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Article(id=1325501980851961975, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1325501647736156411, articleNumber=null, orderNo=null, doi=10.16835/j.cnki.1000-9817.2025089, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1736179200000, receivedDateStr=2025-01-07, revisedDate=1739030400000, revisedDateStr=2025-02-09, acceptedDate=null, acceptedDateStr=null, onlineDate=1793953898871, onlineDateStr=2026-11-06, pubDate=1742832000000, pubDateStr=2025-03-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793953898871, onlineIssueDateStr=2026-11-06, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793953898871, creator=13701087609, updateTime=1793953898871, updator=13701087609, issue=Issue{id=1325501647736156411, tenantId=1146029695717560320, journalId=1256213402557890569, year='2025', volume='46', issue='3', pageStart='305', pageEnd='456', issueExtLink='null', onlineDate='null', pubDate='1742832000000', pubDateStr='2025-03-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793953819450, creator='13701087609', updateTime=1793953819450, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=406, endPage=411, ext={EN=ArticleExt(id=1325501981627908216, articleId=1325501980851961975, tenantId=1146029695717560320, journalId=1256213402557890569, language=EN, title=Trend analysis and prediction of injury burden among children and adolescents in China from 1990 to 2021, columnId=1325500884406379444, journalTitle=Chinese Journal of School Health, columnName=Disease Control, runingTitle=null, highlight=null, articleAbstract=
Objective

To evaluate the prevalence and future trend of change of the disease burden of injuries in Chinese children and adolescents from 1990 to 2021, so as to provide reference for injury prevention and control in this population.

Methods

Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 (GBD 2021), the trend of change in the disease burden of injuries in children and adolescents in China from 1990 to 2021 was analyzed by the Joinpoint regression model. The Bayesian age period cohort model (BAPC) was used to predict the disease burden of injuries among children and adolescents in China from 2022 to 2031.

Results

From 1990 to 2021, the standardized incidence rate, standardized prevalence rate, standardized mortality rate, and standardized disability-adjusted life years (DALYs) rate of injuries among children and adolescents in China showed an overall downward trend (AAPC=-1.14%, -0.76%, -5.41%, -5.03%, P < 0.05). For different genders, the standardized incidence rate (7 106.00/100 000, 5 388.00/100 000), standardized mortality rate (92.00/100 000, 19.00/100 000), and standardized DALYs rate (7 834.00/100 000, 1 673.00/100 000) of injuries in boys were higher than the rate of injuries in girls in 1990 and 2021 (5 188.00/100 000, 3 874.00/100 000; 61.00/100 000, 10.00/100 000; 5 398.00/100 000, 945.00/100 000). Compared with Asia and globally, China had the fastest decline in the standardized mortality rate (AAPC=-5.41) and the slowest decline in the standardized prevalence rate (AAPC=-0.76) among children and adolescents. The results of the Joinpoint burden trend analysis demonstrated that the standardized incidence rate of injuries showed an increasing trend from 2005 to 2021, and the standardized prevalence rate of injuries showed an increasing trend from 2006 to 2021. Among the different age groups, the disease burden of injuries was highest in the 15-19-year-old group in 2021. For different types of injuries, the standardized incidence rate, standardized mortality rate, and standardized DALYs rate of unintentional injury were higher than those of transport injury, and self-harm and interpersonal violence from 1990 to 2021. The BAPC prediction model showed that the standardized incidence rate (4 833.05/100 000-5 313.70/100 000) and standardized prevalence rate (5 433.90/100 000-5 821.88/100 000) of injury showed an increasing trend, and the standardized mortality rate (13.69/100 000-5.52/100 000) and the standardized DALYs rate (1 226.37/100 000-510.14/100 000) showed a decreasing trend during 2022-2031. The analysis of influencing factors found that children and adolescents who drank alcohol were at high risk of injury burden.

Conclusions

From 1990 to 2021, the injury burden of children and adolescents in China generally showed a downward trend. The standardized incidence rate and standardized prevalence rate of injuries are predicted to increase from 2022 to 2031. More targeted and individualized intervention measures should be developed to reduce the injury burden in children and adolescents.

, authors=Xue JIN, Yangguang CAO, Baozhu LI*, authorsList=Xue JIN, Yangguang CAO, Baozhu LI, authorCompany=null, correspAuthors=Baozhu LI, authorNote=null, correspAuthorsNote=null, copyrightStatement=Copyright ©2025 Chinese Journal of School Health. All rights reserved., 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=1325501984970768508, articleId=1325501980851961975, tenantId=1146029695717560320, journalId=1256213402557890569, language=CN, title=中国儿童青少年1990—2021年伤害负担趋势分析与预测, columnId=1325500884628677558, journalTitle=中国学校卫生, columnName=疾病控制, runingTitle=null, highlight=null, articleAbstract=
目的

评估中国儿童青少年1990—2021年伤害疾病负担现状和未来变化趋势，为中国儿童青少年的伤害预防与控制提供参考。

方法

利用2021年全球疾病、伤害和风险因素负担研究(GBD 2021)数据，通过Joinpoint回归模型分析1990—2021年中国儿童青少年伤害疾病负担变化趋势。采用贝叶斯年龄-时期-队列模型(BAPC)对中国儿童青少年2022—2031年伤害疾病负担进行预测。

结果

1990—2021年，中国儿童青少年伤害的标化发生率、标化患病率、标化死亡率和标化残疾调整寿命年(DALYs)率总体均呈下降趋势(AAPC分别为-1.14%，-0.76%，-5.41%，-5.03%，P值均 < 0.05)。对于不同性别儿童青少年，1990和2021年男性伤害的标化发生率(7 106.00/10万，5 388.00/10万)、标化死亡率(92.00/10万，19.00/10万)和标化DALYs率(7 834.00/10万，1 673.00/10万)均高于女性(5 188.00/10万，3 874.00/10万；61.00/10万，10.00/10万；5 398.00/10万，945.00/10万)。与亚洲和全球相比，中国儿童青少年标化死亡率下降速度最快(AAPC=-5.41)，标化患病率下降速度最慢(AAPC=-0.76)(P值均＜0.05)。Joinpoint负担趋势分析结果表明，伤害的标化发生率在2005—2021年呈现上升趋势, 标化患病率在2006—2021年呈现上升趋势。在不同年龄组中，2021年15~19岁组伤害疾病负担最高。对于不同类型伤害，1990—2021年意外伤害的标化发生率、标化死亡率和标化DALYs率均高于交通伤害与自残和人际暴力。BAPC预测模型显示，2022—2031年中国儿童青少年伤害的标化发生率(4 833.05/10万~5 313.70/10万)、标化患病率(5 433.90/10万~5 821.88/10万)呈上升趋势，标化死亡率(13.69/10万~5.52/10万)和标化DALYs率(1 226.37/10万~510.14/10万)呈下降趋势。影响因素分析发现饮酒的儿童青少年是伤害负担的高危人群。

结论

1990—2021年中国儿童青少年伤害负担总体呈下降趋势，经预测2022—2031年伤害标化发生率和标化患病率呈上升趋势；应制定更有针对性和个性化的预防干预措施，以减轻儿童青少年的伤害负担。

, authors=金雪, 曹阳光, 李宝珠*, authorsList=金雪, 曹阳光, 李宝珠, authorCompany=null, correspAuthors=李宝珠, authorNote=

金雪(1998-)，女，安徽亳州人，在读硕士，主要研究方向为慢性病流行病学

, correspAuthorsNote=
李宝珠，E-mail:
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金雪(1998-)，女，安徽亳州人，在读硕士，主要研究方向为慢性病流行病学

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(2024-05-16)[2025-01-13]. https://www.healthdata.org/research-analysis/diseases-injuries-risks/factsheets-hierarchy#injuries., articleTitle=null, refAbstract=null)], funds=[Fund(id=1325502003060801704, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325501980851961975, awardId=null, language=CN, fundingSource=合肥综合性国家科学中心大健康研究院健康大数据与群体医学研究所科研项目(JKS2022023)；安徽省临床医学科研转化项目(202304295107020026)；安徽省教育厅高校科研计划项目(2023AH030119), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1325501986375860349, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325501980851961975, xref=null, ext=[AuthorCompanyExt(id=1325501986593964158, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325501980851961975, companyId=1325501986375860349, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Public Health, Anhui Medical University/Center for Big Data and Population Health of IHM, Hefei (230032), Anhui Province, China), AuthorCompanyExt(id=1325501986623324287, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325501980851961975, companyId=1325501986375860349, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=安徽医科大学公共卫生学院/合肥大健康研究院健康大数据与群体医学研究所，合肥 230032)])], figs=[ArticleFig(id=1325501995062263964, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325501980851961975, language=EN, label=Fig.1, caption=Changes in disease burden of different injuries types among children and adolescents in China from 1990 to 2021, figureFileSmall=iJeBY82ZC3HHI3bYcili2Q==, figureFileBig=P6BUxrFq6S/AbXv5IFIg9Q==, tableContent=null), ArticleFig(id=1325501995485888669, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325501980851961975, language=CN, label=图1, caption=中国儿童青少年1990—2021年不同类型伤害疾病负担变化, figureFileSmall=iJeBY82ZC3HHI3bYcili2Q==, figureFileBig=P6BUxrFq6S/AbXv5IFIg9Q==, tableContent=null), ArticleFig(id=1325501998023442590, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325501980851961975, language=EN, label=Tab.1, caption=

Comparison of disease burden of injuries among children and adolescents in China, Asia and globally in 1990 and 2021/10-5

, figureFileSmall=null, figureFileBig=null, tableContent=
指标性别中国亚洲全球
1990年2021年1990年2021年1990年2021年
标化发生率男7 106.00(5 899.00~8 485.00)5 388.00(4 422.00~6 478.00)8 932.00(7 710.00~10 340.00)6 621.00(5 730.00~7 637.00)12 127.00(10 433.00~14 114.00)8 035.00(6 927.00~9 313.00)
女5 188.00(4 356.00~6 105.00)3 874.00(3 146.00~4 717.00)7 141.00(6 105.00~8 343.00)5 308.00(4 494.00~6 242.00)8 703.00(7 426.00~10 162.00)6 177.00(5 228.00~7 258.00)
合计6 180.96(5 163.73~7 335.88)4 683.75(3 850.85~5 631.09)8 061.64(6 937.93~9 357.34)5 991.88(5 157.00~6 950.22)10 449.36(8 960.22~12 159.93)7 132.89(6 108.79~8 283.90)
标化患病率男5 991.00(5 291.00~6 896.00)4 630.00(3 963.00~5 471.00)6 100.00(5 477.00~6 853.00)4 667.00(4 141.00~5 325.00)7 291.00(6 616.00~8 142.00)5 103.00(4 587.00~5 740.00)
女6 956.00(5 832.00~8 417.00)5 792.00(4 680.00~7 259.00)6 297.00(5 481.00~7 341.00)4 820.00(4 140.00~5 658.00)6 835.00(6 040.00~7 792.00)5 128.00(4 468.00~5 940.00)
合计6 459.62(5 578.09~7 574.38)5 169.93(4 315.48~6 265.35)6 195.74(5 486.47~7 063.51)4 739.93(4 158.36~5 465.59)7 067.89(6 356.25~7 916.64)5 114.82(4 540.63~5 822.08)
标化死亡率男92.00(78.00~108.00)19.00(16.00~23.00)73.00(65.00~81.00)27.00(24.00~31.00)72.00(65.00~79.00)31.00(26.00~35.00)
女61.00(52.00~72.00)10.00(8.00~12.00)49.00(43.00~55.00)16.00(13.00~18.00)44.00(39.00~49.00)17.00(14.00~20.00)
合计76.99(66.45~89.39)14.97(12.54~17.63)61.47(55.06~68.04)21.69(19.08~24.50)58.49(52.90~63.90)23.95(20.20~27.68)
标化DALYs率男7 834.00(6 663.00~9 214.00)1 673.00(1 393.00~1 993.00)6 229.00(5 539.00~6 931.00)2 308.00(2 042.00~2 611.00)6 165.00(5 562.00~6 748.00)2 613.00(2 228.00~3 000.00)
女5 398.00(4 631.00~6 300.00)945.00(797.00~1 118.00)4 315.00(3 826.00~4 845.00)1 403.00(1 209.00~1 625.00)3 936.00(3 511.00~4 367.00)1 530.00(1 266.00~1 806.00)
合计6 663.79(5 751.29~7 729.08)1 334.33(1 135.51~1 552.92)5 302.94(4 760.78~5 879.22)1 874.70(1 657.39~2 125.77)5 075.89(4 591.14~5 560.91)2 087.26(1 779.07~2 417.93)
), ArticleFig(id=1325501998338015391, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325501980851961975, language=CN, label=表1, caption=

中国、亚洲和全球儿童青少年伤害疾病负担1990和2021年比较/10-5

, figureFileSmall=null, figureFileBig=null, tableContent=
指标性别中国亚洲全球
1990年2021年1990年2021年1990年2021年
标化发生率男7 106.00(5 899.00~8 485.00)5 388.00(4 422.00~6 478.00)8 932.00(7 710.00~10 340.00)6 621.00(5 730.00~7 637.00)12 127.00(10 433.00~14 114.00)8 035.00(6 927.00~9 313.00)
女5 188.00(4 356.00~6 105.00)3 874.00(3 146.00~4 717.00)7 141.00(6 105.00~8 343.00)5 308.00(4 494.00~6 242.00)8 703.00(7 426.00~10 162.00)6 177.00(5 228.00~7 258.00)
合计6 180.96(5 163.73~7 335.88)4 683.75(3 850.85~5 631.09)8 061.64(6 937.93~9 357.34)5 991.88(5 157.00~6 950.22)10 449.36(8 960.22~12 159.93)7 132.89(6 108.79~8 283.90)
标化患病率男5 991.00(5 291.00~6 896.00)4 630.00(3 963.00~5 471.00)6 100.00(5 477.00~6 853.00)4 667.00(4 141.00~5 325.00)7 291.00(6 616.00~8 142.00)5 103.00(4 587.00~5 740.00)
女6 956.00(5 832.00~8 417.00)5 792.00(4 680.00~7 259.00)6 297.00(5 481.00~7 341.00)4 820.00(4 140.00~5 658.00)6 835.00(6 040.00~7 792.00)5 128.00(4 468.00~5 940.00)
合计6 459.62(5 578.09~7 574.38)5 169.93(4 315.48~6 265.35)6 195.74(5 486.47~7 063.51)4 739.93(4 158.36~5 465.59)7 067.89(6 356.25~7 916.64)5 114.82(4 540.63~5 822.08)
标化死亡率男92.00(78.00~108.00)19.00(16.00~23.00)73.00(65.00~81.00)27.00(24.00~31.00)72.00(65.00~79.00)31.00(26.00~35.00)
女61.00(52.00~72.00)10.00(8.00~12.00)49.00(43.00~55.00)16.00(13.00~18.00)44.00(39.00~49.00)17.00(14.00~20.00)
合计76.99(66.45~89.39)14.97(12.54~17.63)61.47(55.06~68.04)21.69(19.08~24.50)58.49(52.90~63.90)23.95(20.20~27.68)
标化DALYs率男7 834.00(6 663.00~9 214.00)1 673.00(1 393.00~1 993.00)6 229.00(5 539.00~6 931.00)2 308.00(2 042.00~2 611.00)6 165.00(5 562.00~6 748.00)2 613.00(2 228.00~3 000.00)
女5 398.00(4 631.00~6 300.00)945.00(797.00~1 118.00)4 315.00(3 826.00~4 845.00)1 403.00(1 209.00~1 625.00)3 936.00(3 511.00~4 367.00)1 530.00(1 266.00~1 806.00)
合计6 663.79(5 751.29~7 729.08)1 334.33(1 135.51~1 552.92)5 302.94(4 760.78~5 879.22)1 874.70(1 657.39~2 125.77)5 075.89(4 591.14~5 560.91)2 087.26(1 779.07~2 417.93)
), ArticleFig(id=1325501998497398944, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325501980851961975, language=EN, label=Tab.2, caption=

Trend analysis of Joinpoint burden for children and adolescents injuries in China from 1990 to 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
指标趋势1趋势2趋势3整体趋势
年份APC(95%CI)年份APC(95%CI)年份APC(95%CI)年份APC(95%CI)
标化发生率1990—2001-0.80(-2.06~0.49)2001—2005-8.81(-16.15~-0.83)2005—20210.64(0.01~1.27)1990—2021-1.14(-2.28~0.01)
标化患病率1990—2000-0.58(-0.69~-0.46)2000—2006-3.44(-3.79~-3.09)2006—20210.20(0.13~0.28)1990—2021-0.76(-0.84~-0.68)
标化死亡率1990—2008-4.07(-4.44~-3.69)2008—2021-7.24(-7.89~-6.59)——1990—2021-5.41(-5.75~-5.08)
标化DALYs率1990—1997-2.14(-2.84~-1.44)1997—2008-4.80(-5.11~-4.47)2008—2021-6.76(-7.01~-6.50)1990—2021-5.03(-5.24~-4.82)
), ArticleFig(id=1325501998862303393, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325501980851961975, language=CN, label=表2, caption=

中国儿童青少年1990—2021年伤害Joinpoint负担趋势分析

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指标趋势1趋势2趋势3整体趋势
年份APC(95%CI)年份APC(95%CI)年份APC(95%CI)年份APC(95%CI)
标化发生率1990—2001-0.80(-2.06~0.49)2001—2005-8.81(-16.15~-0.83)2005—20210.64(0.01~1.27)1990—2021-1.14(-2.28~0.01)
标化患病率1990—2000-0.58(-0.69~-0.46)2000—2006-3.44(-3.79~-3.09)2006—20210.20(0.13~0.28)1990—2021-0.76(-0.84~-0.68)
标化死亡率1990—2008-4.07(-4.44~-3.69)2008—2021-7.24(-7.89~-6.59)——1990—2021-5.41(-5.75~-5.08)
标化DALYs率1990—1997-2.14(-2.84~-1.44)1997—2008-4.80(-5.11~-4.47)2008—2021-6.76(-7.01~-6.50)1990—2021-5.03(-5.24~-4.82)
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Disease burden of injuries in children and adolescents of different age groups in China from 1990 to 2021/10-5

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年龄组/岁年份发生率患病率
男女合计男女合计
< 519908 573.737 766.258 194.262 139.871 985.442 061.95
20214 591.803 768.184 209.651 068.37901.24990.82
5~919906 060.854 324.675 227.734 532.584 889.664 703.93
20214 708.393 414.554 102.783 157.983 625.193 376.67
10~1419906 128.194 082.145 138.237 235.078 371.907 785.11
20215 360.743 881.844 670.985 686.017 097.196 344.19
15~1919907 606.234 272.295 983.9811 206.6414 022.2012 576.66
20217 173.714 529.565 948.909 516.0612 823.4211 048.08
年龄组/岁年份死亡率DALYs率
男女合计男女合计
< 51990167.94147.96158.5514 880.6613 137.2414 061.34
202120.1115.1017.791 825.221 376.921 617.21
5~9199074.4034.1255.076 342.533 003.054 740.05
202115.697.9712.081 389.67746.801 088.76
10~14199046.4022.0234.603 855.211 963.392 939.88
202114.886.4210.931 485.26741.721 116.13
15~19199068.5229.8449.705 352.852 539.653 983.98
202127.389.9319.302 222.16971.101 642.65
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中国不同年龄组儿童青少年1990—2021伤害疾病负担情况/10-5

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年龄组/岁年份发生率患病率
男女合计男女合计
< 519908 573.737 766.258 194.262 139.871 985.442 061.95
20214 591.803 768.184 209.651 068.37901.24990.82
5~919906 060.854 324.675 227.734 532.584 889.664 703.93
20214 708.393 414.554 102.783 157.983 625.193 376.67
10~1419906 128.194 082.145 138.237 235.078 371.907 785.11
20215 360.743 881.844 670.985 686.017 097.196 344.19
15~1919907 606.234 272.295 983.9811 206.6414 022.2012 576.66
20217 173.714 529.565 948.909 516.0612 823.4211 048.08
年龄组/岁年份死亡率DALYs率
男女合计男女合计
< 51990167.94147.96158.5514 880.6613 137.2414 061.34
202120.1115.1017.791 825.221 376.921 617.21
5~9199074.4034.1255.076 342.533 003.054 740.05
202115.697.9712.081 389.67746.801 088.76
10~14199046.4022.0234.603 855.211 963.392 939.88
202114.886.4210.931 485.26741.721 116.13
15~19199068.5229.8449.705 352.852 539.653 983.98
202127.389.9319.302 222.16971.101 642.65
), ArticleFig(id=1325501999743107236, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325501980851961975, language=EN, label=Tab.4, caption=

Prediction of disease burden of injuries in children and adolescents in China from 2022 to 2031/10-5

, figureFileSmall=null, figureFileBig=null, tableContent=
年份标化发生率标化患病率标化死亡率标化DALYs率
20224 833.055 433.9013.691 226.37
20234 926.325 523.4412.481 122.94
20245 006.885 599.8411.341 024.60
20255 077.275 658.2710.28932.35
20265 136.755 696.189.30846.81
20275 186.455 717.808.41767.83
20285 227.845 733.777.59695.31
20295 262.185 755.046.84628.62
20305 290.615 784.686.15567.04
20315 313.705 821.885.52510.14
), ArticleFig(id=1325502001714430117, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325501980851961975, language=CN, label=表4, caption=

中国儿童青少年2022—2031年伤害疾病负担预测/10-5

, figureFileSmall=null, figureFileBig=null, tableContent=
年份标化发生率标化患病率标化死亡率标化DALYs率
20224 833.055 433.9013.691 226.37
20234 926.325 523.4412.481 122.94
20245 006.885 599.8411.341 024.60
20255 077.275 658.2710.28932.35
20265 136.755 696.189.30846.81
20275 186.455 717.808.41767.83
20285 227.845 733.777.59695.31
20295 262.185 755.046.84628.62
20305 290.615 784.686.15567.04
20315 313.705 821.885.52510.14
), ArticleFig(id=1325502002125471910, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325501980851961975, language=EN, label=Tab.5, caption=

Influence factors of injuries among children and adolescents in China in 1990 and 2021

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影响因素死亡率DALYs率
1990年/10-52021年/10-5变化率/%1990年/10-52021年/10-5变化率/%
环境因素-1.93-0.30-84.46-182.03-22.95-87.39
  非最佳温度-7.06-1.07-84.84-588.74-85.67-85.45
  职业风险4.720.72-84.75377.1459.39-84.25
行为因素0.450.32-28.8945.5832.51-28.67
  用药0.04< 0.01-91.412.650.25-90.57
  饮酒0.280.293.5722.2623.837.05
  亲密伴侣间暴力0.140.02-85.7120.728.44-59.27
), ArticleFig(id=1325502002540708007, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325501980851961975, language=CN, label=表5, caption=

中国儿童青少年1990和2021年伤害负担的影响因素

, figureFileSmall=null, figureFileBig=null, tableContent=
影响因素死亡率DALYs率
1990年/10-52021年/10-5变化率/%1990年/10-52021年/10-5变化率/%
环境因素-1.93-0.30-84.46-182.03-22.95-87.39
  非最佳温度-7.06-1.07-84.84-588.74-85.67-85.45
  职业风险4.720.72-84.75377.1459.39-84.25
行为因素0.450.32-28.8945.5832.51-28.67
  用药0.04< 0.01-91.412.650.25-90.57
  饮酒0.280.293.5722.2623.837.05
  亲密伴侣间暴力0.140.02-85.7120.728.44-59.27
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中国儿童青少年1990—2021年伤害负担趋势分析与预测
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金雪 , 曹阳光 , 李宝珠 *
中国学校卫生 | 疾病控制 2025,46(3): 406-411
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中国学校卫生 |疾病控制 2025 , 46 (3) : 406 -411
中国儿童青少年1990—2021年伤害负担趋势分析与预测
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金雪(1998-)，女，安徽亳州人，在读硕士，主要研究方向为慢性病流行病学

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金雪, 曹阳光, 李宝珠*
作者信息
  • 安徽医科大学公共卫生学院/合肥大健康研究院健康大数据与群体医学研究所，合肥 230032
通讯作者:
李宝珠，E-mail:
作者简介:

金雪(1998-)，女，安徽亳州人，在读硕士，主要研究方向为慢性病流行病学

Trend analysis and prediction of injury burden among children and adolescents in China from 1990 to 2021
Xue JIN, Yangguang CAO, Baozhu LI*
Affiliations
  • School of Public Health, Anhui Medical University/Center for Big Data and Population Health of IHM, Hefei (230032), Anhui Province, China
出版时间: 2025-03-25 doi: 10.16835/j.cnki.1000-9817.2025089
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摘要
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目的

评估中国儿童青少年1990—2021年伤害疾病负担现状和未来变化趋势，为中国儿童青少年的伤害预防与控制提供参考。

方法

利用2021年全球疾病、伤害和风险因素负担研究(GBD 2021)数据，通过Joinpoint回归模型分析1990—2021年中国儿童青少年伤害疾病负担变化趋势。采用贝叶斯年龄-时期-队列模型(BAPC)对中国儿童青少年2022—2031年伤害疾病负担进行预测。

结果

1990—2021年，中国儿童青少年伤害的标化发生率、标化患病率、标化死亡率和标化残疾调整寿命年(DALYs)率总体均呈下降趋势(AAPC分别为-1.14%，-0.76%，-5.41%，-5.03%，P值均 < 0.05)。对于不同性别儿童青少年，1990和2021年男性伤害的标化发生率(7 106.00/10万，5 388.00/10万)、标化死亡率(92.00/10万，19.00/10万)和标化DALYs率(7 834.00/10万，1 673.00/10万)均高于女性(5 188.00/10万，3 874.00/10万；61.00/10万，10.00/10万；5 398.00/10万，945.00/10万)。与亚洲和全球相比，中国儿童青少年标化死亡率下降速度最快(AAPC=-5.41)，标化患病率下降速度最慢(AAPC=-0.76)(P值均＜0.05)。Joinpoint负担趋势分析结果表明，伤害的标化发生率在2005—2021年呈现上升趋势, 标化患病率在2006—2021年呈现上升趋势。在不同年龄组中，2021年15~19岁组伤害疾病负担最高。对于不同类型伤害，1990—2021年意外伤害的标化发生率、标化死亡率和标化DALYs率均高于交通伤害与自残和人际暴力。BAPC预测模型显示，2022—2031年中国儿童青少年伤害的标化发生率(4 833.05/10万~5 313.70/10万)、标化患病率(5 433.90/10万~5 821.88/10万)呈上升趋势，标化死亡率(13.69/10万~5.52/10万)和标化DALYs率(1 226.37/10万~510.14/10万)呈下降趋势。影响因素分析发现饮酒的儿童青少年是伤害负担的高危人群。

结论

1990—2021年中国儿童青少年伤害负担总体呈下降趋势，经预测2022—2031年伤害标化发生率和标化患病率呈上升趋势；应制定更有针对性和个性化的预防干预措施，以减轻儿童青少年的伤害负担。

创伤和损伤  /  患病代价  /  回归分析  /  儿童  /  青少年
Objective

To evaluate the prevalence and future trend of change of the disease burden of injuries in Chinese children and adolescents from 1990 to 2021, so as to provide reference for injury prevention and control in this population.

Methods

Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 (GBD 2021), the trend of change in the disease burden of injuries in children and adolescents in China from 1990 to 2021 was analyzed by the Joinpoint regression model. The Bayesian age period cohort model (BAPC) was used to predict the disease burden of injuries among children and adolescents in China from 2022 to 2031.

Results

From 1990 to 2021, the standardized incidence rate, standardized prevalence rate, standardized mortality rate, and standardized disability-adjusted life years (DALYs) rate of injuries among children and adolescents in China showed an overall downward trend (AAPC=-1.14%, -0.76%, -5.41%, -5.03%, P < 0.05). For different genders, the standardized incidence rate (7 106.00/100 000, 5 388.00/100 000), standardized mortality rate (92.00/100 000, 19.00/100 000), and standardized DALYs rate (7 834.00/100 000, 1 673.00/100 000) of injuries in boys were higher than the rate of injuries in girls in 1990 and 2021 (5 188.00/100 000, 3 874.00/100 000; 61.00/100 000, 10.00/100 000; 5 398.00/100 000, 945.00/100 000). Compared with Asia and globally, China had the fastest decline in the standardized mortality rate (AAPC=-5.41) and the slowest decline in the standardized prevalence rate (AAPC=-0.76) among children and adolescents. The results of the Joinpoint burden trend analysis demonstrated that the standardized incidence rate of injuries showed an increasing trend from 2005 to 2021, and the standardized prevalence rate of injuries showed an increasing trend from 2006 to 2021. Among the different age groups, the disease burden of injuries was highest in the 15-19-year-old group in 2021. For different types of injuries, the standardized incidence rate, standardized mortality rate, and standardized DALYs rate of unintentional injury were higher than those of transport injury, and self-harm and interpersonal violence from 1990 to 2021. The BAPC prediction model showed that the standardized incidence rate (4 833.05/100 000-5 313.70/100 000) and standardized prevalence rate (5 433.90/100 000-5 821.88/100 000) of injury showed an increasing trend, and the standardized mortality rate (13.69/100 000-5.52/100 000) and the standardized DALYs rate (1 226.37/100 000-510.14/100 000) showed a decreasing trend during 2022-2031. The analysis of influencing factors found that children and adolescents who drank alcohol were at high risk of injury burden.

Conclusions

From 1990 to 2021, the injury burden of children and adolescents in China generally showed a downward trend. The standardized incidence rate and standardized prevalence rate of injuries are predicted to increase from 2022 to 2031. More targeted and individualized intervention measures should be developed to reduce the injury burden in children and adolescents.

Wounds and injuries  /  Cost of illness  /  Regression analysis  /  Child  /  Adolescent
金雪, 曹阳光, 李宝珠. 中国儿童青少年1990—2021年伤害负担趋势分析与预测. 中国学校卫生, 2025 , 46 (3) : 406 -411 . DOI: 10.16835/j.cnki.1000-9817.2025089
Xue JIN, Yangguang CAO, Baozhu LI. Trend analysis and prediction of injury burden among children and adolescents in China from 1990 to 2021[J]. Chinese Journal of School Health, 2025 , 46 (3) : 406 -411 . DOI: 10.16835/j.cnki.1000-9817.2025089
正文
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伤害是全世界儿童青少年死亡和残疾的主要原因[1]。由于特定的行为模式和生长发育的特点，20岁以下的儿童青少年更易于涉及伤害事件[2]。伤害的高发率和高致残性特征消耗了大量的卫生资源，给个人、家庭和社会带来巨大的疾病负担和经济损失[3]。越来越多的研究已关注到伤害造成的疾病负担[4-6]，但现有研究以关注单一伤害亚类的分析为主[7-9]。为促进儿童青少年健康成长，保障儿童青少年生存和发展权利的实现，迫切需要掌握中国儿童和青少年伤害疾病负担现状和趋势。为此，本研究使用2021年全球疾病、伤害和风险因素负担研究(Global Burden of Disease, Injuries, and Risk Factors Study 2021, GBD 2021)数据报告中国儿童青少年1990—2021年伤害疾病负担现状及趋势，并对2022—2031年伤害负担趋势进行预测，为深入开展儿童青少年伤害预防控制政策和分配合理有效的医疗卫生资源提供科学依据和建议。
1　资料来源与方法
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1.1　资料来源
本研究中使用的数据来自GBD 2021数据集。GBD 2021综合文献研究、监测和调查信息、住院和门诊数据、医疗保险情况等信息，评估1980—2021年204个国家地区369种疾病、伤害和87种危险因素的发生率、患病率、死亡率和残疾调整寿命年(isability-adjusted life years, DALYs)率[10]。在数据选择时，本研究选择的伤害类别包括1级伤害原因“injuries”以及2级伤害原因“transport injuries”“unintentional injuries”和“self-harm and interpersonal injuries”，地区为“China”，年份为“1990—2021”，筛选指标为“incidence”“prevalence”“deaths”和“DALYs”，性别为“male”“female”和“both”，年龄段为“ < 5 years”“5-9 years”“10-14 years”“15-19 years”。影响因素分析数据来自于“Risk factor”模块，影响因素类别选择包括1级和2级因素。本研究使用的GBD 2021数据可从 https://vizhub.healthdata.org/gbd-results/公开获取，遵循准确和透明的健康评估报告指南[11]。
1.2　分析指标
本研究将筛选出的中国儿童青少年伤害的发生率、患病率、死亡率和DALYs率根据世界标准人口结构计算其年龄标化率，评价伤害负担情况。在进行伤害的不同年龄组比较时，使用标化前的率；进行伤害的地区比较、Joinpoint负担趋势分析、不同伤害类型分析、伤害预测和影响因素分析时，使用标化后的率。变化率=(2021年的率-1990年的率)/1990年的率×100%。使用Joinpoint软件计算平均年度百分比变化(annual percentage change，AAPC)和年度变化百分比(average annual change，APC)及其相应的95%不确定性区间(95%UI)，以确定疾病的负担趋势。建立贝叶斯年龄-时期-队列模型(Bayesian age period cohort model, BAPC)预测2022—2031年中国儿童青少年伤害疾病负担。
1.3　统计学分析
使用R 4.4.1和Excel 2021软件对数据进行处理。使用Joinpoint 5.2.0软件进行时间趋势分析。Joinpoint回归模型常用于数据时间趋势变化识别，是通过拟合直线的方法计算变化趋势，趋势变化速率用APC和AAPC表示，当APC>0时，表明数据呈上升趋势；APC < 0时，表明数据呈下降趋势；当数据无转折点时，APC=AAPC[12]。BAPC模型假设年龄、时期和队列效应在相邻时间相似，并使用二阶随机游走来平滑年龄、时期和队列效应的先验值，以预测后验发病率等指标。为进一步评估BAPC模型的拟合效果，本研究采用1990—2015年的相应疾病负担数据作为训练集，2016—2021年疾病负担数据(约占总数据量的20%)作为测试集检验该模型对外部数据的预测能力。均方根误差(root mean square error, RMSE)、平均绝对误差(mean absolute error, MAE)和决定系数(R2)作为评价模型预测效果的指标。检验水准α=0.05。
2　结果
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2.1　中国、亚洲和全球儿童青少年1990—2021年伤害负担变化情况
由表1可知，与1990年相比，2021年中国儿童青少年伤害标化发生率、标化患病率、标化死亡率和标化DALYs率均有所下降。2021年，中国儿童青少年除伤害标化患病率高于亚洲和全球外，其他指标均低于亚洲和全球。1990—2021年，与亚洲和全球相比，中国儿童青少年标化死亡率下降速度最快(AAPC=-5.41)，标化患病率下降速度最慢(AAPC=-0.76)(P值均 < 0.05)。对于不同性别，1990和2021年中国男性儿童青少年中除标化患病率外，其他指标均高于女性。2021年，中国儿童青少年中除女性标化患病率高于亚洲和全球外，男女性的其他指标均低于亚洲和全球。
2.2　中国儿童青少年1990—2021年伤害疾病负担趋势分析
1990—2021年中国儿童青少年伤害的标化发生率、标化患病率、标化死亡率和标化DALYs率均有降低趋势，AAPC分别为-1.14%，-0.76%，-5.41%和-5.03%，差异均有统计学意义(P值均 < 0.05)。其中，标化发生率在2005—2021年呈现上升趋势，平均每年增长0.64%；标化患病率在2006—2021年呈现上升趋势，平均每年增长0.20%。见表2。
2.3　中国不同年龄组儿童青少年1990—2021年伤害疾病负担变化情况
见表3。
在4个年龄组中，2021年15~19岁伤害发生率、患病率、死亡率和DALYs率最高，分别为5 948.90/10万，11 048.08/10万，19.30/10万和1 642.65/10万。2021年5~9岁伤害发生率和DALYs率最低，分别为4 102.78/10万和1 088.76/10万；伤害患病率和死亡率最低的年龄组分别为 < 5和10~14岁，分别为990.92/10万和10.93/10万。从1990—2021年各指标率的变化来看， < 5岁年龄组变化最大，其男、女生及总体死亡率的变化率分别为-88.03%，-89.79%和-88.78%。
2.4　中国儿童青少年1990—2021年不同类型伤害疾病负担变化情况
1990—2021年，中国儿童青少年总伤害和3种类型伤害(自残和人际暴力、交通伤害、意外伤害)的标化发生率、标化患病率、标化死亡率和标化DALYs率总体上均呈下降趋势。但总伤害和3种类型伤害的标化发生率和标化患病率随年份先下降后上升，在2008年时出现反弹。意外伤害的标化发生率、标化死亡率和标化DALYs率高于自残和人际暴力、交通伤害，自残和人际暴力的标化患病率高于意外伤害和交通伤害。见图1。
2.5　中国儿童青少年2022—2031年伤害疾病负担预测
见表4。
BAPC模型在测试集上的拟合效果验证结果显示，伤害标化发生率(R2=0.77，RMSE=130.92，MAE=109.68)模型的预测效果基本满足要求；标化患病率(R2=0.88，RMSE=135.35，MAE=117.08)，标化死亡率(R2=0.98，RMSE=0.84，MAE=0.75)和标化DALYs率(R2=0.98，RMSE=80.26，MAE=74.38)模型的预测效果较好。经预测，2022—2031年伤害的标化发生率、标化患病率均呈上升趋势，而标化死亡率和标化DALYs率均呈下降趋势。到2031年标化发生率、标化患病率、标化死亡率和标化DALYs率分别为5 313.70/10万、5 821.88/10万、5.52/10万和510.14/10万。
2.6　中国儿童青少年1990和2021年伤害负担的影响因素比较
GBD 2021根据流行病学证据确定各风险因素的理论标准风险暴露水平，从而计算人群归因分值[13]。人群归因分值=(暴露人群的疾病负担-理论暴露水平下的疾病负担)/总疾病负担。伤害的1级影响因素包括环境因素和行为因素两类。环境因素包括非最佳温度和职业风险等2级影响因素，行为因素包括用药、饮酒和亲密伴侣间暴力等2级影响因素。与1990年相比，2021年饮酒行为导致的伤害负担增加，死亡率从1990年的0.28/10万增加到2021年的0.29/10万，变化率为3.57%；DALYs率从1990年的22.26/10万增加到2021年的23.83/10万，变化率为7.05%。在2级影响因素中，2021年导致中国儿童青少年伤害负担(包括死亡率和DALYs率)居于前3位的分别是职业风险、饮酒和亲密伴侣间暴力。见表5。
3　讨论
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本研究结果显示，1990—2021年中国儿童青少年伤害的疾病负担总体呈下降趋势。但标化发生率在2005—2021年呈上升趋势，标化患病率在2006—2021年呈上升趋势。1990年以来，中国儿童青少年的受教育水平、经济状况和社会支持均得到显著的进步和完善[14-15]，所以中国儿童青少年的伤害负担总量总体是在下降。但城市化进程加快、生活方式转变和心理健康问题的突显，使儿童青少年这一弱势人群承担更多的伤害负担，伤害发生率和患病率也在缓慢上升。
本研究结果显示，15~19岁青少年伤害疾病负担较其他年龄组高。15~19岁的青少年处于由儿童阶段发展为成人阶段的过渡时期，学业任务加重和独立自主意识增强带来的心理问题使其自杀意念检出率高，更容易造成自残和人际暴力问题[16-17]。且该年龄段的青少年社会活动明显增多，由此带来的交通事故发生、致残和死亡也显著增多[18]。因此，应更多关注15~19岁青少年的心理健康问题，做好校园交通方面的宣教工作，预防和减少儿童青少年自残、暴力和交通伤害。
本研究通过构建BAPC模型对中国儿童青少年2022—2031年伤害疾病负担情况进行预测，结果显示伤害的标化发生率、标化患病率呈上升趋势，而标化死亡率和标化DALYs率呈下降趋势。提示尽管在整体医疗水平提升和公共卫生体系不断完善的作用下，儿童青少年伤害的致死性和严重程度可能有所降低，但伤害事件的发生频率和患病人数却在增加，可能与社会环境变化、生活方式改变以及儿童青少年活动范围扩大等多种因素有关。因此，未来需进一步加强伤害预防措施的实施，重点关注高发年龄段和高风险时期；同时优化医疗资源配置，提高对伤害的早期识别和干预能力，以有效应对儿童青少年伤害疾病负担的动态变化，保障其健康成长。
本研究通过比较1990和2021年中国儿童青少年伤害负担的影响因素，发现1990—2021年中国儿童青少年因饮酒行为造成的伤害负担增加，表明饮酒的儿童青少年是伤害负担的高危人群。儿童青少年作为弱势群体，本身面临着社会快速发展带来的危害，再加上对这一群体饮酒问题的关注不够，可以预见我国儿童青少年因饮酒行为造成的伤害负担会增高。提示应加大社会对儿童青少年饮酒行为的管控。
目前的研究尚有一定的局限性：GBD 2021中关于中国儿童和青少年伤害的数据是基于多个数据库的汇总，可能因为监测点覆盖不足而影响数据的精确性。但GBD 2021数据库已通过贝叶斯先验、正则化和修剪的元回归工具，将医疗质量和可及性指数作为协变量，对疾病发生原因的各率(发生率、患病率、死亡率和DALYs率)等进行建模来稳定地理差异[19]。这种工具模型能够有效处理数据中的异质性和不确定性，从而提供更准确的模型估计和预测。
基金
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  • 合肥综合性国家科学中心大健康研究院健康大数据与群体医学研究所科研项目(JKS2022023)；安徽省临床医学科研转化项目(202304295107020026)；安徽省教育厅高校科研计划项目(2023AH030119)
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参考文献 引证文献
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2025年第46卷第3期
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doi: 10.16835/j.cnki.1000-9817.2025089
  • 接收时间：2025-01-07
  • 首发时间：2026-11-06
  • 出版时间：2025-03-25
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  • 收稿日期：2025-01-07
  • 修回日期：2025-02-09
基金
合肥综合性国家科学中心大健康研究院健康大数据与群体医学研究所科研项目(JKS2022023)；安徽省临床医学科研转化项目(202304295107020026)；安徽省教育厅高校科研计划项目(2023AH030119)
作者信息
    安徽医科大学公共卫生学院/合肥大健康研究院健康大数据与群体医学研究所，合肥 230032

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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