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.

Riding practices of e-bike riders after the implementation of electric bike management regulations: An observational study in Hangzhou, China.

Objective: This study aimed to understand the riding behaviors of electric bike (e-bike) users in Hangzhou after the "Regulations of Zhejiang Province on the Administration of Electric Bicycles". Methods: The study consisted of two parts, including a questionnaire survey of local e-bike users in Shangcheng District and Jiande County in Hangzhou City, and a cross-sectional observational study of 16 intersections. Results: A total of 789 e-bike riders participated in the questionnaire survey, and the riding behavior of 99,407 e-bike users was observed. The main purpose of using e-bike was work and daily life, 46.0% of them used e-bikes more than 5 days a week, and 58.5% used e-bikes for less than 30 min each time. A vast majority (81.7%) of e-bike riders believe that the implementation of Zhejiang Regulations has significantly improved the safety level of e-bike riding in the region. The field survey found that the correct rates of helmet wearing by e-bike riders and passengers were 78.83% and 42.27%. The main violations were invalid/non-helmet wearing (21.17%), followed by carrying passengers and running red lights (7.94% and 4.26%). The rates of invalid/non-helmet wearing and running red lights were significantly higher during non-morning rush hour, weekends, and roads without separate non-motorized vehicle lanes than in other conditions (all P < 0.05). Additionally, sunny days and crossroads were risk factors for passenger-carrying and invalid/non-helmet wearing compared to rainy/cloudy days and T-intersections. Conclusions: The phenomenon that e-bike users' correct practice lags far behind the awareness of various violations has shown some improvement. To further enhance safety measures for e-bike riders, it is necessary to promote education, improve infrastructure, and strengthen law enforcement, in support of the "Zhejiang Regulations" and behavioral interventions.

[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.

[Distribution trends and characteristics analysis of non-motor road traffic injury cases monitored in China, 2006-2013].

OBJECTIVE: To describe the distribution characteristics of outpatient/emergency cases of non-motor road traffic injuries in China from 2006-2013. METHODS: Cases of non-motor road traffic injuries were descriptively analyzed based on their data at the sentinel hospitals of the Chinese National Injury Surveillance System (NISS) from 2006 to 2013. RESULTS: The proportion of non-motor road traffic injuries among the total road traffic injuries of the year from 2006 to 2011 was relatively stable, and the proportion in 2013 was higher than 2012 (χ² = 508.138, P < 0.001). In the non-motor road traffic injuries cases in 2013, male cases were higher than females (χ² = 41.018, P < 0.001), mostly found in 15 to 64 years old age groups. In urban areas, the proportion of non-motor road traffic injuries cases (52.11%) was higher than rural areas (47.89%) (χ² = 88.427, P < 0.001). Most injuries were found in lower limbs (29.08%) and head (24.82%). Injuries were mainly bruises (73.54%) and fractures (10.72%). The severities of injuries were mainly mitigated injury (80.49%), and most injuries ended with home return following treatment (82.34%). CONCLUSION: The proportion of non-motor road traffic injuries among total road traffic injuries of the year as found from NISS remained stable from 2006 to 2011, with a slight rise in 2012-2013. Most of the non-motor road traffic injuries were suffered by young and middle aged men. Interventions should be made based on gender and age differences of non-motor road traffic injuries cases.

[Analysis on sports and recreation related injuries through data from the Chinese National Injury Surveillance System, 2009-2013].

OBJECTIVE: To understand the trend and characteristics of sports and recreation related injuries reported from National Injury Surveillance System (NISS) to provide basis for corresponding prevention strategies and decision-making. METHODS: Descriptive analysis was applied to display the overall trend, general information, injury event and clinical characteristics of sports and recreation related injuries from 2009 to 2013. RESULTS: The proportion of sports and recreation related injuries among all injuries increased from 2009 to 2013, with an annual increase exceeding 45% (46.21%, 47.32%, 48.14%, 52.00%, 53.65%, respectively). Sports and recreation related injuries mainly involved males, with 15-29 age groups, particularly in summer and autumn. Sports and recreation related injuries mostly occurred at home, with annual rates of proportion as 33.07%, 34.16%, 32.98%, 34.57 and 36.22%, mostly caused by falls (41.19%, 41.64%, 44.70%, 47.41%, 47.96%). Contusion and abrasion were the leading types of injuries (43.49%, 44.56%, 45.14%, 45.02%, 45.62%) with the serious leading types as fracture, concussion/cerebral contusion or laceration, and sharp force injury/bite/open wounds. Head was the part mainly involved (31.30%, 32.48%, 31.89%, 30.88%, 29.44%) in injuries. Most sports and recreation related injuries were minor and most of the patients headed home after treatment. CONCLUSION: Sports and recreation related injury appeared a growing public health problem in China. Children and the elderly should be the target groups for intervention. Falls prevention in sports and the use of protection gears should be the focus countermeasures for prevention.

[Study on head injuries through data from the National Injury Surveillance System of China, 2013].

OBJECTIVE: To understand the epidemiological characteristics of head injuries through data from the Chinese National Injury Surveillance System (NISS). METHODS: Descriptive analysis was applied to display the overall trend of head injuries in 2013 in NISS and to depict general information, events and clinical characteristics of head injuries with SPSS 19.0 software. RESULTS: In 2013, 195 189 cases of head injuries were collected, males were twice higher than females, with 25.19% of them under 30-44 years of age. The three leading causes responsible for head injuries were falls (42.17%), blunt force injuries (27.46%) and road traffic injury (23.33%). Main locations causing head injuries were in road/street (31.41%), at home (25.02%) and public places (17.17%). Recreation activates (54.22%), driving (19.73%), paid work (12.95%) were the three major activities when injuries took place. Majority of the cases belonged to unintentional (86.79%) with bruise injuries (65.18%). Those mild injuries (78.87%) were treated and discharged (82.02%). CONCLUSION: In 2013, head injuries were seen more in males than in females, mostly involved in labor force population on head injuries. The leading causes for head injuries were falls, blunt injuries and road traffic.

[Trend and current characteristics of road traffic injury in children based on data from the National Injury Surveillance System in China from 2006 to 2013].

OBJECTIVE: To understand the trend and current characteristics of children engaged in road traffic injury. Data was from the Nation Injury Surveillance System (NISS) and the results of the study would provide basis for corresponding intervention strategies and decision-making. METHODS: Descriptive analysis was applied to display the trend of child road traffic injury from 2006 and 2013 and also to depict the general information, injuries event and clinical characteristics of child road traffic injuries in 2013. RESULTS: The number of child road traffic injuries increased from 2006 to 2013 and ranking the second cause of child unintentional injuries during these years. However, the proportion of child road traffic injuries among child unintentional injuries decreased in the same period. In 2013, sex ratio appeared as 1.82, with 17- year-old age group accounting for 10.86% . Injuries caused by motor traffic vehicles accounted for 66.44% , with July/August, weekends and 17-18 PM as the peak period or time. Transportation related injuries accounted for 65.42% , with 73.53% as bruise. 33.81% of the injury involved in the head but 76.42% of injuries were minor, while 74.86% went home after the treatment. CONCLUSION: Child road traffic injury should not be ignored. Age and sex differences should be taken into account when carrying out education programs on child road traffic safety. Male students at senior high school or preschool were target groups when carrying out child road traffic injury intervention programs.

[Analysis on the characteristics of violence based on data from the Chinese National Injury Surveillance System from 2006 to 2013].

OBJECTIVE: To understand the characteristics of victims under violence that were enrolled from clinic and emergency room of the hospitals, to provide basis for the development of violence prevention strategies. METHODS: Data from the National Injury Surveillance Program between 2006 and 2013 were used to analyze: 1) trend of violence proportion in injuries, 2) socio-demographic characteristics of the cases, 3)basic and clinic information on related violence. RESULTS: The proportion of victims of violence decreased during the past 8 years. The number of violence related cases in 2013 was 50 333, including 36 049 males and 14 284 females. Most cases had educational levels as junior (41.2%) or senior high schools (27.3%). 24.0% of the violence occurred between 22:00 PM and 02:59 AM. The proportions of domestic violence were 30.2% in the 0-4 age group and 28.5% in the 65- age group, both were higher than in the other age groups. CONCLUSION: Interventions on violence including children abuse and elderly abuse should be paid attention to.

[Analysis on the characteristics of self-inflicted injury/suicide based on the Chinese National Injury Surveillance System from 2006 to 2013].

OBJECTIVE: To understand the characteristics of self-inflicted injury/suicide cases that were seen from the clinic or the emergency rooms, to provide basis for suicide prevention strategies development. METHODS: Data from the National Injury Surveillance System, from 2006 to 2013 were used to analyze the trend of self-inflicted injury/suicide proportion in injuries as well as the socio-demographic characteristics of the cases with related basic and clinic information related to self-inflicted injury/suicide. RESULTS: The proportion of self-inflicted injury/suicide cases decreased during the past 8 years. 58.6% of the self-inflicted injury/suicide cases were females in 2013 and 42.1% received junior secondary school education. Self-inflicted injury/suicide were mostly taken place at home (76.2% ). Poisoning (56.1% ) and sharp injury were the major ways causing self-inflicted injury or suicide. CONCLUSION: Interventions on self-inflicted injury/suicide should be strengthened including control programs on pesticide/psychotropic drugs. Prevention on future attempts and suicide should include the full use during the in-hospital time of those suicide attempters.

[Analysis on data from Chinese National Injury Surveillance System, 2008-2013 on the characteristics of falls].

OBJECTIVE: To analyze the trend and distribution of Falls, using the data from National Injury Surveillance System (NISS), 2008-2013, to provide basic information for Fall prevention. METHODS: Data of Falls was descriptively analyzed from the Chinese NISS from 2008 to 2013. RESULTS: In total, 1 223 905 cases of Falls were analyzed, that accounted for 32.94% of all the injury cases, with the gender ratio as 1.57. Both the number and the proportion of the cases showed an increasing trend. Labor population (15-64 years-old) accounted for 66.63% of the total 271 502 cases of Falls in 2013. Cases aged 0-4, 5-14 and over 65 accounted for 55.53%, 52.93% and 56.59% among all the types of injuries in each of their age group. Gender ratio appeared to be 1.54 but more females cases were seen with the increase of age. The peak hours that injuries took place were 10:00-10:59 AM (10.04% of total) and 14:00-20:59 PM (43.56% of total). The top three places that injuries took place were home (33.03%), public residents (22.79%) and on the roads (15.49%). Recreation activates (65.38%), paid jobs (13.01%) and housework (7.52%) were the three major ways causing the Falls to take place. The most common parts of body that injuries involved were head (30.41%), low limbs (27.43%) and upper limbs (21.93%), with bruise (54.60%), sprain/strain (16.87%), fractures (15.48%) most commonly seen. 77.76% of the cases were minor but the proportion of moderate and serious injuries increased along with the increase of age. CONCLUSION: Fall was the main type of injury in this country, showing an increasing trend of proportion among all the types of injuries. Though labor-related Falls accounted for the biggest proportion, prevention programs targeting the elderly and children should also be prioritized.

[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.