The burden of injury in China, 1990-2017: findings from the Global Burden of Disease Study 2017.

BACKGROUND: A comprehensive evaluation of the burden of injury is an important foundation for selecting and formulating strategies of injury prevention. We present results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 of non-fatal and fatal outcomes of injury at the national and subnational level, and the changes in burden for key causes of injury over time in China. METHODS: Using the methods and results from GBD 2017, we describe the burden of total injury and the key causes of injury based on the rates of incidence, cause-specific mortality, and disability-adjusted life years (DALYs) in China estimated using DisMod-MR 2.1. We additionally evaluated these results at the provincial level for the 34 subnational locations of China in 2017, measured the change of injury burden from 1990 to 2017, and compared age-standardised DALYs due to injuries at the provincial level against the expected rates based on the Socio-demographic Index (SDI), a composite measure of development of income per capita, years of education, and total fertility rate. FINDINGS: In 2017, in China, there were 77·1 million (95% uncertainty interval [UI] 72·5-81·6) new cases of injury severe enough to warrant health care and 733 517 deaths (681 254-767 006) due to injuries. Injuries accounted for 7·0% (95% UI 6·6-7·2) of total deaths and 10·0% (9·5-10·5) of all-cause DALYs in China. In 2017, there was a three-times variation in age-standardised injury DALY rates between provinces of China, with the lowest value in Macao and the highest in Yunnan. Between 1990 and 2017, the age-standardised incidence rate of all injuries increased by 50·6% (95% UI 46·6-54·6) in China, whereas the age-standardised mortality and DALY rates decreased by 44·3% (41·1-48·9) and 48·1% (44·6-51·8), respectively. Between 1990 and 2017, all provinces of China experienced a substantial decline in DALY rates from all injuries ranging from 16·3% (3·1-28·6) in Shanghai and 60·4% (53·7-66·1) in Jiangxi. Age-standardised DALY rates for drowning; injuries from fire, heat and hot substances; adverse effects of medical treatments; animal contact; environmental heat and cold exposure; self-harm; and executions and police conflict each declined by more than 60% between 1990 and 2017. INTERPRETATION: Between 1990 and 2017, China experienced a decrease in the age-standardised DALY and mortality rates due to injury, despite an increase in the age-standardised incidence rate. These trends occurred in all provinces. The divergent trends in terms of incidence and mortality indicate that with rapid sociodemographic improvements, the case fatality of injuries has declined, which could be attributed to an improving health-care system but also to a decreasing severity of injuries over this time period. FUNDING: Bill & Melinda Gates Foundation.

Road traffic injury happened on the way to school, among primary and secondary school students in Mengzi city, Honghe prefecture, Yunnan province in 2018 / 中华流行病学杂志

Objective@#To understand the current situation of road traffic injuries among primary and secondary school students in Mengzi city.@*Methods@#Using the cluster random sampling method, more than 9 000 primary and secondary school students from 20 primary and secondary schools in Mengzi city, were randomly sampled. A questionnaire survey was conducted on the occurrence of road traffic injuries in school students.@*Results@#A total of 9 197 students were surveyed, including 150 from road traffic injuries. The incidence rates of road traffic injuries was 1.63% among students in Mengzi city and 2.85% among junior high school students, with the high incidence in May. The leading places of injuries were village roads (38.00%), city roads (33.33%) and district roads (12.67%), respectively. 26.67% of the traffic injuries occurred on the way to or from schools, with riding on electric bicycle (52.00%) as the major cause and contusion/abrasion (75.33%) appeared as the major signs. Both lower and upper limbs plus multiple parts were accounting for 45.51%, 22.16% and 16.17%, respectively of all the injuries. 70.67% of all the cases with road traffic injuries in children, recovered after treatment. Children with road traffic injuries would stay in the hospital for up to 90 days but spent less than 30 000 Yuan.@*Conclusion@#The incidence of road traffic injuries among students in Mengzi city seemed relatively high, with junior high school students reached the highest. Riding electric bicycle appeared as the leading cause for traffic injuries in children in Mengzi city of Yunnan province.

Analysis on influence of the self-confidence, motivation and authoritative advice factors on the use of child restraint / 中华流行病学杂志

Objective@#To establish the model of the self-confidence, motivation and authoritative advice factors influencing the use of child restraint and use structural equation model to test it to provide scientific basis for promoting the advocacy of use of child restraint.@*Methods@#Using multi-stage cluster random sampling method, 9 112 parents from the family with one or more private cars and 0-6 years old children in Shanghai and Shenzhen were investigated about the use of child restraint. A theoretical model of the self-confidence, motivation and authoritative advice factors influencing the use of child restraint was constructed. The theoretical model was validated and quantitatively analyzed by structural equation model.@*Results@#The overall model accords with the expected theoretical model, and the goodness of model fit was fine. The indicators had met the standard. RMSEA=0.03, CFI=0.97. The standardization coefficients of each route showed statistical significance (P<0.05). The standardization coefficients of the influence of authoritative suggestions and motives on self-confidence were 0.45 and 0.30 respectively, and the standardization coefficients of the influence of self-confidence on the use of child restraint was 0.40. The standardization coefficient of the influence of authoritative suggestions on motivation was 0.61.@*Conclusions@#In the advocacy of the use of child restraint, we should attach importance to the use of recommendations from experts and organizations with professional authority, good credibility and public welfare. We should take the status of children’s road traffic safety and the mechanism of the role of child restraint as one of the key points of propaganda.

Occurrence of injuries among left-behind children from 27 poor rural areas in 12 provinces of China, 2016 / 中华流行病学杂志

Objective@#To understand the injuries among 16 459 left-behind children from 27 poor rural areas in 12 provinces of China, 2016.@*Methods@#Data were collected from the survey of 'Health Service Needs Assessment’ (HSNA) program on left-behind children, from poor rural areas in the middle and western parts of China. Factors including causes, types, locations, related activities, ways of treatment and outcomes among left-behind children with injuries in 2016, were described and analyzed by gender and age groups.@*Results@#In 2016, per-person and person-time incidence rates of injuries were 8.88% and 11.21%, among the 16 459 left-behind children from 27 poor rural areas in 12 provinces of China, both higher in boys, than in girls. Most injuries were unintentional with its proportion higher in older children. The main types of injuries were seen as falls, blunt and sharp injuries, with burns and animal injuries more common in younger children. Injuries among left-behind children mainly took place at home, kindergarten/school, and on the highways/streets/roads, during playing. Most common ways of treatment would include at the emergency settings, self-treated, with older children more likely to treat by themselves. Most injuries were cured.@*Conclusions@#In programs on prevention and control of injuries targeting the left-behind children in poor rural areas, special attention should be given to older boys, on falls and blunt/sharp injuries, at home or kindergarten/school. Education programs should pinpoint on self-rescue skills and guidance on kids by the parents, with behavioral norms and social support included. Related comprehensive prevention and control mechanism should be developed in families, schools and communities, with medical resources and insurance mechanism explored to serve these population and districts, including those left-behind children.

Disease burden on falls among 0-19 years old population in China, in 1990 and 2017 / 中华流行病学杂志

Objective@#To analyze and compare the disease burden of falls in Chinese population aged 0-19, in 1990 and 2017.@*Methods@#Indicators including number of deaths, mortality rates, years of life lost due to premature mortality (YLL), years lived with disability (YLD) and disability-adjusted of life years (DALY), on falls, were gathered from the Global Burden of Disease (GBD) 2017 and used to describe the disease burden and corresponding parameters on falls, between 1990 and 2017, in China.@*Results@#In 2017, number of death, YLLs, YLDs, DALYs caused by falls were 5 321, 0.43 million person years, 0.14 million person years and 0.57 million person years respectively, among aged 0-19 group. Rates on standardized mortality, YLLs, YLDs and DALYs on falls were 1.76/100 000, 141.49/100 000, 46.99/100 000, and 188.48/100 000, respectively. The burden of falls decreased with the increase of age. Compared with 1990, disease burden of falls decreased in all age groups, both in male and female, with more seen in the lower age groups. Compared with 1990, the number of deaths, rates on YLLs, YLDs and DALYs caused by falls decreased by 65.08%, 46.63%, 47.38% and 36.33% respectively, in 2017. However, the YLDs rate increased by 73.31% between 1990 and 2017. The ratio of YLLs to DALYs decreased from 90.84% in 1990 to 75.07% in 2017, with a proportion as 17.36%.@*Conclusion@#Compared with 1990, although the disease burden of falls among aged 0-19 group showed a decreasing trend, falls still caused serious disease burden for the aged 0-19 group. Research that targeting prevention on falls, should be continued.

Trends of injury mortality among children in different stages of the China Children’s Development Outlines / 中华流行病学杂志

Objective@#To describe the trends and potential reasons responsible for injury mortality among children under 18 years old in different stages of the China Children’s Development Outlines (CCDO) for children from 1990 to 2017, in China.@*Methods@#Data derived from the Global Burden of Disease 2017 (GBD2017) were used to analyze the change of injury mortality, among children under 18 years old, by sex and provinces.@*Results@#Since 1990, the Chinese government had formulated and implemented three CCDOs on Children. Each CCDO proposed corresponding main targets and strategic measures based on the development of children under current situation, in each area, accordingly. The first two CCDOs failed to set clear targets for child injury prevention and control, but the third one did propose a quantifiable target. The injury mortality rate of children under 18 years old showed a declining trend in all periods of the three CCDOs, by 26.07%, 40.68% and 26.48%, respectively. Both boys and girls showed significant downward trend in these three stages. Mortality rate on child injury differed in these three stages in all the 31 provinces.@*Conclusion@#Thanks to the contribution of CCDO in different stages that providing important policies and impetus for the prevention and control of child injury, the number of deaths caused by child injury kept reducing, from 1990 to 2017, in China.

Further promotion on children injury prevention and control in China / 中华流行病学杂志

Injury is an important public health problem that threatening children’s health. Researches have been carried out to prevent child injuries in China. Disease burden on injury for children have been moderated, but remained as the first cause of death in Chinese children, so injury prevention among children should still be treated as priority to promote children’s health. It is necessary to establish and improve strategies in injury prevention which should be led by the government and correlated institutes, as to carry out a systematic, comprehensive and scientific system for children injury prevention and control. In order to reduce children’s injuries and promote children’s health, relevant policies and regulations should base on "Healthy China 2030" to formulate and implement action plans, to carry out practice and scientific research on children injury prevention, and to strengthen the team construction and talent training on this issue.

The death trend of children under 5 years old due to foreign body in airway in China from 1990 to 2017 / 中华预防医学杂志

Objective@#To analyze the current situation and the trend of the death due to foreign body in airway in children less than 5 years old in China from 1990 to 2017.@*Methods@#Using the mortality data of foreign body in airway in China from 1990 to 2017 from the Global Disease Burden 2017 (data covered 31 provinces, autonomous regions, municipalities, as well as Hong Kong and Macau Special Administrative Regions, excluding Taiwan Province) to describe the death status of children under 5 years old due to foreign body in airway in China, and to calculate the relative change and 95% uncertainty interval (UI) of mortality rate and proportion of children under 5 years old due to foreign body in airway between 1990 and 2017. The robust linear regression was performed with the first-order lag of mortality, and the supremum Wald test was used to explore whether the mortality trend had obvious structural changes around a certain time point.@*Results@#In 2017, the mortality rate of children under 5 years old due to foreign body in airway in China was 8.57/100 000 (95%UI: 7.41/100 000-9.57/100 000), and there was no significant difference between boys (9.05/100 000, 95%UI: 6.82/100 000-10.23/100 000) and girls (8.02/100 000, 95%UI: 7.02/100 000-9.12/100 000). The supremum Wald test showed that there was a structural change around the year of 2005 (P<0.001) in terms of the mortality rate of foreign body in the airway among children under 5 years old, which depicted a relatively stable trend before 2005 and a significant downward trend after 2005. Compared with 1990, the mortality rate of foreign body in airway among children, boys and girls under 5 years old in 2017 decreased by 49.32% (95%UI: 37.78%-65.41%), 41.22% (95%UI: 25.68%-68.26%) and 56.91% (95%UI: 44.78%-66.70%), respectively; the mortality proportion of foreign body in airway among increased by 153.33% (95%UI: 75.99%-204.56%), 171.05% (95%UI: 48.75%-239.63%) and 137.90% (95%UI: 86.62%-198.09%), respectively; the rank of foreign body in airway in all disease increased by 6 and became the first leading cause of injury from the second.@*Conclusion@#From 1990 to 2017, the mortality rate of foreign body in airway among children, boys and girls under 5 years old in China generally showed a downward trend. Compared with 1990, the mortality proportion of foreign body in airway among these population increased by a relatively large extent in 2017.

Analysis on suicide mortality and self-inflicted injury/suicide hospital cases in China from 2006 to 2016 / 中华预防医学杂志

Objective@#To describe the epidemiological characteristics of suicide death and self-harm/suicide in China from 2006 to 2016.@*Methods@#Data in this study are from the datasets of National Death Cause Surveillance from 2006 to 2016 and the National Injury Surveillance Dataset 2016. The age-standardized death rate based on the population census in 2000 was used to describe the trend of suicide over years. This study also described the epidemiological characteristics of suicide death and the demographic characteristics, suicide methods and severity of patients who sought medical help after committing suicide or self-inflicted injury in 2016.@*Results@#Age-standardized suicide mortality had been declining from 9.23/100 000 in 2006 to 5.33/100 000 in 2016 by 42.25%. Suicide mortality increased with age. In 2016, the suicide mortality in China was 7.05/100 000, and among people over 85 years old was 49.49/100 000. In 2016, the dominant two suicide methods were poisoning (39.12%) and sharp injury (25.62%). The first leading method of suicide in rural population, urban population and young people aged 10-to 17-year-old was poisoning (65.13%), sharp injury (29.90%) and fall (25.47%), respectively. As age increased, the severity of suicide/self-inflicted injury increased. The proportions of serious cases among young people aged 10-to 17-year-old and older people aged 60 years old and above who sought medical help after committing suicide or self-inflicted injury were 4.88% and 26.86%, respectively.@*Conclusion@#China′s suicide mortality has been declining and special attention should be given to the suicide of old people.

Disease burden of animal injury in China, 1990-2016 / 中华流行病学杂志

Objective To analyze the disease burden of animal injury in China between 1990 and 2016.Methods Data obtained from the Global Burden of Disease 2016 were used to analyze the age and gender specific disease burden of animal injury in China,using the incidence and disability adjusted of life years (DALYs) rate.Relative and annual changes were evaluated.Results In 2016,the age-standardized incidence and DALYs rate of animal injury in China showed as 245.05 per 100 000 people and 12.73 per 100 000.The age-standardized incidence of non-venomous animal injury was significantly higher than that of venomous animal injury,but the differences in age-standardized incidence and DALYs rate between venomous animal injury and non-venomous animal injury were not significant.Between 1990 and 2016,there was a significantly decreasing trend in the age-standardized incidence and DALYs rate of animal injury,and obvious decline could be seen in the incidence of non-venomous animal injury,compared with venomous animal injury.The incidence and DALYs rate of animal injury declined in both males and females and in different age groups.The obvious decline of incidence and DALYs rate could be found in children aged 5-14 years and aged ＜ 5 years.Conclusions Between 1990 and 2016,there was a significant alleviation of the disease burden of animal injury in China.Young children were most prone to animal injury,resulting in serious disability and death,indicating more attention should be paid to this population at high risk and in animal injury prevention and control programs.

Disease burden of animal injury in China, 1990-2016 / 中华流行病学杂志

Objective To analyze the disease burden of animal injury in China between 1990 and 2016.Methods Data obtained from the Global Burden of Disease 2016 were used to analyze the age and gender specific disease burden of animal injury in China,using the incidence and disability adjusted of life years (DALYs) rate.Relative and annual changes were evaluated.Results In 2016,the age-standardized incidence and DALYs rate of animal injury in China showed as 245.05 per 100 000 people and 12.73 per 100 000.The age-standardized incidence of non-venomous animal injury was significantly higher than that of venomous animal injury,but the differences in age-standardized incidence and DALYs rate between venomous animal injury and non-venomous animal injury were not significant.Between 1990 and 2016,there was a significantly decreasing trend in the age-standardized incidence and DALYs rate of animal injury,and obvious decline could be seen in the incidence of non-venomous animal injury,compared with venomous animal injury.The incidence and DALYs rate of animal injury declined in both males and females and in different age groups.The obvious decline of incidence and DALYs rate could be found in children aged 5-14 years and aged ＜ 5 years.Conclusions Between 1990 and 2016,there was a significant alleviation of the disease burden of animal injury in China.Young children were most prone to animal injury,resulting in serious disability and death,indicating more attention should be paid to this population at high risk and in animal injury prevention and control programs.

The analysis of the trend of mortality rate of falls in China from 1990 to 2015 / 中华预防医学杂志

Objective@#To understand the status and trend of the mortality rate of falls in different gender, age groups and provinces in China from 1990 to 2015, to explore the number of subgroups of different trends in all provinces, and to determine the different trajectory of subgroups.@*Methods@#Using the mortality rate of falls in China from 1990 to 2015 from the Global Disease Burden 2015 (data covers 31 provinces, autonomous regions, municipalities, as well as Hong Kong and Macau Special Administrative Regions, excluding Taiwan Province) to describe the status of the mortality rate of falls in different gender, age group and provinces in China 2015 and to calculate the corresponding relative change. Using log linear model to calculate the annual percent changes from 1990 to 2015. The number of subgroups and corresponding characteristics of different trajectories were analyzed by trajectory model to analyze with four indicators, P value of the coefficient of independent variables with different orders in all subgroups, Bayesian information criterion, log Bayes factor and average posterior probability.@*Results@#In 2015, the age standardized mortality rate of falls in China was 8.38/100 000 (95%UI: 5.54/100 000-9.30/100 000), which was higher in men (10.81/100 000, 95%UI: 6.58/100 000-12.14/100 000) than that in women (5.84/100 000,95%UI: 3.41/100 000-6.62/100 000), and in the elderly aged 70-year-old and above (60.50/100 000, 95%UI: 38.36/100 000-67.75/100 000) than that in other age groups. From 1990 to 2015, there was no obvious change in the age standardized mortality rate of falls in total population, men and women with average percent change about 0.37 (95%UI: -0.08-0.83), 0.45 (95%UI: 0.05-0.84) and 0.31 (95%UI: -0.26-0.87) respectively, but a significant decrease and increase could be seen in children under 15-year-old, especially under 5-year-old with average percent change about -4.07 (95%UI: -5.62--2.51), and the elderly aged 70-year-old and above with average percent change about 1.89 (95%UI: 1.42-2.37) respectively. Four types of trajectories could be categorized for different trends of age standardized mortality rate of falls in all provinces. The first group had the lowest fall mortality with a downward trend. The fall mortality was close in the second and third group but with different change tendency, a decreasing propensity in the former and an increasing one in the latter. The fourth group had the highest fall morality with obvious fluctuation.@*Conclusion@#There was no significant change in the age standardized mortality rate of falls in China from 1990 to 2015. However, the trend of age standardized mortality rate of falls varied in different age and provinces during the same period of time.

Prevalence of drink-driving among adults in China: A nationally representative survey in 2010.

OBJECTIVE: We examined the prevalence of and characteristics associated with drink-driving in China. We compared this study's drink-driving findings with those from the United States to explore how effective traffic safety interventions from Western cultures might be adapted for use in China. METHODS: Data from the 2010 China Chronic Disease and Risk Factor Survey were analyzed to describe the prevalence and characteristics associated with drink-driving in China. RESULTS: Overall, 1.5% of Chinese adults reported drink-driving in the past 30 days-3% of males and 0.1% of females. However, among males who had driven a vehicle in the past 30 days and consumed at least one alcoholic beverage in the past 30 days, 19% reported drink-driving during the 30-day period. Excessive drinking, binge drinking, nonuse of seat belts, and having been injured in a road traffic crash in the past year were most strongly associated with drink-driving among males. CONCLUSIONS: Drink-driving is prevalent among male drivers in China. Although large differences exist between China and the United States in the proportion of adults who drive, the proportion who consume alcohol, and some of the personal characteristics of those who drink and drive, similarities between the 2 countries are present in patterns of risk behaviors among drink-driving. To reduce injuries and deaths from drink-driving, effective interventions from Western cultures need to be tailored for adoption in China.

Disease burden of injuries in children aged 0-14-year-old in 1990 and 2013, in China / 中华流行病学杂志

Objective To analyze the disease burden of injuries in Chinese children aged between 0-14-year-old,in 1990 and 2013.Methods Data derived from the Global Burden of Disease 2013 was used to analyze the disease burden of injuries among children aged between 0-14-year-old in each province of China,using relevant indicators including mortality and the rate on disability-adjusted life years (DALY).Results In 2013,the number of deaths,rates on mortality and DALY caused by injuries in children aged between 0-14-year-old were 73 766,29.46 per 100 000 and 2 449.36 per 100 000,respectively.Each indicator of injury burden appeared higher in boys than that in girls.With the increase of age,burden caused by injuries in each age group showed a decreasing trend.Provinces and autonomous regions as Xinjiang,Tibet,Gansu,Qinghai and Ningxia ranked the top 5 regions on both mortality rate and DALY rate among children aged between 0-14-year-old.The top 3 injury-related mortality rates and rate on DALY were drowning,road traffic injury and exposure to mechanic forces,among children.Compared to the disease burden of injuries in the 1990s,all indicators showed decreasing trends in children aged between 0-14-year-old,with girls more than boys,and variations in different age groups.In all areas of China,improvements were seen on intervention programs related to the injury-caused burden among children aged between 0-14-year-old,except for Ningxia,Yunnan and Chongqing.Conclusions During the last two decades,there had been significant improvements in reducing the injury-caused burden among the Chinese children aged between 0-14-year-old.However,injury is still the most important risk on health of children under 4-year-old,with boys in particular.Drowning and road traffic injury were the two leading causes of death in children aged between 1 and 14-year-old.

Disease burden on falls among elderly aged 70 and over in the Chinese population, in 1990 and 2013 / 中华流行病学杂志

Objective To analyze the disease burden of falls in Chinese population aged 70 and over,in 1990 and 2013 and to provide evidence for the development of prevention strategies on falls in the elderly.Methods Indicators including mortality rate,years of life lost due to premature mortality (YLL),years lived with disability (YLD) and disability-adjusted of life years (DALY) on falls,were gathered from the results of Global Burden of Disease 2013 and used to describe the disease burden of falls in China by calculating the changing rates on corresponding parameters in 1990 and 2013.Results In 2013,the number of deaths,YLLs,YLDs,DALYs caused by falls among Chinese population aged 70 and over were 48 800,0.44 million person years,0.30 millions person years,and 0.74 million person years,respectively.The standardized mortality rate,rates on YLLs,YLDs and DALYs of falls were 561.71 per 100 000,55.87 per 100 000,373.98 per 100 000 and 929.85 per 100 000,respectively.The burden of falls increased along with the increase of age.Compared with 1990,the number of deaths,YLLs,YLDs and DALYs caused by falls increased by 308.80％,161.01％,54.67％ and 104.47％,respectively,in 2013,more seen in males than in females.The standardized mortality rate,YLLs and DALYs caused by falls increased by 63.67％,38.54％ and 73.08％,respectively,during 1990 and 2013.However,the standardized YLDs rate fell by 17.90％ during the same period.Conclusion Falls caused heavy disease burden which increased in 1990 and 2013 among the Chinese population aged 70 and over.

Disease burden caused by suicide in the Chinese population, in 1990 and 2013 / 中华流行病学杂志

Objective To provide basic suicide prevention strategy through analyzing the disease burden of suicide in the Chinese population,in 1990 and 2013.Methods Indicators including mortality rate,years of life lost due to premature mortality (YLL),years lived with disability (YLD),and disability-adjusted of life years (DALY) on suicide,were from the results of Global Burden of Disease 2013 and used to describe the burden of disease caused by suicide in Chinese population.Data described the disease burden of suicide in China by comparing the corresponding parameters in 1990 and 2013.Results In 2013,the standard mortality on suicide was 9.08 per 100 000,and 73.39 per 100 000 in the 80 and above year-old,with the highest rates on DALY and YLL seen in the 75-79-year-old.Each parameter related to suicide burden in males appeared higher than that in females.Compare to data in the 1990s,these parameters declined in 2013,especially seen in females.The rate of YLLs/YLDs on suicide was 90.03 in 2013,89.83 in males and 89.00 in females.Conclusion The disease burden of suicide decreased sharply between 1990 and 2013 but was still a serious issue in the elderly that called for more attention.

Disease burden on road injury in the Chinese population, in 1990 and 2013 / 中华流行病学杂志

Objective To explore the disease burden of road injuries in China.Methods The results of Global Burden of Disease 2013 including death rate,disability-adjusted of life years (DALY),years of life lost due to premature mortality (YLL),years lived with disability (YLD),were used to describe the burden caused by road injuries in 2013 and the trends from 1990 to 2013,in China.Results In 2013,there were 313 676 deaths caused by traffic accidents in China.Death rate,rates on DALY,YLL and YLD were 22.52 per 100 000,1 076.54 per 100 000,971.21 per 100 000 and 105.34 per 100 000,respectively.Rates on deaths,YLL and YLD appeared higher in males,pedestrians than in females and other types of road travelers.Burden of injuries caused by traffic accidents was seen higher in those aged 15 to 49-year-old.From 1990 to 2013,the overall death rate on road injuries increased by 0.54 per 100 000 in China,with an increase of 2.34 per 100 000 and 0.81 per 100 000,respectively in males and pedestrians.The rates on DALY,YLL and YLD decreased by 164.21 per 100 000,115.06 per 100 000 and 49.06 per 100 000,respectively.Conclusions During the past 20 years,achievements had been made on road injury prevention and control,with the decrease of disease burden caused by road accidents.Males,young adults and pedestrians should be called for more attention to prevent road injuries.

Disease burden caused by violence in the Chinese population, in 1990 and 2013 / 中华流行病学杂志

Objective To analyze the disease burden of violence in the Chinese population,in 1990 and 2013.Methods Indicators including mortality rate,years of life lost due to premature mortality (YLL),years lived with disability (YLD),and disability-adjusted of life years (DALY)related to violence,were extracted from the Global Burden of Disease 2013 and used to describe the burden of disease caused by violence in the Chinese population.Data related to corresponding parameters on disease burden of violence in 1990 and 2013 were described.Results In 2013,a total of 20 500 people died of violent events,with the death rate as 1.44 per 100 000,in China.DALY caused by violence was 1.08 million person years in 2013.DALY caused by sharp violence was 0.47 million person years,with 0.09 million person years lost due to firearm violence.Disease burden caused by violence appeared higher in males than in females.When comparing with data from the 1990s,reductions were seen by 67.35％ on the standardized death rate of violence,by 68.07％ on the DALY attributable to violence,and by 70.47％ on the standardized DALY rate attributable to violence,respectively,in 2013.Disease burden of violence among young adults and elderly was among the highest.When comparing with data from the 1990,DALY in 2013 decreased among all the age groups except for the 70-year-old showed an increase of 9.36％.The standardized DALY rate in 2013 showed a declining trend in all the age groups,mostly in the 0-4-year-old group.The standardized DALY rates caused by sharp violence or firearm decreased by 75.11％ and 83.20％ in the 0-4-year-old group.Conclusion In recent years,the disease burden caused by violence showed a decreasing trend but appeared higher in males however with the increase of DALY in the eldcr population.

Disease burden on drowning in the Chinese population, in 1990 and 2013 / 中华流行病学杂志

Objective To comprehensively analyze the disease burden of drowning in the Chinese population both at the national and provincial levels in 1990 and 2013,to provide reference for the development of strategies regarding drowning prevention.Methods Both methods related to unified measurement framework and standardized estimation on Global Burden of Disease in 2013,were used.Data on deaths caused by injuries were from the following sources which include:Disease Surveillance Points,the National Maternal and Child Health Surveillance Network,the Death Registration Reporting System of Chinese Center for Disease Control and Prevention,Death Registration System and death information from Macau and Hong Kong areas of China.Injury-related incidence data was from the National Injury Surveillance System and literature review.Parameters as death/death rate,years of life lost due to premature mortality (YLL)/standardized YLL rate,years living with disability (YLD)/standardized YLD rate and disability-adjusted of life years (DALY)/standardized DALY were used to analyze the disease burden and changing trend on drowning at both the national and all the provincial levels.Results In 2013,the number of deaths due to drowning was 63 619 in China,with the standardized mortality rate as 5.29 per 100 000,accounting for 8.0％ of the total injury deaths.Drowning was the fourth leading cause of injury death in the whole population and the first leading cause of injury death among children aged ＜ 5 and 5-14 years old in 2013,with YLL of drowning as 3.49 million person years,YLD as 0.04 million person years,and DALY as 3.53 million person years.Compared with data from 1990,the rates on standardized mortality,standardized YLL,standardized YLD and standardized DALY of drowning all declined in 2013.The five provinces/districts/cities with the highest rates of drowning were Xinjiang (10.08 per 100 000),Jiangxi (8.44 per 100 000),Anhui (7.92 per 100 000),Guizhou (7.77 per 100 000) and Sichuan (7.68 per 100 000).Standardized mortality of drowning reduced in all provinces in 2013.Conclusions Disease burden of drowning in the Chinese population,especially in children,declined significantly in 2013,comparing to 1990.However,drowning remains a serious proble,with children and males in particular,in China.Research regarding prevention on drowning is in great need in the western and central areas where drowning mortalities appeared high.

Comprehensive evaluation on disease burden of injury and improvement of the related evidence system on injury prevention / 中华流行病学杂志

With rapid social and economic development in this country,injury has become one of the three major health issues with public concern.To reduce the burden of diseases as disability and medical treatment that caused by injury also became important in public health.Programs related to comprehensive evaluation on disease burden caused by injury and evidence-based strategies on injury-related prevention became substantially important.Our article-“The Disease Burden caused by Injury”,we involved a series of papers based on the systematic databases which focusing on the current status and the change of types of injuries in the Chinese population.Hopefully,it could provide key clues for the development of injury prevention and control programs in the future.