Richmond Sarah A, D'Cruz Jennifer, Lokku Armend, Macpherson Alison, Howard Andrew, Macarthur Colin
School of Kinesiology and Health Science, York University, Toronto, ON; Department of Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON.
Can J Public Health. 2016 Dec 27;107(4-5):e431-e437. doi: 10.17269/cjph.107.5315.
To examine unintentional injury mortality rates in children (0-19 years) in Canada from 1950 to 2009 against national population-level injury prevention interventions.
Injury mortality rates were age and sex adjusted. Changes in trend and level of mortality rates were assessed at pre-specified intervention periods using segmented linear regression analyses for interrupted time series. Maximum likelihood estimation was used with a second order autoregressive error process.
From 1950 to 2009, the overall unintentional injury mortality rate decreased by 86%. Males had consistently higher mortality rates compared to females; however, the standardized rate ratio decreased from 2.37:1 in 1950 to 1.97:1 in 2009. Substantial declines in choking/suffocation deaths were noted in children less than 1 year of age, predominantly during the period 1970-1988 when the Hazardous Products Act and Crib Regulations were implemented. For burns, significant changes in slope were noted comparing 1972-1994 to pre-1971 (introduction of the Hazardous Products Act - Flammability Regulations), where the greatest decline was noted in children ages 1-4 years (Est. = -0.03, 95% CI = -0.02, -0.04). For 15-19 year olds, there was a 408% increase in motor vehicle collision-related mortality rates between 1950 and 1971; however a significant change in slope was noted during the period 1978-1985, compared to 1972-1977 (Est. = -0.10, 95% CI = -0.20, -0.007) across all age groups.
While this study is not a cause and effect analysis, there is a strong association with implementation of safety campaigns and legislative changes related to child safety and a dramatic decline in childhood fatalities related to injury.
对照全国人口层面的伤害预防干预措施，研究1950年至2009年加拿大儿童（0至19岁）的意外伤害死亡率。
对伤害死亡率进行年龄和性别调整。在预先设定的干预期，使用分段线性回归分析中断时间序列，评估死亡率趋势和水平的变化。采用最大似然估计和二阶自回归误差过程。
1950年至2009年，意外伤害总死亡率下降了86%。男性死亡率一直高于女性；然而，标准化率比从1950年的2.37:1降至2009年的1.97:1。1岁以下儿童窒息/窒息死亡人数大幅下降，主要发生在1970年至1988年期间，当时实施了《危险产品法》和《婴儿床条例》。对于烧伤，将1972 - 1994年与1971年之前（《危险产品法 - 易燃性条例》出台）进行比较，发现斜率有显著变化，其中1至4岁儿童下降幅度最大（估计值 = -0.03，95%置信区间 = -0.02，-0.04）。对于15至19岁青少年，1950年至1971年期间机动车碰撞相关死亡率增加了408%；然而，与1972 - 1977年相比，1978 - 1985年期间所有年龄组的斜率都有显著变化（估计值 = -0.10，95%置信区间 = -0.20，-0.007）。
虽然本研究并非因果分析，但安全运动的实施以及与儿童安全相关的立法变化与儿童伤害相关死亡人数的大幅下降之间存在密切关联。
