Trends in Cause-Specific Injury Mortality in China in 2005-2019: Longitudinal Observational Study

Abstract

Background Over the last few decades, although the age-standardized mortality rate (ASMR) of injury has shown a significant declining trend in China, this pattern has dramatically reversed recently. Objective We aimed to elucidate the geographical, demographic, and temporal trends of cause-specific injuries, the reversal phenomenon of these trends, and the fluctuations of injury burden from 2005 to 2019 in China. Methods A longitudinal observational study was performed using the raw data of injury deaths in the National Cause-of-Death surveillance data provided by the disease surveillance points system in 2005-2019. The cause-specific injuries were divided into disparate subgroups by sex, age, urban/rural region, and eastern/central/western areas of China. The burden of injury was assessed using potential years of life lost (PYLL), average years of life lost (AYLL), and PYLL rate (PYLLR). Temporal trends of mortality rates and burden were evaluated using best-fitting joinpoint models. Results Injury deaths accounted for 7.51% (1,156,504/15,403,835) of all-cause deaths in China in 2005-2019. The crude mortality rate of all-cause injury was 47.74 per 100,000 persons. The top 3 injury types (traffic accident, falls, and suicide) accounted for 70.57% (816,145/1,156,504) of all injury-related deaths. The ASMR of all-cause injury decreased (P=.003), while the crude mortality rate remained unchanged (P=.52) during 2005-2019. A significant reverse trend in ASMR of all-cause injury was observed in urban older adults since 2013, mainly due to the inverted trend in injuries from falls. A reverse trend in ASMR of suicide was observed among individuals aged 10-24 years, with notable increases by 35.18% (annual percentage change 15.4%, 95% CI 4.1%-28.0%) in men since 2017. The AYLL and PYLLR of all-cause injury among older adults showed consistent ascending trends from 2005 to 2019 (average annual percentage change [AAPC] 6.1%, 95% CI 5.4%-6.9%, 129.04% increase for AYLL; AAPC 5.4%, 95% CI 2.4%-8.4%, 105.52% increase for PYLLR). The AYLL due to suicide for individuals aged 10-24 years showed a considerable upswing tendency (AAPC 0.5%, 95% CI 0.4%-0.7%, 8.02% increase). Conclusions Although the ASMR of all-cause injury decreased in China from 2005 to 2019, the trend in suicide among adolescents and young adults and falls among older adults has been on the rise in recent years. Interventions should be encouraged to mitigate the cause-specific burdens of injury death.

Suicide mortality rates in Japan before and beyond the COVID‐19 pandemic era

“… 83 Although suicide among adolescents has been increasing over the long term, most studies from other OECD countries have reported that adolescent CSMRs decreased or remained unchanged during the pandemic. 84 , 85 , 86 , 87 , 88 In contrast, in Japan, CSMRs of males and females of 10–19 years began to increase before the pandemic. 12 , 25 , 26 , 28 To date, there have been no causality analyses using independent variables that may affect the specific temporal fluctuations of adolescent CSMRs.…”

“…Adolescence is a period of psychosocial and biological development that involves various social statuses (e.g., middle school, high school, university, and special vocational school students and working young adults) 83 . Although suicide among adolescents has been increasing over the long term, most studies from other OECD countries have reported that adolescent CSMRs decreased or remained unchanged during the pandemic 84–88 . In contrast, in Japan, CSMRs of males and females of 10–19 years began to increase before the pandemic 12,25,26,28 .…”

Temporal Fluctuations of Suicide Mortality in Japan from 2009 to 2023 Using Government Databases

“…Between 2009 and 2021, suicide was the leading cause of death among adolescents in Japan [59,60]. Although suicide rates among adolescents have globally been increasing over time, most studies from other OECD countries have reported that adolescent SMRs decreased or remained unchanged during the pandemic [61][62][63][64][65], whereas in Japan, it has been reported that the SMRs of both males and females under 20 years old increased during the pandemic [39][40][41]66,67]. These reports attributed the increase in adolescent SMRs to major lifestyle changes during the pandemic, particularly pertaining to the impaired ability to engage in recreational and educational opportunities and being forced to spend much of their time at home due to social restriction measures [39][40][41]66,67].…”

Global, regional, and national health inequalities of Alzheimer’s disease and Parkinson’s disease in 204 countries, 1990–2019

“…It is commonly perceived that higher disease burdens are often directly associated with worse socio-economic status and fewer healthcare resources [ 14 – 16 ]. However, as a consequence of socio-economic progress, burdens of some disorders, such as falls among the elderly, mental health issues among youngsters, and neurological disorders, have tended to grow recently [ 5 , 17 , 18 ], which seem to conflict with health and well-being within the context of sociodemographic and economic development. Among these, mental illnesses, Alzheimer’s disease, and Parkinson’s disease, etc., are more directly associated with societal changes, which seem to stem from the growth of an aging population [ 10 ], rising social stress [ 19 , 20 ], deteriorating sleep issues [ 21 ], and illogical eating habits [ 22 ].…”