| Objectives:Road traffic injuries(RTIs)have always been an important public health issue in China.In this study according to the data of RTIs mortality in China from 1990 to 2017,we make a fully understanding of the trends of RTIs mortality among different genders and road users in China in the past 30 years.In addition,the epidemiological characteristics of RTIs mortality were analyzed by setting up the age-period-cohort model,Smeed’s model,Borsos’ s model and spatial auto-correlation analysis.Meanwhile,the ARIMA model,fractional polynomial regression model(FP)and natural cubic spline regression model(NCS)were applied to explore the prediction of RTIs mortality rate,which provides a scientific basis for relevant departments for the formulation of prevention and control strategies on the RTIs and lays a foundation for evaluating the effects of RTIs prevention in the future.Methods:In this study,the Chinese population was selected as the research object,and the death-related data of RTIs from 1990 to 2017 were collected.The contents mainly include the following five aspects:(1)We studied the trends of of RTIs mortality rate among different genders and types of road users in China from 1990 to 2017 by using the Joinpoint regression model,and estimated the annual percent,the average annual percentage change and its 95% confidence interval of the trend changes.(2)The age,period and cohort trends of RTIs mortality in different genders in China from 1990 to 2017 were described,and the age-period-cohort model with the Intrinsic Estimator was used to assess the independent age,period and cohort effects on RTIs mortality.(3)We analyzed the trend changes of RTIs mortality with the motorization rate from 1996 to 2107 by the Smeed’s model and Borsos’ s model,and compared the fitting effects of the two models.(4)We described the spatial distribution of RTIs mortality in 1996-2017 by the spatial auto-correlation and hot spot analysis.(5)We constructed the ARIMA model,FP regression model and NCS regression model for RTIs mortality in different genders in China from 1990 to 2017,and predicted the age-standardized mortality of RTIs from 2018 to 2022 by the successfully constructed model.Results:(1)The RTIs mortality rate in China showed a tendency of increase first and then decrease from 1990 to 2017 with the highest value in 2000,and the decline rate was significantly accelerated after 2011.The results of Joinpoint showed that the trend RTIs mortality had three significant segments: 1990-2000,2000-2011 and 2011-2017.The mortality rate in 1990-2000 increased at a rate of 1.3% per year,and decreased at a rate of 1.6% and 2.9% per year in 2000-2011 and 2011-2017,respectively.The mortality rates of RTIs in males from 1990-2017 were significantly higher than that in females.The significant segments of RTIs mortality in male were consistent with that in the whole population.The mortality rate during the segment 1990-2000 increased at a rate of 1.5% per year,and during the segments 2011-2017 and 1990-2000 decreased at a rate of 1.4% and 2.9% per year,respectively.The RTIs mortality rate in female experienced four significant trends between 1990 and 2017.The mortality increased at the rate of 1.5% per year in 1990-1996,and during the segments 2001-2007,2010-2015 and 2015-2017 decreased at the rate of 2.5%,2.5% and 4.8% per year,respectively.The trends RTIs mortality among different types of road users were generally consistent with that in the whole population,male and female,showing a tendency of increase first and then decrease.The pedestrian mortality rate was highest among different types of road users,followed in male by motorcyclist,motor vehicles,cyclists and others,while in the whole population and female by motor vehicles,motorcyclist,cyclists and others.Joinpoint analysis showed the similar trend among different types of road users,but the significant segments were different between 1990 and 2017.In addition,the RTIs mortality rate for cyclists increased at an average rate of 1.1% per year.(2)The mortality rate of RTIs in different genders increased with age,reaching the highest in the 90-94 age group,and showed a downward trend with the birth cohort.The independent effects of age,period,and cohort for RTIs mortality were separated by the age-period-cohort model with IE algorithm.Moreover,the risk of RTIs mortality in different genders were roughly similar with age.We found that the overall risk of RTIs mortality in male and female increased with age and decreased with the birth cohort.In addition,when controlling the age and cohort effects,the period effect increased the risk of RTIs mortality in male and decreased the risk of RTIs mortality in female.The cohort effects of RTIs mortality between male and female were also roughly similar.The people born in the 1953-1957 had the highest risk of death,and when controlling the age and period effects,the cohort effect increased the risk of RTIs mortality in both male and female.(3)The level of motorization showed an upward trend with the increase of GDP per capita.From 1996 to 2017,with the increase of motorization level,the RTIs death per100,000 vehicles gradually decreased,and the RTIs death per 100,000 population showed a tendency of increase first and then decrease.Throughout the observation period,the RTIs death per 100,000 vehicles and RTIs death per 100,000 population decreased by 91.28% and 23.77%,respectively,and the RTIs death per 100,000 vehicles decreased faster.With the increase of motorization rate,the Smeed’s curve and Borsos’ s curve of RTIs mortality rate showed a downward trend,but the Borsos’ s curve was closer to the mortality observed values.So Borsos’ s model could better fitting the death of RTIs in China.(4)In 1996,the mortality rate of RTIs in China was mainly distributed in the west regions,such as Xinjiang and Tibet etc.,as well as in coastal regions,such as Zhejiang and Jiangsu and so on.Compared with 1996,the mortality rate of RTIs in the above areas decreased in 2017,but the regions,such as Hubei,Guizhou and Jilin has been the high-risk areas of RTIs mortality.The decline in mortality of RTIs between 2007 and 2017 was significantly faster than the that between 1996 and 2006.The spatial autocorrelation analysis showed that RTIs mortality rate in China was spatially randomized,with no clustering or discrete trend,and the hot-spot analysis results showed that the hot-spot areas were similar to the spatial changes of RTIs mortality from 1996 to 2017.(5)This study constructed the ARIMA,FP and NCS regression models by using the data of RTIs mortality in different genders in China from 1990 to 2017.The ARIMA model was terminated after a stationary and randomized detection of the RTIs mortality in different genders.So the FP(-1-1)regression and the NCS model were established for RTIs mortality in different genders.The fitting effects of different models were evaluated,and the NCS regression model is finally determined as the optimal model.According to the prediction results of the NCS regression model,the RTIs mortality in male and female will continue to decline in the next five years,and the gap between male and female may shrink.According to the current rate of decline,China may not be able to achieve the UN Sustainable Development Goal-halving the number of RTIs deaths by 2020.Conclusions:(1)Between 1990 and 2017,the RTIs mortality showed showed a tendency of increase first and then decrease,and the mortality in male was higher than that of female.Pedestrians,cyclists and motorcyclists are vulnerable to RTIs.(2)When controlling the period and cohort effects,the RTIs mortality in male and female increased with age at the age group of 15-29 years and over 60 years.when controlling the age and cohort effects,the period effect increased the risk of RTIs in male and reduced the risk of RTIs mortality in female.when controlling the age and period effects,the cohort effect increased the risk of RTIs mortality in male and female.(3)With the increase of economy and motorization levels,the RTIs mortality rate showed a downward trend.Borsos’ s model had better effects on fitting the RTIs mortality.(4)The mortality rate of RTIs in China was randomly distributed,and the prevention and control of RTIs in non-high-incidence areas such as Hubei,Guizhou and Jilin could not be ignored.(5)RTIs mortality rate in China would continue to decline in the next five years,and the gap between male and female would further narrow,but it is almost impossible for China to complete the UN goal of halving the number of RTIs deaths by 2020. |
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