背景:在过去的几十年里,尽管中国的年龄标准化死亡率(ASMR)呈明显下降趋势,这种模式最近发生了戏剧性的逆转。
目的:我们旨在阐明地理,人口统计学,和特定原因伤害的时间趋势,这些趋势的逆转现象,以及2005年至2019年中国伤病负担的波动。
方法:使用2005-2019年疾病监测点系统提供的国家死因监测数据中的伤害死亡原始数据进行了纵向观察研究。特定原因的伤害按性别分为不同的亚组,年龄,城市/农村地区,和中国东部/中部/西部地区。使用潜在寿命损失(PYLL)评估受伤负担,平均寿命损失(AYLL),和PYLL费率(PYLLR)。使用最佳拟合连接点模型评估死亡率和负担的时间趋势。
结果:伤害死亡占2005-2019年中国全因死亡的7.51%(1,156,504/15,403,835)。全因伤害的粗死亡率为每100,000人中47.74人。前3种伤害类型(交通事故,falls,和自杀)占所有伤害相关死亡的70.57%(816,145/1,156,504)。全因损伤ASMR降低(P=.003),而粗死亡率在2005-2019年期间保持不变(P=0.52)。自2013年以来,在城市老年人中观察到全因伤害的ASMR呈明显逆转趋势,这主要是由于跌倒造成的伤害呈逆转趋势。在10-24岁的个体中观察到ASMR的自杀趋势相反,显着增长35.18%(年度百分比变化15.4%,自2017年以来,男性95%CI4.1%-28.0%)。从2005年到2019年,老年人全因损伤的AYLL和PYLLR显示出一致的上升趋势(年均百分比变化[AAPC]6.1%,95%CI5.4%-6.9%,AYLL增长129.04%;AAPC5.4%,95%CI2.4%-8.4%,PYLLR增加105.52%)。对于10-24岁的个人,由于自杀导致的AYLL表现出相当大的上升趋势(AAPC0.5%,95%CI0.4%-0.7%,8.02%的增长)。
结论:尽管2005年至2019年中国全因伤害的ASMR有所下降,但近年来青少年和青壮年自杀和老年人跌倒的趋势呈上升趋势。应鼓励采取干预措施,以减轻特定原因造成的伤害死亡负担。
Over the last few decades, although the age-standardized mortality rate (ASMR) of injury has shown a significant declining trend in
China, this pattern has dramatically reversed recently.
We aimed to elucidate the geographical, demographic, and temporal trends of cause-specific injuries, the reversal phenomenon of these trends, and the fluctuations of injury burden from 2005 to 2019 in
China.
A longitudinal observational study was performed using the raw data of injury deaths in the National Cause-of-Death surveillance data provided by the disease surveillance points system in 2005-2019. The cause-specific injuries were divided into disparate subgroups by sex, age, urban/rural region, and eastern/central/western areas of China. The burden of injury was assessed using potential years of life lost (PYLL), average years of life lost (AYLL), and PYLL rate (PYLLR). Temporal trends of mortality rates and burden were evaluated using best-fitting joinpoint models.
Injury deaths accounted for 7.51% (1,156,504/15,403,835) of all-cause deaths in
China in 2005-2019. The crude mortality rate of all-cause injury was 47.74 per 100,000 persons. The top 3 injury types (traffic accident, falls, and suicide) accounted for 70.57% (816,145/1,156,504) of all injury-related deaths. The ASMR of all-cause injury decreased (P=.003), while the crude mortality rate remained unchanged (P=.52) during 2005-2019. A significant
reverse trend in ASMR of all-cause injury was observed in urban older adults since 2013, mainly due to the inverted trend in injuries from falls. A
reverse trend in ASMR of suicide was observed among individuals aged 10-24 years, with notable increases by 35.18% (annual percentage change 15.4%, 95% CI 4.1%-28.0%) in men since 2017. The AYLL and PYLLR of all-cause injury among older adults showed consistent ascending trends from 2005 to 2019 (average annual percentage change [AAPC] 6.1%, 95% CI 5.4%-6.9%, 129.04% increase for AYLL; AAPC 5.4%, 95% CI 2.4%-8.4%, 105.52% increase for PYLLR). The AYLL due to suicide for individuals aged 10-24 years showed a considerable upswing tendency (AAPC 0.5%, 95% CI 0.4%-0.7%, 8.02% increase).
Although the ASMR of all-cause injury decreased in China from 2005 to 2019, the trend in suicide among adolescents and young adults and falls among older adults has been on the rise in recent years. Interventions should be encouraged to mitigate the cause-specific burdens of injury death.