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The Barcelona Injury Surveillance System (BISS) for Safer Cities: Observational, Descriptive Study Using Routine
Katherine Pérez1,2,3, Elena Santamariña-Rubio1, Mònica Cortés-Albaladejo1,3
1Agència de Salut Pública de Barcelona (ASPB), Pl Lesseps, 1, Barcelona, 08023, Spain, 34 932027788.
Background:
Injuries are a major cause of death and disability, but cities often lack surveillance systems that can monitor injury burden across mechanisms, severity levels, and population groups. In Spain, no comprehensive city-level injury surveillance system routinely captures the full spectrum of injuries. The Barcelona Injury Surveillance System (BISS) was developed to address this gap by integrating routine health and police data.
Objective:
This study aims to describe the BISS, including its scope, data sources, and public health rationale, and illustrate its utility through the analysis of recent injury data in Barcelona.
Methods:
We conducted a descriptive study using routinely collected emergency department, hospital discharge, mortality, and police data integrated into the BISS. We analyzed nonfatal injuries in 2024, fatal injuries in 2023, and trends from 2018 onward. Injury indicators were examined by sex, age, mechanism, type, and severity. Crude and age-adjusted rates per 100,000 residents were calculated.
Results:
In 2024, BISS recorded 123,420 emergency department injury episodes and 18,749 injury-related hospitalizations; among residents, these figures were 99,379 and 14,319, respectively. In 2023, 695 injury-related deaths were recorded among residents. Nonfatal injuries were slightly more frequent in females, especially at older ages, whereas injury-related mortality was higher in males. Falls were the leading specified mechanism and were concentrated among older females, particularly those aged ≥75 years. Self-harm hospitalization rates were highest among females aged 15 years to 24 years, whereas self-harm mortality was higher in males. Road traffic injury and overall mortality rates were also higher in males. From 2018 to 2024, most nonfatal injury indicators increased after the decline observed in 2020, while road traffic injuries declined overall.
Conclusions:
BISS demonstrates the value of integrating routine health and police data to generate actionable urban injury intelligence. The findings highlight priorities for prevention, particularly falls in older females, self-harm in young females, and the persistently higher fatal injury burden among males. Integrated city-level surveillance systems such as BISS can support monitoring, equity-oriented prevention, and data-informed public health policy.
