Towards safer cities: insights from the Barcelona Injury Surveillance System (BISS) (Preprint)

BACKGROUND Injuries are a leading cause of mortality and disability worldwide. However, urban areas often lack comprehensive surveillance systems to monitor injuries. Barcelona, a densely populated city in Spain, had a fragmented approach to injury data, prompting the development of the Barcelona Injury Surveillance System (BISS) to integrate multiple data sources for injury monitoring and prevention. OBJECTIVE This article aims to describe the Barcelona Injury Surveillance System (BISS), which integrates multiple existing, exhaustive, consolidated, and routine data sources. Additionally, it illustrates its utility by presenting a comprehensive analysis of injury data for 2021. METHODS We consolidated data on injuries from diverse routine sources, including emergency department visits, hospital discharge records, mortality registers for external causes, police-reported road traffic collisions, and health survey data. Injury cases in 2021 were analyzed by sex, age, mechanism, type, and severity. Incidence rates per 100,000 residents (crude and age-adjusted) were calculated using the city population register as denominator. RESULTS In 2021, BISS recorded 64,087 nonfatal emergency department visits, 9,299 hospitalizations, and 639 injury-related deaths among Barcelona residents. Unintentional falls were the most frequent mechanism among older adults, particularly women aged ≥75 years (hospitalization rate ~2,386 per 100,000). In younger populations, especially men 15–44 years, traffic collisions and interpersonal violence were prominent causes of injury (e.g., hospitalization rate ~214 per 100,000 in men 15–24 years). Fractures were the most common injury type, accounting for 60–70% of all injury hospitalizations. The BISS road traffic injury subsystem revealed notable gender differences: men were disproportionately affected as motor-vehicle drivers (especially motorcyclists), while women were more frequently injured as pedestrians. Preliminary findings also indicated social inequalities in injury risk, with higher injury rates in areas and groups of lower socioeconomic status CONCLUSIONS The BISS offers a scalable model for data-driven injury surveillance and prevention in urban settings and can inform public health strategies to reduce injuries and their inequitable burden. The findings demonstrate the Barcelona Injury Surveillance System capacity to generate actionable data and identify social inequalities. The integration of multiple data sources makes BISS a sustainable model for urban injury surveillance and prevention, with potential applicability to other cities globally.