Body pain and functional disability predict falls in Chinese older adults: a population-based cohort study.

BACKGROUND: Falls are major health care concerns for older adults. Pain is associated with increased falls in older adults. However, the impact of pain on functional disability and how this might predispose Chinese older adults to fall is unclear. AIM: The aim of the current study was to examine whether functional disability mediates the association of any pain, back and/or shoulder pain (B-S pain) and leg and/or knees pain (L-K pain) with falls and serious falls. METHODS: The study included 7619 community-dwelling older adults aged 60 years and above from the China Health and Retirement Longitudinal Study. Baseline data were from Wave 3 and fall outcomes were from Wave 4. Functional disability was measured by the ADLs and IADLs scales. We used a logistic regression model to investigate associations between pain and fall outcomes and KHB method to estimate the mediating effects of ADL/IADL disability on pain-fall relationship. RESULTS: After fully adjusting for covariates, the three pain measures (any pain, back and/or shoulder pain, leg and/or knees pain) were significantly associated with fall outcomes. When body pain was compared with no body pain, the proportion mediated by the ADL disability was 28.43% for falls, while the proportion mediated by IADL disability was 17.96% for falls. For associations between specific parts of body pain and falls, the proportions mediated by the ADL disability were 34.18% and 35.89% in back and/or shoulder pain and leg and/or knees pain, respectively, but the proportions reduced to 21.98% and 20.82% when mediated by the IADL disability. However, there were no significant contributions of ADL/IADL disability for the association between specific part of body pain and serious falls. CONCLUSIONS: Pain in general and pain in specific body sites were significantly associated with an increased risk of fall among older adults living in community in China. Functional disability partially mediated the relationship of pain with falls.

The efficacy of mind-body (Baduanjin) exercise on self-reported sleep quality and quality of life in elderly subjects with sleep disturbances: a randomized controlled trial.

OBJECTIVES: To examine the efficacy of a 24-week Baduanjin exercise program on self-reported sleep quality and quality of life in community-dwelling elderly subjects with sleep disturbances. METHODS: Community-dwelling elderly men and women meeting criteria for sleep disturbances (i.e., Pittsburgh Sleep Quality of Index (PSQI) score ≥ 5) were recruited and randomized to a Baduanjin exercise intervention group or a control group. Participants in the intervention group completed five 45-min exercise sessions per week for 24 weeks, while those in control group were instructed to maintain their usual lifestyle behaviors. RESULTS: A total of 139 participants were enrolled and randomized. Sixty-two of 67 participants in the intervention group (response rate of 92.5%) and 57 of 72 participants (response rate of 79.6%) in the control group completed intervention and follow-up. The intervention group reported significant improvements in overall sleep quality after 24 weeks compared with those randomized to control (PSQI endpoint-to-baseline change = - 2.6 ± 4.0 vs. - 0.5 ± 4.2, time × group interaction p = 0.007). Intervention group participants had higher response rates at both week 12 (23.9% vs. 9.7%, p = 0.025) and week 24 (40.3% vs. 15.3%, p = 0.001) when compared with the control group. There was a trend that the intervention group had increased quality of life (The Short Form Health Survey [SF-36] endpoint=tobaseline change 6.3 ± 10.9 vs. 2.2 ± 10.9, time × group interaction p = 0.06) when compared with the control group. CONCLUSIONS: Baduanjin exercise is an effective and feasible approach to improve self-reported sleep quality but less likely the quality of life in community-dwelling elderly men and women with sleep disturbances. TRIAL REGISTRATION: Effect of Baduanjin Exercise on the Elderly's Sleep; http://www.chictr.org.cn/listbycreater.aspx; ChiCTR1800014706, registered 1 January 2018.

Falls prevention interventions for community-dwelling older people living in mainland China: a narrative systematic review.

BACKGROUND: Falls in community-dwelling older people have been recognised as a significant public health issue in China given the rapidly growing aged population. Although there are several reviews documenting falls prevention programs for community-dwelling older adults, no systematic reviews of the scope and quality of falls prevention interventions in Mainland China exist. Therefore, the aim of this study was to systematically review falls prevention interventions for community-dwelling older people living in Mainland China. METHODS: We systematically reviewed literature from Chinese and English databases. All types of randomised controlled trials (RCTs) and quasi-experimental studies published from 1st January 1990 to 30th September 2019 were included. Observational studies and studies in care facilities and hospitals were excluded. Narrative synthesis was performed to summarise the key features of all included studies. Quality assessment was conducted using the Cochrane Risk of Bias Tool and ROBINS-I tool for randomised and non-randomised studies respectively. RESULTS: A total of 1020 studies were found, and 101 studies were included in the analysis. Overall, very few high quality studies were identified, and there was insufficient rigor to generate reliable evidence on the effectiveness of interventions or their scalability. Most interventions were multiple component interventions, and most studies focused on outcomes such as self-reported falls incidence or awareness of falls prevention. CONCLUSION: There is an opportunity to undertake an evaluation of a rigorously-designed, large-scale falls prevention program for community-dwelling older people in Mainland China. To help mitigate the rising burden of falls in Mainland China, recommendations for future falls prevention interventions have been made. These include: (1) target disadvantaged populations; (2) incorporate personalised interventions; and (3) investigate the effectiveness of those under-explored interventions, such as psychological, social environment, management of urinary incontinence, fluid or nutrition therapy and surgery. The study results will also potentially provide a useful evidence base for other low-and-middle income countries in a similar situation.

Violence prevalence and prevention status in China.

OBJECTIVES: To describe the prevalence status of violence and its prevention in China, and to provide reference for the development of strategies regarding violence prevention. METHODS: Violence mortality data between 2006 and 2015 were obtained from the national disease/death surveillance data set in 2006-2015. Data on violence-related medical cases were collected from the 2015 National Injury Surveillance System. The laws and policies about violence prevention and violence prevention programmes in China were described. RESULTS: Violence mortality declined by 57.02% during 2006-2015 from 1.21/100 000 to 0.52/100 000. Violent death rate in males peaked in the age group 25-29 years (1.05/100 000) and it was low in the age group <15 years. Female violence mortality rate peaked during infancy (0.54/100 000), aged 25-29 (0.53/100 000) and age above 85 (0.98/100 000). The laws and policies about violence prevention were more perfect, while most prevention programmes were limited in scale and duration. CONCLUSIONS: The mortality of violence declined in China during 2006-2015. It is necessary to conduct gender-specific prevention strategies and improve the data collection and prevention service.

Heatwaves increase road traffic injury morbidity risk and burden in China and its provinces.

Previous studies have demonstrated health impacts of climate change, but evidence on heatwaves' associations with road traffic injury (RTI) is limited. In this study, individual information of RTI cases in May-September during 2006-2021 in China were obtained from the National Injury Surveillance System. Daily maximum temperatures (TMmax) during 2006-2021 were collected from the ERA-5 reanalysis, and the projected daily TMmax during 2020-2099 were obtained from the latest Coupled Model Intercomparison Project Phase 6 Shared Socioeconomic Pathways scenarios (SSPs). We used a time-stratified case-crossover analysis to investigate the association between short-term exposure (lag01 days) to heatwaves (exceeding the 92.5th percentile of daily TMmax for ≥ three consecutive days) and RTI, and to project heatwave-related RTI until 2099 across China. Finally, a total of 1 031 082 RTI cases were included in the analyses. Compared with non-heatwaves, the risks of RTI increased by 3.61 % during heatwaves. Greater associations were found in people aged 15-64 years, in people with transportation occupation, for non-motor traffic vehicle injuries, for severe RTI cases, and in Western China particularly in Qinghai province. We projected substantial increases in attributable fraction (AF) of heatwave-related RTI in the future, particularly in Western and Southwest China. The national average increase in AF (per decade) during 2020s-2090s was 0.036 % for SSP1-2.6 scenario, and 0.267 % for SSP5-8.5 scenario. This study provided evidence on the associations of heatwaves with RTI, and the heatwave-related RTI will substantially increase in the future.

Effectiveness of Group-Based Interventions for Fall Prevention Among Community-Dwelling Older Adults - 7 Regions, 6 PLADs, China, 2019-2020.

What is already known about this topic?: Many of the current studies focusing on fall prevention interventions have been conducted in hospital settings within a select few urban areas in China, thus yielding limited evidence on the effectiveness of large-scale, multicenter, community-based interventions. What is added by this report?: In comparison to the control group, participants in the intervention group exhibited a 64% reduction in fall risk. Group-based fall prevention programs have demonstrated efficacy in mitigating fall risk among the elderly population. What are the implications for public health practice?: Group-based fall prevention interventions serve as a significant adjunctive resource for the management of elderly health within communities and offer compelling evidence to support the incorporation of fall prevention strategies into health policy frameworks in China.

Association between multimorbidity and falls and fear of falling among older adults in eastern China: a cross-sectional study.

Background: Growing evidence has reported an association between multimorbidity and falls and fear of falling (FOF) in older adults, however, the results regarding this association from China are limited. Our study aimed to investigate the association between multimorbidity and falls and FOF in older adults in eastern China. Methods: We conducted a cross-sectional study in Zhejiang Province, Eastern China, which recruited a provincial representative sample of adults aged ≥ 60 years. A structured questionnaire including demographic characteristics, chronic diseases, history of falls in the past 12 months, and FOF, was administered by all participants. The exposure variable was multimorbidity, which was defined as the presence of two or more chronic diseases and medical conditions in the same individual. The outcomes included a history of falls and FOF. Multivariate logistic regression was used to evaluate the association between multimorbidity and falls and FOF in older adults. Results: In total of 7,774 participants were included in the analysis, among whom 3,898 (50.1%) were female, with a mean ± standard deviation age is 72.9 ± 8.4 years. Multimorbidity was associated with the increased risk of falling in older adults [adjusted odds ratio (OR), 1.99; 95% confidence interval (CI):1.55-2.36]. The ORs for having experienced single fall and repeated falls were 1.85 (95% CI: 1.42-2.42) and 3.45 (95% CI: 1.47-6.97), respectively, with multimorbidity compared with those without chronic diseases. The older adults with multimorbidity were more likely to report FOF compared with those without chronic diseases (adjusted OR, 1.49; 95%CI:1.30-1.70). Moreover, the association between multimorbidity and FOF remained significant in the older adults with a history of fall (OR, 1.57; 95%CI:1.04-2.38). Conclusion: The association between multimorbidity and falls and FOF is significant in the Chinese population and the effects of multimorbidity on falls and FOF do not vary according to the frequency and history of falls in older adults.

Housing Environmental Factors Driving Falls Among Middle-Aged and Older Adults: A National Cohort Study.

Background and Objectives: Housing is one of the main places where falls occur; however, few studies have examined housing environmental factors driving fall risk. This study aimed to explore the associations between housing environmental factors and falls in China. Research Design and Methods: The study included data of middle-aged and older adults aged ≥45 years from 4 waves of the China Health and Retirement Longitudinal Study. We assessed 7 housing environmental factors: building materials, toilet types, household tidiness, household cooking fuels, and access to electricity, running water, and bathing facilities. Based on these, we divided housing environments into 3 types: good (0-2 poor factors), moderate (3-5 poor factors), and poor (6-7 poor factors). Falls incidence (yes or no) was self-reported during the survey period. We applied the Cox proportional hazard model to estimate the associations, adjusting for a set of covariates such as sociodemographic characteristics, lifestyles, and disease status. Results: A total of 12,382 participants were analyzed, and the incidence of falls was 31.7%. According to the fully adjusted model, having a squatting toilet (hazard ratio [HR] = 1.14, 95% confidence interval [CI] = 1.03-1.26), household untidiness (HR = 1.09, 95% CI = 1.01-1.18), and solid fuel use for cooking (HR = 1.10, 95% CI = 1.02-1.18) were associated with a higher risk of falls (ps < .05), compared to their counterparts. We found a linear relationship between housing environments and falls (p for trend = .001). Specifically, moderate (HR = 1.16, 95% CI = 1.06-1.27) and poor housing environments (HR = 1.21, 95% CI = 1.08-1.34) were associated with a higher risk of falls compared to a good housing environment. Discussion and Implications: Among middle-aged and older Chinese adults, a better household environment, including sitting toilets, tidy living conditions, and clean fuel use for cooking, may reduce the risk of falls. The evidence from our study suggests the need to implement age-friendly housing environments to prevent falls and disability in an aging society.

Perceptions of Facilitators and Barriers to Implementation of Falls Prevention Programs in Primary Health Care Settings in China.

Importance: Falls have become a major public health issue in China with population aging. Although falls prevention for older community-dwelling people has been included in the National Essential Public Health Service Package since 2009, there is limited understanding of the implementation of this program. Objective: To identify the associated factors and provide recommendations to inform the better implementation of falls prevention in the Chinese primary health care system. Design, Setting, and Participants: This qualitative study was conducted in 3 purposively selected cities in China from March 1 to June 7, 2021. Health administrators from the local health commission or bureau, staff members from local Centers for Disease Control and Prevention and primary health care facilities and community-dwelling older people were recruited, using a combination of purposive sampling and snowball sampling. Main Outcomes and Measures: In-depth interviews were conducted with health administrators and focus groups with other participants. Data analysis followed the guidance of the Consolidated Framework for Implementation Research. Study outcomes included facilitators and barriers of implementing falls prevention for older people in the Chinese primary health care settings. A framework with recommendations was developed to inform the future intervention implementation. Results: Among a total of 130 participants interviewed, 77 (59.2%) were female and the mean (SD) age was 47.4 (16.7) years. Clear recognition of the challenges and benefits of falls prevention, adaptive regionally tailored guidance plans, and continuous governmental policy and financial support were the major facilitators, whereas the major barriers consisted of insufficient confidence in delivering interventions and poor understanding of the falls burden, low recognition of the importance of falls prevention, limited multisectoral collaboration, and weak financial incentives. A 7-strategy embedded framework-including data-driven surveillance, audit and feedback, implementation strategy, workforce strengthening, community empowerment, internal services integration, and external enabling environment-was developed to foster successful implementation. Conclusions and Relevance: This qualitative study identified major facilitators and barriers to the implementation of falls prevention for older people at the primary care level, which have the potential to contribute to better implementation of falls prevention for older people in the Chinese primary health care system.

[Association between obesity in childhood and hypertension incidence: a prospective cohort study].

OBJECTIVE: To explore the impact of obesity level and the level change in childhood on hypertension incidence. METHODS: A perspective cohort study was conducted. As part of Beijing Child and Adolescent Metabolic Syndrome Study, 2189 aged 6 - 16 year non-hypertensive children was followed up in December, 2010. In this study, height, weight, waist circumference (WC) and blood pressure was measured at follow-up, and body mass index (BMI) and WC was respectively used to assess overweight, obesity and abdominal obesity. Non-conditional logistic regression was used to evaluate the association between baseline obesity status, change of obesity status and hypertension incidence. OR and 95%CI were computed in the model using obese status as dummy variable and hypertension at follow up visit as dependent variable. RESULTS: The total hypertension incidence of 1184 subjects during 6 years follow-up was 19.9% (236/1184). The hypertension incidence in male (23.2%, 149/643) was higher than that in female (16.1%, 87/541) (χ(2) = 9.257, P = 0.002). The hypertension incidence of non-overweight, overweight and obese children at baseline was 8.7% (45/519), 19.3% (35/181) and 32.4% (156/484) respectively (χ(2) = 9.332, P < 0.001), and the incidence of non-obese and abdominal obese children at baseline was respectively 10.3% (63/613) and 30.7% (173/567) (χ(2) = 77.753, P < 0.001). Hypertension incidence in the baseline obesity group was higher than the non-overweight (BMI: OR = 4.9, 95%CI: 3.4 - 7.0) and non-obese group (WC: OR = 3.9, 95%CI: 2.8 - 5.3). The hypertension incidence increased with the follow-up BMI/WC level, based on the same baseline level of BMI and WC. The hypertension risk increased to 0.21 and 0.07 times respectively with elevation of baseline BMI level by 1 kg/m(2) and WC level by 1 cm, and OR (95%CI) were 1.21 (1.16 - 1.26) and 1.07 (1.05 - 1.09), respectively. Similarly, the hypertension risk increased 0.16 and 0.05 times respectively with the elevation of BMI level change by 1 kg/m(2) and 1 cm, and OR (95%CI) were 1.16 (1.11 - 1.22) and 1.05 (1.03 - 1.07), respectively. CONCLUSION: Obesity and increased obesity level change in childhood can increase the risk of incident hypertension.

Characteristics of Falls Among Older People - China, 2018.

SUMMARY: What is already known about this topic? The incidence of falls among older people is 20.7% in China. Falls are the top cause for death from injuries in people aged 65 years and above, and mortality rates increase with age in China. There are few reports on the epidemiological characteristics of falls in older people nationwide in recent years.What is added by this report? This study found that among older people with falls reported in the National Injury Surveillance System (NISS) in 2018, there were more females than males. The peak time for falls was in the morning. Home was the most common site where falls occurred, and leisure activities and housework were the main activities when falls occurred. After falling, the lower limbs and head were most often injured with bruises and fractures. The degree of injury was mainly mild and moderate.What are the implications for public health practice? Data based on the NISS can be used as an additional data source for research on falls in China. This study identified priorities for the control and prevention of falls.

A Scoping Review of National Policies for Healthy Ageing in Mainland China from 2016 to 2020.

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.

Burden of falls among people aged 60 years and older in mainland China, 1990-2019: findings from the Global Burden of Disease Study 2019.

BACKGROUND: Falls 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. METHOD: Using 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. FINDINGS: In 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]). INTERPRETATION: Between 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. FUNDING: Bill & Melinda Gates Foundation.

Characteristics of Injury Diagnosis among Primary and Secondary School Students - China, 2018.

WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?: Child injury is a serious public health problem in China. The epidemiological characteristics injuries related to primary and secondary school students were usually reported from school-based population surveys conducted in developed regions of China. Medical and health institution-based data were rarely adopted to explore the typical patterns of injury occurrence among primary and secondary school students in China. WHAT IS ADDED BY THIS REPORT?: This study found that among primary and secondary school students with injury diagnosis in the National Injury Surveillance System (NISS), the high-risk group of primary and secondary school students with injury diagnosis was male students. The frequent incidence season was spring and early summer. Noon was the peak incidence time. Falling was the most common cause of injury among students, but other frequent causes of injury differs in students with different education levels. Home and school were the most common places where injury occurs. Students were more likely to suffer injury when they were engaged in leisure and sport activities. Limbs and the head were easily injured with contusions/bruises. WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE?: Medical and health institution-based data could be an additional data source for student-related injury research. Typical patterns could be summarized to provide data-driven basis for the improved formulation of injury prevention and control strategies and measures towards students. The characteristics of injury events differs in students with different education levels and requires more specific attentions towards students when conducting relevant programs in school and school-related places.

[Epidemiological characteristics of product harm cases in 32 hospitals in 11 areas in China, 2012-2014].

OBJECTIVE: To understand the epidemiological characteristics of product harm cases in 32 hospitals in 11 areas in China from 2012 to 2014 and provide the basic data to support for product-specific survey, product harm early warning and the assessment of product safety. METHODS: The descriptive epidemiologic analysis was conducted by using the surveillance data of product harm collected from 32 hospitals in 11 areas in China during 2012-2014. RESULTS: A total of 208 784 product harm cases were reported in the 32 hospitals during 2012-2014, accounting for 19.50% of total harm cases during the same period. A total of 222 401 cases (times) of product harm were reported. For all the product harms, the top five products causing harms were transportation equipment except motor vehicle (36.55%), motor vehicle (21.50%), other products (20.84%), furniture (7.21%) and food, medicine and related products (5.18%). Both the case number and times of product harm were higher in males than in females. Males aged 25-44 years might be at greater risk for product harm. Most product harms, i.e. bruise, were caused by blunt force on heads. CONCLUSIONS: The epidemiologic characteristics of product harm varied with products. It is necessary to take targeted intervention measures to prevent product harm.

[Study on child head-injuries through data derived from the National Injury Surveillance System of China, 2014].

OBJECTIVE: To understand the epidemiological characteristics of head injuries in children. METHODS: Data was derived from the Chinese National Injury Surveillance System (NISS) in 2014. Method on descriptive analysis was applied to depict general information, injuries events and clinical characteristics of head injuries among children under 18 years of age. RESULTS: A total number of 47 690 cases with child head injuries in 2014 were collected, including 32 542 males and 15 148 females. 43.47% of them were under 1-4 years of age. In October, 06:00 PM appeared the peak time for the injuries to happen. The three leading causes responsible for child head injuries were falls (69.57%), hit by blunt force (14.23%) or road traffic (11.01%). Main locations responsible for the head injuries to happen were:at home (44.98%), at public places (19.65%) or on roads/streets (15.81%). Recreation activates (77.88%), driving (7.32%), sports (5.72%) were the three major activities causing the injuries to take place. Majority of the cases happened unintentionally (95.35%), with bruise (71.69%) or mild injuries (85.27%) and went back home after treatment (90.25%). CONCLUSIONS: In 2014, child head injuries were seen more in males than in females and mostly occured at home. The leading causes for head injuries would include falls, hit by blunt stuff or road traffic .

[Analysis on violence injury incidence and prevention in China].

OBJECTIVE: To understand the incidence of violence injury and its prevention in China, and provide reference for the prevention and control of violence injury. METHODS: The violence injury data in China were collected from national death surveillance data set (2006-2013) and national injury surveillance system (2013) for the descriptive epidemiological analysis on the incidence of violence injury and related death. The laws and policies about violence injury prevention, related data collection capacity and violence injury prevention programs in China were described. RESULTS: The violence injury mortality declined by 46.3% during 2006-2013 from 1.21/100000 to 0.65/100000. The incidence of violence injury death in males peaked in age group 30-34 years (1.42/100000), and it was low in age group<15 years. Three peaks of violence injury death were found in females, i.e. 0.84/100000 in infants, 0.72/100000 in age group 30-34 years and 1.18/100000 in age group≥85 years. The laws and policies about violence injury prevention were imperfect, and the data about violence injury were limited. Most prevention programs were limited in scale and duration. CONCLUSIONS: The crude and standardized violence injury mortality declined in China during 2006-2013. It is necessary to conduct gender specific prevention strategies and improve the related law and policy development, data collection and prevention service.

[Epidemiologic characteristics of fall in old population: Results from national injury surveillance in China, 2014].

OBJECTIVE: To understand the epidemiologic characteristics of fall in people aged ≥60 years in China and provide evidence for the development of prevention and control measures of fall in old population. METHODS: Data of fall in people aged ≥60 years in China in 2014 were collected from National Injury Surveillance System (NISS) for the descriptive epidemiologic analysis. RESULTS: A total of 41,073 fall cases were reported in people aged ≥60 years in 2014, accounting for 52.81% of total unintentional injuries in this population. The fall to unintentional injury ratio was higher in older age group. The gender ratio of fall cases was 0.77 and the proportion of females increased with age. Fall mainly occurred during 8:00-11:59 in the morning (33.31%). The top three places where fall might occur were home (55.66%), public residential places (20.52%) and roads (11.64%). Recreational activity (68.94%) and housework/study (16.14%) were the major causes for fall. The common injury sites were low limbs (29.28%), head (24.40%) and body (20.04%), while the common injuries caused by fall were bruise (45.76%) and fractures (29.52%), spain/strain (13.28%). The fall injuries were mainly mild (64.20%), while more moderate and serious fall injuries occurred in older age group. CONCLUSION: Fall is the major cause of injury in old population in China, and the proportion of fall in unintentional injury in this population increased with age, indicating that the prevention of fall in old population should be strengthened.

[Analysis on the characteristics and factors associated with avoidance of activity induced by fear of falling in the community-dwelling elderly].

OBJECTIVE: To investigate the epidemiologic characteristics and factors associated with the avoidance of activity, that induced by fear of falling in the community-dwelling elderly so as to provide evidence for preventing elderly from falling and to increase the quality of life. METHODS: A cross-sectional study was conducted in 1 972 elderly in Zhejiang. Data were collected through face-to-face interview. Both Univariate and multivariate logistic regression models were used to explore the related factors on the avoidance of activity induced by fear of falling. RESULTS: Of the 1 972 elderly, 43.15% (95% CI: 40.97%-45.34%) appeared avoidance of activity induced by fear of falling. There were no significant difference between males (41.79%, 95% CI: 38.61%-44.98%) and females (44.36%, 95% CI: 41.34%-47.38%), with χ² = 1.32, P > 0.05. The corresponding figures of the 60-69 years group, 70-79 years group and the ≥ 80 years group were 37.07%, 44.87% and 59.04%, respectively (Trend χ² = 48.93, P < 0.01). Of those elderly who ever fell in the past 12 months, 51.94% (95% CI: 46.34%-57.53%) of them were afraid of falling which would lead to avoid of engaging in physical activities. Of the elderly who had no histories of falling in the past 12 months, 41.52% (95% CI: 39.14%-43.89%) feared of falling and avoided engaging in related activities (χ² = 11.56, P < 0.01). Results from the Multivariate logistic regression analysis showed that the related factors would include general/poor perceived health status (OR = 1.53-1.69), impaired vision (OR = 1.95-2.98), impaired hearing (OR = 1.77), use of assistive devices (OR = 2.71), osteoporosis (OR = 3.35), dizziness (OR = 3.05), age ≥ 80 years old (OR = 1.56) and the level of received education. CONCLUSION: Avoidance of physical activity induced by fear of falling among community-dwelling elderly was commonly seen. Health education and intervention measures should be strengthened to the elderly, so as to encourage them to engaging in physical activities and to improve their quality of life.

[Evaluation of performance of national injury surveillance in China, 2006-2012].

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.