BackgroundFalls in older people have become a major public health concern worldwide, but a comprehensive assessment of the burden of falls for older people in mainland China has not been done. We aimed to investigate the burden of falls among older people at the national and subnational level in mainland China, and explore the trends from 1990 to 2019, using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019.MethodUsing data from GBD 2019, we estimated the burden of falls among people aged 60 years and older by sex and age group in terms of incidence, mortality, and disability-adjusted life-year (DALY) rates and assessed these indicators at the subnational level in 31 geographical units (hereafter called provinces). We investigated the overall trend in the burden of falls across these 31 provinces from 1990 to 2019, and assessed the change in the burden of falls by sex, age group (60–64, 65–69, 70–74, 75–79, and ≥80 years), and province between 1990 and 2019.FindingsIn 2019, in mainland China, the incidence rate of falls among people aged 60 years and older was 3799·4 (95% uncertainty interval [UI] 3062·4–4645·0) new falls per 100 000 population, and 39·2 deaths (21·8–48·8) per 100 000 population and 1238·9 DALYs (920·5–1553·2) per 100 000 population were due to falls. We found no significant difference in the burden of falls between males and females. The incidence, mortality, and DALY rates of falls for people aged 80 years and older were significantly higher than those in the other age groups, except for incidence rate, which was non-significantly different between the age 75–79 years group and the oldest age group. Large variations in the incidence and DALY rates of falls were observed across 31 provinces. Although between 1990 and 2019 we found no significant changes in overall mortality due to falls in all provinces and in DALY rates for 23 provinces (DALY rates significantly decreased in two provinces and increased in six provinces), we found large increases in the incidence rate of falls in both males (percentage change between 1990 and 2019: 82·9% [67·4–100]) and females (77·0% [63·3–91·8]). The percentage change in incidence rate of falls between 1990 and 2019 varied from 50·0% (42·2–59·5) for people aged 60–64 years to 123·8% (105·4–141·9) for people aged 80 years and older. All provinces had significant increases in the incidence rate of falls between 1990 and 2019, with Sichuan having the greatest increase (148·5% [125·5–171·4]) and Jilin the smallest increase (14·7% [3·6–26·1]).InterpretationBetween 1990 and 2019, the incidence rate of falls increased substantially in older adults across mainland China, whereas the rates of mortality and DALY of falls among older people remained relatively stable, suggesting improvements in outcomes of falls. Nevertheless, falls remain an ongoing health burden for older people in mainland China, and there is an urgent need to introduce system-wide, integrated, and cost-effective measures to protect and support older people to minimise their risks and combat an increasing absolute burden as the population continues ageing.FundingBill & Melinda Gates Foundation.
To evaluate the performance of national injury surveillance in China and provide evidence for the utilization and interpretation of surveillance data and the improvement of injury surveillance.According to the national injury surveillance protocol, a retrospective analysis was conducted on the quality of injury surveillance carried out by the centers for disease control and prevention (CDCs) at all levels in China from 2006 to 2012. And related human resource and budget data in 2012 were collected for analysis.From 2006 to 2012, the injury cases reported to national injury surveillance system increased by 1 time in China. The underreporting rate of injury cases and mis-filling rate of reporting cards decreased in 31 surveillance points (72.1%) and 23 surveillance points (53.5%) respectively. In 2012, the underreporting rates were less than 10% in 33 surveillance points (76.7%) , and the mis-filling rates were less than 10% in 39 surveillance points (90.7%) . Only 19 provincial CDCs (44.2%) and 32 county/district CDCs had full time staff engaged in injury surveillance. Three surveillance points (7.0%) never published their injury surveillance data, while 13 surveillance points shared injury surveillance data with other departments.The quality of injury surveillance was greatly improved in China during 2006-2012, but more efforts are still needed for the further improvement of national injury surveillance, including the increase of human resources and fund investments and more use of surveillance data.
To understand the epidemiological characteristics of head injuries through data from the Chinese National Injury Surveillance System (NISS).Descriptive analysis was applied to display the overall trend of head injuries in 2013 in NISS and to depict general information, events and clinical characteristics of head injuries with SPSS 19.0 software.In 2013, 195 189 cases of head injuries were collected, males were twice higher than females, with 25.19% of them under 30-44 years of age. The three leading causes responsible for head injuries were falls (42.17%), blunt force injuries (27.46%) and road traffic injury (23.33%). Main locations causing head injuries were in road/street (31.41%), at home (25.02%) and public places (17.17%). Recreation activates (54.22%), driving (19.73%), paid work (12.95%) were the three major activities when injuries took place. Majority of the cases belonged to unintentional (86.79%) with bruise injuries (65.18%). Those mild injuries (78.87%) were treated and discharged (82.02%).In 2013, head injuries were seen more in males than in females, mostly involved in labor force population on head injuries. The leading causes for head injuries were falls, blunt injuries and road traffic.
There remains limited literature to facilitate understanding of healthy ageing-related policies in China over the last five-year policy planning cycle. This study aims to characterise all relevant policies and identifies the policy gaps from a health system perspective. A scoping review framework was used. A thorough search for healthy ageing-related policies was performed on the websites of all government ministries affiliated with the Chinese State Council. Essential information was extracted and mapped to an integrated framework of the World Health Organization's Health System Building Blocks and the Chinese 13th Five-Year Plan for Healthy Ageing. A total of 12471 policy documents were identified, while 99 policy documents were included. There were 14 ministries involved in the generation of policies, but multisectoral collaboration between the ministries remained limited. National Health Commission and Ministry of Civil Affairs were the leading ministries. Promoting the integration of medical services and older people care was most frequently addressed within these policies. Applying the health system perspective, governance and financing were often addressed, but there were limited policies on other components of the health system. The findings of this study support four policy recommendations: (1) to enhance multisectoral collaboration in policy development; (2) to strengthen health system building blocks, including healthcare workforce, service delivery, health information, and medical products and technologies; (3) to establish a consolidated policy system centered on the national healthy ageing plan; (4) to formulate a national implementation work plan to promote an integrated health care model for older people.
169 eligible participants aged between 60 and 80 were enrolled in an intervention program focusing on exercising Ba Duan Jin (BDJ), a traditional Chinese health exercise, to improve the balance ability, which was launched in three communities in Shanghai from 2016 to 2017 with an average length of 6 months. One of attractive innovations in this program is that a nine-axis inertial system based bracelet has been particularly developed and adopted to record BDJ exercise situation. Routinely paper-based log was also required to record the exercise. The group interview targeting on the feeling of using the bracelet and the comparison of electronic and self-reported records were conducted to evaluate the effect of the bracelet in promoting this intervention program which were summarized as below: 1. The bracelet could enhance participants' enthusiasm and the sense of acquisition through the utilization of the characteristic curve. This curve contains eight unique waveforms which could be exactly mapped to each movement in BDJ. So, two questions that participants usually concerned, 'how could I improve exercise' and 'whether my exercise has been improved', could be addressed through comparing the current shape of the curve with a standard one performed by a professional instructor and using the previous shape as a benchmark to track the trajectory of exercise proficiency. 2. The bracelet could generate a high-quality data record which is very crucial for the impact evaluation of an intervention. The time, duration, frequency of BDJ exercise could be precisely and real-time recorded by the bracelet with minimal burden and no recall bias. 3. The bracelet could make the 'Big data' and 'Precise intervention' applicable in such a community-based program. With the integration of other biosensors, more physiological indicators, such as blood pressure, heart rate and sleep quality could be easily recorded simultaneously.
To describe the distribution characteristics of outpatient/emergency cases of non-motor road traffic injuries in China from 2006-2013.Cases of non-motor road traffic injuries were descriptively analyzed based on their data at the sentinel hospitals of the Chinese National Injury Surveillance System (NISS) from 2006 to 2013.The proportion of non-motor road traffic injuries among the total road traffic injuries of the year from 2006 to 2011 was relatively stable, and the proportion in 2013 was higher than 2012 (χ² = 508.138, P < 0.001). In the non-motor road traffic injuries cases in 2013, male cases were higher than females (χ² = 41.018, P < 0.001), mostly found in 15 to 64 years old age groups. In urban areas, the proportion of non-motor road traffic injuries cases (52.11%) was higher than rural areas (47.89%) (χ² = 88.427, P < 0.001). Most injuries were found in lower limbs (29.08%) and head (24.82%). Injuries were mainly bruises (73.54%) and fractures (10.72%). The severities of injuries were mainly mitigated injury (80.49%), and most injuries ended with home return following treatment (82.34%).The proportion of non-motor road traffic injuries among total road traffic injuries of the year as found from NISS remained stable from 2006 to 2011, with a slight rise in 2012-2013. Most of the non-motor road traffic injuries were suffered by young and middle aged men. Interventions should be made based on gender and age differences of non-motor road traffic injuries cases.
Objective: To analyze the disease burden of animal injury in China between 1990 and 2016. Methods: Data obtained from the Global Burden of Disease 2016 were used to analyze the age and gender specific disease burden of animal injury in China, using the incidence and disability adjusted of life years (DALYs) rate. Relative and annual changes were evaluated. Results: In 2016, the age-standardized incidence and DALYs rate of animal injury in China showed as 245.05 per 100 000 people and 12.73 per 100 000. The age-standardized incidence of non-venomous animal injury was significantly higher than that of venomous animal injury, but the differences in age-standardized incidence and DALYs rate between venomous animal injury and non-venomous animal injury were not significant. Between 1990 and 2016, there was a significantly decreasing trend in the age-standardized incidence and DALYs rate of animal injury, and obvious decline could be seen in the incidence of non-venomous animal injury, compared with venomous animal injury. The incidence and DALYs rate of animal injury declined in both males and females and in different age groups. The obvious decline of incidence and DALYs rate could be found in children aged 5-14 years and aged <5 years. Conclusions: Between 1990 and 2016, there was a significant alleviation of the disease burden of animal injury in China. Young children were most prone to animal injury, resulting in serious disability and death, indicating more attention should be paid to this population at high risk and in animal injury prevention and control programs.目的： 分析1990－2016年中国动物伤害疾病负担及变化情况。 方法： 利用全球疾病负担研究2016中国动物伤害疾病负担数据，采用发生率和伤残调整寿命年（DALYs）率分析1990－2016年中国不同性别、年龄人群动物伤害、无毒动物伤害和有毒动物伤害疾病负担变化情况，并计算相对变化程度和年度变化百分比。 结果： 2016年中国动物伤害年龄标化发生率和DALYs率分别为245.05/10万人和12.73/10万。无毒动物伤害年龄标化发生率明显高于有毒动物，但有毒动物伤害年龄标化DALYs率与无毒动物无明显差异。1990－2016年，中国动物伤害年龄标化发生率和DALYs率均呈下降趋势，无毒动物伤害下降趋势比有毒动物明显。不同性别和年龄人群的动物伤害发生率和DALYs率均有不同程度下降，其中5~14岁组发生率下降趋势最明显，<5岁组DALYs率下降最明显。 结论： 1990－2016年中国动物伤害疾病负担有明显改善。低龄儿童最容易发生动物伤害，造成的伤残、死亡情况也较为严重，是动物伤害防控工作应重点关注的人群。.
In China, fall is a leading cause of injury death among the elderly, of which the prevalence rate of osteoporosis is estimated about 36%, but the mortality of fall attributed to low bone mineral density (LBMD) in the elderly still remains unclear.
Objective
This study aims to highlight the disparity of the LBMD-attributable mortality of fall in the elderly aged 60 and over by gender and province in China from 1990 to 2015.
Methods
Descriptive analysis is used to depict the current status and trend of the LBMD-attributable mortality of fall and the corresponding percent accounting for the total mortality of fall based on Global Burden Disease 2015. Annual percent change is used to indicate the change of the trend.
Findings
In 2015, 64.95% of fall mortality, about 19.78 per 100,000, could be attributed to LBMD in the elderly aged 60 and over. The corresponding percent of females was much higher than that in males, about 84.58% and 47.92% respectively. Among 33 provinces, the mortality of fall attributed to LBMD varied widely from 3.93 to 75.66 (per 100,000) with a range of percent from 53.28% to 80.04%. From 1990 to 2015, there was no significant change in the LBMD-attributable mortality of fall in females, but an increasing trend in males. No significant difference of percent was found between two genders. 16 provinces saw an increasing trend of percent in both genders during this period, especially in Fujian Province.
Conclusion
LBMD ranks the first attributable risk factor of fall mortality, which imposes a much higher burden on elderly women than elderly men. More efforts of fall and LBMD prevention should be put on elderly women in some provinces.
Policy implications
Region and population-specific policy pertaining on fall and LBMD prevention in the elderly should be adopted in China.
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