Urban-rural disparities in injury mortality in China, 2006

The epidemiology and outcomes of hospitalized drowning in Thai children: a national data analysis 2015-2019

BACKGROUND

Drowning remains a common cause of death among children. However, the epidemiology and impact of drowning in Thailand was underexplored. This study aimed to analyze the epidemiology and clinical outcomes of pediatric drowning in Thailand and to determine the factors associated with the need for intubation and mortality.

METHODS

Data derived from the Thai healthcare delivery system for the period between 2015 and 2019 were used to examine the monthly admissions, mortality rates, length of hospital stay, and the number of patients who received endotracheal intubation. Multivariate logistic regression analysis was employed to identify the risk factors associated with the need for intubation and mortality.

RESULTS

Of the 4,911, 58.8% were under six years old, 63.5% were male, and 31.2% were from the Northeastern region. The majority drowned during April, which is the summer season in Thailand. Among these patients, 28.8% required intubation, with the highest proportion found in the 6-<12 years age group (35.9%). The independent risk factors for intubation were metabolic acidosis (adjusted odd ratio [aOR] 9.74; 95% confidence interval [CI] 7.14-13.29; p < 0.001) and pulmonary edema (aOR 5.82; 95%CI 3.92-8.65; p < 0.001). The overall mortality rate due to drowning was 12.6%. Factors significantly associated with mortality included in-hospital cardiac arrest (aOR 4.43; 95%CI 2.78-7.06; p < 0.001), and the presence of drowning-related complications, particularly renal failure (aOR 7.13; 95%CI 3.93-12.94; p < 0.001).

CONCLUSION

Drowning admissions and mortality were highest among male children under six years old, occurring mainly during the summer season. Significant factors associated with intubation requirement included metabolic acidosis and pulmonary edema. The mortality was significantly associated with in-hospital cardiac arrest and drowning-related complications, particularly renal failure.

TRIAL REGISTRATION

This is an observational study, does not include any intervention, and has therefore not been registered.

Changing Patterns of Injury Mortality Among the Elderly Population in Urban and Rural Areas - China, 1987-2021

What is already known about this topic?

Injury is a significant public health issue, particularly among the elderly population. However, the extent of this problem varies significantly based on age, gender, and geographic location.

What is added by this report?

This study aims to examine the changing patterns of injury mortality rates in China over a 35-year period and assess the age-period-cohort effects on mortality trends.

What are the implications for public health practice?

This study examines the evolving patterns of injury mortality in the elderly population and identifies potential high-risk groups. The findings offer valuable insights for informing injury prevention policies.

Mediating and Moderating Effects of Internet Use on Urban-Rural Disparities in Health Among Older Adults: Nationally Representative Cross-Sectional Survey in China

BACKGROUND

The urban-rural disparities in health outcomes in China are remarkable. The internet has shown the potential to reduce the likelihood of contracting a disease by increasing disease knowledge. However, little is known about the effects of internet use in alleviating health inequities between urban and rural areas.

OBJECTIVE

This study aimed to examine the mediation and moderation of health disparities between urban and rural older adults through internet use.

METHODS

A total of 8223 respondents were selected from the China Health and Retirement Longitudinal Study 2018 data set. Basic activities of daily living, a brief Community Screening Instrument for Dementia, and the Centre for Epidemiologic Studies Depression Scale were used to measure functional disability, cognitive function, and depressive symptoms, respectively. Logistic regressions testing "internet use×urban-rural status" interactions for moderation and Karlson-Holm-Breen decomposition for mediation were performed.

RESULTS

Internet use moderated the urban-rural disparities in cognitive function (odds ratio 7.327, 95% CI 3.011-17.832) and depressive symptoms (odds ratio 1.070, 95% CI 1.037-1.787), but the moderating effects were significant only for those using the internet daily. Karlson-Holm-Breen results showed the suppression effects of using the internet daily (β=.012, 95% CI .002-.021) on the association between urban-rural status and cognitive function. The urban-rural inequality in depressive symptoms was partially attributed to the disparity in internet use (β=-.027, 95% CI -.043 to -.009).

CONCLUSIONS

The urban-rural inequalities in mental health are partially attributable to disparities in the prevalence of internet use between the 2 groups. However, using the internet is more beneficial for the psychological health of rural users, thereby alleviating the urban-rural disparities in health. Providing convenient channels for rural older adults to use the internet, improving the ability of rural users to effectively use the internet, and promoting internet popularity in rural areas are effective approaches to reducing urban-rural health inequalities.

Caregiver accounts of unintentional childhood injury events in rural Uganda

OBJECTIVE

Complex environmental, social, and individual factors contribute to unintentional childhood injury events. Understanding context-specific antecedents and caregiver attributions of childhood injury events can inform the development of locally-targeted interventions to reduce injury risk in rural Uganda.

METHODS

Fifty-six Ugandan caregivers were recruited through primary schools and completed qualitative interviews regarding 86 unintentional childhood injury events. Descriptive statistics summarized injury characteristics, child location and activity, and supervision at time of injury. Qualitative analyses informed by grounded theory identified caregiver attributions of injury causes and caregiver actions to reduce injury risk.

RESULTS

Cuts, falls, and burns were the most common injuries reported. At the time of injury, the most common child activities were farming and playing and the most common child locations were the farm and kitchen. Most children were unsupervised. In cases where supervision was provided, the supervisor was typically distracted. Caregivers most often attributed injuries to child risk-taking but also identified social, environmental, and chance factors. Caregivers most often made efforts to reduce injury risk by teaching children safety rules, but also reported efforts to improve supervision, remove hazards, and implement environmental safeguards.

CONCLUSION

Unintentional childhood injuries have a significant impact on injured children and their families, and caregivers are motivated to reduce child injury risk. Caregivers frequently perceive child decision-making a primary factor in injury events and respond by teaching children safety rules. Rural communities in Uganda and elsewhere may face unique hazards associated with agricultural labor, contributing to a high risk of cuts. Interventions to support caregiver efforts to reduce child injury risk are warranted.

Modelling Determinants of Deaths Attributable to External Causes Among Adults in India

The study aimed at finding the risk factors associated with adult mortality (15-59 years) due to external causes (accidents, suicide, poisoning, homicide, and violence). Using National Family Health Survey data-4 consisting of 1,756,867 sample, we applied a Robust Poisson Regression Model to determine the potential risk factors. Findings suggest that the highest proportion of deaths due to external causes was in the age group 20-24 years. The prevalence of these deaths was higher among older adults (age 50 years and above). The risk was more among males (Incident Rate Ratio (IRR) for females is: 0.29, p < 0.001), rural residents (IRR: 1.16, p < 0.001), exposed to mass-media (IRR: 1.08, p < 0.05), residing in female-headed households, in households having a member with higher education. This risk decreased for large families (IRR: 0.89, p < .001). A need to strengthen awareness and mentorship programs for young-adults and middle-aged people to control such avoidable deaths is recommended.

Risk Factors for Road-Traffic Injuries Associated with E-Bike: Case-Control and Case-Crossover Study

The Electric Bike (EB) has become an ideal mode of transportation because of its simple operation, convenience, and because it is time saving, economical and environmentally friendly. However, electric bicycle road-traffic injuries (ERTIs) have become a road-traffic safety problem that needs to be solved urgently, bringing a huge burden to public health. In order to provide basic data and a theoretical basis for the prevention and control of ERTIs in Shantou, mixed research combining a case-control study and a case-crossover study was carried out to investigate the cycling behavior characteristics and injury status of EB riders in Shantou city, and to explore the influencing factors of ERTI. The case-control study selected the orthopedic inpatient departments of three general hospitals in Shantou. The case-crossover study was designed to assess the effect of brief exposure on the occurrence of ERTIs, in which each orthopedic inpatient serves as his or her own control. Univariable and multivariable logistic regressions were used to examine the associated factors of ERTIs. In the case-control study, multivariable analysis showed that chasing or playing when cycling, finding the vehicle breakdown but continuing cycling, not wearing the helmet, and retrograde cycling were risk factors of ERTIs. Compared with urban road sections, suburb and township road sections were more likely to result in ERTIs. Astigmatism was the protective factor of ERTI. The case-crossover study showed that answering the phone or making a call and not wearing a helmet while cycling increased the risk of ERTIs. Cycling in the motor-vehicle lane and cycling on the sidewalk were both protective factors. Therefore, the traffic management department should effectively implement the policy about wearing a helmet while cycling, increasing the helmet-wearing rate of EB cyclists, and resolutely eliminate illegal behaviors such as violating traffic lights and using mobile phones while cycling. Mixed lanes were high-incidence road sections of ERTIs. It was suggested that adding people-non-motor-vehicles/motor vehicles diversion and isolation facilities in the future to ensure smooth roads and safety would maximize the social economic and public health benefits of EB.

Traumatic spinal cord injury mortality from 2006 to 2016 in China

Purpose: To report on the national traumatic spinal cord injury (TSCI) mortality of China population, and assess sex-, age-, location-, and cause-specific mortality rates, respectively.Methods: A population-based longitudinal study based on mortality data from the Disease Surveillance Points system of China, 2006-2016. TSCI was defined according to the 10th International Classification of Disease. Negative binomial regression was used to test the significance of the change in overall and subgroup mortality rate.Results: Age-adjusted TSCI mortality rate increased by 64% from 2006 to 2016, ranging from 0.19 to 0.34 per 100,000 population. The crude mortality was 0.31 per 100,000 population in 2016. Males and rural residents had higher TSCI mortality rates than females and urban residents. The age-adjusted TSCI mortality rate increased 53% for males, 107% for females, 75% in an urban area, and 59% in a rural area. In comparison with insignificant change in the age group of 0-44 years, TSCI mortality increased 56% and 147% in age groups of 45-64 years and 65 years. Falls accounted for 45.4% of total mortality.Conclusions: TSCI mortality rates were higher in males and in rural residents than in females and in urban residents during the study time period. TSCI mortality increased quickly as age increased; adults aged 65 years and older had the highest mortality rate. Falls and motor vehicle crashes were the two most common causes of TSCI mortality. More prevention efforts are needed to reduce a number of deaths from TSCI injury considering a substantial increase in TSCI mortality.

Social and environmental risk factors for unintentional suffocation among infants in China: a descriptive analysis

Background

This retrospective study aimed to determine the epidemiological features of deaths caused by unintentional suffocation among infants in China.

Methods

The data used in this study were obtained from China’s Under 5 Child Mortality Surveillance System (U5CMSS) from October 1, 2015, to September 30, 2016. A total of 377 children under 1 year of age who died from unintentional suffocation were included in the survey. Primary caregivers were interviewed individually using the Unintentional Suffocation Mortality among Children under 5 Questionnaire. EpiData was used to establish the database, and the results were analysed using SPSS 22.0.

Results

Most (85.9%) unintentional infant suffocations occurred in rural areas, and 67.5% occurred in infants 0 to 3 months old. Among the primary caregivers of the infants, most (82.7%) had a junior middle school education or below, and 83.1% of them lacked unintentional suffocation first aid skills. Of the 377 unintentional suffocated-infant deaths, the causes of death were accidental suffocation and strangulation in bed (ASSB) (193, 51.2%), inhalation suffocation (154, 40.8%), other unintentional suffocation (6, 1.6%), and unknown (24, 6.4%). Among the infant deaths due to ASSB, overlaying (88.6%) was the most frequently reported circumstance. A total of 93.8% of cases reported occurred during co-sleeping/bed sharing with parents, and in 72.8% of the cases, the infants were covered with the same quilt as their parents. In our study, most inhalation suffocation deaths (88.3%) involved liquid food (such as breast milk and formula milk). A total of 80.5% of infant deaths reportedly occurred after eating; in 28.2% of those cases, the infants were held upright and patted by their caregivers, and 57.2% of them were laid down to sleep immediately after eating.

Conclusions

To reduce the occurrence of unintentional suffocation, local government should strengthen knowledge and awareness of unintentional suffocation prevention and safety among parents and caregivers. Additionally, health care providers should educate parents and caregivers about safety issues of unintentional suffocation, and relevant policies should be introduced to provide environments and activities that reduce the risk of suffocation, such as promoting the Safe to Sleep Campaign. It is important to enhance the focus on infant unintentional suffocation as a health issue.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-021-02925-4.

Trend of unintentional suffocation death for infants under 1 year of age from 2009 to 2018 in Hunan, China: a cross-sectional study

OBJECTIVE

Few studies have addressed the unintentional suffocation of infants in China. This study is to assess the mortality rate of unintentional suffocation among infants and the differences across age groups, gender, rural versus urban locations and related healthcare services.

DESIGN

A cross-sectional study on unintentional suffocation death of infants under 1 year of age in Hunan Province from 2009 to 2018.

SETTING

Hunan Province, with a population of 74 million, has an area of 210 000 square kilometres and 123 counties/districts.

PARTICIPANTS

The total data of 4109 unintentional suffocation deaths of infants in Hunan Province from 2009 to 2018 was collected, including 2331 boys, 1766 girls, 12 infants of unknown gender, 2906 rural children and 1203 urban children.

MAIN OUTCOME MEASURE

The unintentional suffocation mortality rate of infants is defined as the number of unintentional suffocation deaths of children under 1 year of age per 100 000 live births in the same year.

RESULTS

The infant mortality rate showed a downward trend from 2009 to 2018. Infant unintentional suffocation death decreased first and then fluctuated. The proportion of unintentional suffocation death to infant death showed an upward trend in fluctuation. Boys and rural children had higher mortality rates than those of girls and urban children. A total of 43.5% of the deaths occurred in winter. Forty-eight per cent of the unintentional suffocations were infants between 1 and 4 months of age. A total of 46.4% of the deaths occurred at home, and 71.6% were not treated; approximately 81.8% of the untreated cases were mainly due to a lack of time to get to the hospital. A total of 65.2% of the deaths were diagnosed postmortem.

CONCLUSION

The mortality rate of unintentional suffocation among infants in Hunan Province should attract the attention of the population, and measures should be taken according to epidemiological investigations.

The relationship between geographic location and outcomes following injury: A scoping review

INTRODUCTION

Globally, injury incidence and injury-fatality rates are higher in regional and remote areas. Recovery following serious injury is complex and requires a multi-disciplinary approach to management and community re-integration to optimise outcomes. A significant knowledge gap exists in understanding the regional variations in hospital and post-discharge outcomes following serious injury. The aim of this study was to review the evidence exploring the association between the geographic location, including both location of the event and place of residence, and outcomes following injury.

MATERIALS AND METHODS

A scoping review was used to investigate this topic and provide insight into geographic variation in outcomes following traumatic injury. Seven electronic databases and reference lists of relevant articles were searched from inception to October 2018. Studies were included if they measured injury-related mortality, outcomes associated with hospital admission, post-injury physical or psychological function and analysed these outcomes in relation to geographic location.

RESULTS

Of the 2,213 studies identified, 47 studies were included revealing three key groups of outcomes: mortality (n = 35), other in-hospital outcomes (n = 8); and recovery-focused outcomes (n = 12). A variety of measures were used to classify rurality across studies with inconsistent definitions of rurality/remoteness. Of the studies reporting injury-related mortality, findings suggest that there is a greater risk of fatality in rural areas overall and in the pre-hospital phase. For those patients that survived to hospital, the majority of studies included identified no difference in mortality between rural and urban patient groups. In the small number of studies that reported other in-hospital and recovery outcomes no consistent trends were identified.

CONCLUSION

Rural patients had a higher overall and pre-hospital mortality following injury. However, once admitted to hospital, there was no significant difference in mortality. Inconsistencies were noted across measures of rurality measures highlighting the need for more specific and consistent international classification methods. Given the paucity of data on the impact of geography on non-mortality outcomes, there is a clear need to develop a larger evidence base on regional variation in recovery following injury to inform the optimisation of post-discharge care services.

Unintentional falls mortality in China, 2006-2016

BACKGROUND

To examine trends in unintentional falls mortality from 2006 to 2016 in China by location (urban/rural), sex, age group and mechanism.

METHODS

Mortality data were retrieved from the National Disease Surveillance Points system (DSPs) of China, a nationally representative data source. Percent change in mortality between 2006 and 2016 was calculated as "mortality rate ratio - 1" based on a negative binomial regression model.

RESULTS

The crude unintentional falls mortality was 9.55 per 100 000 population in 2016. From 2006 to 2016, the age-adjusted unintentional falls mortality increased by 5% (95% confidence interval (CI) = 1%-9%), rising from 7.65 to 8.03 per 100 000 population. Males, rural residents and older age groups consistently had higher falls mortality rates than females, urban residents and younger age groups. Falls on the same level from slipping, tripping and stumbling (W01) was the most common mechanisms of falls mortality, accounting for 29% of total mortality.

CONCLUSIONS

Unintentional falls continued to be a major cause of death in China from 2006 to 2016. Empirically-supported interventions should be implemented to reduce unintentional falls mortality.

Under-five mortality from unintentional suffocation in China, 2006-2016

Background

We used nationally representative data to examine trends in under-five unintentional suffocation mortality from 2006 to 2016 in China and mortality differences across age groups, sexes, rural vs urban locations and injury mechanisms.

Methods

Mortality data came from 161 surveillance points of China's disease surveillance points (DSPs) system. Unintentional suffocation deaths were identified through the 10th International Classification of Disease (ICD-10 codes: w75-w84). Negative binomial regression tested the significance of change in overall and subgroup mortality between 2006 and 2016.

Results

Despite minor fluctuations, a steady trend in overall age-adjusted unintentional suffocation mortality was observed from 2006 to 2016 in Chinese children under 5 years of age. Infants (<1 year), boys and rural children had higher mortality rates than children aged 1-4 years, girls and urban children, respectively. Strangulation and suffocation in bed was the most common cause of mortality for infants, accounting for 66% of deaths. Children aged 1-4 years suffered more often from inhalation suffocation (55% of deaths).

Conclusions

Unintentional suffocation mortality rates in under-five children remained fairly stable in China over the past decade but remained at high levels. We discuss actions that might be implemented to reduce pediatric suffocation rates in China.

Under-five mortality from unintentional suffocation in China, 2006-2016

Background

We used nationally representative data to examine trends in under-five unintentional suffocation mortality from 2006 to 2016 in China and mortality differences across age groups, sexes, rural vs urban locations and injury mechanisms.

Methods

Mortality data came from 161 surveillance points of China’s disease surveillance points (DSPs) system. Unintentional suffocation deaths were identified through the 10th International Classification of Disease (ICD-10 codes: w75-w84). Negative binomial regression tested the significance of change in overall and subgroup mortality between 2006 and 2016.

Results

Despite minor fluctuations, a steady trend in overall age-adjusted unintentional suffocation mortality was observed from 2006 to 2016 in Chinese children under 5 years of age. Infants (<1 year), boys and rural children had higher mortality rates than children aged 1-4 years, girls and urban children, respectively. Strangulation and suffocation in bed was the most common cause of mortality for infants, accounting for 66% of deaths. Children aged 1-4 years suffered more often from inhalation suffocation (55% of deaths).

Conclusions

Unintentional suffocation mortality rates in under-five children remained fairly stable in China over the past decade but remained at high levels. We discuss actions that might be implemented to reduce pediatric suffocation rates in China.

Epidemiological characteristics of injury mortality in Guangdong Province, China, 2015

BACKGROUND

As the fourth leading cause of death, injury is an important public health concern in Guangdong Province, China. The epidemiological characteristics of injury mortality is changing along with the social development. This study described the epidemiological characteristics of injury mortality in Guangdong Province by analyzing the death surveillance data in a few areas in Guangdong Province in 2015.

METHODS

Using the mortality data from the Disease Surveillance Points (DSP) system, injury deaths were classified according to the International Classification of Disease-10th Revision (ICD-10). The data were stratified by areas (urban/rural), gender, age groups, injury types, and then overall and type-specific injury mortality rates were estimated for the whole Guangdong Province, China.

RESULTS

We estimated that about 38,200 individuals died from injury in Guangdong Province in 2015, producing a mortality rate of 43.11/100,000. The overall age-standardized injury mortality in men was higher in rural areas compared with urban areas (41.29/100,000 versus 24.89/100,000). In terms of injury intent, unintentional injuries were the commonnest injury type, which accounted for 83.93% of the overall injury deaths, however, the deaths caused by suicide should not be ignored, which occupied 12.67% of the total injury deaths. In terms of injury cause type, falls, road-traffic accidents, suicide, drowning, and accidental poisoning were the top five leading types of injury deaths.

CONCLUSIONS

In Guangdong Province, injury is an important cause of death. Road-traffic accidents, falls, suicide, drowning, and accidental poisoning should be the priorities of intervention. Moreover, in rural areas, the men were the most targeted subpopulation of the prevention activities.

Poisoning deaths in China, 2006-2016

Objective

To provide a comprehensive overview of poisoning mortality patterns in China.

Methods

Using mortality data from the Chinese national disease surveillance points system, we examined trends in poisoning mortality by intent and substance from 2006 to 2016. Differences over time between urban and rural residents among different age groups and across external causes of poisoning were quantified using negative binomial models for males and females separately.

Results

In 2016, there were 4936 poisoning deaths in a sample of 84 060 559 people (5.9 per 100 000 people; 95% confidence interval: 5.6–6.2). Age-adjusted poisoning mortality dropped from 9.2 to 5.4 per 100 000 people between 2006 and 2016. Males, rural residents and older adults consistently had higher poisoning mortality than females, urban residents and children or young adults. Most pesticide-related deaths (34 996 out of 39 813) were suicides among persons older than 15 years, although such suicides decreased between 2006 and 2016 (from 6.1 per 100 000 people to 3.6 for males and from 5.8 to 3.0 for females). In 2016, alcohol caused 29.3% (600/2050) of unintentional poisoning deaths in men aged 25–64 years. During the study period, unintentional fatal drug poisoning by narcotics and psychodysleptics in individuals aged 25–44 years increased from 0.4 per 100 000 people to 0.7 for males and from 0.05 to 0.13 for females.

Conclusion

Despite substantial decreases in mortality, poisoning is still a public health threat in China. This warrants further research to explore causative factors and to develop and implement interventions targeting at-risk populations.

A comparative study of unintentional injuries among schooling left-behind, migrant and residential children in China

BACKGROUND

Children who suffer from parental migration have been manifested to exhibit physical and mental impairments at higher rates. This current study aims to explore unintentional injury disparity among schooling left-behind children, migrant children and residential children in China, and to examine the risk factors of unintentional injury among the three types of children based on a multi-level system framework. This study will fill the gaps of this topic for China and contribute to the world literature in the context of countries with frequent population migration.

METHODS

Data for 4479 children aged 6-16 of a representative population sample were obtained from a survey conducted in China in 2017. Child's unintentional injury in this survey was measured based on the definition and classification of ICD-10. Descriptive analysis, multivariable logistic regression and zero-inflated negative binomial regression were employed in this study.

RESULTS

Left-behind children showed higher prevalence of total unintentional injury than migrant and residential children, as well as in 14 specific unintentional injuries. There was a statistical difference between left-behind and residential children's unintentional injuries, but no significant difference was found between migrant and residential children. Results also indicated that both individual and environmental factors constructed as a multi-level system were associated with children's unintentional injuries.

CONCLUSIONS

Family migration may have contributed to the increased unintentional injury risks among children. Left-behind children were more vulnerable to suffer from unintentional injuries than migrant and residential children, and specific attentions should be paid to unique group of children, especially the left-behind children. Given the importance and serious consequences of children's unintentional injuries, the findings may provide implications for necessary intervention.

Trends in injury morbidity in China, 1993-2013: A longitudinal analysis of population-based survey data

Understanding long-term trends in injury morbidity is critical to prevention and intervention planning. The aim of this study was to assess long-term trends in injury morbidity rates in China from 1993 to 2013. Using data from the National Health Service Survey (NHSS), which is conducted every five years, crude and age-standardized prevalence during the previous two weeks and hospitalization rates in the last 12 months with 95% confidence intervals (CI) were calculated. The Rao-Scott Chi-square test examined injury morbidity differences across the five survey years by location (urban/rural), sex, age group, and household income. Percent changes in morbidity rate were approximated using logistic regressions. Sampling weights were applied to all analyses. In 2013, crude two-week injury prevalence in China was 0.46% (95% CI: 0.40%, 0.52%) and 12-month crude hospitalization rate was 0.70% (95% CI: 0.63%, 0.77%). Age-standardized injury prevalence increased 31.4% (95% CI: 7.6%, 60.6%) between 1993 and 2013 (29.4%, 95% CI: 6.7%, 56.9% from 1993-2003; 1.6%, 95% CI: -14.8%, 21.0% from 2003-2013), and age-standardized hospitalization rates rose 107.2% (95% CI: 75.1%, 145.2%) from 1993 to 2013 (-9.5%, 95% CI: -24.6%, 8.6% from 1993-2003 and 129.0%, 95% CI: 93.9%, 170.4% from 2003-2013). Subgroup analyses showed similar trends over time. The leading cause of injury was dislocation, sprain or strain for prevalence, and fractures for hospitalization. In conclusion, injury morbidity increased substantially from 1993 to 2013 in China. Inconsistent changes in two-week prevalence and 12-month hospitalization rate merit attention from researchers and policy-makers.

Reimbursement for injury-induced medical expenses in Chinese social medical insurance schemes: A systematic analysis of legislative documents

Social medical insurance schemes are crucial for realizing universal health coverage and health equity. The aim of this study was to investigate whether and how reimbursement for injury-induced medical expenses is addressed in Chinese legislative documents relevant to social medical insurance. We retrieved legislative documents from the China National Knowledge Infrastructure and the Lawyee databases. Four types of social medical insurance schemes were included: urban employee basic medical insurance, urban resident basic medical insurance, new rural cooperative medical system, and urban and rural resident medical insurance. Text analyses were conducted on all identified legislative documents. As a result, one national law and 1,037 local legislative documents were identified. 1,012 of the 1,038 documents provided for reimbursement. Of the 1,012 documents, 828 (82%) provided reimbursement only for injuries without a legally responsible person/party or not caused by self-harm, alcohol use, drug use, or other law violations, and 162 (16%) did not include any details concerning implementation. Furthermore, 760 (92%) of the 828 did not provide an exception clause applying to injuries when a responsible person/party could not be contacted or for situations when the injured person cannot obtain reimbursement from the responsible person/party. Thus, most Chinese legislative documents related to social medical insurance do not provide reimbursement for medical expenses from injuries having a legally responsible person/party or those caused by illegal behaviors. We argue that all injury-induced medical expenses should be covered by legislative documents related to social medical insurance in China, no matter what the cause of the injury. Further research is needed to explore the acceptability and feasibility of such policy changes.

Hotspots of road traffic crashes in a redeveloping area of Shanghai

To identify high-risk locations (hotspots) of road traffic crashes (RTC) in a redeveloping area of Shanghai, for formulating relevant countermeasures in similar areas. After geocoding the crash locations on electronic map, assessment of spatial clustering of accidents and hotspots spatial densities was conducted following Moran's I method, the kernel density estimation, the Ripley's K-function and the network-based kernel density estimation (NKDE). A total of 21,679 RTC incidents resulting in 24,147 victims were recorded from 2010 to 2012. RTCs tended to occur among male (81.8%) aged 20-49 years old (84.9%) riding buses (60.1%) or electric bikes (16.1%) in working time (15%). The network spatial analysis pinpointed the hotspots of RTC at the street level in the Songjiang new urban area, and more RTCs occurred at road intersections than on road segments. Findings from this research may help the authorities develop efficient programmes to target high-risk locations and specific vulnerable populations.

Non-fatal injuries treated outside a hospital in Hunan, China: results from a household interview survey

Background: Injury morbidity data are collected through hospital-based surveillance in many countries. We assessed the extent of non-fatal injures treated outside a hospital. Methods: Data from the first provincial health household interview survey of Hunan, China, conducted in 2013, were used. Injury events were identified and included as medically significant when any of the following circumstances occurred in the prior 14 days: (i) receiving medical treatment from a doctor at a hospital following an injury; (ii) receiving medical treatment by self or others outside a hospital following an injury (e.g. taking medications, or receiving massage or hot compress); and/or (iii) being off work or school, or in bed for more than 1 day, following an injury. The 2-week prevalence of non-fatal injuries and 95% confidence intervals were calculated. We calculated the proportion of injury events treated outside a hospital and the reasons for not visiting a hospital for injury events occurring during the previous 2 weeks. Results: We captured 56 injury events during the previous 2 weeks. The weighted injury prevalence was 4.9 per 1000 persons during the last 2 weeks (95% confidence interval: 2.9–6.9 per 1000 persons). Of the 56 events, 14 (weighted proportion 41.2%) were treated outside a hospital. Primary explanations for skipping hospital visits included perceiving injuries were too minor and economic limitations to travel to hospitals or seek treatment. Conclusion: Results imply the burden of non-fatal injury may be underestimated by hospital-based surveillance systems such as that used in China.

Trends in traumatic brain injury mortality in China, 2006-2013: A population-based longitudinal study

BACKGROUND

Traumatic brain injury (TBI) is a significant global public health problem, but has received minimal attention from researchers and policy-makers in low- and middle-income countries (LMICs). Epidemiological evidence of TBI morbidity and mortality is absent at the national level for most LMICs, including China. Using data from China's Disease Surveillance Points (DSPs) system, we conducted a population-based longitudinal analysis to examine TBI mortality, and mortality differences by sex, age group, location (urban/rural), and external cause of injury, from 1 January 2006 to 31 December 2013 in China.

METHOD AND FINDINGS

Mortality data came from the national DSPs system of China, which has coded deaths using the International Classification of Diseases-10th Revision (ICD-10) since 2004. Crude and age-standardized mortality with 95% CIs were estimated using the census population in 2010 as a reference population. The Cochran-Armitage trend test was used to examine the significance of trends in mortality from 2006 to 2013. Negative binomial models were used to examine the associations of TBI mortality with location, sex, and age group. Subgroup analysis was performed by external cause of TBI. We found the following: (1) Age-adjusted TBI mortality increased from 13.23 per 100,000 population in 2006 to 17.06 per 100,000 population in 2008 and then began to fall slightly. In 2013, age-adjusted TBI mortality was 12.99 per 100,000 population (SE = 0.13). (2) Compared to females and urban residents, males and rural residents had higher TBI mortality risk, with adjusted mortality rate ratios of 2.57 and 1.71, respectively. TBI mortality increased substantially with older age. (3) Motor vehicle crashes and falls were the 2 leading causes of TBI mortality between 2006 and 2013. TBI deaths from motor vehicle crashes in children aged 0-14 years and adults aged 65 years and older were most often in pedestrians, and motorcyclists were the first or second leading category of road user for the other age groups. (4) TBI mortality attributed to motor vehicle crashes increased for pedestrians and motorcyclists in all 7 age groups from 2006 to 2013. Our analysis was limited by the availability and quality of data in the DSPs dataset, including lack of injury-related socio-economic factors, policy factors, and individual and behavioral factors. The dataset also may be incomplete in TBI death recording or contain misclassification of mortality data.

CONCLUSIONS

TBI constitutes a serious public health threat in China. Further studies should explore the reasons for the particularly high risk of TBI mortality among particular populations, as well as the reasons for recent increases in certain subgroups, and should develop solutions to address these challenges. Interventions proven to work in other cultures should be introduced and implemented nationwide. Examples of these in the domain of motor vehicle crashes include policy change and enforcement of laws concerning helmet use for motorcyclists and bicyclists, car seat and booster seat use for child motor vehicle passengers, speed limit and drunk driving laws, and alcohol ignition interlock use. Examples to prevent falls, especially among elderly individuals, include exercise programs, home modification to reduce fall risk, and multifaceted interventions to prevent falls in all age groups.

Red-light running rates at five intersections by road user in Changsha, China: An observational study

The red-light running rate by type of road users has not been reported in China so far. We conducted an observation study to report the violation rate in Changsha, China. Portable digital devices were used to record red-light running violations at five selected intersections. The observation was performed for three days (weekday, weekend and holiday), four time periods per day and an hour per time period (peak and off-peak hours in the morning and in the afternoon). Violation rate was calculated as number of violations divided by total number of vehicles/pedestrians×100%. We used adjusted violation rate ratio (VRR) to quantify the effects of type of day and time period based on Poisson model. Totally, 162,124 vehicles (including motor vehicles, motorcycles and bicycles) and 31,649 pedestrians were recorded. The red-light running rate was 0.14% for motor vehicle drivers, far lowering than those for motorcyclists (18.64%), bicyclists (18.74%) and pedestrians (18.54%). The rate on holiday was 1.89 times that on weekday for drivers. The rate for motorcyclists was high in off-peak hours (adjusted VRR: 1.11), but low on weekend and on holiday (adjusted VRRs: 0.80 and 0.65). The rate for bicyclists was 32% lower on weekend than on weekday. For pedestrians, the rates were high on weekend and holiday and in off-peak hours (adjusted VRR: 1.09, 1.67 and 1.30). The red-light running rate of motor vehicle drivers is far lower than those for motorcyclists, bicyclists and pedestrians. The effects of type of day and time period on violation rate vary with road users, indicating the type of day and time period should be considered when developing and implementing interventions to reduce red-light running of different road users.

Associations of Undergoing a Routine Medical Examination or Not with Prevalence Rates of Hypertension and Diabetes Mellitus: A Cross-Sectional Study

Background: Undergoing a routine medical examination may be associated with the prevalence rate of chronic diseases from a population-based household interview survey. However, this important issue has not been examined so far. Methods: Data came from the first health service household interview of Hunan province, China, in 2013. A Rao–Scott chi-square test was performed to examine the difference in prevalence rates between subgroups. Adjusted odds ratio (OR) was calculated using the PROC SURVEYLOGISTIC procedure of SAS9.1 statistical software. Results: In total, 24,282 residents of 8400 households were surveyed. A higher proportion of elderly adults had undergone a medical examination within the prior 12 months compared with young adults (≥65 years, 60%; 45–64 years, 46%; 18–44 years, 37%). After controlling for location, sex, and household income per capita, undergoing a medical examination was significantly associated with high prevalence rates of hypertension (adjusted OR: 2.0, 95% CI: 1.1–3.5) and of diabetes mellitus (adjusted OR: 3.3, 95% CI: 1.7–6.5) for young adults aged 18–44 years. The associations were not statistically significant for age groups 45–64 years and 65 years or older. Conclusion: The prevalence rates of hypertension and diabetes mellitus may be seriously underestimated for young adults not undergoing a routine medical examination in a health household interview survey.

Large urban-rural disparity in the severity of two-week illness: updated results based on the first health service survey of Hunan Province, China

Background

To examine urban–rural differences in the severity of non-fatal disease and injury using the latest household interview survey data of Hunan Province, China.

Methods

Two-week illness data were from the first provincial health household interview survey of Hunan in 2013. The proportion of patients being bedridden, the average days of being bedridden and the average off-work days were calculated to measure the severity of two-week illness. Rao-Scott-adjusted chi-square test was performed to examine the significance of two-week illness severity differences from demographic variables. Multiple logistic regression and linear regression were used to control for sex, age and household income.

Results

The two-week illness prevalence was 22.8 % in Hunan province. Despite similar two-week ill prevalence rates between urban areas and rural areas (23.0 % vs. 22.8 %), rural residents had higher proportions of being bedridden and of being off work than urban residents after controlling for sex, age and household income, with adjusted odds ratios of 3.4 and 6.9, respectively. Similarly, the average days of being bedridden and of being off work in rural residents were 0.45 days and 1.61 days longer than in urban residents after controlling for demographic variables, respectively.

Conclusion

The recent data shows that two-week illness in rural residents is more serious than urban residents in Hunan Province, China in spite of very similar two-week prevalence rates. The neglected urban–rural disparities in the severity of two-week illness deserve the attention of health policy-makers and researchers.

Spatiotemporal variation and social determinants of suicide in China, 2006-2012: findings from a nationally representative mortality surveillance system

BACKGROUND

Suicide in China has declined since the 1990s. However, there has been limited investigation of the potential spatiotemporal variation and social determinants of suicide during subsequent periods.

METHOD

Annual suicide counts from 2006 to 2012 stratified by county, 5-year age group (⩾15 years) and gender were obtained from the Chinese Disease Surveillance Points system. Trends and geographic differentials were examined using multilevel negative binomial regression models to explore spatiotemporal variation in suicide, and the role of key sociodemographic factors associated with suicide.

RESULTS

The suicide rate (per 100 000) in China decreased from 14.7 to 9.1, 2006-2012. Rates of suicide were higher in males than females and increased substantially with age. Suicide rates were higher in rural areas compared with urban areas; however, urban-rural disparities reduced over time with a faster decline for rural areas. Within both urban and rural areas, higher rates of suicide were evident in areas with lower socio-economic circumstances (SEC) [rate ratio (RR) 1.85, 95% confidence interval (CI) 1.31-2.62]. Suicide rates varied more than twofold (median RR 2.06) across counties, and were highest in central and southwest regions of China. A high proportion of the divorced population, especially for younger females, was associated with lower suicide rates (RR 0.60, 95% CI 0.46-0.79).

CONCLUSIONS

Geographic variations for suicide should be taken into account in policy making, particularly for older males living in rural areas and urban areas with low SEC. Measures to reduce disparities in socio-economic level and alleviate family relation stress are current priorities.

Burden and trend analysis of injury mortality in China among children aged 0-14 years from 2004 to 2011

OBJECTIVE

To track changes of the burden and trends of childhood injury mortality among children aged 0-14 years in China from 2004 to 2011.

DESIGN

National representative data from the Chinese Disease Surveillance Points system and Chinese Maternal and Child Mortality Surveillance system from 2004 to 2011 were used. Rates and 95% CIs of aged-standardised mortality, as well as the proportions of injury death, were estimated.

SETTING

Urban and rural China.

PARTICIPANTS

Children aged 0-14 years from 2004 to 2011.

RESULTS

The proportion of injury among all deaths in children increased from 18.69% in 2004 to 21.26% in 2011. A 'V' shape change was found in the age-standardised injury mortality rate during the study period among the children aged 0-14 years, with the age-standardised injury mortality rate decreasing from 29.71 per 100,000 per year in 2004 to 24.12 in 2007, and then increasing to 28.12 in 2011. A similar change was observed in the rural area. But the age-standardised mortality rate decreased consistently in the urban area. The rate was higher among boys than among girls. Drowning, road traffic accidents and falls were consistently the top three causes of death among children.

CONCLUSIONS

Childhood injury is an increasingly serious public health problem in China. The increasing trend of childhood injury mortality is driven by the rural areas rather than urban areas. More effective strategies and measures for injury prevention and control are needed for rural areas, boys, drowning, road traffic accidents and falls.

Estimated trends and patterns of road traffic fatalities in China, 2002-2012

OBJECTIVE

This study examined the time trends and age distribution patterns of estimated road traffic fatalities (RTFs) in China over the period 2002-2012.

METHODS

Data on age-, sex-, and region-specific RTF rates were provided by the Chinese Ministry of Health. The crude rates were standardized and the Mann-Kendall test was used to test the significance of time trends. Annual number of RTFs was calculated. To minimize the effect of yearly variations, magnitude of changes in and age distribution patterns of the RTFs were examined using mean values of 2 years.

RESULTS

RTFs increased significantly in China during the study period. Several features were identified for the RTFs in China. First, RTF rates skyrocketed in rural areas including towns and counties. Second, a significant increase in RTFs was also observed in cities even though the change in RTF rates was not statistically significant there. Third, individuals aged 20-24, 40-49, and 55-64, especially in rural areas, were particularly at risk for RTFs in recent years. Finally, RTFs became more common among middle-aged and older adults than young Chinese, with roughly 57% of all RTFs occurring among individuals aged 45 and above during 2011-2012.

CONCLUSIONS

RTFs increased dramatically in China during the past decade, especially in rural areas. Age distribution patterns of RTFs have changed there. Community-based public health education and intervention programs are warranted.

Can China diminish its burden of non-communicable diseases and injuries by promoting health in its policies, practices, and incentives?

China has rapidly progressed through epidemiological and demographic transitions and is now confronting an increasing burden from non-communicable diseases and injuries. China could take advantage of what has been learnt about prevention and control of non-communicable diseases and injuries, which is well summarised in the WHO best buys (a set of affordable, feasible, and cost-effective intervention strategies in any resource setting), to improve individual and population health. Implementation of these strategies could allow China to exceed the incremental gains in decreasing non-communicable diseases and injury burdens of high-income countries, and greatly shorten the interval needed to achieve decreased morbidity and mortality in its population. With the lessons learnt from other countries and its own programmes and policies, China could provide a health model for the world.

Study on the trend and disease burden of injury deaths in Chinese population, 2004-2010

Injuries are a growing public health concern in China, accounting for more than 30% of all Person Years of Life Lost (PYLL) due to premature mortality. This study analyzes the trend and disease burden of injury deaths in Chinese population from 2004 to 2010, using data from the National Disease Surveillance Points (DSPs) system, as injury deaths are classified based on the International Classification of Disease-10(th) Revision (ICD-10). We observed that injury death accounted for nearly 10% of all deaths in China throughout the period 2004-2010, and the injury mortality rates were higher in males than those in females, and higher in rural areas than in urban areas. Traffic crashes (33.79-38.47% of all injury deaths) and suicides (16.20-22.01%) were the two leading causes of injury deaths. Alarmingly, suicide surpassed traffic crashes as the leading cause of injury mortality in rural females, yet adults aged 65 and older suffered the greatest number of fatal falls (20,701 deaths, 2004-2010). The burden of injury among men (72.11%) was about three times more than that of women's (28.89%). This study provides indispensible evidence that China Authority needs to improve the surveillance and deterrence of three major types of injuries: Traffic-related injury deaths should be targeted for injury prevention activities in all population, people aged 65+ should be encouraged to take individual fall precautions, and prevention of suicidal behavior in rural females should be another key priority for the government of China.

Leading causes of unintentional injury and suicide mortality in Canadian adults across the urban-rural continuum

OBJECTIVE

We examined the leading causes of unintentional injury and suicide mortality in adults across the urban-rural continuum.

METHODS

Injury mortality data were drawn from a representative cohort of 2,735,152 Canadians aged ≥ 25 years at baseline, who were followed for mortality from 1991 to 2001. We estimated hazard ratios and 95% confidence intervals for urban-rural continuum and cause-specific unintentional injury (i.e., motor vehicle, falls, poisoning, drowning, suffocation, and fire/burn) and suicide (i.e., hanging, poisoning, firearm, and jumping) mortality, adjusting for socioeconomic and demographic characteristics.

RESULTS

Rates of unintentional injury mortality were elevated in less urbanized areas for both males and females. We found an urban-rural gradient for motor vehicle, drowning, and fire/burn deaths, but not for fall, poisoning, or suffocation deaths. Urban-rural differences in suicide risk were observed for males but not females. Declining urbanization was associated with higher risks of firearm suicides and lower risks of jumping suicides, but there was no apparent trend in hanging and poisoning suicides.

CONCLUSION

Urban-rural gradients in adults were more pronounced for unintentional motor vehicle, drowning, and fire/burn deaths, as well as for firearm and jumping suicide deaths than for other causes of injury mortality. These results suggest that the degree of urbanization may be an important consideration in guiding prevention efforts for many causes of injury fatality.

Neglected increases in rural road traffic mortality in China: findings based on health data from 2005 to 2010

BACKGROUND

Recent changes in rural road traffic mortality have not been examined in China although rural residents were reported as having greater risk of road traffic injury than urban residents. We aimed to examine changes in urban and rural road traffic mortality rates between 2005 and 2010 in China.

METHODS

Mortality rates came from the publicly available health data of the Ministry of Health-Vital Registration System that is based on a national representative sample (about 10% of total population), including 41 surveillance points in urban areas (15 large cities and 21 middle/small cities) and 85 surveillance points in rural areas. The causes of deaths were coded using the Tenth International Classification of Diseases (ICD-10). Linear regression was used to test the statistical significance of changes in mortality rates. We calculated the percent change in rates to quantify the change between 2005 and 2010, which was calculated as regression coefficient * 100 * 5 divided by the rate in 2005.

RESULTS

In rural areas, road traffic mortality increased by 70%, changing from 13.3 per 100,000 population in 2005 to 22.7 per 100,000 population in 2010. In contrast, the road traffic mortality merely increased by 4% in the study time period, rising from 13.1 to 13.9 per 100,000 population in urban areas. Both the increases in road traffic mortality from motor vehicle crashes and from non-motor vehicle crashes were larger in rural areas than in urban areas (106% vs. 4%; 29% vs. 3%).

CONCLUSION

The tremendous increase in road traffic mortality in rural areas calls for urgent actions to reduce road traffic injuries to motor vehicle occupants, motorcyclists, bicyclists and pedestrians in in rural areas.

Modeling Unintentional Drowning Mortality Rates in Thailand, 2000-2009

The objectives of this study were to investigate the pattern of unintentional drowning deaths and to identify the factors associated with drowning deaths in Thailand from 2000 to 2009. Reported death data were obtained from the Bureau of Health Policy and Strategy, Ministry of Public Health. During the period from 2000 to 2009, 41 620 deaths were reported and 1016 deaths were excluded from this study because of unknown place of death. The overall drowning death rate per 100 000 population was 6.3 (9.6 in males and 3.0 in females). The highest death rate was in males aged 0 to 4 years and in year 2006. Males in all age-groups (except in those aged 15-29 years) and females aged 0 to 4 years had higher drowning death rates than the average rate. Death rates in some public health areas in the central, the northeast, and the northern regions and in year 2005 and 2006 were higher than the average rate.

The gap in injury mortality rates between urban and rural residents of Hubei Province, China

BACKGROUND

Injury is a growing public health concern in China. Injury death rates are often higher in rural areas than in urban areas in general. The objective of this study is to compare the injury mortality rates in urban and rural residents in Hubei Province in central China by age, sex and mechanism of injury.

METHODS

Using data from the Disease Surveillance Points (DSP) system maintained by the Hubei Province Centers for Disease Control and Prevention (CDC) from 2006 to 2008, injury deaths were classified according to the International Classification of Disease-10th Revision (ICD-10). Crude and age-adjusted annual mortality rates were calculated for rural and urban residents of Hubei Province.

RESULTS

The crude and age-adjusted injury death rates were significantly higher for rural residents than for urban residents (crude rate ratio 1.9, 95% confidence interval 1.8-2.0; adjusted rate ratio 2.4, 95% confidence interval 2.3-2.4). The age-adjusted injury death rate for males was 81.6/100,000 in rural areas compared with 37.0/100,000 in urban areas; for females, the respective rates were 57.9/100,000 and 22.4/100,000. Death rates for suicide (32.4 per 100,000 vs 3.9 per 100,000), traffic-related injuries (15.8 per 100,000 vs 9.5 per 100,000), drowning (6.9 per 100,000 vs 2.3 per 100,000) and crushing injuries (2.0 per 100,000 vs 0.7 per 100,000) were significantly higher in rural areas. Overall injury death rates were much higher in persons over 65 years, with significantly higher rates in rural residents compared with urban residents for suicide (279.8 per 100,000 vs 10.7 per 100,000), traffic-related injuries, and drownings in this age group. Death rates for falls, poisoning, and suffocation were similar in the two geographic groups.

CONCLUSIONS

Rates of suicide, traffic-related injury deaths and drownings are demonstrably higher in rural compared with urban locations and should be targeted for injury prevention activity. There is a need for injury prevention policies targeted at elderly residents, especially with regard to suicide prevention in rural areas in Central China.

Road traffic injury in China: a review of national data sources

OBJECTIVE

Road traffic injury (RTI) has become one of the leading causes of deaths in China, yet numbers on road traffic deaths are often inconsistent. This study sought to systematically review 4 national-level data sources that can be used to estimate burdens of RTI, including mortality, injury, and crashes in China.

METHODS

We conducted structured literature reviews in PubMed, using combined key words of injury or fatality or injury surveillance and traffic and China in order to identify relevant studies (in both English and Chinese) and data sources. We also conducted interviews and hosted seminars with key researchers from the Chinese Center for Disease Control and Prevention (Chinese CDC) to identify potential useful data sources for injury surveillance. We then extracted key information from publicly available reports of each data source.

RESULTS

Four national-level data sources were reviewed and compared: Ministry of Health-Vital Registration (MOH-VR) System, Chinese CDC-Disease Surveillance Points (DSP), Chinese CDC-National Injury Surveillance System (NISS), and police reports. Together they provide a complementary yet somewhat contradictory epidemiological profile of RTIs in China. Estimates on road traffic fatalities obtained from MOH-VR and police reports are often used by researchers and policymakers, whereas DSP and NISS, both with great merits, have virtually not been used for RTI research. Despite the well-documented problems of underreported deaths with both MOH-VR and DSP, estimated road traffic deaths from both systems were 3 times those reported by the police.

CONCLUSIONS

As the foundation of injury prevention, national-level data sources and surveillance systems were reviewed in the study. Existing data infrastructures present the Chinese government a great opportunity to strengthen and integrate existing surveillance systems to better track road traffic injury and fatality and identify the population at risk.

Analysis of injury death trends among women in Macheng City, China, 1984-2008

BACKGROUND

There are few studies on trends in injury death rates in China during the recent decades of tremendous change in this society. This paper examined trends in injury mortality rates among women aged 15 years or older in Macheng City from 1984-2008.

METHODS

Data on injury deaths in women from 1984 to 2008 were obtained from the Death Registry System in Macheng City. Injuries were classified using the International Classification of Diseases (ICD), 9th and 10th editions.

RESULTS

The average overall injury death rate of women aged 15 or older was 87.6/100,000 in Macheng City from 1984-2008. Injuries were the leading cause of death for women aged 15-44 and the fourth cause of death for all women during this period. The all-cause injury mortality rate decreased from 149.01 per 100,000 population in 1984 to 32.90 per 100,000 population in 2008 for women. Road traffic injury (RTI) was the only injury for which the mortality rate increased dramatically from 1984 (1.35 per 100,000) to 2008 (4.63 per 100,000). For all age groups, suicide was the leading cause of injury death. For women aged 15 to 64, RTI and drowning were the second and third leading causes of injury deaths, respectively.

CONCLUSIONS

The injury mortality rate for women aged 15 years or older decreased by 77.92% from 1984-2008. In contrast, RTI deaths increased sharply in the 2000s compared with the 1980s. Although the suicide rate decreased dramatically, it was still the leading cause of injury death for women. Research is needed to identify risk factors contributing to the increase in RTI and decrease in suicides.