JMIR Publications

ABSTRACT

Background:

Over the last few decades, the injury age-standardized mortality rate (ASMR) has shown a significant declining trend in China, however, this pattern was dramatically reversed recently.

Objective:

We aimed to elucidate the specific cause of the reversal phenomenon from 2005 to 2019, and the fluctuations of injury burden.

Methods:

A longitudinal observational study was performed using the raw data of injury death in the National Cause-of-Death surveillance data provided by the disease surveillance points (DSP) system during the 2005-2019 period. By gender, age, urban-rural region, and east-central-west area, the cause-specific injuries were divided into disparate subgroups, respectively. The burden of injury death was assessed using potential years of life lost (PYLL), average years of life lost (AYLL), and potential years of life lost rate (PYLLR). The latest temporal and age trends in injury mortality and burden were examined using best-fitting joinpoint models with annual percentage change (APC) showing the rate for certain periods and average annual percentage change (AAPC) representing the average change rate from 2005 to 2019.

Results:

Injury deaths accounted for 7.51% of all-cause of death in China during 2005-2019. The crude mortality rate (CMR) of all injuries was 47.74 per 100,000 persons. The top three injury types (traffic accident, falls and suicide) accounted for 70.57% of all-injury-related deaths. The ASMR of all-cause injury decreased during 2005-2019 (P<0.01), while the CMR remained unchanged (P>0.05). Reverse trends in ASMR of all-cause injury had been found in urban people aged 65+ years since 2007, mainly resulting from inverted trends in falls. Despite suicide exhibiting the steepest decreasing trend in ASMR among disparate types of injuries, a reversal trend was observed in recent years among adolescents and young adults aged 10-24 years, with notable increases by 35.18% [APC=15.3%, 95% confidence interval (CI) 3.0%,29.0%] in men since 2017. The AYLL and PYLLR of all-cause injury showed a substantial diminution, while 65 and over age groups showed consistent ascending trends from 2005 to 2019 (AAPC=6.1%, 95%CI 5.4%,6.9%, 129.04% increase for AYLL; AAPC=5.4%, 95%CI 2.4%,8.4%, 105.52% increase for PYLLR). Meantime, AYLL of suicide for people aged 10-24 years displayed a considerable upswing tendency (AAPC=0.5%, 95%CI 0.4%,0.7%, 8.02% increase).

Conclusions:

Injury continued to account for a large proportion of mortality in China, despite a significant decreasing trend from 2005 to 2019. The trend in suicide had reversed considerably among adolescents and young adults in recent years; the ASMRs in falls among the elderly aged 65+ years were on the rise since 2007. Hence, intervention should be encouraged to mitigate the cause-specific burdens of injury death.