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Article(id=1324070972436906171, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324070892967428793, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202508089, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1754409600000, receivedDateStr=2025-08-06, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793612719878, onlineDateStr=2026-11-02, pubDate=1766592000000, pubDateStr=2025-12-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793612719878, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793612719878, creator=13701087609, updateTime=1793612719878, updator=13701087609, issue=Issue{id=1324070892967428793, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='24', pageStart='4417', pageEnd='4608', issueExtLink='null', onlineDate='null', pubDate='1766592000000', pubDateStr='2025-12-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793612700931, creator='13701087609', updateTime=1793612772549, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324071193430602023, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324070892967428793, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324071193430602024, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324070892967428793, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=4495, endPage=4500, ext={EN=ArticleExt(id=1324070972759867580, articleId=1324070972436906171, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Epidemiological patterns of unintentional injury burden in children aged 0-14 globally and in China and health inequality analysis, columnId=1228016568949474136, journalTitle=Modern Preventive Medicine, columnName=Child and Adolescent health, Maternal and Child Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To reveal the epidemiological patterns of unintentional injury among children and evaluate health inequality, providing a scientific basis for formulating appropriate prevention strategies.

Methods

Based on the Global Burden of Diseases, Injuries, and Risk Factors Study framework, we extracted disability-adjusted life years (DALYs) and DALYs rate for unintentional injury and its types among children 0～14 from 1990 to 2021. We employed the Joinpoint regression model to calculate the average annual percentage change (AAPC) for trend analysis. Das Gupta decomposition method was applied to quantify the contributions of age structure, population size and epidemiological factors changes to variations in DALYs. The Slope Index of Inequality and Concentration Index were used to analyze relative inequality and absolute inequality, respectively.

Results

In 2021, the AAPC of DALYs for unintentional injury among children was -2.82%, and the AAPC of DALYs rate was -3.81% globally. In China, the AAPC of DALYs and DALYs rate were -6.41% and -5.76%, respectively. Males and children under 5 years old had higher DALYs and DALYs rate. Globally, the contributions of epidemiological factors changes, age structure, and population size to DALYs were -44.06 million, -1.77 million, and 6.46 million, respectively. In China, the corresponding values were -12.91 million, -0.66 million, and -1.84 million. The Slope Index of Inequality was decreased from -4 044.77 per 100 000 populations in 1990 to -1 473.73 per 100 000 populations in 2021. The Concentration Index was -0.30 in 2019, and -0.43 in 2021.

Conclusion

Although the burden of unintentional injury among children has shown downward trends, boys and children under 5 years old remain priority populations for targeted interventions. Relative health inequality has intensified, and countries or regions with lower Socio-Demographic Index (SDI) bear a heavier disease burden from unintentional injury.

, authors=Hai-rui JIANG1, Gang LI2, Meng MI1, Xiao-wen PANG1, authorsList=Hai-rui JIANG, Gang LI, Meng MI, Xiao-wen PANG, authorCompany=null, correspAuthors=Xiao-wen PANG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324070975494553797, articleId=1324070972436906171, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=全球和中国0～14岁儿童意外伤害疾病负担流行特征与健康不平等分析, columnId=1228016570031604578, journalTitle=现代预防医学, columnName=儿少卫生与妇幼保健, runingTitle=null, highlight=null, articleAbstract=
目的

揭示儿童意外伤害疾病负担的流行特征以及健康不平等状况，为制定适宜的预防策略提供科学依据。

方法

基于全球疾病负担研究框架获取1990—2021年0～14岁儿童意外伤害及其亚类的伤残调整生命年（DALYs）和DALYs率指标，使用Joinpoint回归模型计算平均年度百分比变化（AAPC）进行趋势分析，利用Das Gupta分解分析量化年龄结构、人口规模和流行病学因素对DALYs的影响，使用斜率不平等指数和集中指数评估健康不平等。

结果

2021年全球儿童意外伤害DALYs的AAPC为-2.82%，DALYs率的AAPC为-3.18%，中国儿童意外伤害DALYs的AAPC为-6.41%，DALYs率的AAPC为-5.76%。男性儿童和5岁以下儿童的DALYs与DALYs率较高。全球流行病学因素、年龄结构和人口规模的贡献效应为-4 405.68万人年、-177.04万人年和645.57万人年，在中国对应贡献效应分别为-1 291.13万人年、-65.89万人年和-183.50万人年。斜率不平等指数由1990年的-4 044.77/10万降低至-1 473.73万/10万，1990年集中指数为-0.30，2021年为-0.43。

结论

儿童意外伤害负担下降，但男性和5岁以下儿童仍是重点干预群体。健康相对不平等性加剧，社会人口指数（SDI）较低的国家或地区负担更沉重。

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降海蕊（1995—），女，硕士，研究方向：卫生事业管理

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庞晓雯，E-mail：
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BMC Public Health, 2020, 20 (1): 564., articleTitle=Austerity policy and child health in European countries: a systematic literature review, refAbstract=null)], funds=[Fund(id=1324070980380918001, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324070972436906171, awardId=82172926; 81874156, language=CN, fundingSource=国家自然科学基金项目(82172926; 81874156), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1324070975746212038, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324070972436906171, xref=1., ext=[AuthorCompanyExt(id=1324070975758794951, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324070972436906171, companyId=1324070975746212038, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Quality Management, Tangdu Hospital, Fourth Military Medical University, Xi’an, Shanxi 710038, China), AuthorCompanyExt(id=1324070975771377864, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324070972436906171, companyId=1324070975746212038, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.空军军医大学唐都医院质量管理科，陕西　西安　710038)]), AuthorCompany(id=1324070975859458249, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324070972436906171, xref=2., ext=[AuthorCompanyExt(id=1324070975867846858, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324070972436906171, companyId=1324070975859458249, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.空军军医大学唐都医院神经外科)])], figs=[ArticleFig(id=1324070977948221673, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324070972436906171, language=EN, label=Fig.1, caption=Decomposition analysis of change in DALYs, figureFileSmall=w1dOd9ByVC9QvBB2cl4jYw==, figureFileBig=bz169j3nkHu9GYt//BY2yw==, tableContent=null), ArticleFig(id=1324070978023719146, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324070972436906171, language=CN, label=图1, caption=按性别分层的DALYs分解分析

注：·表示总效应，即年龄结构效应、人口规模效应和流行病学效应之和；图A：全球；图B：中国。

, figureFileSmall=w1dOd9ByVC9QvBB2cl4jYw==, figureFileBig=bz169j3nkHu9GYt//BY2yw==, tableContent=null), ArticleFig(id=1324070978229240043, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324070972436906171, language=EN, label=Fig.2, caption=Analysis of health inequality of unintentional injuries among children aged 0-14 years across 204 countries and regions, figureFileSmall=OmQCzWbw+thJGsQVzc18XA==, figureFileBig=VyWwTP/G8fGNRR9t3Q1PWg==, tableContent=null), ArticleFig(id=1324070978300543212, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324070972436906171, language=CN, label=图2, caption=204个国家及地区0～14岁儿童意外伤害的健康不平等分析图

注：A：绝对不平等图；B：相对不平等图。

, figureFileSmall=OmQCzWbw+thJGsQVzc18XA==, figureFileBig=VyWwTP/G8fGNRR9t3Q1PWg==, tableContent=null), ArticleFig(id=1324070979974070509, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324070972436906171, language=EN, label=Table 1, caption=

DALYs and DALYs rate of unintentional injuries by type in 2021, with AAPC from 1990 to 2021 (Global and China)

, figureFileSmall=null, figureFileBig=null, tableContent=
分类全球
DALYs（万）DALYs率（/10万）
2021年AAPC[%, (95% CI)]2021年AAPC[%, (95% CI)]
所有意外伤害2 339.39-2.82（-3.11～-2.53）1 162.80-3.18（-3.49～-2.87）
跌倒312.86-1.61（-1.75～-1.47）155.51-2.06（-2.17～-1.96）
溺水816.84-4.05（-4.26～-3.83）406.01-4.51（-4.65～-4.38）
火灾、高温和高温物体217.48-2.62（-2.69～-2.54）108.10-3.09（-3.21～-2.98）
中毒78.29-2.54（-2.69～-2.38）38.91-2.94（-3.06～-2.83）
暴露于机械性力111.97-2.26（-2.34～-2.17）55.65-2.73（-2.83～-2.62）
医疗副作用185.16-1.92（-2.16～-1.67）92.04-2.39（-2.62～-2.17）
动物接触160.55-2.53（-2.94～-2.13）79.80-3.05（-3.57～-2.52）
异物伤害278.45-2.64（-2.76～-2.51）138.40-3.09（-3.2～-2.99）
暴露于自然力36.76-3.86（-7.76～0.21）18.27-4.25（-8.16～-0.17）
环境高温和寒冷暴露15.25-2.53（-2.82～-2.25）7.58-3.01（-3.30～-2.72）
其他意外伤害125.76-3.09（-3.17～-3.00）62.51-3.54（-3.65～-3.43）
分类中国
DALYs（万）DALYs率（/10万）
2021年AAPC[%, (95% CI)]2021年AAPC[%, (95% CI)]
所有意外伤害219.68-6.41（-7.40～-5.41）846.13-5.76（-5.97～-5.54）
跌倒35.38-4.39（-4.81～-3.97）136.26-3.80（-4.15～-3.45）
溺水106.51-7.28（-7.72～-6.84）410.22-6.63（-6.98～-6.29）
火灾、高温和高温物体4.65-8.66（-9.31～-8.02）17.92-8.08（-8.85～-7.29）
中毒9.25-4.98（-5.77～-4.18）35.62-4.46（-4.76～-4.16）
暴露于机械性力11.41-5.00（-5.53～-4.46）43.95-4.44（-4.99～-3.87）
医疗副作用2.81-9.38（-9.79～-8.97）10.82-8.81（-9.28～-8.34）
动物接触1.22-9.12（-9.75～-8.48）4.71-8.57（-9.03～-8.11）
异物伤害40.20-5.47（-5.99～-4.95）154.85-4.90（-5.49～-4.31）
暴露于自然力1.17-3.41（-7.46～0.82）4.52-2.00（-6.21～2.4）
环境高温和寒冷暴露1.24-7.50（-7.92～-7.07）4.76-6.84（-7.11～-6.57）
其他意外伤害5.84-7.43（-8.06～-6.79）22.51-6.86（-7.24～-6.48）
), ArticleFig(id=1324070980087316718, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324070972436906171, language=CN, label=表1, caption=

2021年全球和中国儿童不同意外伤害的DALYs和DALYs率及1990—2021年AAPC趋势

, figureFileSmall=null, figureFileBig=null, tableContent=
分类全球
DALYs（万）DALYs率（/10万）
2021年AAPC[%, (95% CI)]2021年AAPC[%, (95% CI)]
所有意外伤害2 339.39-2.82（-3.11～-2.53）1 162.80-3.18（-3.49～-2.87）
跌倒312.86-1.61（-1.75～-1.47）155.51-2.06（-2.17～-1.96）
溺水816.84-4.05（-4.26～-3.83）406.01-4.51（-4.65～-4.38）
火灾、高温和高温物体217.48-2.62（-2.69～-2.54）108.10-3.09（-3.21～-2.98）
中毒78.29-2.54（-2.69～-2.38）38.91-2.94（-3.06～-2.83）
暴露于机械性力111.97-2.26（-2.34～-2.17）55.65-2.73（-2.83～-2.62）
医疗副作用185.16-1.92（-2.16～-1.67）92.04-2.39（-2.62～-2.17）
动物接触160.55-2.53（-2.94～-2.13）79.80-3.05（-3.57～-2.52）
异物伤害278.45-2.64（-2.76～-2.51）138.40-3.09（-3.2～-2.99）
暴露于自然力36.76-3.86（-7.76～0.21）18.27-4.25（-8.16～-0.17）
环境高温和寒冷暴露15.25-2.53（-2.82～-2.25）7.58-3.01（-3.30～-2.72）
其他意外伤害125.76-3.09（-3.17～-3.00）62.51-3.54（-3.65～-3.43）
分类中国
DALYs（万）DALYs率（/10万）
2021年AAPC[%, (95% CI)]2021年AAPC[%, (95% CI)]
所有意外伤害219.68-6.41（-7.40～-5.41）846.13-5.76（-5.97～-5.54）
跌倒35.38-4.39（-4.81～-3.97）136.26-3.80（-4.15～-3.45）
溺水106.51-7.28（-7.72～-6.84）410.22-6.63（-6.98～-6.29）
火灾、高温和高温物体4.65-8.66（-9.31～-8.02）17.92-8.08（-8.85～-7.29）
中毒9.25-4.98（-5.77～-4.18）35.62-4.46（-4.76～-4.16）
暴露于机械性力11.41-5.00（-5.53～-4.46）43.95-4.44（-4.99～-3.87）
医疗副作用2.81-9.38（-9.79～-8.97）10.82-8.81（-9.28～-8.34）
动物接触1.22-9.12（-9.75～-8.48）4.71-8.57（-9.03～-8.11）
异物伤害40.20-5.47（-5.99～-4.95）154.85-4.90（-5.49～-4.31）
暴露于自然力1.17-3.41（-7.46～0.82）4.52-2.00（-6.21～2.4）
环境高温和寒冷暴露1.24-7.50（-7.92～-7.07）4.76-6.84（-7.11～-6.57）
其他意外伤害5.84-7.43（-8.06～-6.79）22.51-6.86（-7.24～-6.48）
), ArticleFig(id=1324070980171202799, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324070972436906171, language=EN, label=Table 2, caption=

DALYs and DALYs rate of unintentional injuries by age and sex, with AAPC from 1990 to 2021 (Global and China)

, figureFileSmall=null, figureFileBig=null, tableContent=
区域分类DALYDALYs率
1990年
（万）		2021年
（万）		AAPC[%, (95% CI)]1990年
（万）		2021年
（万）		AAPC[%, (95% CI)]
全球男3 713.911 409.91-2.84（-3.05～-2.62）4 156.621 358.08-3.21（-3.45～-2.97）
女2 562.63929.48-2.81（-3.21～-2.41）3 030.341 149.54-3.17（-3.59～-2.74）
<5岁4 219.121 363.72-3.12（-3.41～-2.84）6 805.722 071.99-3.47（-3.75～-3.19）
5～9岁1 255.10502.76-2.86（-3.14～-2.58）2 150.88731.77-3.45（-3.91～-3.05）
10～14岁802.32472.90-1.75（-2.29～-1.20）1 497.75709.38-2.14（-2.50～-1.77）
中国男1 086.72149.14-6.13（-6.84～-5.42）6 534.611 076.31-5.62（-6.02～-5.22）
女673.6970.54-7.35（-7.81～-6.90）4 429.98582.69-6.03（-6.55～-5.51）
<5岁1 224.8797.65-8.03（-8.60～-7.45）10 955.341 257.26-6.41（-7.00～-5.81）
5～9岁344.2467.64-5.36（-6.41～-4.31）3 301.17706.27-5.19（-5.81～-4.56）
10～14岁191.2954.39-4.44（-5.42～-3.45）1 870.06631.07-3.14（-3.64～-2.65）
), ArticleFig(id=1324070980255088880, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324070972436906171, language=CN, label=表2, caption=

全球和中国儿童不同年龄和性别意外伤害的DALYs和DALYs率及1990—2021年AAPC趋势

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区域分类DALYDALYs率
1990年
（万）		2021年
（万）		AAPC[%, (95% CI)]1990年
（万）		2021年
（万）		AAPC[%, (95% CI)]
全球男3 713.911 409.91-2.84（-3.05～-2.62）4 156.621 358.08-3.21（-3.45～-2.97）
女2 562.63929.48-2.81（-3.21～-2.41）3 030.341 149.54-3.17（-3.59～-2.74）
<5岁4 219.121 363.72-3.12（-3.41～-2.84）6 805.722 071.99-3.47（-3.75～-3.19）
5～9岁1 255.10502.76-2.86（-3.14～-2.58）2 150.88731.77-3.45（-3.91～-3.05）
10～14岁802.32472.90-1.75（-2.29～-1.20）1 497.75709.38-2.14（-2.50～-1.77）
中国男1 086.72149.14-6.13（-6.84～-5.42）6 534.611 076.31-5.62（-6.02～-5.22）
女673.6970.54-7.35（-7.81～-6.90）4 429.98582.69-6.03（-6.55～-5.51）
<5岁1 224.8797.65-8.03（-8.60～-7.45）10 955.341 257.26-6.41（-7.00～-5.81）
5～9岁344.2467.64-5.36（-6.41～-4.31）3 301.17706.27-5.19（-5.81～-4.56）
10～14岁191.2954.39-4.44（-5.42～-3.45）1 870.06631.07-3.14（-3.64～-2.65）
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全球和中国0～14岁儿童意外伤害疾病负担流行特征与健康不平等分析
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降海蕊 1 , 李刚 2 , 米萌 1 , 庞晓雯 1
现代预防医学 | 儿少卫生与妇幼保健 2025,52(24): 4495-4500
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现代预防医学 |儿少卫生与妇幼保健 2025 , 52 (24) : 4495 -4500
全球和中国0～14岁儿童意外伤害疾病负担流行特征与健康不平等分析
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降海蕊1, 李刚2, 米萌1, 庞晓雯1
作者信息
  • 1.空军军医大学唐都医院质量管理科，陕西　西安　710038
  • 2.空军军医大学唐都医院神经外科
通讯作者:
庞晓雯，E-mail：
作者简介:

降海蕊（1995—），女，硕士，研究方向：卫生事业管理

Epidemiological patterns of unintentional injury burden in children aged 0-14 globally and in China and health inequality analysis
Hai-rui JIANG1, Gang LI2, Meng MI1, Xiao-wen PANG1
Affiliations
  • Department of Quality Management, Tangdu Hospital, Fourth Military Medical University, Xi’an, Shanxi 710038, China
出版时间: 2025-12-25 doi: 10.20043/j.cnki.MPM.202508089
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摘要
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目的

揭示儿童意外伤害疾病负担的流行特征以及健康不平等状况，为制定适宜的预防策略提供科学依据。

方法

基于全球疾病负担研究框架获取1990—2021年0～14岁儿童意外伤害及其亚类的伤残调整生命年（DALYs）和DALYs率指标，使用Joinpoint回归模型计算平均年度百分比变化（AAPC）进行趋势分析，利用Das Gupta分解分析量化年龄结构、人口规模和流行病学因素对DALYs的影响，使用斜率不平等指数和集中指数评估健康不平等。

结果

2021年全球儿童意外伤害DALYs的AAPC为-2.82%，DALYs率的AAPC为-3.18%，中国儿童意外伤害DALYs的AAPC为-6.41%，DALYs率的AAPC为-5.76%。男性儿童和5岁以下儿童的DALYs与DALYs率较高。全球流行病学因素、年龄结构和人口规模的贡献效应为-4 405.68万人年、-177.04万人年和645.57万人年，在中国对应贡献效应分别为-1 291.13万人年、-65.89万人年和-183.50万人年。斜率不平等指数由1990年的-4 044.77/10万降低至-1 473.73万/10万，1990年集中指数为-0.30，2021年为-0.43。

结论

儿童意外伤害负担下降，但男性和5岁以下儿童仍是重点干预群体。健康相对不平等性加剧，社会人口指数（SDI）较低的国家或地区负担更沉重。

意外伤害  /  疾病负担  /  伤残调整生命年  /  分解分析  /  健康不平等
Objective

To reveal the epidemiological patterns of unintentional injury among children and evaluate health inequality, providing a scientific basis for formulating appropriate prevention strategies.

Methods

Based on the Global Burden of Diseases, Injuries, and Risk Factors Study framework, we extracted disability-adjusted life years (DALYs) and DALYs rate for unintentional injury and its types among children 0～14 from 1990 to 2021. We employed the Joinpoint regression model to calculate the average annual percentage change (AAPC) for trend analysis. Das Gupta decomposition method was applied to quantify the contributions of age structure, population size and epidemiological factors changes to variations in DALYs. The Slope Index of Inequality and Concentration Index were used to analyze relative inequality and absolute inequality, respectively.

Results

In 2021, the AAPC of DALYs for unintentional injury among children was -2.82%, and the AAPC of DALYs rate was -3.81% globally. In China, the AAPC of DALYs and DALYs rate were -6.41% and -5.76%, respectively. Males and children under 5 years old had higher DALYs and DALYs rate. Globally, the contributions of epidemiological factors changes, age structure, and population size to DALYs were -44.06 million, -1.77 million, and 6.46 million, respectively. In China, the corresponding values were -12.91 million, -0.66 million, and -1.84 million. The Slope Index of Inequality was decreased from -4 044.77 per 100 000 populations in 1990 to -1 473.73 per 100 000 populations in 2021. The Concentration Index was -0.30 in 2019, and -0.43 in 2021.

Conclusion

Although the burden of unintentional injury among children has shown downward trends, boys and children under 5 years old remain priority populations for targeted interventions. Relative health inequality has intensified, and countries or regions with lower Socio-Demographic Index (SDI) bear a heavier disease burden from unintentional injury.

Unintentional injury  /  Burden of disease  /  Disability-adjusted life years  /  Decomposition method  /  Health inequality
降海蕊, 李刚, 米萌, 庞晓雯. 全球和中国0～14岁儿童意外伤害疾病负担流行特征与健康不平等分析. 现代预防医学, 2025 , 52 (24) : 4495 -4500 . DOI: 10.20043/j.cnki.MPM.202508089
Hai-rui JIANG, Gang LI, Meng MI, Xiao-wen PANG. Epidemiological patterns of unintentional injury burden in children aged 0-14 globally and in China and health inequality analysis[J]. Modern Preventive Medicine, 2025 , 52 (24) : 4495 -4500 . DOI: 10.20043/j.cnki.MPM.202508089
正文
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在全球疾病负担研究框架下，意外伤害是指除道路伤害与自残和人际暴力外，由于非故意或外部因素导致的伤害所造成的死亡或身体损伤，包括跌倒、溺水、中毒等12种类型[1]。意外伤害是全球范围内重大健康问题之一，其疾病负担高于其他伤害类型[2-3]。儿童处于特殊发展阶段，缺乏经验知识，对潜在伤害的预见性仍不足，易被新奇刺激吸引而忽视安全隐患[4]，因此加强对儿童意外伤害的预防和干预尤为重要。既往研究表明不同国家间的健康状况存在显著差异[5]，反映社会经济因素、健康风险因素和卫生资源等在全球范围内的不均衡分布，国家或地区间群体健康差异需要持续关注，尤其对于弱势群体。目前国内关于儿童意外伤害疾病负担研究以及健康不平等的分析较少，本次研究通过揭示全球和中国儿童意外伤害的流行规律以及健康不平等情况，为制定有效的预防措施和管理政策提供科学依据，从而优化儿童意外伤害防治工作。
1　资料与方法
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1.1　资料来源
本研究数据来源于2021年全球疾病负担研究数据库，该数据库针对1990—2021年间204个国家和地区，按年龄－性别－地区－年份维度综合评估了371种疾病和伤害伤残生存年（years lived with disability，YLDs）、寿命损失年（years of life lost，YLLs）、伤残调整生命年（Disability Adjusted Life Years，DALYs）和健康寿命预期（healthy life expectancy，HALE）等核心指标，数据来源于生命登记系统、口头尸检、人口普查、入户健康调查、专科疾病登记、医疗卫生服务记录以及其他补充数据源[6]。
1.2　评价指标
使用结果工具获取1990—2021年全球204个国家和地区0～14岁儿童意外伤害及其亚类的DALYs和DALYs率。DALYs指因特定疾病导致的健康生命年损失年，是YLDs和YLLs之和。DALYs率是指每10万人口因特定疾病损失的伤残调整寿命年。获取204个国家和地区的社会人口指数（Socio-Demographic Index，SDI），该指标是人均收入，平均受教育年限和总和生育率的复合性指标，用于衡量国家或地区发展水平，范围在（0～1），值越大代表发展水平越高，并被划分为低SDI、中低SDI、中SDI、中高SDI、高SDI五个水平[7]。本研究0～14岁被分为三个亚分组<5岁，5～9岁和10～14岁。
1.3　研究方法
1.3.1　趋势分析
利用Joinpoint回归模型计算1990—2021年全球和中国儿童意外伤害的DALYs和DALYs率的平均年度百分比变化（Average Annual Percent Change，AAPC）以及95%置信区间（Confidence Interval，CI），评估观察到的整体趋势与趋势显著性，研究设置最大拐点为6。该方法通过蒙特卡洛重新抽样的置换检验确定趋势发生显著变化的拐点数量，并采用Bonferroni校正进行多重检验，通过判断包含拐点的不同模型的贝叶斯信息准则（Bayesian Information Criterion，BIC）来选择最优模型[8]。拐点将时间序列数据划分成不同区间段，对区间数据进行对数线性回归拟合，生成年度百分比变化，AAPC为年度百分比变化的加权平均。当趋势没有变化时，年度百分比变化值与AAPC值等同。
1.3.2　分解分析
通过Das Gupta分解分析量化年龄结构变化、人口规模变化和流行病学因素变化对DALYs的独立贡献效应，识别疾病负担变化的潜在驱动因素[9]，根据贡献效应计算对应贡献度，基于DALYs估算的1 000次抽样，计算贡献效应和贡献度的不确定性区间（Uncertainty Interval ，UI），以判断统计显著性。年龄结构因素指儿童不同年龄段人口结构的变化，人口规模因素指儿童人口数的变动，流行病学因素指意外伤害DALYs率的变化。Das Gupta分解分析方法可以表示为：
其中：DALYsa_y,p_y,e_y表示年份y基于年龄结构、人口规模和流行病学因素的DALYs；ai,y代表年份y第i个年龄组（共3个年龄组）的人口比例；py表示年份y的总人口数；ei,y是年份y中第i个年龄组的DALYs率。
本研究通过控制其他因素不变，计算1990—2021年各因素对DALYs变化的效应。以年龄结构效应（a_effect）为例，计算公式如下：
1.3.3　健康不平等分析
通过斜率不平等指数和集中指数量化疾病负担指标在不同SDI国家或地区绝对不平等和相对不平等情况。基于稳健的线性回归模型，以SDI排序后人口加权相对序位为自变量，以DALYs率为因变量构建方程，其斜率为斜率不平等指数。集中指数以SDI排序后人口累积比例为自变量，以DALYs的累积比例为因变量构建洛伦兹曲线，通过数值积分法计算集中指数[10]，使用复杂样本方差估计判断集中指数的统计显著性。集中指数取值范围在（-1～1），正值代表疾病负担更多集中在较高SDI国家人群中，负值代表疾病负担更多集中在较低SDI国家人群。斜率不平等指数或集中指数的绝对值越高表示疾病负担在各国间的不平等程度越严重。
使用Joinpoint软件（5.4.0版本）计算AAPC，使用RStudio软件（4.5.0版本）进行分解分析和健康不平等分析。检验水平α=0.05。
2　结果
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2.1　全球和中国儿童意外伤害负担趋势变化
1990—2021年，全球意外伤害DALYs的AAPC为-2.82%，DALYs率的AAPC为-3.18%，中国DALYs和DALYs率的AAPC分别为-6.41%和-5.76%，下降趋势较全球明显。1990和2021年，全球及中国DALYs和DALYs率最高的意外伤害类型均是溺水。次之全球为跌倒，中国为异物伤害。见表1。
2.2　全球和中国儿童意外伤害负担的性别与年龄特征
1990—2021年全球男性儿童意外伤害DALYs的AAPC为-2.84%，DALYs率的AAPC为-3.21%，且1990和2021年的DALYs和DALYs率均高于女性儿童，<5岁儿童DALYs的AAPC为-3.12%，DALYs率的AAPC为-3.47%，DALYs和DALYs率高于其他年龄段。中国男性儿童的DALYs的AAPC为-6.13%，DALYs率的AAPC为-5.62%，1990和2021年的DALYs和DALYs率高于女性，10～14岁儿童DALYs的AAPC为-4.44%，DALYs率的AAPC为-3.14%，DALYs和DALYs率低于其他年龄段。1990—2021年全球和中国不同性别和年龄的儿童意外伤害负担都呈现下降趋势。见表2。
2.3　儿童意外伤害负担的分解分析
从1990到2021年，全球0～14岁儿童意外伤害DALYs呈现显著下降趋势，总量减少3 937.16（95% UI：-4 273.06～-3 660.54）万人年，流行病学因素、年龄结构和人口规模变化对DALYs的贡献效应分别为-4 405.68（95% UI：-4 858.83～-4 027.85）万人年、-177.04（95% UI：-220.72～-138.18）万人年和645.57（95% UI：505.48～806.49）万人年，贡献率分别为111.90%（95% UI：110.03%～113.71%）、4.50%（（95% UI：3.77%～5.17%）和-16.40%（95% UI：-18.87%～-13.81%）。
同期中国儿童意外伤害DALYs降低1 540.72（95% UI：-1 942.13～-1 232.51）万人年，流行病学因素、年龄结构和人口规模对DALYs负担的贡献效应分别为-1 291.13（95% UI：-1 942.13～-1 232.51）万人年、-65.89（95% UI：-87.99～-49.33）万人年和-183.50（95% UI：-229.88～-150.03）万人年，贡献率分别为83.81%（95% UI：83.82%～83.63%），4.28%（95% UI：4.00%～4.53%）和11.91%（95% UI：11.84%～12.17%）。
流行病学因素的变化是推动意外伤害DALYs负担降低的主要因素，对男性儿童的影响更大。见图1。
2.4　儿童意外伤害负担的健康不平等分析
1990年204个国家和地区0～14岁儿童意外伤害疾病负担的斜率不平等指数为-4 044.77/10万（95% CI：-4 480.08/10万～-3 609.47/10万），2021年降低至-1 473.73万/10万（95% CI：-1 618.86/10万～-1 328.60/10万），低SDI国家与高SDI国家间的疾病负担绝对差距缩小。1990年0～14岁儿童意外伤害疾病负担的集中指数为-0.30（t=-41.633，95% CI：-0.30～-0.27），2021年为-0.43（t=-145.474，95% CI：-0.43～-0.42），提示DALY健康不公平相对差距扩大。见图2。
3　讨论
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3.1　儿童意外伤害疾病负担流行特征
通过对1990—2021年全球与中国0～14岁儿童意外伤害的疾病负担分析，中国儿童的意外伤害流行特征与全球趋势相似，都呈现下降趋势，与全球平均水平相比，中国儿童意外伤害DALYs率下降速度更快，体现中国在儿童意外伤害防治领域的显著成效。然而由于庞大的人口基数，2021年中国儿童意外伤害DALYs总量仍维持在较高水平，占比9.39%，在204个国家和地区中排位第3，仅次于印度和尼日利亚，DALYs率排位第93名，低于海地、中非和南苏丹等，但是远高于新加坡、安道尔和荷兰等国家。此外，中国和全球儿童意外伤害导致的疾病负担都呈现出明显的性别与年龄差异，研究表明中国和全球男性儿童意外伤害导致的DALYs总量与DALYs率都显著高于女不行，可能与男性儿童更高的风险暴露相关。在年龄分布上，中国和全球五岁以下儿童意外伤害负担都是最重的。五岁以下儿童身体协调性和认知能力有限，其对危险行为的判断力尤为不足[11]，随着年龄的增长意外伤害负担下降。未来需进一步优化干预策略，持续强化男性儿童的针对性干预，重点关注低龄儿童，推动全球儿童健康水平提升。
3.2　流行病学因素改善有效降低意外伤害负担
从全球来看，儿童意外伤害疾病负担指标降幅约62.73%，主要由流行病学变化驱动，且男性儿童受益更显著，但人口规模增长部分抵消了部分下降。中国儿童意外伤害DALYs总量下降幅度87.50%，其中男性儿童减少938万DALYs，占比60.85%，表明男性儿童改善更为显著，但2021年残余负担仍是女性的2.11倍，提示男性儿童是高风险人群。和全球发展态势不一样的是中国儿童人口规模变化引起负担下降，可能与生育率下降、儿童数量减少有关。据统计，1990年中国0～14岁儿童数量约3.2亿，占比为27.7%，2021年儿童数量为2.5亿，占比下降到17.5%[12]，人口减少一定程度降低意外伤害的DALYs。无论中国还是全球，流行病学因素都是意外伤害负担降低的核心驱动力，表明行为风险降低、家庭，学校和社会安全环境的优化，健康教育与监督、健康政策的实施以及医疗急救技术的进步等是负担下降的主导因素。在不同的意外伤害类型中溺水造成的负担最重，而通过有效的预防措施可以有效减少溺水的发生。预防溺水投资论证报告预测，到2025年全球通过加强为学龄前儿童提供日托服务、教授学龄儿童基本游泳技能这两项措施，可以挽救超过77万名儿童的生命，防止近百万非致命儿童溺水[13]。
3.3　关注儿童意外伤害负担的健康不平等情况
健康不平等分析提示不同SDI水平国家和地区的儿童健康不平等现象仍然存在，虽然1990—2021年绝对不平等情况有所改善，但需要注意的是相对不平等程度加剧，凸显了全球范围内儿童意外伤害负担的地域不平衡问题。根据世界卫生组织健康不平等分级标准[14]，全球儿童意外伤害疾病负担分布已经处于相对较高的不平等水平，SDI较低的国家和地区承担与其儿童人口不成比例的更高意外伤害疾病负担，2021年低SDI国家或地区儿童意外伤害DALYs率达2 069.52/10万，高SDI国家或地区为370.47/10万。另外其他研究表明社会经济和教育等因素与儿童意外伤害疾病负担存在负相关关系[15-16]，社会经济发展水平和教育程度越高，儿童意外伤害负担越低。Rajmil L等人[17]的研究也印证来自弱势背景的儿童不良健康结果的发生率不成比例地增加，全球范围内儿童意外伤害的预防和救助工作对于推动健康公平具有重要作用，特别是对于落后地区。本研究主要从国家或地区层面关注疾病负担差异反映的不平等情况，而国家层面的评估在一定程度会掩盖内部不同社会群体之间健康状况的不平等现象，提示我们还要从不同层面审视儿童健康状况的不平等现象。
研究存在一定局限性，全球疾病负担研究数据库中数据来源和准确性受不同国家统计机构的影响，特别是欠发达地区数据获取有限，缺乏次国家级数据，限制对疾病负担进行更细致的分层分析。
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  • 国家自然科学基金项目(82172926; 81874156)
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2025年第52卷第24期
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doi: 10.20043/j.cnki.MPM.202508089
  • 接收时间：2025-08-06
  • 首发时间：2026-11-02
  • 出版时间：2025-12-25
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  • 收稿日期：2025-08-06
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国家自然科学基金项目(82172926; 81874156)
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    1.空军军医大学唐都医院质量管理科，陕西　西安　710038
    2.空军军医大学唐都医院神经外科

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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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