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Analysis of the Burden and Trend of Injury in Sichuan, China, from 2006 to 2015: Results from the National Injury Surveillance System

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Analysis of the Burden and Trend of Injury in Sichuan, China, from 2006 to 2015: Results from the National Injury Surveillance System Open access Original research BMJ Open: first published as 10.1136/bmjopen-2019-031184 on 18 November 2019. Downloaded from Analysis of the burden and trend of injury in Sichuan, China, from 2006 to 2015: results from the national injury surveillance system Peng Cai,1,2 Xianping Wu,3 Zhihao Liu,4 Ying Deng,3 Xiaofang Chen,5 Guanghui Yi,3 Jiang Xu,2 Shirong Huang,2 Rongsheng Luan1 To cite: Cai P, Wu X, Liu Z, ABSTRACT Strengths and limitations of this study et al. Analysis of the burden Objective This study investigates the distribution, burden and trend of injury in Sichuan, and trends of injuries in Sichuan, China. ► This study examined the distribution, burden and China, from 2006 to 2015: Design A surveillance study using injury data collected by results from the national injury trend of injuries in the Sichuan over a 10 year period the National Injury Surveillance System. surveillance system. BMJ Open based on a surveillance system with strict quality Setting and participants 312 511 injury cases reported 2019;9:e031184. doi:10.1136/ control. in the National Injury Surveillance System in Sichuan, bmjopen-2019-031184 ► One limitation is that this study uses data from a China, from 2006 to 2015. facility- based surveillance system, and population- ► Prepublication history and Primary outcome measures Years of potential life lost based incidence rates cannot be generated easily additional material for this (YPLL) were calculated to determine the disease burden paper are available online. To based on this data. from injuries. Trend analysis was performed to assess the view these files, please visit ► Moreover, deaths that occurred outside hospitals trends in specific injuries over time. the journal online (http:// dx. doi. were not captured in the current study, and injury- Results A total of 312 511 injury cases were reported in org/ 10. 1136/ bmjopen- 2019- related deaths were underestimated. 031184). the last 10 years in Sichuan with 192 904 (men: 58.58%) and 119 607 (men: 67.11%) cases from the urban and PC and XW contributed equally. rural surveillance hospitals, respectively. The annual 5–8 number of injury cases increased from 21 257 in 2006 to death. Estimating injury- related incidence Received 06 May 2019 44 112 in 2015 with an average annual increase of 8.45%. and mortality is essential for raising aware- Revised 16 October 2019 The top three common causes of injury were fall (29.3%), Accepted 23 October 2019 ness of injury burden and proposing effective animal-rela ted injury (19.1%) and road-rela ted injury policies and strategies to reduce this public http://bmjopen.bmj.com/ (14.6%) in the urban area and fall (38.4%), road-rela ted problem. injury (17.2%) and blunt injuries (16.0%) in the rural area. Injury surveillance systems are essential to YPLLs from injuries accounted for 13% of the total YPLLs identify at- risk populations, support preven- in the urban area. tion efforts and evaluate the effects of preven- Conclusions The number of injury cases varied according 9 to rural/urban areas and gender and increased sharply in tion strategies. The WHO recommended Sichuan over the last decade. It is necessary to develop that countries and regions should establish targeted prevention and control measures to reduce the and maintain injury surveillance systems disease burden of injuries. to systematically collect injury data based on October 2, 2021 by guest. Protected copyright. on their available resources.10 The WHO published injury surveillance guidelines that INTRODUCTION aim to guide healthcare professionals with The WHO estimates that injuries cause over practical assistance to develop and maintain 58 million deaths each year that accounts injury surveillance systems.10 Many developed for 10% of all global deaths. Injuries are the countries, including the USA and Canada, © Author(s) (or their leading cause of death in the population aged have set- up national surveillance systems for employer(s)) 2019. Re- use 5 to 44 years.1 According to the Global Burden injuries.11 12 The lack of high- quality data permitted under CC BY-NC. No commercial re- use. See rights of Diseases (GBD) 2010 report, injury-related on injuries to inform decision- making leads and permissions. Published by disability- adjusted life years (DALYs) account to less advanced injury prevention efforts in BMJ. for 12.4% of all-cause DALYs globally.2–4 In low- and middle-income countries, including For numbered affiliations see China, 200 million injury events occur each China, than in developed countries.9 13 14 end of article. year that leads to 14 million hospitalisations The National Injury Surveillance System Correspondence to and one million disabilities. Injuries affect the (NISS), the first hospital-based national Dr Rongsheng Luan; health and welfare of all age groups because system in China, was established in 2006 to Luan_ chuan123@ 163. com of disability, medical costs and premature understand the burden of injuries.15 Sichuan Cai P, et al. BMJ Open 2019;9:e031184. doi:10.1136/bmjopen-2019-031184 1 Open access BMJ Open: first published as 10.1136/bmjopen-2019-031184 on 18 November 2019. Downloaded from Province, located in southwestern China, has a population Table 1 Data elements of national injury surveillance form of 83.41 million and covers an area of 486 000 km2. Inju- ries are the fourth leading cause of death both in Sichuan Category Example elements and in China. Results from the study in Sichuan will serve Demographics Age, sex, occupation, ID, education to inform the development of local injury prevention level and occupation strategies and facilitate targeted injury prevention poli- Basic information Time of injury occurrence, time of cies. The objectives of this study were to track the burden of the injury event treatment, mechanism, place and and trend of injuries in Sichuan using data from the NISS activity of injury occurrence and intent collected between 2006 and 2015. of injury Clinical Nature of injury, body part injured, information of the severity, clinical diagnosis and injury event disposition of injury METHODS Surveillance hospitals Other information Name of data reporter and date of reporting The surveillance hospitals were from the NISS in Sichuan.15 The NISS was established in China in 2006, and 126 hospitals from 43 sample locations, including 23 rural and 20 urban sites, were recruited.15 There were three categories with the following definitions: (1) Minor two sample locations in Sichuan: the Qingyang District in injury: no apparent or just slight or superficial injury, for Chengdu (urban) and Miyi County in Panzhihua (rural). example, bruises and minor cuts; (2) Moderate injury: In the Qingyang, the largest tertiary hospital and two required sutures or skilled treatment, for example, frac- secondary hospitals were selected as urban surveillance tures; (3) Severe injury: required intensive medical or hospitals. In Miyi County, the hospital with the largest surgical management, for example, internal haemor- number of outpatients in the local area and two general rhage, punctured organs and severed blood vessels. township health centres were selected as rural surveil- Quality control lance hospitals. The data accuracy and completeness of our study were Case recruitment ensured with the following strategies. First, face- to-face In the surveillance hospitals, an injury case was defined training sessions were held with item-by- item expla- as the first hospital visit or presentation due to an injury nations of all data elements at all provincial and local event to an emergency room, outpatient department or CDCs and surveillance hospitals. All trainees received a other clinical departments. Cases were excluded if they working manual of the project with details regarding data were transferred from other medical institutions or were entry. All trainees were tested, and those who failed were repeat visits to the same hospital for the same injury event. retrained. Additionally, after the establishment of the An injury was defined as damage to the physical body NISS, quality control efforts focusing on data collection, http://bmjopen.bmj.com/ processing, entering and reporting at different levels by acute exposure to energy or due to a lack of a vital 15 element with the International Classification of Diseases were established. (ICD) codes of S00 to T98. Statistical analyses Categorical variables were reported as numbers and Data collection proportions. X2 tests were used to calculate the signifi- The National Injury Surveillance Form was used to cance of the differences between groups. Years of poten- collect information for all eligible injury cases between st st tial life lost (YPLL) were calculated to evaluate the disease 1 January, 2006, and 31 December, 2015. This included on October 2, 2021 by guest. Protected copyright. burden from injuries. A two-sided p value<0.05 was patient demographics, basic information regarding the considered statistically significant. All statistical analysis injury event and clinical information associated with the was performed with SAS 9.2 and JMP 10.0 software (SAS event (table 1). Trained doctors and nurses recorded Institute Inc, Cary, North Carolina, USA). injury and medical information of the patients using the NISS surveillance form. Subsequently, the forms were Patient and public involvement collected and archived by the prevention and health Patients and the public were not involved in the design protection department of each hospital and reported to and conception of this study. the local county or district Centres for Disease Control and Prevention (CDC) every month. In the county or district CDC office, the data were entered into a database RESULTS using a uniform and specialised software (National Injury Injury case demographics Information System). The electronic data were reported A total of 312 511 injury cases were reported over the last to the provincial CDC each quarter.15 10 years from 2006 to 2015 in Sichuan with 192 904 (men: External causes of injury were classified based on 58.58%) and 119 607 (men: 67.11%) from urban and the International Classification of External Causes of rural surveillance hospitals, respectively (table 2).
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