BACKGROUND: Injury remains a major concern to public health in the European region. Previous iterations of the Global Burden of Disease (GBD) study showed wide variation in injury death and disability adjusted life year (DALY) rates across Europe, indicating injury inequality gaps between sub-regions and countries. The objectives of this study were to: 1) compare GBD 2019 estimates on injury mortality and DALYs across European sub-regions and countries by cause-of-injury category and sex; 2) examine changes in injury DALY rates over a 20 year-period by cause-of-injury category, sub-region and country; and 3) assess inequalities in injury mortality and DALY rates across the countries. METHODS: We performed a secondary database descriptive study using the GBD 2019 results on injuries in 44 European countries from 2000 to 2019. Inequality in DALY rates between these countries was assessed by calculating the DALY rate ratio between the highest-ranking country and lowest-ranking country in each year. RESULTS: In 2019, in Eastern Europe 80 [95% uncertainty interval (UI): 71 to 89] people per 100,000 died from injuries; twice as high compared to Central Europe (38 injury deaths per 100,000; 95% UI 34 to 42) and three times as high compared to Western Europe (27 injury deaths per 100,000; 95%UI 25 to 28). The injury DALY rates showed less pronounced differences between Eastern (5129 DALYs per 100,000; 95% UI: 4547 to 5864), Central (2940 DALYs per 100,000; 95% UI: 2452 to 3546) and Western Europe (1782 DALYs per 100,000; 95% UI: 1523 to 2115). Injury DALY rate was lowest in Italy (1489 DALYs per 100,000) and highest in Ukraine (5553 DALYs per 100,000). The difference in injury DALY rates by country was larger for males compared to females. The DALY rate ratio was highest in 2005, with DALY rate in the lowest-ranking country (Russian Federation) 6.0 times higher compared to the highest-ranking country (Malta). After 2005, the DALY rate ratio between the lowest- and the highest-ranking country gradually decreased to 3.7 in 2019. CONCLUSIONS: Injury mortality and DALY rates were highest in Eastern Europe and lowest in Western Europe, although differences in injury DALY rates declined rapidly, particularly in the past decade. The injury DALY rate ratio of highest- and lowest-ranking country declined from 2005 onwards, indicating declining inequalities in injuries between European countries.

Academic Public Health Department Public Health England London UK

Addictology Department Russian Medical Academy of Continuous Professional Education Moscow Russia

Administrative and Economic Sciences Department University of Bucharest Bucharest Romania

Associated Laboratory for Green Chemistry University of Porto Porto Portugal

Beijing Institute of Ophthalmology Beijing Tongren Hospital Beijing China

Biomedical Research Networking Center for Mental Health Network Madrid Spain

Biomedical Research Networking Center for Mental Health Network San Juan de Dios Sanitary Park Sant Boi de Llobregat Spain

Cardiology Department Carol Davila University of Medicine and Pharmacy Bucharest Romania

Carlos 3 Health Institute Biomedical Research Networking Center for Mental Health Network Madrid Spain

Catalan Institution for Research and Advanced Studies Barcelona Spain

Center for Innovation in Medical Education Pomeranian Medical University Szczecin Poland

Centre for Medical Informatics University of Edinburgh Edinburgh UK

Centre for Population Family and Health Department of Sociology University of Antwerp Antwerp Belgium

Clinic of Social and Family Medicine School of Medicine University of Crete Crete Greece

Clinical Dermatology IRCCS Istituto Ortopedico Galeazzi University of Milan Milan Italy

Clinical Epidemiology and Public Health Research Unit Burlo Garofolo Institute for Maternal and Child Health Trieste Italy

Clinical Legal Medicine Department National Institute of Legal Medicine Mina Minovici Bucharest Romania

Clinical Microbiology and Parasitology Unit Dr Zora Profozic Polyclinic Zagreb Croatia

Clinical Trials Service Unit and Epidemiological Studies Unit Nuffield Department of Population Health University of Oxford Oxford UK

Community Nursing Unit Ireland Hospital Abbeyleix Ireland

Department No 16 Moscow Research and Practical Centre On Addictions Moscow Russia

Department of Biomedical and Neuromotor Sciences Alma Mater Studiorum University of Bologna Bologna Italy

Department of Biostatistics and Health Informatics Madda Walabu University Bale Robe Ethiopia

Department of Biostatistics Near East University Nicosia Cyprus

Department of Chemical Sciences University of Porto Porto Portugal

Department of Chemistry University of Porto Porto Portugal

Department of Clinical and Experimental Medicine University of Catania Catania Italy

Department of Clinical Sciences and Community Health University of Milan Milan Italy

Department of Community Medicine Kasturba Medical College Manipal Academy of Higher Education Manipal Karnataka India

Department of Dermatology Case Western Reserve University Cleveland OH USA

Department of Epidemiology and Health Monitoring Robert Koch Institute Berlin Germany

Department of Epidemiology and Medical Statistics Faculty of Public Health College of Medicine University of Ibadan Ibadan Nigeria

Department of Epidemiology and Population Health Faculty of Health Sciences American University of Beirut Beirut Lebanon

Department of Epidemiology University of Kragujevac Kragujevac Serbia

Department of Experimental Medicine University of Campania Luigi Vanvitelli Naples Italy

Department of Family Medicine and Public Health University of Opole Opole Poland

Department of Family Medicine United Arab Emirates University Al Ain United Arab Emirates

Department of Forensic Medicine Lumbini Medical College Palpa Nepal

Department of General Surgery Carol Davila University of Medicine and Pharmacy Bucharest Romania

Department of General Surgery Emergency Hospital of Bucharest Bucharest Romania

Department of General Surgery School of Medicine Liverpool University Hospitals NHS Foundation Trust University of Liverpool Liverpool UK

Department of General Surgery University General Hospital of Patras Patras Greece

Department of Global Community Health and Behavioral Sciences Tulane University New Orleans LA USA

Department of Global Health Economics and Policy University of Kragujevac Kragujevac Serbia

Department of Health and Behavior Studies Teachers College Columbia University New York NY USA

Department of Health Care Administration and Economics National Research University Higher School of Economics Moscow Russia

Department of Health Sciences School of Sciences European University Cyprus Nicosia Cyprus

Department of Healthcare Faculty of Public Health University of Vlora Vlora Albania

Department of Hypertension Medical University of Lodz Lodz Poland

Department of Legal Medicine and Bioethics Carol Davila University of Medicine and Pharmacy Bucharest Romania

Department of Medical and Surgical Sciences University of Bologna Bologna Italy

Department of Medical Statistics London School of Hygiene and Tropical Medicine London UK

Department of Medical Surgical Sciences and Advanced Technologies University of Catania Catania Italy

Department of Medicine University of Valencia Valencia Spain

Department of Mental Health AUSL Romagna Cesena Italy

Department of Molecular Medicine and Surgery Karolinska Institute Stockholm Sweden

Department of Neurology University Hospital of Larissa University of Thessaly Larissa Greece

Department of Non Communicable Diseases and Injuries Santé Publique France Saint Maurice France

Department of Nursing and Health Promotion Oslo Metropolitan University Oslo Norway

Department of Ophthalmology Heidelberg University Mannheim Germany

Department of Ophthalmology University Hospital of Larissa Larissa Greece

Department of Orthopedics University Medical Center Utrecht Utrecht Netherlands

Department of Otorhinolaryngology Father Muller Medical College Mangalore India

Department of Pathology and Legal Medicine University of São Paulo Ribeirão Preto Brazil

Department of Physiotherapy College of Health Sciences University of Sharjah Sharjah United Arab Emirates

Department of Primary Care and Mental Health University of Liverpool Liverpool UK

Department of Primary Care and Public Health Imperial College London London UK

Department of Project Management National Research University Higher School of Economics Moscow Russia

Department of Propedeutics of Internal Diseases and Arterial Hypertension Pomeranian Medical University Szczecin Poland

Department of Psychiatry University of Nairobi Nairobi Kenya

Department of Psychology Reykjavik University Reykjavik Iceland

Department of Psychosocial Science University of Bergen Bergen Norway

Department of Public Health Aarhus University Aarhus Denmark

Department of Public Health and Clinical Medicine Sustainable Health Umea University Umea Sweden

Department of Public Health Birmingham City University Birmingham UK

Department of Public Health Erasmus MC University Medical Center Rotterdam The Netherlands

Department of Public Health Institute for Global Health and Epidemiology Faculty of Health Sciences and Social Work Trnava University Trnava Slovakia

Department of Public Health University of Naples Federico 2 Naples Italy

Department of Respiratory Medicine Medical School Democritus University of Thrace University General Hospital Dragana Alexandroupolis Greece

Department of Social and Clinical Pharmacy Charles University Hradec Kralova Prague Czech Republic

Department of Statistics and Econometrics Bucharest University of Economic Studies Bucharest Romania

Department of Translational Medicine University of Eastern Piedmont Novara Italy

Division of Clinical Geriatrics Department of Neurobiology Karolinska Institute Stockholm Sweden

Division of General Internal Medicine Harvard University Boston MA USA

Division of Neurology Department of Medicine University of Ottawa Ottawa ON Canada

Division of Psychology and Language Sciences University College London London UK

Division of Respirology Department of Medicine McMaster University Hamilton Canada

Edinburgh Spinal Surgery Outcome Studies Group Department of Neurosurgery Royal Infirmary of Edinburgh Edinburgh UK

Epidemiology Unit Central Tuscany Local Health Authority Florence Italy

Experimental Surgery and Oncology Laboratory Kursk State Medical University Kursk Russia

Faculty of Health and Life Sciences Coventry University Coventry UK

Faculty of Health and Social Sciences Bournemouth University Bournemouth UK

Faculty of Life Sciences and Medicine King's College London London UK

Faculty of Medicine and Health University of Leeds Leeds UK

Faculty of Medicine University of Belgrade Belgrade Serbia

Faculty of Medicine University of Porto Porto Portugal

Faculty of Social Sciences Unit of Health Sciences Tampere University Tampere Finland

Finnish Institute of Occupational Health Helsinki Finland

Forensic Medicine Division Imam Abdulrahman Bin Faisal University Dammam Saudi Arabia

Geriatrics and Long Term Care Department Hamad Medical Corporation Doha Qatar

Gerontology Research Center Tampere University Tampere Finland

Global South Health Services and Research GSHS Amsterdam The Netherlands

Health Systems and Policy Research Unit Ahmadu Bello University Zaria Nigeria

Heidelberg Institute of Global Health Heidelberg University Heidelberg Germany

Hospital Universitario de La Princesa Instituto de Investigación Sanitaria Princesa Madrid Spain

Icelandic Centre for Social Research and Analysis Reykjavik Iceland

Institute for Research and Innovation in Health University of Porto Porto Portugal

Institute of Applied Health Research University of Birmingham Birmingham UK

Institute of Clinical Physiology National Research Council Pisa Italy

Institute of Family Medicine and Public Health University of Tartu Tartu Estonia

Institute of Hygiene Health Information Center Kaunas Lithuania

Institute of Public Health Charité Universitätsmedizin Berlin Berlin Germany

Institute of Public Health of Republic of North Macedonia Saints Cyril and Methodius University of Skopje Skopje North Macedonia

Institute of Public Health United Arab Emirates University Al Ain United Arab Emirates

Institute of Research and Advanced Training in Health Sciences and Technologies Gandra Portugal

International Centre for Diarrhoeal Disease Research Dhaka Bangladesh

International Research Center of Excellence Institute of Human Virology Nigeria Abuja Nigeria

IRCCS Fondazione Don Carlo Gnocchi Milan Italy

Julius Centre for Health Sciences and Primary Care Utrecht University Utrecht The Netherlands

Laboratório de Farmacognosia Departamento de Química Faculdade de Farmácia Universidade Do Porto Porto Portugal

Laboratory for Process Engineering Environment Biotechnology and Energy University of Porto Porto Portugal

Laboratory of Genetics and Genomics Moscow Research and Practical Centre On Addictions Moscow Russia

Laboratory of Public Health Indicators Analysis and Health Digitalization Moscow Institute of Physics and Technology Dolgoprudny Russia

Laboratory of Social Medicine Medical School Democritus University of Thrace Alexandroupolis Greece

Laboratory of Toxicology Faculty of Pharmacy University of Porto Porto Portugal

Lincoln International Institute for Rural Health University of Lincoln Lincoln UK

N A Semashko Department of Public Health and Healthcare 1 M Sechenov 1st Moscow State Medical University Moscow Russia

National Center On Addictions and Doping Istituto Superiore Di Sanità Rome Italy

National School of Public Health Institute of Health Carlos 3 Madrid Spain

Neurology Unit Helsinki University Hospital Helsinki Finland

NIHR Global Health Research Unit On Global Surgery University of Birmingham Birmingham UK

Northumbria Healthcare NHS Foundation Trust Cramlington UK

Occupational Health Unit Sant'Orsola Malpighi Hospital Bologna Italy

Outpatient and Inpatient Care Service Central Health Directorate Friuli Venezia Giulia Region Trieste Italy

Pediatrics Department Russian Medical Academy of Continuous Professional Education Moscow Russia

Polish Mothers' Memorial Hospital Research Institute Lodz Poland

Primary Care Department NHS North West London London England

Professional Association of Licensed Optometry Professionals Linda a Velha Portugal

Psychology Department University of Sheffield Sheffield UK

Public Health Laboratories Hellenic Pasteur Institute Athens Greece

Research and Development Unit San Juan de Dios Sanitary Park Sant Boi de Llobregat Spain

Research Center On Public Health University of Milan Bicocca Monza Italy

Research Institute for Sustainable Land Development University of Extremadura Caceres Spain

Research Unit On Applied Molecular Biosciences University of Porto Porto Portugal

School of Health Sciences Kristiania University College Oslo Norway

School of Health Sciences University of Melbourne Melbourne VIC Australia

School of International Development and Global Studies University of Ottawa Ottawa ON Canada

School of Population Health and Environmental Sciences King's College London London UK

School of Public Health and Community Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden

School of Public Health and Health Management University of Belgrade Belgrade Serbia

School of Public Health University of Haifa Haifa Israel

Surgery Research Unit University of Oulu Oulu Finland

T H Chan School of Public Health Harvard University Boston MA USA

The George Institute for Global Health University of Oxford Oxford UK

Therapeutic Department Balashiha Central Hospital Balashikha Russia

UKK Institute Tampere Finland

University Centre Varazdin University North Varazdin Croatia

University College London Hospitals London UK

Vision and Eye Research Institute Anglia Ruskin University Cambridge UK

World Health Organization Collaborating Centre for Public Health Education and Training Imperial College London London UK

World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases Division of Country Health Programmes WHO Regional Office for Europe Moscow Russian Federation

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