Trends in traumatic brain injury mortality in China, 2006-2013: A population-based longitudinal study.
Trends in traumatic brain injury mortality in China, 2006-2013: A population-based longitudinal study.
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DOI：
10.1371/journal.pmed.1002332
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发表时间：
2017-07
期刊：
影响因子：
15.8
通讯作者：
Zhou M
中科院分区：
文献类型：
--
作者：
Cheng P;Yin P;Ning P;Wang L;Cheng X;Liu Y;Schwebel DC;Liu J;Qi J;Hu G;Zhou M
创伤性脑损伤(TBI)是一个重要的全球公共卫生问题，但在低收入和中等收入国家(LMIC)，研究人员和政策制定者对此关注很少。在国家层面上，包括中国在内的大多数低分子肝病患者缺乏脑外伤发病率和死亡率的流行病学证据。利用中国疾病监测点(DSPs)的数据，对中国2006年1月1日至2013年12月31日的脑外伤死亡率及其性别、年龄、地点(城乡)和外因的差异进行了纵向分析。死亡数据来自中国的国家数字信号处理器系统，该系统自2004年以来一直使用国际疾病分类第10版(ICD-10)对死亡进行编码。使用2010年的人口普查人口作为参考人口，估计了95%的顺位指数的粗略和年龄标准化死亡率。科克伦-阿米蒂奇趋势检验被用来检验2006年至2013年死亡率趋势的重要性。负二项模型被用来检验颅脑损伤死亡率与地点、性别和年龄组的关系。按外因进行亚组分析。我们发现：(1)年龄调整后的脑外伤死亡率从2006年的13.23/10万上升到2008年的17.06/10万，然后开始略有下降。2013年，经年龄调整的脑外伤死亡率为每10万人12.99人(SE=0.13)。(2)与女性和城市居民相比，男性和农村居民具有更高的脑外伤死亡风险，调整后的死亡率比分别为2.57和1.71。脑外伤死亡率随着年龄的增加而显著增加。(3)2006-2013年间，机动车碰撞和跌倒是颅脑损伤死亡的两大主要原因。0-14岁儿童和65岁及以上成年人死于机动车撞车事故的人数最多的是行人，骑摩托车的人是其他年龄组的第一或第二主要道路使用者。(4)从2006年到2013年，所有7个年龄组的行人和骑摩托车的人因机动车碰撞而导致的脑外伤死亡率都有所上升。我们的分析受到DSPs数据集中数据可获得性和质量的限制，包括缺乏与伤害相关的社会经济因素、政策因素以及个人和行为因素。该数据集在TBI死亡记录中也可能是不完整的，或者包含死亡数据的错误分类。脑外伤对中国构成严重的公共卫生威胁。进一步的研究应探讨特定人群中脑外伤死亡率特别高的原因，以及最近某些亚组死亡率上升的原因，并应制定解决办法，以应对这些挑战。在其他文化中被证明有效的干预措施应该在全国范围内引入和实施。机动车撞车事故方面的例子包括关于摩托车和骑自行车者使用头盔、儿童机动车乘客使用汽车座椅和助推器座椅、限速和酒驾法律以及酒精点火互锁使用的政策变化和法律的执行。预防跌倒的例子，特别是在老年人中，包括锻炼计划，减少跌倒风险的家居改造，以及防止所有年龄段跌倒的多方面干预。在一项以人群为基础的队列研究中，胡国庆及其同事研究了2006年至2013年中国的创伤性脑损伤死亡率趋势。创伤性脑损伤是一个严重的全球公共卫生问题，但在中国这样的低收入和中等收入国家，流行病学证据很少。中国的基于人群的脑外伤死亡率仍未在全国范围内报告。利用国家疾病监测点(DSP)系统的数据，对2006年至2013年中国地区(城乡)、性别、年龄组和外因的脑外伤死亡趋势及差异进行了以人群为基础的纵向分析。2006年至2013年，中国的脑外伤相关死亡率总体上保持相对稳定，处于较高水平，每10万人中有12.99至17.06人死亡。从2006年到2013年，中国的男性、农村居民和老年人的脑外伤死亡率一直显著高于女性、城市居民、儿童和年轻人。机动车碰撞和跌倒是中国75岁以下人群脑外伤死亡的两个最重要原因，但在2006年至2013年期间，跌倒是75岁及以上成年人脑外伤死亡的主要原因。在0-14岁的儿童和65岁及以上的成年人中，因机动车碰撞而导致的脑外伤死亡最多发生在行人中，但在15岁-的中国居民中，骑摩托车的人和行人一样容易受到脑外伤死亡的影响。脑外伤是一个严重的公共卫生问题，应该被视为中国的公共卫生优先事项。应在中国引入经过验证且负担得起的干预措施，并在全国范围内实施，以保护公民--特别是男性、农村居民和老年人等高危人群--免受脑外伤的伤害和死亡。
Traumatic brain injury (TBI) is a significant global public health problem, but has received minimal attention from researchers and policy-makers in low- and middle-income countries (LMICs). Epidemiological evidence of TBI morbidity and mortality is absent at the national level for most LMICs, including China. Using data from China’s Disease Surveillance Points (DSPs) system, we conducted a population-based longitudinal analysis to examine TBI mortality, and mortality differences by sex, age group, location (urban/rural), and external cause of injury, from 1 January 2006 to 31 December 2013 in China. Mortality data came from the national DSPs system of China, which has coded deaths using the International Classification of Diseases–10th Revision (ICD-10) since 2004. Crude and age-standardized mortality with 95% CIs were estimated using the census population in 2010 as a reference population. The Cochran–Armitage trend test was used to examine the significance of trends in mortality from 2006 to 2013. Negative binomial models were used to examine the associations of TBI mortality with location, sex, and age group. Subgroup analysis was performed by external cause of TBI. We found the following: (1) Age-adjusted TBI mortality increased from 13.23 per 100,000 population in 2006 to 17.06 per 100,000 population in 2008 and then began to fall slightly. In 2013, age-adjusted TBI mortality was 12.99 per 100,000 population (SE = 0.13). (2) Compared to females and urban residents, males and rural residents had higher TBI mortality risk, with adjusted mortality rate ratios of 2.57 and 1.71, respectively. TBI mortality increased substantially with older age. (3) Motor vehicle crashes and falls were the 2 leading causes of TBI mortality between 2006 and 2013. TBI deaths from motor vehicle crashes in children aged 0–14 years and adults aged 65 years and older were most often in pedestrians, and motorcyclists were the first or second leading category of road user for the other age groups. (4) TBI mortality attributed to motor vehicle crashes increased for pedestrians and motorcyclists in all 7 age groups from 2006 to 2013. Our analysis was limited by the availability and quality of data in the DSPs dataset, including lack of injury-related socio-economic factors, policy factors, and individual and behavioral factors. The dataset also may be incomplete in TBI death recording or contain misclassification of mortality data. TBI constitutes a serious public health threat in China. Further studies should explore the reasons for the particularly high risk of TBI mortality among particular populations, as well as the reasons for recent increases in certain subgroups, and should develop solutions to address these challenges. Interventions proven to work in other cultures should be introduced and implemented nationwide. Examples of these in the domain of motor vehicle crashes include policy change and enforcement of laws concerning helmet use for motorcyclists and bicyclists, car seat and booster seat use for child motor vehicle passengers, speed limit and drunk driving laws, and alcohol ignition interlock use. Examples to prevent falls, especially among elderly individuals, include exercise programs, home modification to reduce fall risk, and multifaceted interventions to prevent falls in all age groups. In a population-based cohort study, Guoqing Hu and colleagues examine trends in traumatic brain injury mortality in China, 2006–2013. Traumatic brain injury (TBI) is a serious public health problem worldwide, but epidemiological evidence is scarce in low- and middle-income countries like China. Population-based mortality from TBI remains unreported at the national level for China. Using data from the national Disease Surveillance Points (DSPs) system, we conducted a population-based longitudinal analysis to report trends in TBI mortality and differences based on location (urban/rural), sex, age group, and external cause of TBI from 2006 through 2013 in China. Overall TBI-related mortality remained relatively stable and at a high level, ranging from 12.99 to 17.06 per 100,000 population, between 2006 and 2013 in China. Males, rural residents, and older adults consistently had significantly higher TBI mortality compared to females, urban residents, children, and young adults in China from 2006 to 2013. Motor vehicle crashes and falls were the 2 most important causes of TBI mortality for Chinese individuals younger than 75 years, but falls were the leading cause of TBI deaths for adults aged 75 years and older between 2006 and 2013. TBI deaths attributed to motor vehicle crashes in children aged 0–14 years and adults aged 65 years and older were most often in pedestrians, but motorcyclists were as vulnerable to TBI deaths as pedestrians among Chinese residents aged 15–64 years. TBI represents a serious public health problem and should be considered a public health priority in China. Proven and affordable interventions should be introduced in China and implemented nationwide to protect citizens—and especially high-risk populations such as males, rural residents, and older adults—from TBI injuries and deaths.
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DOI：
10.2471/blt.10.080317
发表时间：
2011-01-01
期刊：
Bulletin of the World Health Organization: International Journal of Public Health
影响因子：
--
作者：
Hu, Guoqing;Baker, Timothy;Baker, Susan P
通讯作者：
Baker, Susan P
影响因子：
1.5
作者：
Barr, Gavin C., Jr.;Kane, Kathleen E.;Kane, Bryan G.
通讯作者：
Kane, Bryan G.
影响因子：
3.8
作者：
Kessaram T;McKenzie J;Girin N;Roth A;Vivili P;Williams G;Hoy D
通讯作者：
Hoy D
影响因子：
48
作者：
Feigin, Valery L.;Theadom, Alice;Ameratunga, Shanthi
通讯作者：
Ameratunga, Shanthi
影响因子：
4.1
作者：
Coronado, Victor G.;McGuire, Lisa C.;Xu, Likang
通讯作者：
Xu, Likang