Trends in Diabetes Mortality in Urban and Rural China, 1987-2019: A Joinpoint Regression Analysis

Application of the integrated data platform combined with dietary management for adults with diabetes: A prospective randomized controlled trial

AIMS

To investigate the efficacy of the integrated data platform of cloud hospital combined with dietary management for adults with type 2 diabetes.

MATERIALS AND METHODS

We conducted a randomized controlled clinical trial. One hundred eighty patients with type 2 diabetes were randomly allocated into a control group (Group A) and an experimental group (Group B). Routine standard diabetes care was applied to the patients in Group A. The integrated data platform with dietary management was applied to Group B. Individualized diabetes education videos were sent to the patients through the platform. The primary endpoint was the change in HbA1c and change in body weight from baseline to Week 12 during the follow-up.

RESULTS

At Week 12, HbA1c was 7.4 ± 0.7%, 6.9 ± 0.9% in Groups A and B, P < 0.01. The rate of fasting blood glucose <7 mmol/L, and glycosylated hemoglobin <7% was higher in Group B than in Group A. At Week 12, there was a significant weight loss and body mass index decrease in the overweight or obese patients of the experimental group. Those overweight or obese patients in the experimental group utilizing the appetite suppressant semaglutide achieved the most significant weight loss, with a 13.4% reduction after 12 weeks.

CONCLUSIONS

The integrated data platform combined with personalized diabetes education video delivery was verified to be a more effective management mode for diabetes. For overweight or obese adults with diabetes, the use of semaglutide in conjunction with dietary management and the integrated data platform led to greater weight loss.

Knowledge, attitudes, and practices among patients with diabetes mellitus and hyperuricemia toward disease self-management

Background

This study aimed to assess the knowledge, attitudes and practices (KAP) among patients with diabetes mellitus and hyperuricemia toward disease self-management.

Methods

This web-based cross-sectional study was conducted between June 2023 and January 2024 at Heilongjiang Provincial Hospital. A self-designed questionnaire was developed to collect demographic information of patients with diabetes mellitus and hyperuricemia, and assess their knowledge, attitudes and practices toward disease self-management.

Results

A total of 482 participants were enrolled in this study, among them, 364 (75.52%) were male, 235 (48.76%) were aged between 40 and 59 years, 226 (46.89%) had a body mass index (BMI) ranging from 24 to 28 kg/m2, 337 (69.92%) had received a diagnosis of diabetes for a duration of 2 years or more, while 245 (50.83%) had been diagnosed with hyperuricemia for a similar duration. Their median (range) knowledge, attitude and practice scores were 10.00 (9.00, 11.00) (possible range: 0-12), 38.00 (36.00, 40.00) (possible range: 9-45), and 30.00 (26.00, 34.75) (possible range: 10-50), respectively. The path analysis demonstrated that knowledge had direct effects on attitude (β = 0.508, p < 0.001), and attitude had direct effects on practice (β = 0.448, p < 0.001). Additionally, there was an indirect effect of knowledge on practice mediated through attitude, with a path coefficient of 0.228 (p < 0.001).

Conclusion

This study demonstrates that patients with diabetes mellitus and hyperuricemia exhibit relatively proficient responses to certain items within the KAP dimensions. However, it also exposes a certain degree of inadequacy in the KAP level toward disease management. Interventions should focus on improving patients' understanding of their conditions while fostering positive attitudes, ultimately translating into better self-management practices.

Examining the Relationship Between Social Support, Self-Efficacy, Diabetes Self-Management, and Quality of Life Among Rural Individuals With Type 2 Diabetes in Eastern China: Path Analytical Approach

BACKGROUND

Patients with type 2 diabetes (T2D) in rural China frequently exhibit inadequate diabetes self-management (DSM) and a reduced quality of life (QoL). Social support and self-efficacy are known to influence DSM and QoL. However, the pathways through which social support and self-efficacy impact DSM and QoL among patients with T2D in rural China has yet to be fully elucidated.

OBJECTIVE

This study offers a foundation for developing policies in rural chronic disease management, thereby, contributing to the improvement of T2D prevention and control in China and other transitional countries.

METHODS

This study used a cross-sectional design, collecting data from a survey conducted between May and July 2021 on DSM and QoL among rural patients diagnosed with T2D in 2 townships in East China. All patients with T2D were enrolled through cluster sampling from the township health center database, and a questionnaire survey was administered by investigators. Structural equation modeling and multiple regression analyses were used to explore the pathways through which social support influences DSM and QoL, as well as the mediating role of self-efficacy.

RESULTS

It was found that the DSM score (mean 37.42, SD 7.70) was less than half of the maximum theoretical score. The QoL score (mean 48.92, SD 8.88) accounted for 36% of the maximum theoretical score. Social support directly and positively affected the DSM and QoL of Chinese rural patients with T2D (P<.01); an increase of 1 unit in social support was associated with a direct increment of 0.339 units in DSM and 0.397 units in QoL. Self-efficacy played a positive mediating role (P<.01), further increasing DSM and QoL by 0.147 and 0.159 units, respectively. The mediating effect of self-efficacy accounted for 30.2% and 28.6% of the total effect of social support on DSM and QoL. Furthermore, the family and friend dimension of social support, along with the symptom and disease management dimensions of self-efficacy, were significantly associated with DSM or QoL (P<.01).

CONCLUSIONS

The study confirmed the direct and indirect influences of social support on DSM and QoL and elucidated the mediating effect of self-efficacy among rural patients with T2D in eastern China. Interventions should be developed to enhance both social support and self-efficacy, creating a positive cycle of mutual reinforcement to improve DSM and QoL among this group.

Dietary Potassium and Magnesium Intake with Risk of Type 2 Diabetes Mellitus Among Rural China: the Henan Rural Cohort Study

Previous studies exploring the relationship between dietary potassium and magnesium intake and the risk of type 2 diabetes mellitus (T2DM) have yielded inconsistent results and the lack evidence from rural China. Therefore, we aimed to investigate the association between dietary potassium and magnesium intake and the risk of T2DM in rural China. Data was collected from the Henan Rural Cohort Study in 2017. A validated semi-quantitative food frequency questionnaire assessed dietary potassium and magnesium intake. Logistic regression models were used to calculate odds ratio (ORs) and 95% confidence intervals (CIs) to evaluate the effect of dietary potassium, magnesium and the potassium-magnesium ratio on the risk of T2DM. A total of 38384 individuals were included in the study, and 3616 participants developed T2DM. Logistic regression analysis revealed that the OR (95% CI) of the highest versus dietary potassium and magnesium and potassium-magnesium ratio intakes were 0.67 (0.59, 0.75), 0.76 (0.67, 0.88), and 0.57 (0.50, 0.66), respectively, compared to the subjects with the lowest quartile of intakes. In addition, gender partially influences the relationship between dietary magnesium and T2DM prevalence (P-interaction = 0.042). The group with the highest dietary potassium and dietary magnesium intake had the lowest risk of T2DM, with an OR (95% CI) of 0.63 (0.51-0.77). Dietary potassium and magnesium intake are important modifiable risk factors for T2DM in rural China. Dietary potassium intake > 1.8g/day, dietary magnesium intake > 358.6mg/day and < 414.7mg/day and potassium-magnesium ratio >5.1 should be encouraged to prevent better and manage T2DM.

Point-of-care Testing HbA1c screening for type 2 diabetes in urban and rural areas of China: a cost-effectiveness analysis

Background

Point-of-care Testing (POCT) glycosylated hemoglobin (HbA1c) is a convenient, cheap, effective and accessible screening method for type 2 diabetes in rural areas and community settings that is widely used in the European region and Japan, but not yet widespread in China. The study is the first to evaluate the cost-effectiveness of POCT HbA1c, fasting capillary glucose (FCG), and venous blood HbA1c to screen for type 2 diabetes in urban and rural areas of China, and to identify the best socio-economically beneficial screening strategy.

Methods

Based on urban and rural areas in China, economic models for type 2 diabetes screening were constructed from a social perspective. The subjects of this study were adults aged 18-80 years with undiagnosed type 2 diabetes. Three screening strategies were established for venous blood HbA1c, FCG and POCT HbA1c, and cost-effectiveness analysis was performed by Markov models. One-way sensitivity analysis and probabilistic sensitivity analysis were performed on all parameters of the model to verify the stability of the results.

Results

Compared with FCG, POCT HbA1c was cost-effective with an incremental cost-utility ratio (ICUR) of $500.06/quality-adjusted life year (QALY) in urban areas and an ICUR of $185.10/QALY in rural areas, within the willingness-to-pay threshold (WTP = $37,653). POCT HbA1c was cost-effective with lower cost and higher utility compared with venous blood HbA1c in both urban and rural areas. In the comparison of venous blood HbA1c and FCG, venous blood HbA1c was cost-effective (ICUR = $20,833/QALY) in urban areas but not in rural areas (ICUR = $41,858/QALY). Sensitivity analyses showed that the results of the study were stable and credible.

Conclusions

POCT HbA1c was cost-effective for type 2 diabetes screening in both urban and rural areas of China, which could be considered for future clinical practice in China. Factors such as geographic location, local financial situation and resident compliance needed to be considered when making the choice of venous blood HbA1c or FCG.

Evaluating the Usability of mHealth Apps: An Evaluation Model Based on Task Analysis Methods and Eye Movement Data

Advancements in information technology have facilitated the emergence of mHealth apps as crucial tools for health management and chronic disease prevention. This research work focuses on mHealth apps for the management of diabetes by patients on their own. Given that China has the highest number of diabetes patients in the world, with 141 million people and a prevalence rate of 12.8% (mentioned in the Global Overview of Diabetes), the development of a usability research methodology to assess and validate the user-friendliness of apps is necessary. This study describes a usability evaluation model that combines task analysis methods and eye movement data. A blood glucose recording application was designed to be evaluated. The evaluation was designed based on the model, and the feasibility of the model was demonstrated by comparing the usability of the blood glucose logging application before and after a prototype modification based on the improvement suggestions derived from the evaluation. Tests showed that an improvement plan based on error logs and post-task questionnaires for task analysis improves interaction usability by about 24%, in addition to an improvement plan based on eye movement data analysis for hotspot movement acceleration that improves information access usability by about 15%. The results demonstrate that this study presents a usability evaluation model for mHealth apps that enables the effective evaluation of the usability of mHealth apps.

Decadal Analysis of Age-Adjusted Mortality Rates for Acute and Chronic Kidney Disease in Brazil, 2000-2021

Introduction Renal failure, comprising acute kidney injury (AKI) and chronic kidney disease (CKD), involves a decline or loss of kidney function. AKI is sudden and reversible, with a rapid decline in function over hours to days, while CKD involves persistent abnormalities lasting at least three months. Developing countries are seeing a rise in AKI cases, especially in critically ill patients. Globally, there's a growing occurrence and mortality rate linked to CKD. Methods The study used a retrospective cross-sectional design to analyze AKI and CKD mortality rates in Brazil from 2019 to 2022. Data on population and demographics, including sex and age, were obtained from the Brazilian Institute of Geography and Statistics. Mortality data for kidney diseases were sourced from the Brazilian Hospital Information System. The analysis utilized the Joinpoint Regression Program to calculate average annual percentage changes (AAPCs) and their respective 95% confidence intervals. Weighted Bayesian information criterion was used to determine the significance levels and identify the best-fitting combination of line segments and joinpoints. Results The study findings revealed a significant rise in AKI mortality rates for both males and females, from 2008 to 2021 (APC = 3.16; CI: 2.29 to 5.93), with higher mortality rates recorded among males compared to women over the entire study period. Analyses according to age groups showed that males between the ages 40 to 49 experienced the most rapid increase in mortality during the 2019 - 2021 period (APC = 35.41; CI: 16.72 to 46.57); meanwhile, the most rapid increase in mortality for females was observed from 2019 to 2021, and this was among those aged 30 to 39 (APC = 40.33; CI = 6.48 to 59.78). Furthermore, there was an observable upward trend in mortality related to CKD (APC = 0.70; CI: 0.41 to 1.01), with males consistently having higher mortality rates throughout the entire study period. The elderly population, both males and females, experienced the most rapid increase in CKD-related mortality, with AAPC values of 2.32 (CI: 1.82 to 2.89) for males and 1.62 (CI: 1.08 to 2.10) for females. Conclusion We observed a consistent increase in mortality rates from acute kidney diseases for both males and females since 2008, with males experiencing higher mortality rates overall. The study highlighted the need for further research to understand the underlying factors contributing to these trends. Additionally, interventions targeting modifiable risk factors and improving access to healthcare could help reduce mortality related to renal failure.

The Impact of Biological and Social Factors on Mortality in Older Adults Living in Rural Communities

BACKGROUND

Information on factors that increase mortality in remote settings is limited. This study aims to estimate the independent and joint role of several factors on mortality risk among older adults living in rural Ecuador.

METHODS

Participants were selected from community-dwelling older adults who were included in previous studies targeting mortality risk factors in the study population. Generalized structural equation modeling (GSEM) was utilized to evaluate prior causal assumptions, to redraw causal links, and to introduce latent variables that may help to explain how the independently significant variables are associated with mortality.

RESULTS

The study included 590 individuals (mean age: 67.9 ± 7.3 years; 57% women), followed for a median of 8.2 years. Mortality rate was 3.4 per 100 person-years. Prior work on separate multivariate Poisson and Cox models was used to build a tentative causal construct. A GSEM containing all variables showed that age, symptoms of depression, high social risk, high fasting glucose, a history of overt stroke, and neck circumference were directly associated with mortality. Two latent variables were introduced, 1 representing the impact of biological factors and another, the impact of social factors on mortality. The social variable significantly influenced the biological variable which carried most of the direct effect on mortality.

CONCLUSIONS

Several factors contributed to mortality risk in the study population, the most significant being biological factors which are highly influenced by social factors. High social risk interact with biological variables and play an important role in mortality risk.

Diabetes Mellitus Mortality Trends in Brazil From 2000 to 2021: An In-Depth Joinpoint Analysis

Diabetes mellitus (DM) is a public health concern in Brazil, with deleterious effects on quality of life and increasing mortality rates. The prevalence of diabetes in Brazil is on the rise, and it is imperative to understand its effects on mortality rates in the last two decades in order to effectively mitigate the detrimental impact of diabetes on public health. This study aims to analyze mortality trends related to diabetes in Brazil from 2000 to 2021, encompassing both type 1 and type 2 diabetes, across sex and various age cohorts. Using joinpoint regression analysis, temporal trends in Brazil were assessed, while also incorporating findings from previous studies and considering potential influencing factors, such as government initiatives and cuts in healthcare investment. The study revealed a general upward trend in mortality rates associated with DM1 and DM2 over the study period, in both males and females, with men showing a higher AAPC (average annual percent change), which translated into significantly increased mortality difference at the end of the study. Additionally, it revealed elevated mortality values for extreme age groups in the age cohorts studied, with the exception of middle-aged cohort groups in DM2, which showed an expected higher APC (annual percent change), considering the age of highest incidence of DM2 in those age groups. This comprehensive analysis provides critical insights into the escalating impact of diabetes on mortality rates in Brazil and highlights the urgent need for healthcare strategies. It is expected that the increased prevalence of diabetes in the Brazilian population adds an additional economic burden to healthcare expenditure by the Brazilian government, further worsening the health disparities among different social groups. Unless several political decisions to reduce healthcare expenditure are reversed, greater difficulties in accessing treatments will be detrimental for vulnerable social groups in Brazil. By understanding the nuanced patterns of diabetes-related mortality, healthcare providers and policymakers can allocate resources effectively and implement tailored interventions to better address diabetes in Brazil.

LASSO-based machine learning algorithm to predict the incidence of diabetes in different stages

BACKGROUND

Formal risk assessment is crucial for diabetes prevention. We aimed to establish a practical nomogram for predicting the risk incidence of prediabetes and prediabetes conversion to diabetes.

METHODS

A cohort of 1428 subjects was collected to develop prediction models. The LASSO was used to screen for important risk factors in prediabetes and diabetes and was compared with other algorithms (LR, RF, SVM, LDA, NB, and Treebag). Multivariate logistic regression analysis was used to construct the prediction model of prediabetes and diabetes, and drawn the predictive nomogram. The performance of the nomograms was evaluated by receiver-operating characteristic curve and calibration.

RESULTS

These findings revealed that the other six algorithms were not as good as LASSO in terms of diabetes risk prediction. The nomogram for individualized prediction of prediabetes included "Age," "FH," "Insulin_F," "hypertension," "Tgab," "HDL-C," "Proinsulin_F," and "TG" and the nomogram of prediabetes to diabetes included "Age," "FH," "Proinsulin_E," and "HDL-C". The results showed that the two models had certain discrimination, with the AUC of 0.78 and 0.70, respectively. The calibration curve of the two models also indicated good consistency.

CONCLUSIONS

We established early warning models for prediabetes and diabetes, which can help identify prediabetes and diabetes high-risk populations in advance.

[Comparison of therapeutic effect of metformin hydrochloride/vildagliptin and liraglutide on type 2 diabetes mellitus in obese patients]

OBJECTIVE

To evaluate the therapeutic effects of two therapeutic strategies based on metformin hydrochloride/vildagliptin and liraglutide on type 2 diabetes mellitus (T2DM) in obese patients.

METHODS

We retrospectively collected the clinical data of 107 obese patients (BMI>25 kg/m2) with T2DM treated in Second Affiliated Hospital of Wannan Medical College (Wuhu, China) during 2019-2021, including 53 patients treated continuously with metformin hydrochloride/vildagliptin and 54 with liraglutide for 3 months. The changes in BMI, waist circumference, fasting blood glucose (FBG), postprandial blood glucose, HbA1C, fasting C-peptide, postprandial C-peptide, fasting insulin and postprandial insulin of the patients after treatment were compared between the two groups.

RESULTS

In both of the groups, the patients all showed significant reductions of BMI, waist circumference, FBG, postprandial blood glucose and HbA1C (all P < 0.05) with improved fasting and postprandial C-peptide levels after the treatments (P < 0.05). The two treatment regimens showed comparable blood glucoselowering effects, but liraglutide produced better effect in reducing waist circumference (P < 0.01). Neither of two regimens obviously affected insulin level of the patients (P>0.05).

CONCLUSION

Both metformin hydrochloride/vildagliptin and liraglutide have good therapeutic effects on T2DM in obese patients and can achieve good blood glucose and weight control, but liraglutide has a better effect for weight control.

Geographic heterogeneity of the epidemiological impact of the COVID-19 pandemic in Italy using a socioeconomic proxy-based classification of the national territory

Objectives

This study aimed to evaluate the differences in incidence, non-intensive care unit (non-ICU) and intensive care unit (ICU) hospital admissions, and COVID-19-related mortality between the "inner areas" of Italy and its metropolitan areas.

Study design

Retrospective population-based study conducted from the beginning of the pandemic in Italy (20 February 2020) to 31 March 2022.

Methods

The municipalities of Italy were classified into metropolitan areas, peri-urban/intermediate areas and "inner areas" (peripheral/ultra-peripheral). The exposure variable was residence in an "inner area" of Italy. Incidence of diagnosis of SARS-CoV-2 infection, non-ICU and ICU hospital admissions and death within 30 days from diagnosis were the outcomes of the study. COVID-19 vaccination access was also evaluated. Crude and age-standardized rates were calculated for all the study outcomes. The association between the type of area of residence and each outcome under study was evaluated by calculating the ratios between the standardized rates. All the analyses were stratified by period of observation (original Wuhan strain, Alpha variant, Delta variant, Omicron variant).

Results

Incidence and non-ICUs admissions rates were lower in "inner areas." ICU admission and mortality rates were much lower in "inner areas" in the early phases of the pandemic, but this protection progressively diminished, with a slight excess risk observed in the "inner areas" during the Omicron period. The greater vaccination coverage in metropolitan areas may explain this trend.

Conclusion

Prioritizing healthcare planning through the strengthening of the primary prevention policies in the peripheral areas of Italy is fundamental to guarantee health equity policies.

Activities of daily living and its influencing factors for older people with type 2 diabetes mellitus in urban communities of Fuzhou, China

Background

Type 2 diabetes mellitus (T2DM) is an independent risk factor for functional limitations among the older population. The predicted increase in T2DM cases combined with the ongoing rapidly aging population may further burden the already overloaded healthcare system and aggravate the loss of economic self-sufficiency. This study aimed to investigate the activities of daily living (ADL) and its influencing factors on older people with T2DM, and to provide implications for the development and improvement of community nursing services in the context rapidly aging population in China.

Methods

From March 2019 to June 2020, we conducted a cross-sectional questionnaire survey among older T2DM patients in Fuzhou, using a multi-stage cluster sampling approach. Functional status was measured by the Lawton ADL scale. Stata "nptrend" test was used to examine the trend of ordinal variables on ADL. Non-conditional logistic regression was used to identify factors affecting ADL limitations.

Results

A total of 2016 questionnaires were received, with a response rate of 96%. 12.4% of participants suffered from varying degrees of functional impairment. ADL limitations increased with age. More comorbidities were associated with a greater risk of developing functional limitations in ADLs. the following sub-groups were more likely to suffer from ADL impairment: those aged 70 and over years (OR = 1.99, 95%CI 1.77-2.56), living in an aged care house or with spouse/children (OR = 2.31, 95%CI 1.25-4.26), low monthly income (OR = 1.49, 95%CI 1.28-1.64), without health insurance (OR = 1.82, 95%CI 1.40-2.40), tight family expenses (OR = 1.95, 95%CI 1.42-2.69), having stroke (OR = 6.70, 95%CI 2.22-20.23) or malignant tumor (OR = 4.45, 95%CI 1.27-15.53), irregular eating habit (OR = 2.55, 95%CI 2.23-2.92), smoking (OR = 1.40, 95%CI 1.22-1.60), sedentary lifestyle (OR = 2.04, 95%CI 1.46-2.85), lack of physical exercise (OR = 1.35, 95%CI 1.19-1.53), sleeping difficulty (OR = 1.25, 95%CI 1.10-1.42), and lack of family support (OR = 1.19, 95%CI 1.10-1.29).

Conclusion

Older adults (≥70 years) with T2DM had a high prevalence of functional limitations across a range of daily living tasks, which not only affect individual life of quality but also present a huge burden on the family, health services system, and the whole society. Identified factors associated with ADL limitations may provide useful information for targeted nursing practice and health promotion.

Spatiotemporal Analysis and Risk Assessment Model Research of Diabetes among People over 45 Years Old in China

Diabetes, which is a chronic disease with a high prevalence in people over 45 years old in China, is a public health issue of global concern. In order to explore the spatiotemporal patterns of diabetes among people over 45 years old in China, to find out diabetes risk factors, and to assess its risk, we used spatial autocorrelation, spatiotemporal cluster analysis, binary logistic regression, and a random forest model in this study. The results of the spatial autocorrelation analysis and the spatiotemporal clustering analysis showed that diabetes patients are mainly clustered near the Beijing−Tianjin−Hebei region, and that the prevalence of diabetes clusters is waning. Age, hypertension, dyslipidemia, and smoking history were all diabetes risk factors (p < 0.05), but the spatial heterogeneity of these factors was weak. Compared with the binary logistic regression model, the random forest model showed better accuracy in assessing diabetes risk. According to the assessment risk map generated by the random forest model, the northeast region and the Beijing−Tianjin−Hebei region are high-risk areas for diabetes.

Injury and Poisoning Mortality Trends in Urban and Rural China from 2006 to 2020 Based on Age-Period-Cohort Analysis

Injury and poisoning, common public health problems, currently rank fifth among the causes of death in China. In this study, we aimed to analyze the trends and influencing factors of injury and poisoning mortality in urban and rural China using an age-period-cohort model. Crude mortality data for injury and poisoning by sex, age group, and region were obtained from the China Health Statistical Yearbook (2006-2020). Age-standardized mortality rates for injury and poisoning in urban and rural areas were estimated using the Seventh Census of China 2020 population. The trends of injury and poisoning mortality were assessed using Joinpoint analysis. Age-period-cohort models were used to explore the age, period, and birth cohort effects affecting mortality risk. Over a 15-year period, age-standardized mortality rates decreased from 28.81/100,000 in 2006 to 24.78/100,000 in 2020 in urban areas and from 45.49/100,000 to 44.39/100,000 in rural areas. In the male population, the annual change in mortality was -0.4% (95% CI = -1.8%, 1.0%) in urban areas and -1.0% (95% CI = -1.9%, 0.0%) in rural areas. In the female population, the annual change in mortality was -1.2% (95% CI = -2.3%, -0.1%) in urban areas compared with -1.6% (95% CI = -3.1%, -0.1%) in rural areas. The age-period-cohort model showed a significant increase in urban and rural mortality rates starting at ages 49 and 39 years. Both showed a decline followed by an increase in the period. The cohort from 1929 to 2013 showed an overall trend of increasing and then decreasing. From 2006 to 2020, the overall injury and poisoning mortality rates in China showed a decreasing trend, and the mortality rates decreased faster in women than in men and in rural areas than in urban areas. Age effects were the most important risk factors for changes in injury and poisoning mortality. The results of this study will help researchers explore the possible causes of mortality changes in urban and rural areas and provide a scientific basis for injury and poisoning prevention and control priorities and policy formulation in China.