Road-traffic deaths in China, 1985-2005: threat and opportunity

The trend of unintentional injury-related mortality among children aged under-five years in China, 2010-2020: a retrospective analysis from a national surveillance system

BACKGROUND

In this study, we estimated the trend of unintentional injury mortality among children aged under-five years in China during 2010-2020.

METHODS

Data were obtained from China's Under 5 Child Mortality Surveillance System (U5CMSS). The total unintentional injury mortality and all specific-causes unintentional injury mortality was calculated, annual numbers of deaths and live births were adjusted by a 3-year moving average under-reporting rate. The Poisson regression model and the Cochran-Mantel-Haenszel method were used to calculate the average annual decline rate (AADR) and the adjusted relative risk (aRR) of the unintentional injury mortality.

RESULTS

In 2010-2020, a total of 7,925 unintentional injury-related deaths were reported in U5CMSS, accounting for 18.7% of all reported deaths. The overall proportion of unintentional injury-related deaths to total under-five children deaths has increased from 15.2% to 2010 to 23.8% in 2020 (χ2 = 227.0, p < 0.001), the unintentional injury mortality significantly decreased from 249.3 deaths per 100,000 live births in 2010 to 178.8 deaths per 100,000 live births in 2020, with an AADR 3.7% (95%CI 3.1-4.4). The unintentional injury mortality rate decreased from 2010 to 2020 in both urban (from 68.1 to 59.7 per 100,000 live births) and rural (from 323.1 to 230.0 per 100,000 live births) areas (urban: χ2 = 3.1, p < 0.08; rural: χ2 = 113.5, p < 0.001). The annual rates of decline in rural areas and urban areas were 4.2% (95%CI 3.4-4.9) and 1.5% (95%CI 0.1-3.3), respectively. The leading causes of unintentional injury mortality were suffocation (2,611, 32.9%), drowning (2,398, 30.3%), and traffic injury (1,428, 12.8%) in 2010-2020. The cause-specific of unintentional injury mortality rates decreased with varying AADRs in 2010-2020, except for traffic injury. The composition of unintentional injury-related deaths also varied by age group. Suffocation was the leading cause in infants, drowning and traffic injury were the leading causes in children aged 1-4 years. Suffocation and poisoning has high incidence in October to March and drowning has high in June to August.

CONCLUSION

The unintentional injury mortality rate of children aged under-five years decreased significantly from 2010 to 2020 in China, but great inequity exists in unintentional injury mortality in urban and rural areas. Unintentional injuries are still an important public health problem affecting the health of Chinese children. Effective strategies should be strengthened to reduce unintentional injury in children and these policies and programmes should be targeted to more specific populations, such as rural areas and males.

Analysis of road traffic injuries and casualties in China: a ten-year nationwide longitudinal study

Background

Road traffic injuries (RTIs) are a serious global problem, and a huge challenge for both economic development and public health.

Methods

This longitudinal study was based on the national data from Chinese authorities. Descriptive analysis was utilized to analyze the prevalence and trend of RTIs among different types, groups and regions. In addition, ridge regression or/and curve regression were also used to explore the relationship between those possible influencing factors and RTIs.

Results

From 2010 to 2019, the death toll from motor vehicle accidents (MVAs) decreased firstly and then increased, while the death toll from non-MVAs continued to rise since 2012, and the death toll from pedestrian and occupant accidents fluctuated only a little. The mortality rate of MVA was relatively stable from 2010 to 2012, and declined from 2013. The mortality rate of motor vehicle accidents was higher in rural than urban, the same to male compared with female. The results of ridge regression showed that gross domestic product (GDP)-per-capita, total population, number of health personnel and car ownership were positively correlated with the death toll of non-MVAs (P < 0.05). Additionally, the results of curve regression suggested that the quadratic or cubic relationship between each factor and the number of MVAs was well fitted, while only partially fitted in fatalities.

Conclusions

In recent years, RTIs in China show different trends, and the problem of non-motor vehicle traffic injuries has been neglected which should be paid more attention. Moreover, according to the new trends and traffic conditions in RTIs revealed in this study, it is necessary to formulate targeted intervention measures establish a multi-faceted comprehensive safety system to reduce the disease burden of RTIs as well as the total injuries.

Defending the city's cleanliness with their lives? A study of road traffic collisions involving sanitation workers in China over five years

BACKGROUND

With increasing urbanization in developing countries, sanitation workers are frequently involved in road traffic collisions. Our purpose was to study specific collisions involving sanitation workers and provide decision-making suggestions and reference measures for the sanitation industry and urban managers to reduce the occurrence of collisions.

METHODS

We obtained online news data about sanitation worker road traffic collisions in China between 2013 and 2017 and analyzed occurrence time and location, victim characteristics, and causes of collisions.

RESULTS

In China, between 2013 and 2017, 511 road traffic collisions were reported, with the fewest in February and July. Most occurred around 5:00 a.m. in Eastern regions and in urban areas. Victims were mainly over 50 years old, with more females than males. Collisions usually resulted in death at the scene. The ambiguity of laws, the exploitation of workers through industry outsourcing, and the difficulty of processing claims may be the main factors preventing victims from obtaining legal compensation.

CONCLUSIONS

The most common cause of collisions was drivers' speeding, but workers also regularly risk death by crossing the road in pursuit of their duties. The absence of legal controls for environmental protection, the excessive pursuit of efficiency in urban governance, and the lack of basic education of sanitation workers are underlying causes of collisions. Raising awareness about sanitation worker road traffic collisions will help protect the work safety rights of this vulnerable group.

Characteristic and Introspection of Road Traffic Injuries in China from 2012 to 2017

Background

To analyze whether the area differences of RTIs (road traffic injuries, RTIs) caused by unequal development in China, provide suggestions for the prevention of the RTIs.

Methods

The data of RTIs in China was collected from the authoritative official website and yearbook of China.

Results

Total RTIs in the East was the highest (RTIs frequency: 591789; injured people: 600611; death toll: 168885; economic loss: 27.22 billion RMB), followed by the Center (RTIs frequency: 321807; injured people: 352769; death toll: 91966; economic loss: 23.90 billion RMB) and the lowest in the West (RTIs frequency: 289482; injured people: 332517; death toll: 101095; economic loss: 16.35 billion RMB). The multivariate linear correlation and regression showed that the characteristic of RTIs was highly related with GDP (r=0.99, P < 0.001).

Conclusion

The economically developed areas had a large amount of traffic damages. The government should focus on preventing high RTIs in the East and high death tolls in the West.

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

Background

Road 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.

Objectives

The 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.

Methods

Road 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.

Results

Over 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.

Conclusion

Even 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.

An analysis of trends and distribution of the burden of road traffic injuries in Uganda, 2011 to 2015: a retrospective study

Introduction

Gobally, 1.3 million people die from road traffic injuries every year. Over 90% of these deaths occur in low-and-middle-income countries. In Uganda, between 2012 and 2014, about 53,147 road traffic injuries were reported by the police, out of which 8,906 people died. Temporal and regional distribution of these injuries is not known, hence hindering targeted interventions. We described the trends and distribution of health facility reported road traffic injuries in Uganda from 2011 to 2015.

Methods

We obtained monthly data on road traffic injuries, from 112 districts from the Ministry of Health Uganda. We analyzed the data retrospectively to generate descriptive statistics.

Results

A total of 645,805 road traffic injuries were reported from January 2011 through December 2015 and 2,807 deaths reported from 2011 through 2014. Injuries increased from 37,219 in 2011 to 222,267 in 2014 and sharply dropped in December 2015 to 57,149. Kampala region had the highest number of injuries and deaths (18.3% (117,950/645,805) and 22.6% (634/2807)) respectively whereas Karamoja had the lowest injuries and deaths (1.7% (10,823/645,805) and 0.8% (21/2807)) respectively. Children aged 0-4 years accounted for 21.9% (615/2807) deaths; mostly females 81% (498/615) were affected.

Conclusion

Road traffic injuries increased during 2011-2014. Injuries and deaths were highest in Kampala and lowest in Karamoja region. It was noted that health facilities mostly received serious injuries. It is likely that the burden is higher but under reported. Concerted efforts are needed to increase road safety campaigns in Kampala and surrounding regions and to link pre-hospital deaths so as to understand the burden of road traffic crashes and recommend appropriate interventions.

A social change perspective on injury prevention in China

INTRODUCTION

China has undergone massive social change over the past four decades. Since national estimates became available in 1987, the overall fatal injury rate has decreased. This paper investigates targeted interventions and sociodemographic factors that may have contributed to fatal injury rate changes particularly for road traffic fatality (RTF), suicide and drowning.

AIMS

(1) To review the recent epidemiology of injury in China.(2)To investigate factors influencing trends in overall and specific cause injury mortality rates.

METHODS

Published injury mortality statistics and related literature were reviewed. Factors potentially influencing trends were investigated in the context of rapid development based on literature reviews of targeted interventions, macrolevel and microlevel contextual factors and changes specific to RTF, suicide and drowning.

RESULTS

Overall estimated national injury mortality rates in China decreased between 1987 and 2015, despite a rapid rise in RTF. Suicide and drowning rates decreased significantly and falls displaced drowning among the leading causes. The higher female to male suicide ratio reversed. Differences were observed in frequencies and proportions of deaths by major cause by age group and over time.

DISCUSSION

Economic and structural development and related social change in this period include: urbanisation, changes in demographics, life choices (eg, internal migration), education, poverty alleviation, health insurance and relevant regulations/legislation. These factors potentially explain much of the change in fatal injury rates in China. Data limitations persist. Increased investment in data and research would provide realistic opportunities for accelerated progress in implementing effective targeted interventions to further reduce China's injury burden.

A comparative analysis of child passenger restraint use in China and the United States

BACKGROUND

Few published studies have examined child passenger safety practices across countries. This study compared the prevalence and associated factors of child passenger restraint use among children, aged 0 to 17 in the state of Iowa in the United States, and the city of Shantou in China.

METHODS

Child restraint use observations were conducted in Iowa and in Shantou in 2012, respectively, among child passengers. Observations in Iowa were conducted at randomly selected gas stations, while in Shantou observations were completed at randomly selected schools or medical clinics. Research observers approached the driver, observed restraint use, and collected brief survey data.

RESULTS

A total of 3049 children from Iowa and 3333 children aged 0 to 17 years from Shantou were observed. For children aged 0 to 3 years, only 0.1% were compliantly restrained in Shantou as compared to 95.9% in Iowa. The proportion of children who were compliantly restrained in Shantou increased with age, but generally decreased with age in Iowa. In Shantou, 36.0% of children aged 0 to 3 were sitting in the front seat as compared to only 1.7% of children of the same age in Iowa. Driver seat belt use was significantly associated with child restraint in both Iowa and Shantou; the association was stronger in Iowa than Shantou for all age groups.

CONCLUSIONS

A significantly higher prevalence of children who were not appropriately restrained was observed in Shantou than in Iowa. Our findings support the need of mandatory child safety restraint use legislation in China.

Demographic and regional characteristics of road traffic injury deaths in Jiangsu Province, China

Background

The study investigates the magnitude and distribution of fatal road traffic injuries (RTIs) in the Chinese province of Jiangsu by road user.

Method

The 13 694 RTI deaths and years of potential life lost (YPLL) that occurred in 2012 were analysed; vulnerable and non-vulnerable road users were considered separately. Age-adjusted mortality and YPLL were compiled and the association between demographic characteristics and RTI mortality rate was analysed using negative binomial regression.

Results

The age-adjusted RTI mortality and YPLL in Jiangsu in 2012 were 18.14 (95% CI: 17.84-18.45) and 494.3 (95% CI: 492.7-496.0) per 100 000 population. Half of the deaths were among pedestrians and for vulnerable road users as a whole, male fatalities were over three times that of female (adjusted incidence rate ratio = 3.26, 95% CI: 1.89-3.77). Fatalities in the oldest age group (80+ years) were over 14 times that of the youngest one (0-9 years) (adjusted incidence rate ratio = 14.13, 95% CI: 9.49-21.01). Fatality rates in the central and northern regions surpassed that of the south.

Conclusion

As in the rest of the country, RTIs are a considerable public health problem in Jiangsu where fatality and YPLL rates fall heavily on pedestrians, men, and older persons and are more pronounced in the less developed regions.

Prevalence and regional correlates of road traffic injury among Chinese urban residents: A 21-city population-based study

OBJECTIVE

This study estimated the prevalence of road traffic injury among Chinese urban residents and examined individual and regional-level correlates.

METHOD

A cross-sectional multistage process was used to sample residents from 21 selected cities in China. Survey respondents reported their history of road traffic injury in the past 12 months through a community survey. Multilevel, multivariable logistic regression analysis was used to identify injury correlates.

RESULTS

Based on a retrospective 12-month reporting window, road traffic injury prevalence among urban residents was 13.2%. Prevalence of road traffic injury, by type, was 8.7, 8.7, 8.5, and 7.7% in the automobile, bicycle, motorcycle, and pedestrian categories, respectively. Multilevel analysis showed that prevalence of road traffic injury was positively associated with minority status, income, and mental health disorder score at the individual level. Regionally, road traffic injury was associated with geographic location of residence and prevalence of mental health disorders.

CONCLUSIONS

Both individual and regional-level variables were associated with road traffic injury among Chinese urban residents, a finding whose implications transcend wholesale imported generic solutions. This descriptive research demonstrates an urgent need for longitudinal studies across China on risk and protective factors, in order to inform injury etiology, surveillance, prevention, treatment, and evaluation.

How did the economic recession (2008-2010) influence traffic fatalities in OECD-countries?

This paper presents analyses of how the economic recession that started in 2008 has influenced the number of traffic fatalities in OECD countries. Previous studies of the relationship between economic recessions and changes in the number of traffic fatalities are reviewed. Based on these studies, a causal diagram of the relationship between changes of the business cycle and changes in the number of traffic fatalities is proposed. This causal model is tested empirically by means of multivariate analyses and analyses of accident statistics for Great Britain and Sweden. Economic recession, as indicated both by slower growth of, or decline of gross national product, and by increased unemployment is associated with an accelerated decline in the number of traffic fatalities, i.e. a larger decline than the long-term trend that is normal in OECD countries. The principal mechanisms bringing this about are a disproportionate reduction of driving among high-risk drivers, in particular young drivers and a reduction of fatality rate per kilometre of travel, probably attributable to changes in road user behaviour that are only partly observable. The total number of vehicle kilometres of travel did not change very much as a result of the recession. The paper is based on an ITF-report that presents the analyses in greater detail.

An overview of geospatial methods used in unintentional injury epidemiology

Background

Injuries are a leading cause of death and disability around the world. Injury incidence is often associated with socio-economic and physical environmental factors. The application of geospatial methods has been recognised as important to gain greater understanding of the complex nature of injury and the associated diverse range of geographically-diverse risk factors. Therefore, the aim of this paper is to provide an overview of geospatial methods applied in unintentional injury epidemiological studies.

Methods

Nine electronic databases were searched for papers published in 2000–2015, inclusive. Included were papers reporting unintentional injuries using geospatial methods for one or more categories of spatial epidemiological methods (mapping; clustering/cluster detection; and ecological analysis). Results describe the included injury cause categories, types of data and details relating to the applied geospatial methods.

Results

From over 6,000 articles, 67 studies met all inclusion criteria. The major categories of injury data reported with geospatial methods were road traffic (n = 36), falls (n = 11), burns (n = 9), drowning (n = 4), and others (n = 7). Grouped by categories, mapping was the most frequently used method, with 62 (93%) studies applying this approach independently or in conjunction with other geospatial methods. Clustering/cluster detection methods were less common, applied in 27 (40%) studies. Three studies (4%) applied spatial regression methods (one study using a conditional autoregressive model and two studies using geographically weighted regression) to examine the relationship between injury incidence (drowning, road deaths) with aggregated data in relation to explanatory factors (socio-economic and environmental).

Conclusion

The number of studies using geospatial methods to investigate unintentional injuries has increased over recent years. While the majority of studies have focused on road traffic injuries, other injury cause categories, particularly falls and burns, have also demonstrated the application of these methods. Geospatial investigations of injury have largely been limited to mapping of data to visualise spatial structures. Use of more sophisticated approaches will help to understand a broader range of spatial risk factors, which remain under-explored when using traditional epidemiological approaches.

Electronic supplementary material

The online version of this article (doi:10.1186/s40621-016-0097-0) contains supplementary material, which is available to authorized users.

The association between meteorological factors and road traffic injuries: a case analysis from Shantou city, China

Few studies examined the associations of meteorological factors with road traffic injuries (RTIs). The purpose of the present study was to quantify the contributions of meteorological factors to RTI cases treated at a tertiary level hospital in Shantou city, China. A time-series diagram was employed to illustrate the time trends and seasonal variation of RTIs, and correlation analysis and multiple linear regression analysis were conducted to investigate the relationships between meteorological parameters and RTIs. RTIs followed a seasonal pattern as more cases occurred during summer and winter months. RTIs are positively correlated with temperature and sunshine duration, while negatively associated with wind speed. Temperature, sunshine hour and wind speed were included in the final linear model with regression coefficients of 0.65 (t = 2.36, P = 0.019), 2.23 (t = 2.72, P = 0.007) and -27.66 (t = -5.67, P < 0.001), respectively, accounting for 19.93% of the total variation of RTI cases. The findings can help us better understand the associations between meteorological factors and RTIs, and with potential contributions to the development and implementation of regional level evidence-based weather-responsive traffic management system in the future.

Disparities in Under-Five Child Injury Mortality between Developing and Developed Countries: 1990-2013

OBJECTIVE

Using estimates from the 2013 Global Burden of Disease (GBD) study, we update evidence on disparities in under-five child injury mortality between developing and developed countries from 1990 to 2013.

METHODS

Mortality rates were accessed through the online visualization tool by the GBD study 2013 group. We calculated percent change in child injury mortality rates between 1990 and 2013. Data analysis was conducted separately for <1 year and 1-4 years to specify age differences in rate changes.

RESULTS

Between 1990 and 2013, over 3-fold mortality gaps were observed between developing countries and developed countries for both age groups in the study time period. Similar decreases in injury rates were observed for developed and developing countries (<1 year: -50% vs. -50% respectively; 1-4 years: -56% vs. -58%). Differences in injury mortality changes during 1990-2013 between developing and developed nations varied with injury cause. There were greater reductions in mortality from transport injury, falls, poisoning, adverse effects of medical treatment, exposure to forces of nature, and collective violence and legal intervention in developed countries, whereas there were larger decreases in mortality from drowning, exposure to mechanical forces, and animal contact in developing countries. Country-specific analysis showed large variations across countries for both injury mortality and changes in injury mortality between 1990 and 2013.

CONCLUSIONS

Sustained higher child injury mortality during 1990-2013 for developing countries merits the attention of the global injury prevention community. Countries that have high injury mortality can benefit from the success of other countries.

Examining Road Traffic Mortality Status in China: A Simulation Study

Background

Data from the Chinese police service suggest substantial reductions in road traffic injuries since 2002, but critics have questioned the accuracy of those data, especially considering conflicting data reported by the health department.

Methods

To address the gap between police and health department data and to determine which may be more accurate, we conducted a simulation study based on the modified Smeed equation, which delineates a non-linear relation between road traffic mortality and the level of motorization in a country or region. Our goal was to simulate trends in road traffic mortality in China and compare performances in road traffic safety management between China and 13 other countries.

Results

Chinese police data indicate a peak in road traffic mortalities in 2002 and a significant and a gradual decrease in population-based road traffic mortality since 2002. Health department data show the road traffic mortality peaked in 2012. In addition, police data suggest China’s road traffic mortality peaked at a much lower motorization level (0.061 motor vehicles per person) in 2002, followed by a reduction in mortality to a level comparable to that of developed countries. Simulation results based on health department data suggest high road traffic mortality, with a mortality peak in 2012 at a moderate motorization level (0.174 motor vehicles per person). Comparisons to the other 13 countries suggest the health data from China may be more valid than the police data.

Conclusion

Our simulation data indicate China is still at a stage of high road traffic mortality, as suggested by health data, rather than a stage of low road traffic mortality, as suggested by police data. More efforts are needed to integrate safety into road design, improve road traffic management, improve data quality, and alter unsafe behaviors of pedestrians, drivers and passengers in China.

Estimated trends and patterns of road traffic fatalities in China, 2002-2012

OBJECTIVE

This study examined the time trends and age distribution patterns of estimated road traffic fatalities (RTFs) in China over the period 2002-2012.

METHODS

Data on age-, sex-, and region-specific RTF rates were provided by the Chinese Ministry of Health. The crude rates were standardized and the Mann-Kendall test was used to test the significance of time trends. Annual number of RTFs was calculated. To minimize the effect of yearly variations, magnitude of changes in and age distribution patterns of the RTFs were examined using mean values of 2 years.

RESULTS

RTFs increased significantly in China during the study period. Several features were identified for the RTFs in China. First, RTF rates skyrocketed in rural areas including towns and counties. Second, a significant increase in RTFs was also observed in cities even though the change in RTF rates was not statistically significant there. Third, individuals aged 20-24, 40-49, and 55-64, especially in rural areas, were particularly at risk for RTFs in recent years. Finally, RTFs became more common among middle-aged and older adults than young Chinese, with roughly 57% of all RTFs occurring among individuals aged 45 and above during 2011-2012.

CONCLUSIONS

RTFs increased dramatically in China during the past decade, especially in rural areas. Age distribution patterns of RTFs have changed there. Community-based public health education and intervention programs are warranted.

Hospital-based program to increase child safety restraint use among birthing mothers in China

OBJECTIVE

To evaluate a hospital-based educational program to increase child safety restraint knowledge and use among birthing mothers.

METHODS

A prospective experimental and control study was performed in the Obstetrics department of hospitals. A total of 216 new birthing mothers from two hospitals (114 from intervention hospital and 102 from comparison hospital) were recruited and enrolled in the study. Intervention mothers received a height chart, an 8-minute video and a folded pamphlet regarding child safety restraint use during their hospital stay after giving birth. Evaluation data on the child safety seat (CSS) awareness, attitudes, and use were collected among both groups before and after the intervention. An additional phone interview was conducted among the intervention mothers two months after discharge.

RESULTS

No significant differences existed between groups when comparing demographics. Over 90% of the intervention mothers found the educational intervention to be helpful to some extent. A significantly higher percentage of mothers in the intervention than the comparison group reported that CSS are necessary and are the safest seating practice. Nearly 20% of the intervention mothers actually purchased CSS for their babies after the intervention. While in both the intervention and comparison group, over 80% of mothers identified the ages of two through five as needing CSS, fewer than 50% of both groups identified infants as needing CSS, even after the intervention.

CONCLUSION

The results indicated that child safety restraint education implemented in hospitals helps increase birthing mothers' overall knowledge and use of CSS. Further efforts are needed to address specific age-related needs to promote car seats use among infants.

Neglected increases in rural road traffic mortality in China: findings based on health data from 2005 to 2010

BACKGROUND

Recent changes in rural road traffic mortality have not been examined in China although rural residents were reported as having greater risk of road traffic injury than urban residents. We aimed to examine changes in urban and rural road traffic mortality rates between 2005 and 2010 in China.

METHODS

Mortality rates came from the publicly available health data of the Ministry of Health-Vital Registration System that is based on a national representative sample (about 10% of total population), including 41 surveillance points in urban areas (15 large cities and 21 middle/small cities) and 85 surveillance points in rural areas. The causes of deaths were coded using the Tenth International Classification of Diseases (ICD-10). Linear regression was used to test the statistical significance of changes in mortality rates. We calculated the percent change in rates to quantify the change between 2005 and 2010, which was calculated as regression coefficient * 100 * 5 divided by the rate in 2005.

RESULTS

In rural areas, road traffic mortality increased by 70%, changing from 13.3 per 100,000 population in 2005 to 22.7 per 100,000 population in 2010. In contrast, the road traffic mortality merely increased by 4% in the study time period, rising from 13.1 to 13.9 per 100,000 population in urban areas. Both the increases in road traffic mortality from motor vehicle crashes and from non-motor vehicle crashes were larger in rural areas than in urban areas (106% vs. 4%; 29% vs. 3%).

CONCLUSION

The tremendous increase in road traffic mortality in rural areas calls for urgent actions to reduce road traffic injuries to motor vehicle occupants, motorcyclists, bicyclists and pedestrians in in rural areas.

Bicyclist mortality between 2006 and 2010 in China: findings from national Disease Surveillance Points (DSP) data

CONTEXT

While road traffic mortality has been reported to be seriously undercounted by the police in China, non-police-reported data have not been explored previously to examine vulnerable road user mortality.

OBJECTIVE

To examine changes in bicyclist mortality between 2006 and 2010 in China, using the Disease Surveillance Points (DSP) data of China.

DESIGN, SETTING AND DATA SOURCE

Mortality data of 2006-2010 from DSP data, covering 73 million population, was analysed. Poisson regression was used to examine the significance of year after controlling for sex, age and urban/rural location.

MAIN OUTCOME MEASURE(S)

Mortality rate and mortality rate ratio (MRR).

RESULTS

Between 2006 and 2010, the mortality rate for bicyclists increased from 1.1 to 1.6 per 100 000 population according to DSP data. Between 2006 and 2010, more than 90% of bicyclist deaths were undercounted by the police compared to the findings from DSP data. Contrary to the 34% increase between 2006 and 2010 reflected by DSP data (adjusted MRR: 1.34, 95% CI 1.23 to 1.46), police data revealed a 64% decrease in bicyclist mortality (unadjusted MRR: 0.36, 95% CI 0.32 to 0.40) in the study time period.

CONCLUSIONS

Health data should be used to assess the road traffic injuries in China. The recent increase in bicyclist mortality merits attention from policy makers and researchers.

Urbanisation and health in China

China has seen the largest human migration in history, and the country's rapid urbanisation has important consequences for public health. A provincial analysis of its urbanisation trends shows shifting and accelerating rural-to-urban migration across the country and accompanying rapid increases in city size and population. The growing disease burden in urban areas attributable to nutrition and lifestyle choices is a major public health challenge, as are troubling disparities in health-care access, vaccination coverage, and accidents and injuries in China's rural-to-urban migrant population. Urban environmental quality, including air and water pollution, contributes to disease both in urban and in rural areas, and traffic-related accidents pose a major public health threat as the country becomes increasingly motorised. To address the health challenges and maximise the benefits that accompany this rapid urbanisation, innovative health policies focused on the needs of migrants and research that could close knowledge gaps on urban population exposures are needed.

Road traffic injury in China: a review of national data sources

OBJECTIVE

Road traffic injury (RTI) has become one of the leading causes of deaths in China, yet numbers on road traffic deaths are often inconsistent. This study sought to systematically review 4 national-level data sources that can be used to estimate burdens of RTI, including mortality, injury, and crashes in China.

METHODS

We conducted structured literature reviews in PubMed, using combined key words of injury or fatality or injury surveillance and traffic and China in order to identify relevant studies (in both English and Chinese) and data sources. We also conducted interviews and hosted seminars with key researchers from the Chinese Center for Disease Control and Prevention (Chinese CDC) to identify potential useful data sources for injury surveillance. We then extracted key information from publicly available reports of each data source.

RESULTS

Four national-level data sources were reviewed and compared: Ministry of Health-Vital Registration (MOH-VR) System, Chinese CDC-Disease Surveillance Points (DSP), Chinese CDC-National Injury Surveillance System (NISS), and police reports. Together they provide a complementary yet somewhat contradictory epidemiological profile of RTIs in China. Estimates on road traffic fatalities obtained from MOH-VR and police reports are often used by researchers and policymakers, whereas DSP and NISS, both with great merits, have virtually not been used for RTI research. Despite the well-documented problems of underreported deaths with both MOH-VR and DSP, estimated road traffic deaths from both systems were 3 times those reported by the police.

CONCLUSIONS

As the foundation of injury prevention, national-level data sources and surveillance systems were reviewed in the study. Existing data infrastructures present the Chinese government a great opportunity to strengthen and integrate existing surveillance systems to better track road traffic injury and fatality and identify the population at risk.

Traffic accidents on expressways: new threat to China

OBJECTIVE

As China is building one of the largest expressway systems in the world, expressway safety problems have become serious concerns to China. This article analyzed the trends in expressway accidents in China from 1995 to 2010 and examined the characteristics of these accidents.

METHODS

Expressway accident data were obtained from the Annual Report for Road Traffic Accidents published by the Ministry of Public Security of China. Expressway mileage data were obtained from the National Statistics Yearbook published by the National Bureau of Statistics of China. Descriptive statistical analyses were conducted based on these data.

RESULTS

Expressway deaths increased by 10.2-fold from 616 persons in 1995 to 6300 persons in 2010, and the average annual increase was 17.9 percent over the past 15 years, and the overall other road traffic deaths was -0.33 percent. China's expressway mileage accounted for only 1.85 percent of highway mileage driven in 2010, but expressway deaths made up 13.54 percent of highway traffic deaths. The average annual accident lethality rate [accident deaths/(accident deaths + accident injuries)] for China's expressways was 27.76 percent during the period 1995 to 2010, which was 1.33 times higher than the accident lethality rate of highway traffic accidents.

CONCLUSIONS

China's government should pay attention to expressway construction and safety interventions during the rapid development period of expressways. Related causes, such as geographic patterns, speeding, weather conditions, and traffic flow composition, need to be studied in the near future. An effective and scientific expressway safety management services system, composed of a speed monitoring system, warning system, and emergency rescue system, should be established in developed and underdeveloped provinces in China to improve safety on expressway.

Injury in China: a systematic review of injury surveillance studies conducted in Chinese hospital emergency departments

BACKGROUND

Injuries represent a significant and growing public health concern in China. This Review was conducted to document the characteristics of injured patients presenting to the emergency department of Chinese hospitals and to assess of the nature of information collected and reported in published surveillance studies.

METHODS

A systematic search of MEDLINE and China Academic Journals supplemented with a hand search of journals was performed. Studies published in the period 1997 to 2007 were included and research published in Chinese was the focus. Search terms included emergency, injury, medical care.

RESULTS

Of the 268 studies identified, 13 were injury surveillance studies set in the emergency department. Nine were collaborative studies of which eight were prospective studies. Of the five single centre studies only one was of a prospective design. Transport, falls and industrial injuries were common mechanisms of injury. Study strengths were large patient sample sizes and for the collaborative studies a large number of participating hospitals. There was however limited use of internationally recognised injury classification and severity coding indices.

CONCLUSION

Despite the limited number of studies identified, the scope of each highlights the willingness and the capacity to conduct surveillance studies in the emergency department. This Review highlights the need for the adoption of standardized injury coding indices in the collection and reporting of patient health data. While high level injury surveillance systems focus on population-based priority setting, this Review demonstrates the need to establish an internationally comparable trauma registry that would permit monitoring of the trauma system and would by extension facilitate the optimal care of the injured patient through the development of informed quality assurance programs and the implementation of evidence-based health policy.

Pre-hospital trauma care resources for road traffic injuries in a middle-income country--a province based study on need and access in Iran

BACKGROUND

Access to pre-hospital trauma care can help minimize many of traffic related mortality and morbidity in low- and middle-income countries with high rate of traffic deaths such as Iran. The aim of this study was to assess if the distribution of pre-hospital trauma care facilities reflect the burden of road traffic injury and mortality in different provinces in Iran.

METHODS

This national cross-sectional study is based on ecological data on road traffic mortality (RTM), road traffic injuries (RTIs) and pre-hospital trauma facilities for all 30 provinces in Iran in 2006. Lorenz curves and Gini coefficients were used to describe the distributions of RTM/RTIs and pre-hospital trauma care facilities across provinces. Spearman rank-order correlation was performed to assess the relationship between RTM/RTI and pre-hospital trauma care facilities.

RESULTS

RTM and RTIs as well as pre-hospital trauma care facilities were distributed unequally between different provinces. There was no significant association between the rate of RTM and RTIs and the number of pre-hospital trauma care facilities across the country.

CONCLUSIONS

The distribution of pre-hospital trauma care facilities does not reflect the needs in terms of RTM and RTIs for different provinces. These results suggest that traffic related mortality and morbidity could be reduced if the needs in terms of RTM and RTIs were taken into consideration when distributing pre-hospital trauma care facilities between the provinces.

Attitudes and behavior of Chinese drivers regarding seatbelt use

In the current study, research was conducted in five cities in China to examine seatbelt use and to explore Chinese drivers' attitudes toward using seatbelts. Multiple data collection methods consisted of 35 initial semi-structured interviews to create questions for an in-person survey and 500 driver observations that included administering the in-person survey. Questions explored were why Chinese drivers use or do not use seatbelts and what they think would be the best interventions to increase the rate of seatbelt use in Chinese drivers. The relationships between various personal characteristics and seatbelt use rates were investigated. Also examined were the relationships between seatbelt use (both objective observation and subjective self-reported use) and self-reported car crashes and traffic violations. This study provides insight into the attitudes of Chinese drivers on seatbelt use and potential interventions.

Comparing road traffic mortality rates from police-reported data and death registration data in China

OBJECTIVE

To compare death rates from road traffic injuries in China in 2002-2007 when derived from police-reported data versus death registration data.

METHODS

In China, police-recorded data are obtained from police records by means of a standardized, closed-ended data collection form; these data are published in the China statistical yearbook of communication and transportation. Official death registration data, on the other hand, are obtained from death certificates completed by physicians and are published in the China health statistics yearbook. We searched both sources for data on road traffic deaths in 2002-2007, used the χ(2) test to compare the mortality rates obtained, and performed linear regression to look for statistically significant trends in road traffic mortality over the period.

FINDINGS

For 2002-2007, the rate of death from road traffic injuries based on death registration data was about twice as high as the rate reported by the police. Linear regression showed a significant decrease of 27% (95% confidence interval, CI: 35-19) in the death rate over the period according to police sources but no significant change according to death registration data.

CONCLUSION

The widely-cited recent drop in road traffic mortality in China, based on police-reported data, may not reflect a genuine decrease. The quality of the data obtained from police reports, which drives decision-making by the Government of China and international organizations, needs to be investigated, monitored and improved.

Leading a Healthy Lifestyle: The Challenges for China

Increasing affluence and changing lifestyles are resulting in a greater burden of noncommunicable diseases (NCDs) in China. The challenge of how to counter the rising rates of obesity associated with increasingly sedentary lifestyles and diets higher in fats and sugars as well as countering the persistent threat from high rates of tobacco smoking among men, including male doctors, need to be public health priorities within the rapidly developing economy of China. While promoting a healthier environment is one important element, the increasing rates of diabetes and hypertension throw into sharp relief the need not only for primary prevention but also for screening programs to detect and provide early treatment for these common diseases. There is an increasing need for an integrated response that emphasizes the key role the health system can play in preventing mortality and morbidity from NCDs. As such, this needs to be a priority within the health care reform agenda.

Availability, functionality, and use of seat belts in Beijing taxis prior to the 2008 Beijing Olympic Games

Use of driver seat belts and availability and functionality of passenger seat belts in a convenience sample of 231 Beijing taxis were examined in the months prior to the 2008 Beijing Olympic Games. Driver and front passenger seat belt use was mandated in China from 2004 to help address the growing public health crisis of road trauma. Results from observations made by in-vehicle passengers revealed that 21.2% of drivers were correctly wearing a belt, approximately half were not, and one third were using the belt in a non-functional way. Over 3/4 of this sample of taxi drivers were unrestrained while working. The percentage of functionally available belts was higher for front than rear passengers (88.3% and 22.9%, respectively). This low rate of belt availability in rear seats calls into question the preparedness of the fleet to cater for the safety needs of foreign visitors to China, particularly those from countries with high levels of restraint use. Factors influencing the use/misuse of seat belts in China remain largely unexplored. Results of this pilot study support further investigations of barriers to using injury prevention mechanisms such as seat belts in less motorised countries.