Injuries In China Research Articles

The incidence, risk factors and outcomes of chemotherapy related acute kidney injury in China.

e24161 Background: Nephrotoxicity of chemotherapeutic agents remains a significant complication limiting the efficacy of the treatment. However, comprehensive data on the epidemiology and outcomes of chemotherapy related acute kidney Injury in China is lacking. Methods: We conducted a nationwide cohort study of hospitalized patients from 25 general and children’s hospitals in China during 2013-2015. Patient-level data were obtained from the electronic hospitalization information system, prescription database and laboratory databases of all cancer patients who received chemotherapy and had at least two serum creatinine tests within any 7-day window during the hospitalization. AKI was defined and staged according to Kidney Disease Improving Global Outcomes criteria. The incidence of AKI in patients with various type of cancer and chemotherapeutic agents was examined. The outcomes of AKI, including in-hospital mortality, death after discharge, kidney recovery, and length of stay, were also assessed. Results: A total of 23,232 cancer patients, including 3,120 children ( < 18 years old), 16,310 adult (19-65 years old) and 3,802 elderly patients ( > 65 years old), were analyzed. Platinum compounds and pyrimidine analogues were the most common used chemotherapy agents for cancer patients. The overall incidence of AKI was 4.9%. Patients with urinary system malignancy (12.3%), hematological malignancy (10.2%) and nerve motor system malignancy (4.1%) have the highest incidence of HA-AKI. The top three types of chemotherapy drugs with the highest incidence of AKI were Purine analogues (30.1%), folic acid analogues (15.3%) and combinations of antineoplastic agents (14.1%). The nephrotoxicity of chemotherapy drugs was different among age groups. AKI is associated with a higher risk of in-hospital mortality and death after discharge. Conclusions: The risk of AKI in cancer patients varied in different age group, type of cancer and chemotherapeutic agents.

Factors affecting length of stay in hospital of patients with traumatic spinal cord injury in China.

To investigate factors associated with length of stay in hospital of patients with traumatic spinal cord injury in China, based on recent data spanning a period of 10 years. The study was conducted in the China Rehabilitation Research Center, Beijing, which is the largest rehabilitation hospital in China. Associated variables were statistically analysed, including sex, age, marital status, patient's home address, and payment method as demographic variables, and cause of injury, severity of injury, level of injury, spasticity, osteoporosis, neurogenic bladder, and complications as clinical variables. Univariate analysis and multiple linear regression analysis were used to determine the association between length of stay and these var-iables. A total of 2,110 participants were included in this study. Median length of stay in hospital was 113.5 days. Longer length of stay correlated significantly with higher age, single status, being struck by an object, motor vehicle collision, complete injury, and complications. Patients whose injury resulted from a fall from a low height, those with neurogenic bladder, and/or patients of older age had shorter lengths of stay. Analysis of data for patients with traumatic spinal cord injury, spanning a recent period of 10 years in China, shows that close attention should be paid to those patients with osteoporosis, spasticity, complete injury, injury caused by object striking or motor vehicle collision, patients with single status, or who are in the age range 15-29 years. Active measures should be taken to reduce length of stay in patients with complications, such as urinary tract infection, respiratory infection, or neuropathic pain.

Prevalence and Altered Causes of Traumatic Brain Injury in China: A Nationwide Survey in 2013

Background: Traumatic brain injury (TBI) is one of the leading causes of death and disability annually worldwide. However, the epidemiology of TBI had not been established in China. We conducted a nationally representative door-to-door survey in the general population across all age groups in 31 provinces in mainland China in 2013. Methods: All participants were reviewed for a history of physician-diagnosed TBI by trained investigators using a structured questionnaire. TBI survivors were considered as prevalent cases at the prevalent time. The present study also examined the odds of TBI as a function of sex, age, and other demographical variables using logistic regression model. Results: Of 583,870 participants, 2,673 individuals had suffered from a TBI during their past life, yielding a weighted prevalence of being 442.4 (95% CI 342.2–542.6) per 100,000 person. The TBI prevalence increased with increasing age. The present study observed the multiadjusted ORs of TBI were 1.9 (95% CI 1.8–2.1) for the male, 1.9 (95% CI 1.2–3.1) for the farmers, 1.9 (95% CI 1.2–3.3) for the retiree or homemakers, 3.4 (95% CI 1.5–7.7), and 2.8 (95% CI 1.1–6.6) for those whose education were primary school and high school, respectively. The most common external cause was road traffic accidents among those who were aged 18–34 years old and those whose educational levels were middle school in both genders. Conclusions: Our results indicate TBI was substantially prevalent among Chinese population and underscore the need to develop national strategies to improve the safe education on road and traffic of TBI in rural residents and some subgroup population.

Factors associated with injuries among tornado victims in Yancheng and Chifeng, China

BackgroundAs extremely violent meteorological disasters, tornadoes often cause serious casualties. The study aims to analyze the characteristics and causes of tornado injuries in China under certain humanistic and geographical conditions.MethodsA random sampling questionnaire survey was developed and distributed to tornado victims from two separate occurrences: an Enhanced Fujita 4 tornado in Yancheng, and a Fujita 3 tornado in Chifeng. The information of demographic characteristics, disaster environment, and individual behaviors in victims was collected. Chi-square test and binary logistic regression were used to analyze influencing factor of injuries.ResultsA total of 94 valid questionnaires (participation rate 95.9%) were finally collected in Yancheng tornado and 67 valid questionnaires (participation rate 93.1%) in Chifeng tornado. Residents’ annual income (OR = 0.10, 95% CI 0.02–0.50, P = 0.005), degree of house collapse (OR = 183.12, 95% CI 8.04–4173.34, P = 0.001) have a significant impact on the probability of injury. Differences in tornado disaster drill awareness (P = 0.009), individual behaviors (P = 0.011) and fear level (P = 0.011) significantly affected the incidence of trauma. Whether victims were indoors or not has no statistical difference on injuries in China.ConclusionsOur study clarifies risk factors and is conducive to the expansion of the investigation in tornado casualties. The government should improve the wind-resistance of residential buildings. Victims should participate in disaster prevention drills to take effective disaster avoidance actions.

Epidemiology of Traumatic Spinal Cord Injury in China

Background: China accounts for nearly one-fifth of the world's population. However, the national epidemiology of traumatic spinal cord injury (TSCI) is still unknown. Therefore, this study aimed to clarify the incidence and epidemiological characteristics of TSCI in China. Methods: We retrospectively reviewed the medical records of patients with spinal cord injury in hospitals and the ability to treat TSCI. TSCI was defined as the clinical manifestation of paraplegia or quadriplegia after trauma. We collected general data, causes of injury, level of injury, severity of injury, multiple injuries, complications and other data through the designed medical record questionnaire, and then performed an analysis according to geographical region, age and gender, and calculated the overall incidence of the whole country and each region. Findings: The study included medical records of 4,134 patients with a male to female ratio of 2·99:1. In 2018, the overall TSCI rate in China was 50·484 cases (95% CI: 50·122, 50·846) per one million persons, and the expected number of cases was 74,890. The highest incidence rate in the East was 53·791 (95% CI: 53·217, 54·365) cases per one million persons, and the expected number of cases was 33,724. The leading cause of injury was high falls (29·58%), the most common level of injury was cervical injury (64·49%). Regarding the severity of injury, the highest percentages of incomplete quadriplegia (55·20%). Interpretation: The estimated overall incidence of TSCI in China is similar to that of the United States. The leading cause of injury in different regions of China was determined. Preventive work should be carried out in a targeted manner. With the ageing population, there are more TSCIs in the elderly population due to low falls. Future public health policies need more strategies to prevent low falls and to widely publicize them. Funding Statement: This study was supported by the Key Program from the National Natural Science Funds (81830077); the General Program from the National Natural Science Funds (81772357);the National Natural Science Foundation of China; the Key Project from the Science and Technology Commission of Shaanxi (2017ZDXM-SF-054); the Department of Health, Shaanxi Province (2018E002); the Major Research from the Xi'an Science and Technology Department (2017123SF/YX017). Declaration of Interests: The authors declare that they have no conflicts of interest. Ethics Approval Statement: The Ethics Committee of Xi'an Honghui Hospital and the ethics committee of each participating centre approved the current study.

Further promotion on children injury prevention and control in China

Injury is an important public health problem that threatening children's health. Researches have been carried out to prevent child injuries in China. Disease burden on injury for children have been moderated, but remained as the first cause of death in Chinese children, so injury prevention among children should still be treated as priority to promote children's health. It is necessary to establish and improve strategies in injury prevention which should be led by the government and correlated institutes, as to carry out a systematic, comprehensive and scientific system for children injury prevention and control. In order to reduce children's injuries and promote children's health, relevant policies and regulations should base on "Healthy China 2030" to formulate and implement action plans, to carry out practice and scientific research on children injury prevention, and to strengthen the team construction and talent training on this issue.

The burden of injury in China, 1990–2017: findings from the Global Burden of Disease Study 2017

SummaryBackgroundA 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 Diseases, Injuries, and Risk Factors Study (GBD) 2017 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.MethodsUsing the methods and results from GBD 2017, we describe the burden of total injury and the key causes of injury based on the rates of incidence, cause-specific mortality, and disability-adjusted life years (DALYs) in China estimated using DisMod-MR 2.1. We additionally evaluated these results at the provincial level for the 34 subnational locations of China in 2017, measured the change of injury burden from 1990 to 2017, and compared age-standardised DALYs due to injuries at the provincial level against the expected rates based on the Socio-demographic Index (SDI), a composite measure of development of income per capita, years of education, and total fertility rate.FindingsIn 2017, in China, there were 77·1 million (95% uncertainty interval [UI] 72·5–81·6) new cases of injury severe enough to warrant health care and 733 517 deaths (681 254–767 006) due to injuries. Injuries accounted for 7·0% (95% UI 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-times variation in age-standardised injury DALY rates between provinces of China, with the lowest value in Macao and the highest in Yunnan. Between 1990 and 2017, the age-standardised incidence rate of all injuries increased by 50·6% (95% UI 46·6–54·6) in China, whereas the age-standardised mortality and DALY rates decreased by 44·3% (41·1–48·9) and 48·1% (44·6–51·8), respectively. Between 1990 and 2017, all provinces of China experienced a substantial decline in DALY rates from all injuries ranging from 16·3% (3·1–28·6) in Shanghai and 60·4% (53·7–66·1) in Jiangxi. Age-standardised DALY rates for drowning; injuries from fire, heat and hot substances; adverse effects of medical treatments; animal contact; environmental heat and cold exposure; self-harm; and executions and police conflict each declined by more than 60% between 1990 and 2017.InterpretationBetween 1990 and 2017, China experienced a decrease in the age-standardised DALY and mortality rates due to injury, despite an increase in the age-standardised incidence rate. These trends occurred in all provinces. The divergent trends in terms of incidence and mortality indicate that with rapid sociodemographic 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.FundingBill & Melinda Gates Foundation.

Road traffic injuries in China from 2007 to 2016: the epidemiological characteristics, trends and influencing factors.

BackgroundRoad traffic accidents are one of the serious disasters that cause public injury, fatality and great economic loss. They are a growing public health problem around the world.ObjectivesThe aim of this study was to determine epidemiological characteristics, tendency and possible influencing factors of road traffic injuries (RTIs) in China, so as to give target suggestions on preventative measures.MethodsRoad traffic accident data were obtained from National Bureau of Statistics of China and Ministry of Transport of the People’s Republic of China. Descriptive statistic such as RTIs frequency, trends of different accident types from 2007 to 2016; the RTIs difference between different regions and road surfaces were compared; and the possible influencing factors of RTIs were also explored.ResultsOver the past decade, with the mileage of constructed highway increased, the frequency of road traffic accidents have declined substantially in China, and the death toll from road traffic accidents with motor vehicles has declined from 2007 to 2015, Conversely, the number of deaths from non-motor vehicle accidents has risen rapidly since 2012. Our study showed that the traffic accident related mortality in Guizhou province was different from the level of the whole nation, and the Eastern, Central and Western areas of China were all significantly different (P < 0.001). Linear regression suggested a significant affected of gross domestic product (GDP)-per-capita, education level, the number of health institutions, populations, and car ownership status on traffic accident death tolls (P < 0.001). Moreover, cement concrete pavement roads were associated with the highest occurrence rates of RTI, and RTIs was statistically significant (P < 0.001) on different road surfaces.ConclusionEven though the frequency of road traffic accidents has declined, RTIs remain an urgent public health problem in China. Thus, the government should give some target preventative measures to reduce RTIs, aiming at different regions, the increasing trend of the death toll related to non-motor vehicles and the highest occurrence on cement concrete pavement roads.

In Vivo Evaluation of Tectoridin from &lt;i&gt;Puerariae flos &lt;/i&gt;on Anti-alcoholism Property in Rats

Puerariae Flos have developed into one of the improved selling herbal medicines for healing of diseases such as alcohol intoxication and liver injury in China and Japan. Herbal medicines with the multi-targeted and less toxic characteristic have fascinated more attention in the prevention of Alcoholic liver disease ALD. The aim of this study was to investigate the effects of tectorigenin on chemically induced liver fibrosis in rats, Chinese medicine is considered to be an imperative and substitute approach. Tectoridin, naturally extracted from pueraria thunbergiana flos, is commercially acclaimed for its anti-alcoholism function. Furthermore, it was analyzed the effects of tectoridin on sobering the rats up, and to explore the mechanisms of tectoridin from Pueraria thunbergiana Flos sobering the roots up by decreasing the alcohol content, ADH activity in a rat model and the best anti-alcoholism properties among tectoridin, tectorigenin and tectorigenin sodium sulfonate. Acute alcohol poisoning experiment models of rats were set up to evaluate the blood alcohol content in blood and ADH activity in liver. Results showed that tectoridin demonstrated the anti-alcoholism property and a dose of 75mg·kg-1·bw tectoridin showed the strongest clearance rate of ethanol. The comparison of the anti-alcoholism capacity were as follows: tectorigenin sodium sulfonate (52.86%) was better than tectoridin (47.31%) (P < 0.01) and tectoridin was better than tectorigenin (43.67%) (P < 0.01).

Practice of Sedation and Analgesia in Patients With Severe Brain Injury in China

Practice of Sedation and Analgesia in Patients With Severe Brain Injury in China

Strengthen the study of anti-tuberculosis drug-induced liver injury in China

抗结核药物性肝损伤（ATB-DILI）是抗结核药物常见的毒性及不良反应，若贻误诊治后果严重。如何减少或避免ATB-DILI，一直困扰着广大结核病防治工作者。我国抗结核药物性肝损伤方面的研究尚处在起步阶段，不少方面还需进行系统的临床和基础研究，同时也应引起我们足够的重视。.

Road traffic mortality in China: analysis of national surveillance data from 2006 to 2016

Sustainable Development Goal (SDG) 3.6 is to halve the number of global deaths and injuries from road traffic accidents by 2020. We aimed to investigate progress in reducing mortality rates from road traffic injury in China from 2006 to 2016. We obtained data from national disease surveillance points. Crude and age-standardised mortality were calculated, with SEs. Joinpoint regression analysis was used to examine and quantify trends in overall and subgroup road traffic mortality from 2006 to 2016. Subgroup analyses were done by place (urban and rural), sex, age group, geographical location (province), and road user, and by type of vehicle for motor vehicle occupant deaths. In 2016 in China, crude road traffic mortality was 11·0 (SE 0·11) deaths per 100 000 population. Overall age-adjusted road traffic mortality increased from 12·6 (SE 0·03) deaths per 100 000 population in 2006 to 15·5 (0·03) deaths per 100 000 population in 2011 then decreased to 10·4 (0·03) deaths per 100 000 population in 2016. Subgroup mortality rates generally followed similar trends. Males, older adults, and rural areas consistently had higher road traffic mortality rates than did females, younger people, and urban areas. Mortality changes varied across urban and rural areas and by sex, age group, and province between 2006 and 2016, revealing large urban-rural and provincial disparities and highlighting pedestrians as the most vulnerable road users. Deaths among occupants of cars and three-wheeled motor vehicles constituted 48% and 20%, respectively, of total occupant mortality from road traffic accidents between 2006 and 2016. Despite a substantial decrease in road traffic mortality since 2011, the SDG target to halve deaths and injuries from road traffic accidents by 2020 is unlikely to be reached in China. Systematic and sustainable efforts are needed to accelerate progress in road traffic safety in China. National Natural Science Foundation of China.

Drug-Induced Acute Kidney Injury in China: A Multicenter Cross-Sectional Survey

Background: Acute kidney injury (AKI) is a severe kidney disease. Drug-induced AKI (D-AKI) is one type of AKI, which is difficult to be diagnosed. The incidence of D-AKI in China has rarely been studied. This study aims to explore the disease burden, related drugs and diagnosis status of D-AKI. Methods: A nationwide cross-sectional survey was conducted in adult patients from 23 academic hospitals in 17 provinces in mainland China. Suspected AKI was screened based on serum creatinine changes according to the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Acute Kidney Injury and patients who met the diagnosis of hospital-acquired AKI in January and July of 2014 were defined. D-AKI was firstly evaluated by pharmacists using Naranjo Adverse Drug Reaction Probability Scale and further confirmed by nephrologists through carefully reviewing the medical records. Findings: Altogether 280,255 hospitalized patients were screened and 1960 cases were diagnosed as hospital-acquired AKI, among which 735 cases were defined as D-AKI (37.50%, 735/1960) with a hospital mortality rate of 13.88% and 54.34% of the survivors not achieving full renal recovery. 1642 drugs were related to AKI in these 735 D-AKI patients. Anti-infectives (34.35%, 564/1642), diuretics (21.80%, 358/1642) and proton pump inhibitors (PPIs) (10.48%, 172/1642) were the top 3 types of drugs relavent to D-AKI, accounting for 66.63% cumulatively. Besides age, AKI staging, severe disease, hypoalbuminemia, plasma substitutes and carbapenems related D-AKI were independent risk factors for in-hospital mortality of D-AKI patients. Interpretation: In China, D-AKI has caused a substantial medical burden. Chinese pharmacists and nephrologists should bear the major responsibility of leading the campaign of managing D-AKI. Funding Statement: This study is supported by Medical Policy and Administration Department, National Health and Family Planning Commission of China, 2015. The National Natural Science Foundation of China (No.91742205 and No.81625004), the Beijing Young Scientist Program (BJJWZYJH01201910001006), and Peking University Clinical Scientist Program by the Fundamental Research Funds for the Central Universities. Declaration of Interests: The authors declare that they have no conflicts of interest. Ethics Approval Statement: This study was approved by the Ethics Committee of Xuanwu Hospital of Capital Medical University.

Pragmatic Studies for Acute Kidney Injury in China: Renal Replacement Therapy for Acute Kidney Injury and Sepsis Consensus Report of Acute Disease Quality Initiative XIX

In this article, we report consensus of 19th Acute Disease Quality Initiative (ADQI) conference and pragmatic trial proposals on renal replacement therapy (RRT) for acute kidney injury (AKI)and sepsis. The committee develop a list of key questions for the pragmatic trials. Then a systematic literature search was performed using PubMed and Embase. Finally the group summarized the proposed trials using PICO(Patient, Intervention, Comparator, Outcome). The groups recommended the first step would be a prospective observational study to document the current clinical practice of RRT in ICUs. Then the second stage would be to develop a quality improvement (QI) tools to improve and standardize the RRT practice in ICUs. The committee also proposed the primary outcome and secondary outcomes of the trial. Consensus had been reached for the pragmatic trial of RRT for AKI and sepsis in Chinese ICUs.

Injury Prevention in China: Government-Supported Initiatives on the Leading Causes of Injury-Related Deaths.

The article focuses on government-supported initiatives in China to help reduce injury-related deaths. It states injuries are one of the top five causes of death in China in 2018 and cause over 500,000 deaths annually with rural residents and men having the highest mortality rate from injuries. It comments 80 percent of accidental injuries in China are road traffic injuries and mentions the use of infrastructure improvements, legal mandates, and educational campaigns to reduce injury incidence.

Outcome indicators in the transitional care of people with spinal cord injury in China: a Delphi survey based on the International Classification of Functioning, Disability and Health

Objective: To identify the categories of the International Classification of Functioning, Disability and Health most suitable as outcome indicators in the transitional care for people with spinal cord injury in China.Methods: A three-round Delphi survey was conducted surveying 37 experts selected through purposive sampling. In the first round, each expert was required to suggest the most useful indicators in the transitional care for spinal cord injury patients. Categories of the International Classification of Functioning, Disability and Health were linked with the concepts extracted from the responses. In the second round, the experts were asked to make a yes/no judgment about the utility of those categories as outcome indicators and to rate their importance from 1 to 10. In the third round, the experts were asked to re-judge and re-rate the importance considering the second-round results.Results: Forty-one categories, seven personal factors, and three concepts not covered in the International Classification of Functioning, Disability and Health were identified. They generated agreement percentages over 80% in the third round. The means of the importance ratings ranged from 5.15 to 9.52.Conclusions: A set of categories and concepts was identified in the Delphi survey based on the International Classification of Functioning, Disability and Health. They provided a reference and a basis for establishing a system of outcome indicators in the transitional care for patients with spinal cord injury in China.Implications for rehabilitationIn China, the people with spinal cord injury who live at home after discharge urgently need professional transitional care which can be extended from medical institutions to families.The categories and concepts identified by the Delphi survey based on the International Classification of Functioning, Disability and Health reflect the focuses in the transitional care of people with spinal cord injury in China.Those categories and concepts provide a reference and a basis for establishing a system of outcome indicators in the transitional care for patients with spinal cord injury in China.

Disease burden of animal injury in China, 1990-2016

Objective: To analyze the disease burden of animal injury in China between 1990 and 2016. Methods: Data obtained from the Global Burden of Disease 2016 were used to analyze the age and gender specific disease burden of animal injury in China, using the incidence and disability adjusted of life years (DALYs) rate. Relative and annual changes were evaluated. Results: In 2016, the age-standardized incidence and DALYs rate of animal injury in China showed as 245.05 per 100 000 people and 12.73 per 100 000. The age-standardized incidence of non-venomous animal injury was significantly higher than that of venomous animal injury, but the differences in age-standardized incidence and DALYs rate between venomous animal injury and non-venomous animal injury were not significant. Between 1990 and 2016, there was a significantly decreasing trend in the age-standardized incidence and DALYs rate of animal injury, and obvious decline could be seen in the incidence of non-venomous animal injury, compared with venomous animal injury. The incidence and DALYs rate of animal injury declined in both males and females and in different age groups. The obvious decline of incidence and DALYs rate could be found in children aged 5-14 years and aged <5 years. Conclusions: Between 1990 and 2016, there was a significant alleviation of the disease burden of animal injury in China. Young children were most prone to animal injury, resulting in serious disability and death, indicating more attention should be paid to this population at high risk and in animal injury prevention and control programs.

Pedestrian-vehicle crashes: Risk perception and responsibility attribution among children, adolescents and adults.

:Background:Child pedestrian injuries in China result from crashes not just with cars. We considered how Chinese youth and young adults perceive pedestrian risk from four vehicle types-bicycles, electric bicycles, cars, buses—evaluating perceptions for two factors that may influence pedestrian behavior and risk-taking, perception of road environment risk and responsibility to avoid crashes. Understanding how pedestrians perceive risk, and how these perceptions change as children grow older, could guide prevention efforts.Methods:383 children (grades 3-4, 5-6, 8) and university students completed self-report surveys. We analyzed overall responses, plus age/gender differences in risk perception and responsibility attribution, across vehicle types and number of vehicles approaching, using multivariate analysis of variance (MANOVA) and generalized estimating equation (GEE) models.Results:Overall, larger vehicles were perceived as riskier (p less than .001). Compared tochildren, university students perceived bicycles and electric bicycles as less risky (Mean=2.66 vs. 3.69, 3.34 vs. 3.62, respectively, p less than .05). Cars and buses were perceived as equally risky across age groups. Across all vehicle types and number of vehicles traversing the road, both children and young adults perceived more pedestrian responsibility to avoid collisions relative to drivers (p less than .001). Children attributed less personal responsibility to avoid pedestrian-vehicle crashes than university students (e.g., buses odds ratio (OR)=0.20, p less than .001; OR=0.26, p less than .01; OR=0.28, p less than .01 for third/fourth, fifth/sixth, eighth graders, respectively). University students and fifth/sixth graders also identified greater pedestrian responsibility to avoid collisions with multiple vs. one vehicle approaching (e.g., university students/cars OR=4.17, p less than .001).Conclusions:We discuss cognitive and perceptual development factors in childhood, adolescence, and young adulthood that may contribute to differences in risk perception and responsibility attribution among Chinese pedestrians and suggest future research should explore those processes and subsequently develop evidence-based interventions to reduce pedestrian injury risk.

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

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.

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

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