Injury and Poisoning Mortality Trends in Urban and Rural China from 2006 to 2020 Based on Age-Period-Cohort Analysis

Abstract

Injury and poisoning, common public health problems, currently rank fifth among the causes of death in China. In this study, we aimed to analyze the trends and influencing factors of injury and poisoning mortality in urban and rural China using an age-period-cohort model. Crude mortality data for injury and poisoning by sex, age group, and region were obtained from the China Health Statistical Yearbook (2006–2020). Age-standardized mortality rates for injury and poisoning in urban and rural areas were estimated using the Seventh Census of China 2020 population. The trends of injury and poisoning mortality were assessed using Joinpoint analysis. Age–period–cohort models were used to explore the age, period, and birth cohort effects affecting mortality risk. Over a 15-year period, age-standardized mortality rates decreased from 28.81/100,000 in 2006 to 24.78/100,000 in 2020 in urban areas and from 45.49/100,000 to 44.39/100,000 in rural areas. In the male population, the annual change in mortality was −0.4% (95% CI = −1.8%, 1.0%) in urban areas and −1.0% (95% CI = −1.9%, 0.0%) in rural areas. In the female population, the annual change in mortality was −1.2% (95% CI = −2.3%, −0.1%) in urban areas compared with −1.6% (95% CI = −3.1%, −0.1%) in rural areas. The age–period–cohort model showed a significant increase in urban and rural mortality rates starting at ages 49 and 39 years. Both showed a decline followed by an increase in the period. The cohort from 1929 to 2013 showed an overall trend of increasing and then decreasing. From 2006 to 2020, the overall injury and poisoning mortality rates in China showed a decreasing trend, and the mortality rates decreased faster in women than in men and in rural areas than in urban areas. Age effects were the most important risk factors for changes in injury and poisoning mortality. The results of this study will help researchers explore the possible causes of mortality changes in urban and rural areas and provide a scientific basis for injury and poisoning prevention and control priorities and policy formulation in China.

Changing Patterns of Injury Mortality Among the Elderly Population in Urban and Rural Areas — China, 1987–2021

“…These include enhanced medical access and services resulting from economic growth, making previously fatal injuries treatable. Additionally, expanded public health services and social security have improved healthcare for the elderly, particularly for high-risk groups ( 6 ). Moreover, increased health education initiatives have raised awareness and led to a reduction in accidental injuries.…”

“…The impact of age on injury-related mortality among the elderly in China has been identified as significant ( 10 ). A notable age disparity in injury mortality rates was observed, with rates increasing exponentially with age ( 6 , 10 ). This finding suggests that the older-age elderly are at a higher risk for injuries, potentially due to factors such as declining physical function, pre-existing health conditions, cognitive decline, and sensory impairments.…”

“…Sex disparity and urban-rural disparity in injury mortality rates are apparent ( 7 , 10 ). Males, particularly in rural areas, face the highest risk of injury, likely due to their participation in outdoor activities that increase exposure to injury hazards ( 6 ). Inadequate treatment for injuries among rural elderly can be attributed to limited access to medical resources and lower economic and educational levels.…”

“…Period effects demonstrate a decline in injury mortality among the elderly over time ( 6 ). Higher mortality rates in earlier birth cohorts suggest that improvements in medical resources and social services have contributed to the reduction in injury mortality.…”

“…Given the rapid growth of China’s aging population, these burdens are expected to escalate, underscoring the need for research on elderly injuries ( 4 - 5 ). Previous studies have shown a downward trend in injury-related mortality among Chinese elderly individuals ( 6 ). However, there is limited documentation on the long-term patterns of urban-rural disparities in injury mortality by age, period, and cohort ( 7 ).…”