The Burden of Injury in China, 1990-2017: Findings from the Global Burden of Disease Study 2017

Abstract

Background: A comprehensive evaluation of the burden of injury is an important foundation for selecting and formulating strategies of injury prevention. We present results from the Global Burden of Disease (GBD) 2017 study of non-fatal and fatal outcomes of injury at the national and subnational level, and the changes in burden for key causes of injury over time in China. Methods: Using the methods and results from GBD 2017, we describe the burden of total injury and four key causes of injury (road injuries, falls, drowning and self-harm) based on the rates of incidence, cause-specific mortality, and disability-adjusted life years (DALYs) in China. We additionally evaluate these results at provincial level in 2017, measure the change of injury burden from 1990 to 2017, and compare age-standardized DALY rates of injuries for the 34 subnational locations of China against the expected rates based on the socio-demographic index (SDI), a measure of development combining an equal weighting of lag-distributed income per capita, average years of education in the population over age 15 years, and total fertility rate under 25 years of age. Findings: In 2017, in China, there were 77.1 (95% uncertainty interval 72.5-81.7) million new cases of injury severe enough to warrant health care, and 733,517 (681,254-767,007) deaths due to injuries. Injuries accounted for 7.0% (6.6-7.2) of total deaths, and 10.0% (9.5-10.5) of all-cause DALYs in China. In 2017, there was a three-fold variation in age-standardized injury DALY rates between provinces of China, with the lowest value in Macao and the highest in Yunnan. Between 1990 and 2017, the age-standardized incidence rate of all injuries increased by 50.6% (46.6%- 54.6%) in China, while the age-standardized mortality and DALY rates rapidly decreased, by 44.3% (41.1% - 48.9%) and 48.1% (44.6% - 51.8%), respectively. All provinces of China experienced a substantial decline in DALY rates from all injuries ranging between 16.4% (3.1% - 28.6%) and 60.4% (53.7% - 66.2%) between 1990 and 2017. Age-standardized DALY rates for drowning; fire, heat and hot substances; self-harm; animal contact; adverse effects of medical treatments; environmental heat and cold exposure; and executions and police conflict each declined by more than 60% between 1990 and 2017. Interpretation: China has experienced a decrease in the age-standardized DALY and mortality rates due to injury from 1990 to 2017, despite an increase in the age-standardized incidence rate. These trends have occurred in all provinces. The divergent trends in terms of incidence and mortality indicate that with rapid socio-demographic improvements the case fatality of injuries has declined, which could be attributed to an improving health care system but also to a decreasing severity of injuries over this time period. Funding Statement: Bill & Melinda Gates Foundation Declaration of Interests: All authors have completed the ICMJE uniform disclosure form at icmje.org/coi_disclosure.pdf and declare support from the Bill & Melinda Gates Foundation; no financial relationships with any organizations that might have an interest in the submitted work; no other relationships or activities that could appear to have influenced the submitted work. Ethics Approval Statement: The authors state that there were No patients directly involved in this study.