| Objective:Injury and poisoning,as major causes of death in China,are widespread and long-standing public health problems that deserve priority attention.Subcategories such as traffic accidents,accidental poisoning,suicide,and drowning are included in the "injury and poisoning" classification according to the ICD-10 International Classification of Diseases.In this study,the risk of death from injury and poisoning in urban and rural areas of China was estimated using the age-period-cohort model,using the data collected from the 2006-2020 China Statistical Yearbook,to reveal the changes in the risk of death from injury and poisoning with age,period,and cohort,to explore the development trend of death from injury and poisoning and its main influencing factors,and to analyze its possible causes,so as to provide a basis for the prevention and control strategy of injury and poisoning in China.The results of this study will provide a basis for the development of injury and poisoning prevention and control strategies and related policies in China.Methods:In this study,injury and poisoning mortality data of urban and rural residents from the China Health Statistics Yearbook were used to calculate age-standardized mortality rates for urban and rural men and women using the seventh census of China in 2020 stratified by age,sex,and region.Joinpoint software was used to analyze the trends of injury and poisoning mortality among urban and rural Chinese residents,and the age-period-cohort model was used to estimate the risk of injury and poisoning mortality among urban and rural Chinese residents,reflecting the trends of mortality among urban and rural Chinese residents at different ages,periods,and cohorts.Results:1.Mortality rates for injury and poisoning in urban and rural areas of China showed a decreasing trend from 2006 to 2020.The age-standardized mortality rate in urban areas decreases from 28.81/100,000 in 2006 to 24.78/100,000 in 2020,and in rural areas from 45.49/100,000 in 2006 to 44.39/100,000 in 2020.2.Changes in crude and age-standardized mortality rates for the four subgroups were analyzed by Joinpoint regression.For crude mortality,there was a decreasing trend in deaths for all four subgroups from 2006 to 2020.Mortality rates for urban males,rural males,and rural females increased and then decreased,with turning points occurring in 2016,2012,and 2008,respectively.Rural female mortality declined the fastest(AAPC = 0.9%;95% CI:-2.6%,0.8%)and rural male mortality declined the slowest(AAPC=0.6%;95% CI :-1.7%,0.6%).Age-standardized mortality rates were 0.4%(95%CI:-1.8%,1.0%)and 1.2%(95%CI:-2.3%,-0.1%)for urban males and urban females,respectively.The age-standardized mortality rate for rural males showed an increasing trend followed by a decreasing trend turning point in 2012.The age-standardized mortality rate for rural females showed an increasing trend followed by a decreasing trend with a turning point in 2008.The rate of downward age-standardized mortality rate was lower for rural males(AAPC=1.0%;95% CI:-1.9%,0.0%)than for rural females(AAPC=1.6%;95% CI:-3.1%,-0.1%).3.In analyzing age-specific mortality trends for urban age groups,the overall trend for urban males was to decline and then increase with age,with an inflection point at age 55 years and fluctuating rates of change.The rate of decline for urban males declined from 3.3% to 0.9% in the 5 to 20 age group,and increased from 1.3%to a peak of 5.4% before declining to 1.4% in the 20 to 55 age group.From age 55 to79 years,the rate of mortality increase with age,rising from 1.0% to 2.4% and then decreasing to 0.8%.Urban women experienced an overall decrease in mortality in the5 to 64 age group,with a rebound in the 10 to 14 age group reaching 2.5%(95% CI:0.4%,4.7%).the fastest decrease in mortality was seen in the 40 to 44 age group reaching 6.3%(95% CI:-10.1%,-2.4%).A small increase was seen in the 65 to 69 age group,with an increase of no more than 1.0%.4.Analysis of mortality trends by age group in rural areas showed that mortality among rural males first declined between the ages of 5 and 24 years,slightly increased to 0.3%(95% CI:-2.4%,3.0%)between the ages of 25 and 29 years,and generally declined between the ages of 30 and 59 years.the decline in the 40-44 age group reached 5.4%(95% CI:-8.2%,-2.6%).Starting at age 60,mortality increased with age.The mortality rate for rural females generally decreased at all ages from 5 to79 years,with increases reaching 1.9%(95% CI:-5.0%,9.3%)and 0.3%(95% CI:-1.1%,1.7%)for the age groups 10 to 14 years and 75 to 79 years,respectively.Meanwhile,the fastest decrease in mortality was observed in the 40-to 44-year-old age group reaching 7.4%(95% CI:-9.4%,-5.3%).5.From an age perspective,mortality rates increase with age.The rate of increase is slower and less volatile in urban areas than in rural areas,and the rate of increase is lower for females than for males.From urban males and urban females mortality decreases with age between the ages of 5 and 49,and increases with age after 49,with effect coefficients of-0.994 and-1.009 for males and females,respectively,at the inflection point.the lowest age effect for rural males and rural females occurs between the ages of 35 and 39 The impact coefficients are-0.518 and-0.525 for rural males and females,respectively.6.From a period perspective,the overall risk of death increased over time for the four subgroups of injury and poisoning in China,with all four subgroups showing a decreasing and then increasing trend.The continuously increasing period effect may be related to medical imperfections and population aging;therefore,the period effect is also an important factor in the increase of mortality from injury and poisoning in China.7.From a cohort perspective,those born in the 1959 to 1963 age group had the highest cohort effect for injury and poisoning mortality,with a risk of death of 1.146 and 1.190 for urban males and urban females and 0.651 and 0.689 for rural males and rural females,with younger cohorts having a lower risk of injury and poisoning mortality than older cohorts.Conclusion:This study used Joinpoint regression models to analyze long-term trends in crude and standardized mortality rates for injury and poisoning by sex in urban and rural China,and age-period-cohort models to assess the age,period,and birth cohort effects of injury and poisoning mortality in urban and rural China.1.From 2006 to 2020,injury and poisoning mortality rates were higher among males than females in urban and rural China,and higher in rural areas than in urban areas.2.From 2006 to 2020,injury and poisoning mortality rates in urban and rural China showed a decreasing trend,with females decreasing faster than males and rural areas decreasing faster than urban areas.3.The age-period-cohort model showed that injury and poisoning mortality had a strong age effect,with mortality increasing with age.Period and cohort effects were smaller.4.Males,older populations,and rural areas should receive more attention as potential high-risk populations and high-risk areas. |
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