Peishan Ning

Trends in traumatic brain injury mortality in China, 2006–2013: A population-based longitudinal study

Background 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. Method and findings 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. Conclusions 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.

Global progress in road injury mortality since 2010

We aimed to examine progress in global road injury mortality since the initiation of Global Plan for the Decade of Action for Road Safety 2011–2020. We examined annual percent changes in age-adjusted road traffic mortality using data from the Global Burden of Disease Study 2013. Association between changes in road traffic mortality and legislative efforts in individual nations was explored using data from Global Status Reports on Road Safety 2013 and 2015. We found that global age-adjusted mortality, both overall and for user-specific road traffic injuries, decreased significantly between 2010 and 2013 (annual percent change in rates range from -1.43% to -0.99%). Developed countries witnessed a larger decrease than developing countries in both overall and user-specific road mortality (about 2.0–4.6 times). However, there were substantial disparities within developed countries and within developing countries, with some countries seeing large reductions in mortality rates and others seeing none. The annual percent change in road traffic mortality during 2010–2013 was significantly correlated with total national law enforcement score (Spearman rs = -0.38). We concluded that results highlight the need for continued effort to reduce the burden of road injury mortality, especially in LMIC countries.

Healthy China 2030: a missed opportunity for injury control

On 25 October 2016, the Central Committee of the Communist Party of China and the State Council of China released the Healthy China 2030 blueprint guide.1 For the first time, a long-term national health initiative includes injury control, as it specifies actions to improve occupational safety, road traffic safety and injury prevention. However, the blueprint misses a fundamental priority for injury control—no specific department or agency is assigned to lead and coordinate the efforts of the multiple departments and social partners working to prevent injuries in China.2 ,3 The absence of such a lead agency …

Associations of Undergoing a Routine Medical Examination or Not with Prevalence Rates of Hypertension and Diabetes Mellitus: A Cross-Sectional Study

Background: Undergoing a routine medical examination may be associated with the prevalence rate of chronic diseases from a population-based household interview survey. However, this important issue has not been examined so far. Methods: Data came from the first health service household interview of Hunan province, China, in 2013. A Rao–Scott chi-square test was performed to examine the difference in prevalence rates between subgroups. Adjusted odds ratio (OR) was calculated using the PROC SURVEYLOGISTIC procedure of SAS9.1 statistical software. Results: In total, 24,282 residents of 8400 households were surveyed. A higher proportion of elderly adults had undergone a medical examination within the prior 12 months compared with young adults (≥65 years, 60%; 45–64 years, 46%; 18–44 years, 37%). After controlling for location, sex, and household income per capita, undergoing a medical examination was significantly associated with high prevalence rates of hypertension (adjusted OR: 2.0, 95% CI: 1.1–3.5) and of diabetes mellitus (adjusted OR: 3.3, 95% CI: 1.7–6.5) for young adults aged 18–44 years. The associations were not statistically significant for age groups 45–64 years and 65 years or older. Conclusion: The prevalence rates of hypertension and diabetes mellitus may be seriously underestimated for young adults not undergoing a routine medical examination in a health household interview survey.

Non-fatal injuries treated outside a hospital in Hunan, China: results from a household interview survey

Abstract Background: Injury morbidity data are collected through hospital-based surveillance in many countries. We assessed the extent of non-fatal injures treated outside a hospital. Methods: Data from the first provincial health household interview survey of Hunan, China, conducted in 2013, were used. Injury events were identified and included as medically significant when any of the following circumstances occurred in the prior 14 days: (i) receiving medical treatment from a doctor at a hospital following an injury; (ii) receiving medical treatment by self or others outside a hospital following an injury (e.g. taking medications, or receiving massage or hot compress); and/or (iii) being off work or school, or in bed for more than 1 day, following an injury. The 2-week prevalence of non-fatal injuries and 95% confidence intervals were calculated. We calculated the proportion of injury events treated outside a hospital and the reasons for not visiting a hospital for injury events occurring during the previous 2 weeks. Results: We captured 56 injury events during the previous 2 weeks. The weighted injury prevalence was 4.9 per 1000 persons during the last 2 weeks (95% confidence interval: 2.9–6.9 per 1000 persons). Of the 56 events, 14 (weighted proportion 41.2%) were treated outside a hospital. Primary explanations for skipping hospital visits included perceiving injuries were too minor and economic limitations to travel to hospitals or seek treatment. Conclusion: Results imply the burden of non-fatal injury may be underestimated by hospital-based surveillance systems such as that used in China.

Common traffic violations of bus drivers in urban China: an observational study

OBJECTIVE To report common traffic violations in bus drivers and the factors that influence those violations in urban China. METHODS We conducted an observational study to record three types of traffic violations among bus drivers in Changsha City, China: illegal stopping at bus stations, violating traffic light signals, and distracted driving. The behaviors of bus drivers on 32 routes (20% of bus routes in the city) were observed. A two-level Poisson regression examined factors that predicted bus driver violations. RESULTS The incidence of illegal stopping at bus stations was 20.2%. Illegal stopping was less frequent on weekends, sunny days, and at stations with cameras, with adjusted incidence rate ratios (IRRs) of 0.81, 0.65 and 0.89, respectively. The incidence of violating traffic light signals was 2.2%, and was lower on cloudy than sunny days (adjusted IRR: 0.60). The incidence of distracted driving was 3.3%. The incidence of distracted driving was less common on cloudy days, rainy or snowy days, and foggy/windy/dusty days compared to sunny days, with adjusted IRRs of 0.54, 0.55 and 0.07, respectively. CONCLUSION Traffic violations are common in bus drivers in urban China and they are associated with the date, weather, and presence of traffic cameras at bus station. Further studies are recommended to understand the behavioral mechanisms that may explain bus driver violations and to develop feasible prevention measures.

Child pedestrian street-crossing behaviors outside a primary school: Developing observational methodologies and data from a case study in Changsha, China

Background Child pedestrian injury is a significant global public health challenge, and prevention programming requires an understanding of the context children face when crossing the street. Methods to understand childrens behavior in real-world pedestrian settings are sparse in low- and middle-income countries. Methods Children in grades 1-6 were videotaped crossing a three-lane street outside their school in Changsha, China. Tapes were coded to collect: (1) extent of adult supervision, (2) whom children crossed the street with, and (3) safe behaviors exhibited by children. Results Observational videotape methods yielded data that could be reliably coded to understand Chinese childrens behavior crossing the street outside their primary school. In total, we observed 216 child pedestrians crossing the street, including 105 girls, 105 boys, and 6 for whom gender could not be determined. 51% of observations occurred in the morning before school and 49% in the afternoon after school. Children encountered a busy and somewhat-chaotic traffic environment. Adults were always present to help, but children appeared to heed adult advice concerning the crossing only about 70% of the time. Fewer than 1/3 of children looked at oncoming traffic before they entered a lane and over 1/3 entered a lane with moving traffic approaching. Conclusion Observational methods of coding videotaped behavior proved effective to understand and code childrens risk and safety while crossing the street outside their primary school. At the street environment we studied, we found that childrens pedestrian behavior involved significant risk.

Comparing U.S. Injury Death Estimates from GBD 2015 and CDC WONDER

Objective: The purpose of the present study was to examine consistency in injury death statistics from the United States CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) with those from GBD 2015 estimates. Methods: Differences in deaths and the percent difference in deaths between GBD 2015 and CDC WONDER were assessed, as were changes in deaths between 2000 and 2015 for the two datasets. Results: From 2000 to 2015, GBD 2015 estimates for the U.S. injury deaths were somewhat higher than CDC WONDER estimates in most categories, with the exception of deaths from falls and from forces of nature, war, and legal intervention in 2015. Encouragingly, the difference in total injury deaths between the two data sources narrowed from 44,897 (percent difference in deaths = 41%) in 2000 to 34,877 (percent difference in deaths = 25%) in 2015. Differences in deaths and percent difference in deaths between the two data sources varied greatly across injury cause and over the assessment years. The two data sources present consistent changes in direction from 2000 to 2015 for all injury causes except for forces of nature, war, and legal intervention, and adverse effects of medical treatment. Conclusions: We conclude that further studies are warranted to interpret the inconsistencies in data and develop estimation approaches that increase the consistency of the two datasets.

Comparative Effectiveness of Published Interventions for Elderly Fall Prevention: A Systematic Review and Network Meta-Analysis

Background: Falls are a major threat to older adults worldwide. Although various effective interventions have been developed, their comparative effectiveness remains unreported. Methods: A systematic review and network meta-analysis was conducted to determine the most effective interventions to prevent falls in community-dwelling adults aged 60 and over. Combined odds ratio (OR) and 95% credible interval (95% CrI) were calculated. Results: A total of 49 trials involving 27,740 participants and 9271 fallers were included. Compared to usual care, multifactorial interventions (MFI) demonstrated the greatest efficacy (OR: 0.64, 95% CrI: 0.53 to 0.77) followed by interventions combining education and exercise (EDU + EXC) (OR: 0.65, 95% CrI: 0.38 to 1.00) and interventions combining exercise and hazard assessment and modification (EXC + HAM) (OR: 0.66, 95% CrI: 0.40 to 1.04). The effect of medical care performed the worst (OR: 1.02, 95% CrI: 0.78 to 1.34). Model fit was good, inconsistency was low, and publication bias was considered absent. The overall quality of included trials was high. The pooled odds ratios and ranking probabilities remained relatively stable across all sensitivity analyses. Conclusions: MFI and exercise appear to be effective to reduce falls among older adults, and should be considered first as service delivery options. Further investigation is necessary to verify effectiveness and suitableness of the strategies to at-risk populations.

Reimbursement for injury-induced medical expenses in Chinese social medical insurance schemes: A systematic analysis of legislative documents

Social medical insurance schemes are crucial for realizing universal health coverage and health equity. The aim of this study was to investigate whether and how reimbursement for injury-induced medical expenses is addressed in Chinese legislative documents relevant to social medical insurance. We retrieved legislative documents from the China National Knowledge Infrastructure and the Lawyee databases. Four types of social medical insurance schemes were included: urban employee basic medical insurance, urban resident basic medical insurance, new rural cooperative medical system, and urban and rural resident medical insurance. Text analyses were conducted on all identified legislative documents. As a result, one national law and 1,037 local legislative documents were identified. 1,012 of the 1,038 documents provided for reimbursement. Of the 1,012 documents, 828 (82%) provided reimbursement only for injuries without a legally responsible person/party or not caused by self-harm, alcohol use, drug use, or other law violations, and 162 (16%) did not include any details concerning implementation. Furthermore, 760 (92%) of the 828 did not provide an exception clause applying to injuries when a responsible person/party could not be contacted or for situations when the injured person cannot obtain reimbursement from the responsible person/party. Thus, most Chinese legislative documents related to social medical insurance do not provide reimbursement for medical expenses from injuries having a legally responsible person/party or those caused by illegal behaviors. We argue that all injury-induced medical expenses should be covered by legislative documents related to social medical insurance in China, no matter what the cause of the injury. Further research is needed to explore the acceptability and feasibility of such policy changes.