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中国1990—2020年儿童青少年意外伤害负担及变化趋势分析
Analysis of the burden and changing trends of unintentional injuries among children and adolescents in China from 1990 to 2020
目的 了解中国1990—2020年儿童青少年意外伤害的负担和变化趋势,为制定相关防治策略提供科学依据。方法 基于2021年全球疾病负担研究(GBD 2021)中的相关数据,以死亡数、伤残调整寿命年(DALYs)、伤残损失寿命年(YLDs)、过早死亡损失寿命年(YLLs)为指标,对伤害负担的变化情况以及不同性别、年龄段和风险因素之间的差异展开分析。应用Joinpoint 5.3.0软件,计算不同性别伤害负担的平均年度变化百分比(AAPC),采用分段回归分析探究不同类型意外伤害死亡的趋势变化。结果 1990—2020年,中国儿童青少年意外伤害负担整体呈下降趋势,死亡率、DALYs率、YLDs率、YLLs率分别下降80.91%、80.27%、40.52%、81.40%,死亡百分比从1990年的0.15%升至2008年峰值0.23%,后波动降至2020年的0.20%,但仍高于1990年水平。女性意外伤害负担低于男性且整体呈下降趋势。2~4岁年龄段意外伤害死亡降幅最大,达94.86%。不同类型的意外伤害死亡率均下降,但降幅存在差异。环境和行为风险因素所致的YLDs在研究期间分别由11.09万人年降至1.95万人年,0.17万人年降至0.09万人年。结论 男性和2~4岁年龄段人群为儿童青少年意外伤害的高发群体,环境风险因素引起意外伤害所致的YLDs显著高于行为风险因素。
Objective To analyze the burden and changing trends of unintentional injuries among children and adolescents in China from 1990 to 2020,and to provide a scientific basis for formulating relevant prevention and control strategies. Methods Based on the data from the Global Burden of Disease Study 2021 (GBD 2021),indicators such as the number of deaths,disability-adjusted life years (DALYs),years lived with disability (YLDs),and years of life lost (YLLs) were used to analyze the changes in injury burden,as well as the differences among genders,age groups,and risk factors.Joinpoint 5.3.0 software was selected to calculate the average annual percentage change (AAPC) of injury burden by gender,and segmented regression analysis was used to explore the changing trends in mortality from different types of unintentional injuries. Results From 1990 to 2020,the overall burden of unintentional injuries among children and adolescents in China showed a decreasing trend.The mortality rate,DALYs rate,YLDs rate,and YLLs rate decreased by 80.91%,80.27%,40.52%,and 81.40%,respectively.The percentage of deaths increased from 0.15% in 1990 to a peak of 0.23% in 2008,then fluctuated and decreased to 0.20% in 2020,but still remained higher than the level in 1990.The burden of unintentional injuries in females was lower than that in males,and the overall downward trend was more significant.The largest decrease in mortality due to unintentional injuries was observed in the 2-4 years old age group (94.86%).The mortality rates of different types of unintentional injuries all decreased,but the magnitude of decrease varied.During the study period,YLDs caused by environmental and behavioral risk factors decreased from 110 900 person-years to 19 500 person-years,and from 1 700 person-years to 900 person-years,respectively. Conclusion Males and children aged 2-4 years are the high-risk populations for unintentional injuries among children and adolescents,and the YLDs caused by environmental risk factors are significantly higher than those caused by behavioral risk factors.
儿童青少年 / 意外伤害 / 变化趋势 / 环境风险因素 / 疾病负担 / 年龄差异
Children and adolescents / Unintentional injuries / Changing trends / Environmental risk factors / Disease burden / Age differences
| [1] |
GBD 2021 Causes of Death Collaborators. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations,1990-2021:a systematic analysis for the Global Burden of Disease Study 2021[J]. Lancet, 2024, 403(10440):2100-2132.
|
| [2] |
Unintentional injury accounts for one-third of deaths in children and adolescents each year, primarily from motor vehicle crashes. Children younger than 13 years should be restrained in the back seat, and infants and toddlers should remain rear-facing until at least two years of age. Infants should be positioned on their backs in a crib, on a mattress with only a fitted sheet to avoid suffocation, and all items that could potentially entrap or entangle the child should be removed from the sleep environment. Fencing that isolates swimming pools from the house is effective in preventing drownings. Swimming lessons are recommended for all children by four years of age. Inducing vomiting after toxic ingestions is not recommended. Installing and maintaining smoke detectors, having a home escape plan, and teaching children how to respond during a fire are effective strategies for preventing fire-related injuries or death. The most effective way to prevent gun-related injuries in children and adolescents is the absence of guns from homes and communities. Family physicians should counsel patients with guns in the home to keep them locked, unloaded, and with ammunition stored in a separate locked location. Fall injuries can be reduced by avoiding walkers for infants and toddlers. Consistent helmet use while bicycling reduces head and brain injuries. Although direct counseling by physicians seems to improve some parental safety behaviors, its effect on reducing childhood injuries is unclear. Community-based interventions can be effective in high-risk populations.
|
| [3] |
朱晓琳, 唐文艺, 张佳彬, 等. 2018—2022年南昌市5-<20岁儿童青少年死因及减寿分析[J]. 职业与健康, 2024, 40(12):1647-1651+1656.
|
| [4] |
易光辉, 徐阳, 谭大华, 等. 2019—2020学年四川省儿童伤害监测结果分析[J]. 职业卫生与病伤, 2021, 36(4):241-244.
|
| [5] |
戴宁彬, 王菁, 龚甜, 等. 苏州市0-14岁儿童伤害流行病学特征分析[J]. 中华疾病控制杂志, 2019, 23(3):299-303.
|
| [6] |
|
| [7] |
张雍, 彭焱, 周琦, 等. 重庆市渝中区健康教育对降低0-6岁儿童意外伤害干预效果评价[J]. 中国预防医学杂志, 2016, 17(8):569-573.
|
| [8] |
颜丹虹, 陈湘怡, 甘同舟, 等. 1990—2019年中国归因于高BMI的老年失智症疾病负担趋势分析[J]. 现代预防医学, 2024, 51(9):1550-1554+1596.
|
| [9] |
林琪菲, 魏佳慧, 李向云. 1990—2019年归因于高BMI的痴呆症疾病负担分析[J]. 公共卫生与预防医学, 2024, 35(3):6-9.
|
| [10] |
田珍, 孟春辉, 史靖靖, 等. 焦作市2019—2023年居民伤害死亡特征及趋势分析[J]. 安徽预防医学杂志, 2025, 31(2):132-136.
|
| [11] |
国家统计局. 2021年《中国儿童发展纲要(2021—2030年)》统计监测报告[EB/OL].(2023-04-20)[2025-02-14]. http://www.gov.cn/lianbo/2023-04/20/content_5752337.htm.
|
| [12] |
中国疾病预防控制中心. 汶川特大地震医疗救援分析报告(儿童专题)[R]. 北京: 人民卫生出版社, 2010:28-41.
|
| [13] |
Children and adolescents are vulnerable to non-accidental injury. Early identification and prevention rely on detailed epidemiological studies, which are limited in Asia. This retrospective study used the registry data of Pan-Asian Trauma Outcome Study (PATOS) from October 1, 2015 to December, 31, 2020. Pediatric patients (aged < 20 years) with non-accidental injuries were enrolled, which were divided by age into preschool (0–6 years), child (7–12 years), and adolescent (13–19 years) groups. Baseline characteristics, injury epidemiology, and excess mortality ratio-adjusted injury severity score (EMR-ISS) were collected. Major trauma was defined as an EMR-ISS score > 24. The study enrolled 451 patients with non-accidental injuries, accounting for 2.81% of pediatric trauma events presented to an emergency department in the PATOS registry. The overall mortality rate was 0.9%, similar to those in Western countries. Mortality rate was high in preschool children (8.7%, p = 0.017) than in other age groups. The sex-specific incidence was higher in boys (3.10% vs. 2.13%, p = 0.001). In adolescents, more events occurred on the street (25.9%), whereas home remained the most common locale in girls of all ages. In the multivariable regression analysis, abdominal and multiple injuries were risk factors for major trauma.
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| [14] |
常雪莉, 刘馨宇, 李倩. 芜湖市镜湖区2016—2020年居民死因及期望寿命分析[J]. 安徽预防医学杂志, 2022, 28(4):328-331+335.
|
| [15] |
哈林娜, 徐昊立. 2018—2022年广东省5岁以下儿童意外死亡流行分析[J]. 中国儿童保健杂志, 2024, 32(2):218-222.
目的 了解2018—2022年广东省5岁以下儿童意外死亡的主要死因及其流行病学分布情况,为制订进一步的预防措施和干预方法提供理论依据。方法 以广东省2018—2022年死亡的5岁以下儿童为研究对象,将ICD10中S00-T98和V01-Y98系列疾病作为分类标准筛选出其中意外原因导致死亡的个案,计算相关的率、构成比等,分析儿童意外死亡原因及三间分布。结果 2018—2022年广东省总死亡率为2.94‰,死亡人数21 329人,其中意外死亡人数3 819人(0.53‰),男女性别比为1.29∶1,不同年龄组间意外伤害的性别构成差异有统计学意义(χ<sup>2</sup>=16.38,P＜0.01)。意外死亡原因前三位为意外窒息(1 590/3 819)、溺水(926/3 819)和交通意外(527/3 819)。各年龄段男童意外死亡率均高于女童,差异无统计学意义(χ<sup>2</sup>=13.68,P=0.19),不同意外死因儿童的年龄组差异有统计学意义(χ<sup>2</sup>=1 723.28,P＜0.01),死前救治情况差异有统计学意义(χ<sup>2</sup>=174.31,P＜0.01)。结论 广东省5岁以下儿童死亡的主要原因为意外窒息、溺水。应分年龄采取不同的预防措施提高儿童及家长的意外伤害识别防范意识,降低5岁以下儿童意外死亡率。
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| [16] |
Unintentional injury is a global burden that occurs everywhere, including in our homes. Young children are most vulnerable to home injuries because they still develop their physical and psychological skills and spend most of their time at home. Despite being largely preventable, three consecutive national surveys show no reduction in the rate of injury among children under five. More surprisingly, children from high-income families were found to have the highest incidence of injury, contradicting the findings from other countries.
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| [17] |
To investigate the changes and underlying mechanisms in parents' safety awareness and the use of child safety seats after the mandatory legislation in Shanghai city, China.This study was carried out by Shanghai Key Laboratory of Environment and Children's Health using a multi-stage, simple random sampling method. Volunteers with children aged 0-12 months were recruited. Child safety seats were sent to each volunteer's family. Telephone encounters and/or on-site visits were used to collect data from parents using a phased survey on children's safety during car use.Among all respondents, 91.2% had heard of motor vehicle accidents involving children, and 97.2% could describe the appropriate use of a safety seat to minimize the risk of child injury in a collision. Among 1078 families with newborns, awareness of child safety seats was 91.9%. There were 86% patients aware that new laws and regulations have been released regarding the use of child safety seats, and 98.5% of them plan to comply with the new laws. Moreover, 61% patients think that taxis should be routinely equipped with child safety seats.The parents in Shanghai obtained a high level of awareness of children's traffic safety after the introduction of child safety seats legislation, and had a positive experience related to the use of child safety seats. Taxi may be an important area of focus for implementation of child traffic safety. Traffic safety laws and regulations with further impact should be continuously studied.Copyright © 2019. Production and hosting by Elsevier B.V.
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| [18] |
Injuries are a leading cause of death and disability among children. Numerous injury prevention strategies have been successful in high-income countries, but the majority of unintentional injuries happen to children living in low- and middle-income countries (LMICs). This project aims to delineate the childhood injury prevention initiatives in LMICs. For inclusion, peer-reviewed articles needed to address unintentional injury, include children <18, assess a prevention-related intervention, contain a control group, and be published after 1988. Two pairs of reviewers evaluated articles independently to determine study eligibility. 74 articles were included. 30 studies addressed road traffic injuries, 11 drowning, 8 burns, 3 falls, 8 poisonings, and 21 an unspecified injury type. The findings show positive effects on injury outcome measures following educational interventions, the need for longer follow-up periods after the intervention, the need for effectiveness trials for behavior change, and the need for an increase in injury prevention services in LMICs. This is the first systematic review to summarize the prevention initiatives for all types of childhood unintentional injuries in LMICs. Increased attention and funding are required to go beyond educational initiatives with self-reported measures and little follow-up time to robust interventions that will reduce the global burden of unintentional injuries among children.
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| [19] |
|
| [20] |
刘盛元, 段蕾蕾, 邓晓, 等. 中国农村0-14岁儿童伤害环境危险因素分析[J]. 中国公共卫生, 2021, 37(8):1153-1157.
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| [21] |
In Nepal, unintentional home injury is a leading reason for death and disability among pre-school children. However, there is a lack of evidence to inform culturally appropriate interventions to reduce home injuries. This study explored the potential for home environmental change at a community level to prevent unintentional home injury in children and identified the barriers to, and facilitators of, such changes. Focus groups were conducted in the Nepali language with mothers, fathers, teachers, school students and community health volunteers in rural areas of Makwanpur district in Nepal. The discussions were audio-recorded, transcribed, translated into English and analysed thematically. NVivo software was used to support coding and identification of themes. Five focus groups, involving forty-seven participants, were completed leading to the development of four themes. Overall, the findings highlight that community people perceive injuries to be a normal part of childhood and, therefore, few prevention measures were considered. Parents were, however, able to identify ways to change their environment that made it safer. Changes included removing hazards or adding safety equipment, adapting the home or restricting access to potential hazards. Barriers to implementation included limited awareness about injury hazards and risk management, poor quality housing and financial constraint. Facilitators included raising community awareness, acquiring resources and financial support and involving the family and community. Development of interventions to prevent injuries at home in pre-school children should reflect local context and culture; this is best achieved through engagement with parents.
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| [22] |
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