were 290 million euro, of which 190 million euro were paid for injuries sustained by women. Wrist fractures were the most expensive injuries (83 million euro) due to high incidence, whereas upper arm fractures were the most expensive injuries per case (4,440 euro). Major cost peaks were observed for fractures in elderly women due to high incidence and costs per patient.
  
  
  CONCLUSIONS
  The overall incidence of upper extremity injury in the Netherlands increased by 13% in the period 1986-2008. Females with upper extremity fractures and especially elderly women with wrist fractures accounted for a substantial share of total costs.
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Polinder
authors.forename: Gijs I T
authors.initials: GI
authors.lastname: Iordens
authors.forename: Martien J M
authors.initials: MJ
authors.lastname: Panneman
authors.forename: Denise
authors.initials: D
authors.lastname: Eygendaal
authors.forename: Peter
authors.initials: P
authors.lastname: Patka
authors.forename: Dennis
authors.initials: D
authors.lastname: Den Hartog
authors.forename: Esther M M
authors.initials: EM
authors.lastname: Van Lieshout
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001134:Arm Injuries / Q000191:economics / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D000070599:Shoulder Injuries; D014954:Wrist Injuries / Q000191:economics / Q000453:epidemiology*; D055815:Young Adult