| Due to its high incidence and high consumption of a large number of health resources,injury bring a heavy burden of disease to the country,society,families and individuals.Compared with the prevention and treatment of infectious diseases and chronic noncommunicable diseases,there is still a big gap in the prevention and treatment of injury prevention.One of the main reasons is the lack of in-depth study on the epidemic situation and preventive measures,especially the urban and rural areas.According to this situation,this study describes the incidence,hospitalization and morbidity of injury in Jiading area on the basis of the injury monitoring in Jiading District of Shanghai.By investigating the injury of students and elderly prevalence in Jiading area,injury related risk factors were studied.Objectives1.To analyse the epidemiological characteristics of injury related deaths,injury inpatients,injury cases in Jiading district in Shanghai and provide evidence for the prevention and control of injury.2.Calculate the cause eliminated life expectancy(CELE),years of potential life lost(YPLL),average years of life expectancy lost(YLEL)due to injury,and length,costs of hospital stay of hospitalization injury to partly reflect the disease burden and economic burden of injury.3.To explore the epidemiological characteristics and factors related to injury in primary and secondary school strudents,provide the basis for prevention and control of injury.4.To explore the epidemiological characteristics and factors related to falls in older people living in urban communities and to provide evidence for developing prevention program.Methods1.Data was gathered from vital statistics and registration system.Mortality level,main causes of death in 1988-2015 were described.Time trend of death was analyzed and annual percentage changes(APCs)were estimated.Data related to cause eliminated life expectancy(CELE),years of potential life lost(YPLL)and proportion of YPLL on total deaths were also calculated.The population used for standardization was from census in 1990 and each five-year was counted as an age group.2.A grade-2 general hospital in Jiading district of Shanghai were selected as the monitoring point,and the inpatients who sought hospitalization treatment there and were diagnosed as injury for the first time from October 1st,2012 to September 30 th,2015 were enrolled in the study.The epidemiological characteristics and hospitalization expenses were described,and the circular distribution was used to analyze the concentrated trend of the injury.3.13 centers for community-based health services in Jiading district were selected to establish an injury surveillance system.Patients who were first diagnosed as injuries at ambulatory clinics from January 1st,2013 to December 31 th,2013 were enrolled as the research objectives.4.One primary school,one junior middle school and one senior middle school was selected from JiaDing district by PPS(Probability Proportional to Size)sampling method.One class was selected from each grade in selected school by simple random sampling method.The questionnaire survey on the conditions of injuries during the last 12 months was conducted among all the students(totally 430 students)in selected class.The parents of the children in primary schools and students by his own in middle schools were asked to answer the question.5.A cross-sectional study was conducted in four communities of Jiading District,Shanghai.Persons over 55 was selected with multistage random-cluster sampling method,Data on falls within previous 12 months and fall-related risk factors was collected through face-to-face interview.Results1.The cause of death monitoring showed the average crude death rates of injury during 1988-2015 was 54.80/100 000 and accounting for 7.37% of all deaths,Ranking the fourth among the main cause of death for local population in Jiading.In males and females,the crude death rates of injury varied between 43.43/100 000-76.22/100 000 and 42.12/100 000-68.36/100 000 respectively,while the standardized death rates of injury varied between 17.18/100000-58.79/100000 and 11.23/100 000-54.64/100 000 respectively.Declining trends on injury crude death rate in males during 1988-2015 was found and the APC was-0.97%.Standardized death rate in males and females showed significant declining trend and the APC was-4.35% and-4.85% respectively.Injury was the first cause of death for the aged 1-39.Traffic accident,fall,suicide,drowning and suffocation were the five top causes of injury,accounting for 88.31% of all the injury mortality.The death rate of traffic accident rose from 1993 and decreased from 2005 while fall showed a rising trend from 1994 with APC 5.51%.During 28 years,average years of life expectancy lost(YLEL)due to injury in males and females was 1.16 and 1.04 respectively,average years of potential life lost(YPLL)due to injury was 1050.78 person years per 100 000,and average proportion of YPLL due to injury on total deaths was 17.67% while YPLL due to injury decreased annually.2.Injury inpatient case registration results show that among 1808 injury inpatients,the male to female ratio was 2.35:1,and most of them were people aged 40-64 years old(49.17%).The top six causes of injury were slip/fall(47.68%),motor vehicle traffic accidents(25.00%),blunt injury(17.09%),non-motor vehicle traffic accidents(4.81%),knife/sharp injury(4.31%)and burning/scald(0.39%).The case number in July was the highest.The fractures were the primary outcome of all cases,accounting for 72.16%.The slip/fall was the main cause of injury in people over 65 years old,accounting for 71.71%,the hospitalization expense per capita was 17 788.12 yuan.The injured of traffic accident were mainly electric bicycle riders.3.Community outpatient injury monitoring results show that a total of 19242 injury cases in community health centers were reported,the male to female ratio of the cases was 1.84:1.The cases aged from 15 to 39 accounted for 40.26%.Native cases covered 42.73% while non-native cases covered 57.27%.Injuries were mostly occured in July(13.43%).The top 6 causes of injury were injury by sharp object(34.22%),falls(31.47%),injury by blunt object(22.53%),nonmotor vehicle traffic accidents(8.73%),contact with heat and hot substances(1.61%),motor vehicle traffic accidents(1.55%).The top 10 injury related objects were metal sheet(20.60%),nail(11.98%),cement floor(9.50%),kitchen knife(5.18%),storage battery car(4.40%),timber(4.12%),cutting tool(3.91%),glass products(2.63%),shoes(2.37%),stone(1.93%).4.Results of investigation on the injury and risk factors of primary and middle school students show that overall incidence of injury among the students was 25.11%(95% CI=23.04%-27.20%).The top five causes of injury were slip/fall(38.9%),animal injury(14.8%),blunt injury(12.0%),traffic accidents(11.1%),and knife/sharp injury(10.2%).Injuries were mostly happened at home(31.5%),street/road(17.6%),sports and sports venues(16.7%),school(13.9%).Injuries were mostly happened when students were in physical exercise(25.0%),in recreation activities(25.0%).The main parts of body injured were upperlimb(41.7%),lower limb(21.3%).Results from multivariate logistic regression analyses showed that risk factors for student injury included run the red light while walking(OR=1.848,95%CI=1.246-2.740),ride on a bicycle after shool(OR=2.679,95%CI=1.075-6.674),doing warm-up before physical exercise(OR=1.421,95%CI=1.133-1.782),The protective factors was senior high school student(OR=0.301,95%CI=0.118-0.767).5.Results of investigation on elderly falls and risk factors show that overall incidence of fall was 8.49%(95%CI=7.16%-9.83%)within one year among 1672 interviewees,while it was 9.92% among people over 60 years old and it was 15.85% among people over 75 years old.Results from multivariate logistic regression analyses showed that risk factors for fall included female(OR=2.150,95% CI=1.352-3.420),antihypertensive drug use(OR=2.107,95%CI=1.068-4.158),age from 75 to 80 years(OR=2.032,95%CI=1.245-3.314),athletic sports(OR=1.273,95%%CI=1.057-1.535),clumsy gait(OR=2.149,95%%CI=1.118-4.130),using support device in walking(OR=4.373,95%CI=1.740-10.989).The protective factors were no lifting or carrying groceries limit(OR=0.527,95%CI=0.347-0.799),physical disability(OR=0.246,95%CI=0.097-0.622).Conclusions1.The trends of mortality rates on injuries were declining,while diseases of the circulatory system and neoplasms were still the primary cause death among Jiading people.Injury is still the main death cause for those young people,and the highest priority of injury prevention should be given to fall and traffic accident.2.The hospitalization injury report showed that the main injured in the traffic accident is riding electric / motor vehicle,and it is necessary to pay attention to the secondary prevention of injury in the elderly.3.The injury report from community health center showed that floating population accounts for about 60% of the total number of reports.Floating population injury occurs mainly young and middle-aged,occupational-related injuries more common,should pay attention to the floating population and occupation-related injuries.4.There is a trend that incidence of injury decreases with the age of the students in primary school and middle school.Not obeying traffic rules is an improtant risk factor for students accurring traffic accidents.Students who go to and from school by walking,cycling,or taxi alone are easily occurring traffic accidents.5.Falls in the eldely was the result caused by combined intrinsic and extrinsic factors,suggesting the intervention should be targeted on risk factors multifactorially. |
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