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

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.

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.

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.