Inequalities in injury burden in the Americas, 2000-2021: A systematic analysis.

Objective: To assess mortality and disability due to injuries in the Americas, with a focus on subregional and gender disparities, and changes over time. Methods: Data from the 2021 World Health Organization Global Health Estimates were analyzed, covering all injury causes (ICD-10: V01-Y89) across 35 countries in the Americas from 2000 to 2021. Age-standardized mortality and disability-adjusted life year (DALY) rates were calculated by sex, cause, and subregion. Inequalities were quantified using absolute differences, relative ratios, and the index of disparity (IDisp). Results: In 2021, injuries caused over 662 000 deaths and 40.6 million DALYs in the Americas, with men accounting for nearly three-quarters of the burden. While age-standardized injury rates declined in most subregions, marked inequalities persisted. Interpersonal violence was the leading cause of injury-related mortality and disability, followed by road injuries, especially among men and boys aged 15-39 years. Self-harm increased substantially in both sexes, and falls rose in association with population aging. Interpersonal violence and drowning showed the highest between-country disparities, with IDisp values of 85.3 and 88.9, respectively, in 2021. Conclusions: Although some progress has been made in reducing injury burden in parts of the Americas, substantial challenges, including in some cases widening inequalities, remain. A renewed commitment to violence and injury prevention - rooted in equity, intersectoral action, and regional collaboration - is essential to reducing avoidable harms across the life course.