Lancet Public Health. 2025 Jun;10(6):e456-e466. doi: 10.1016/S2468-2667(25)00069-6.
Injuries are among the top causes of mortality and disability in southeast Asia. Although injury prevention is a key health priority in the Post-2015 Health Development Agenda of the Association of Southeast Asian Nations (ASEAN), the focus was placed solely on road injuries. The absence of a broader recognition of injury burden and trends hinders future intervention efforts. This study aims to provide a comprehensive analysis of the burden and epidemiological trends of all injuries across ASEAN countries.
In this analysis of the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2021, we estimated incidence, cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age, sex, location, and year for ten ASEAN member states (Brunei, Cambodia, Indonesia, Myanmar, Laos, Malaysia, the Philippines, Singapore, Thailand, and Viet Nam) from 1990 to 2021. Incidence and non-fatal disease burden were estimated using disease model Bayesian meta-regression (DisMod-MR) 2.1. Mortality was derived from the GBD Cause of Death Ensemble model. Estimates include 95% uncertainty intervals where appropriate.
In 2021, an estimated 35·5 million (95% UI 33·5-37·7) injury incident cases were reported in ASEAN, resulting in approximately 317 000 deaths (286 000-350 000). Substantial variation was observed across the region, with the age-standardised mortality ranging from 13·4 per 100 000 people (12·7-14·1) in Singapore to 68·5 per 100 000 (54·4-81·9) in Viet Nam. Road injury was the leading cause of mortality and morbidity in most ASEAN countries, with the highest age-standardised DALY rates in Thailand and Malaysia. Self-harm was the leading cause of mortality in Singapore, whereas interpersonal violence was the leading cause of injury deaths in the Philippines. From 1990 to 2021, the region's age-standardised injury incidence rate declined by 23·0% (21·8-24·1). Age-standardised DALY rates decreased substantially for drowning (60·6% [53·2-66·7]) and road injuries (39·6% [32·1-46·4]), whereas falls saw a smaller and more heterogeneous decline of 12·3% (2·6-21·0) over the past 31 years.
The injury epidemiological landscape in ASEAN is complex, with substantial geographical variations and emerging challenges triggered by the rapid sociodemographic transition in the region. Progress has been uneven. Effective burden reduction across different causes of injury requires strategies addressing the wide range of socioenvironmental determinants and system shortfalls. Prevention programmes need to be customised to each country's unique context and development.
Bill & Melinda Gates Foundation.
伤害是东南亚地区死亡和残疾的主要原因之一。尽管预防伤害是东南亚国家联盟（东盟）《2015年后卫生发展议程》中的一项关键卫生重点，但此前仅关注道路伤害。对伤害负担和趋势缺乏更广泛的认识阻碍了未来的干预努力。本研究旨在全面分析东盟国家所有伤害的负担和流行病学趋势。
在这项对《2021年全球疾病、伤害及风险因素负担研究》（GBD）的分析中，我们估算了1990年至2021年期间东盟10个成员国（文莱、柬埔寨、印度尼西亚、缅甸、老挝、马来西亚、菲律宾、新加坡、泰国和越南）按年龄、性别、地点和年份划分的发病率、特定病因死亡率、寿命损失年数（YLLs）、伤残调整生命年数（YLDs）以及伤残调整生命年（DALYs）。发病率和非致命疾病负担采用疾病模型贝叶斯元回归（DisMod-MR）2.1进行估算。死亡率来自GBD死因综合模型。估算值在适当情况下包括95%的不确定性区间。
2021年，东盟地区报告的伤害事件估计有3550万起（95%不确定区间为3350万 - 3770万），导致约31.7万人死亡（28.6万 - 35万）。该地区存在显著差异，年龄标准化死亡率从新加坡的每10万人13.4例（12.7 - 14.1）到越南的每10万人68.5例（54.4 - 81.9）不等。道路伤害是大多数东盟国家死亡和发病的主要原因，泰国和马来西亚的年龄标准化伤残调整生命年率最高。自我伤害是新加坡死亡的主要原因，而人际暴力是菲律宾伤害死亡的主要原因。1990年至2021年期间，该地区的年龄标准化伤害发病率下降了23.0%（21.8% - 24.1%）。溺水（60.6% [53.2% - 66.7%]）和道路伤害（39.6% [32.1% - 46.4%]）的年龄标准化伤残调整生命年率大幅下降，而在过去31年中，跌倒的下降幅度较小且差异较大，为12.3%（2.6% - 21.0%）。
东盟地区的伤害流行病学情况复杂，存在显著的地理差异以及该地区快速的社会人口转变引发的新挑战。进展并不均衡。要有效减轻不同伤害原因造成的负担，需要制定应对广泛的社会环境决定因素和系统缺陷的策略。预防方案需要根据每个国家的独特情况和发展进行定制。
比尔及梅琳达·盖茨基金会
