West China Second University Hospital, National Office for Maternal and Child Health Surveillance of China, Sichuan University, Chengdu, Sichuan, China.
Department of pediatrics, Sichuan Zhongjiang County People's Hospital, Deyang, Sichuan, China.
BMC Public Health. 2023 Apr 11;23(1):673. doi: 10.1186/s12889-023-15546-6.
In this study, we estimated the trend of unintentional injury mortality among children aged under-five years in China during 2010-2020.
Data were obtained from China's Under 5 Child Mortality Surveillance System (U5CMSS). The total unintentional injury mortality and all specific-causes unintentional injury mortality was calculated, annual numbers of deaths and live births were adjusted by a 3-year moving average under-reporting rate. The Poisson regression model and the Cochran-Mantel-Haenszel method were used to calculate the average annual decline rate (AADR) and the adjusted relative risk (aRR) of the unintentional injury mortality.
In 2010-2020, a total of 7,925 unintentional injury-related deaths were reported in U5CMSS, accounting for 18.7% of all reported deaths. The overall proportion of unintentional injury-related deaths to total under-five children deaths has increased from 15.2% to 2010 to 23.8% in 2020 (χ2 = 227.0, p < 0.001), the unintentional injury mortality significantly decreased from 249.3 deaths per 100,000 live births in 2010 to 178.8 deaths per 100,000 live births in 2020, with an AADR 3.7% (95%CI 3.1-4.4). The unintentional injury mortality rate decreased from 2010 to 2020 in both urban (from 68.1 to 59.7 per 100,000 live births) and rural (from 323.1 to 230.0 per 100,000 live births) areas (urban: χ2 = 3.1, p < 0.08; rural: χ2 = 113.5, p < 0.001). The annual rates of decline in rural areas and urban areas were 4.2% (95%CI 3.4-4.9) and 1.5% (95%CI 0.1-3.3), respectively. The leading causes of unintentional injury mortality were suffocation (2,611, 32.9%), drowning (2,398, 30.3%), and traffic injury (1,428, 12.8%) in 2010-2020. The cause-specific of unintentional injury mortality rates decreased with varying AADRs in 2010-2020, except for traffic injury. The composition of unintentional injury-related deaths also varied by age group. Suffocation was the leading cause in infants, drowning and traffic injury were the leading causes in children aged 1-4 years. Suffocation and poisoning has high incidence in October to March and drowning has high in June to August.
The unintentional injury mortality rate of children aged under-five years decreased significantly from 2010 to 2020 in China, but great inequity exists in unintentional injury mortality in urban and rural areas. Unintentional injuries are still an important public health problem affecting the health of Chinese children. Effective strategies should be strengthened to reduce unintentional injury in children and these policies and programmes should be targeted to more specific populations, such as rural areas and males.
本研究旨在估计 2010-2020 年期间中国 5 岁以下儿童非故意伤害死亡率的趋势。
数据来自中国 5 岁以下儿童死亡率监测系统（U5CMSS）。计算了总非故意伤害死亡率和所有特定原因非故意伤害死亡率，通过 3 年移动平均漏报率对年度死亡人数和活产人数进行调整。采用泊松回归模型和 Cochran-Mantel-Haenszel 方法计算非故意伤害死亡率的年均下降率（AADR）和调整后的相对风险（aRR）。
2010-2020 年，U5CMSS 共报告 7925 例非故意伤害相关死亡，占所有报告死亡的 18.7%。非故意伤害相关死亡占所有 5 岁以下儿童死亡的比例从 2010 年的 15.2%增加到 2020 年的 23.8%（χ2=227.0，p<0.001），非故意伤害死亡率从 2010 年的每 100000 例活产 249.3 例下降到 2020 年的 178.8 例，AADR 为 3.7%（95%CI 3.1-4.4）。2010-2020 年，城乡地区非故意伤害死亡率均有所下降（城市地区从 68.1 例/100000 例活产下降至 59.7 例/100000 例活产，农村地区从 323.1 例/100000 例活产下降至 230.0 例/100000 例活产）（城市地区：χ2=3.1，p<0.08；农村地区：χ2=113.5，p<0.001）。城乡地区的年下降率分别为 4.2%（95%CI 3.4-4.9）和 1.5%（95%CI 0.1-3.3）。2010-2020 年，非故意伤害死亡率的主要原因是窒息（2611 例，32.9%）、溺水（2398 例，30.3%）和交通伤害（1428 例，12.8%）。2010-2020 年，除交通伤害外，其他原因的非故意伤害死亡率的特定原因 AADR 均有所下降。非故意伤害相关死亡的构成也因年龄组而异。窒息是婴儿的主要原因，溺水和交通伤害是 1-4 岁儿童的主要原因。窒息和中毒的发病率在 10 月至 3 月较高，溺水的发病率在 6 月至 8 月较高。
2010-2020 年期间，中国 5 岁以下儿童非故意伤害死亡率显著下降，但城乡地区非故意伤害死亡率存在较大差异。非故意伤害仍然是影响中国儿童健康的一个重要公共卫生问题。应加强有效策略，减少儿童非故意伤害，并针对农村地区和男性等特定人群制定这些政策和方案。
