中国儿童青少年1990—2021年伤害负担趋势分析与预测

金雪; 曹阳光; 李宝珠

doi:10.16835/j.cnki.1000-9817.2025089

中国儿童青少年1990—2021年伤害负担趋势分析与预测

doi: 10.16835/j.cnki.1000-9817.2025089

安徽医科大学公共卫生学院/合肥大健康研究院健康大数据与群体医学研究所，合肥 230032

基金项目:

合肥综合性国家科学中心大健康研究院健康大数据与群体医学研究所科研项目 JKS2022023

安徽省临床医学科研转化项目 202304295107020026

安徽省教育厅高校科研计划项目 2023AH030119

详细信息

作者简介:
金雪(1998-)，女，安徽亳州人，在读硕士，主要研究方向为慢性病流行病学

通讯作者:
李宝珠，E-mail: lbz88730@163.com

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R179 B845.67 R195
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出版历程
- 收稿日期: 2025-01-07
- 修回日期: 2025-02-09
- 网络出版日期: 2025-04-03
- 刊出日期: 2025-03-25

Trend analysis and prediction of injury burden among children and adolescents in China from 1990 to 2021

School of Public Health, Anhui Medical University/Center for Big Data and Population Health of IHM, Hefei (230032), Anhui Province, China

摘要

摘要: 目的评估中国儿童青少年1990—2021年伤害疾病负担现状和未来变化趋势，为中国儿童青少年的伤害预防与控制提供参考。方法利用2021年全球疾病、伤害和风险因素负担研究(GBD 2021)数据，通过Joinpoint回归模型分析1990—2021年中国儿童青少年伤害疾病负担变化趋势。采用贝叶斯年龄-时期-队列模型(BAPC)对中国儿童青少年2022—2031年伤害疾病负担进行预测。结果 1990—2021年，中国儿童青少年伤害的标化发生率、标化患病率、标化死亡率和标化残疾调整寿命年(DALYs)率总体均呈下降趋势(AAPC分别为-1.14%，-0.76%，-5.41%，-5.03%，P值均 < 0.05)。对于不同性别儿童青少年，1990和2021年男性伤害的标化发生率(7 106.00/10万，5 388.00/10万)、标化死亡率(92.00/10万，19.00/10万)和标化DALYs率(7 834.00/10万，1 673.00/10万)均高于女性(5 188.00/10万，3 874.00/10万；61.00/10万，10.00/10万；5 398.00/10万，945.00/10万)。与亚洲和全球相比，中国儿童青少年标化死亡率下降速度最快(AAPC=-5.41)，标化患病率下降速度最慢(AAPC=-0.76)(P值均＜0.05)。Joinpoint负担趋势分析结果表明，伤害的标化发生率在2005—2021年呈现上升趋势, 标化患病率在2006—2021年呈现上升趋势。在不同年龄组中，2021年15~19岁组伤害疾病负担最高。对于不同类型伤害，1990—2021年意外伤害的标化发生率、标化死亡率和标化DALYs率均高于交通伤害与自残和人际暴力。BAPC预测模型显示，2022—2031年中国儿童青少年伤害的标化发生率(4 833.05/10万~5 313.70/10万)、标化患病率(5 433.90/10万~5 821.88/10万)呈上升趋势，标化死亡率(13.69/10万~5.52/10万)和标化DALYs率(1 226.37/10万~510.14/10万)呈下降趋势。影响因素分析发现饮酒的儿童青少年是伤害负担的高危人群。结论 1990—2021年中国儿童青少年伤害负担总体呈下降趋势，经预测2022—2031年伤害标化发生率和标化患病率呈上升趋势；应制定更有针对性和个性化的预防干预措施，以减轻儿童青少年的伤害负担。
- 创伤和损伤 /
- 患病代价 /
- 回归分析 /
- 儿童 /
- 青少年
Abstract: Objective To evaluate the prevalence and future trend of change of the disease burden of injuries in Chinese children and adolescents from 1990 to 2021, so as to provide reference for injury prevention and control in this population. Methods Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 (GBD 2021), the trend of change in the disease burden of injuries in children and adolescents in China from 1990 to 2021 was analyzed by the Joinpoint regression model. The Bayesian age period cohort model (BAPC) was used to predict the disease burden of injuries among children and adolescents in China from 2022 to 2031. Results From 1990 to 2021, the standardized incidence rate, standardized prevalence rate, standardized mortality rate, and standardized disability-adjusted life years (DALYs) rate of injuries among children and adolescents in China showed an overall downward trend (AAPC=-1.14%, -0.76%, -5.41%, -5.03%, P < 0.05). For different genders, the standardized incidence rate (7 106.00/100 000, 5 388.00/100 000), standardized mortality rate (92.00/100 000, 19.00/100 000), and standardized DALYs rate (7 834.00/100 000, 1 673.00/100 000) of injuries in boys were higher than the rate of injuries in girls in 1990 and 2021 (5 188.00/100 000, 3 874.00/100 000; 61.00/100 000, 10.00/100 000; 5 398.00/100 000, 945.00/100 000). Compared with Asia and globally, China had the fastest decline in the standardized mortality rate (AAPC=-5.41) and the slowest decline in the standardized prevalence rate (AAPC=-0.76) among children and adolescents. The results of the Joinpoint burden trend analysis demonstrated that the standardized incidence rate of injuries showed an increasing trend from 2005 to 2021, and the standardized prevalence rate of injuries showed an increasing trend from 2006 to 2021. Among the different age groups, the disease burden of injuries was highest in the 15-19-year-old group in 2021. For different types of injuries, the standardized incidence rate, standardized mortality rate, and standardized DALYs rate of unintentional injury were higher than those of transport injury, and self-harm and interpersonal violence from 1990 to 2021. The BAPC prediction model showed that the standardized incidence rate (4 833.05/100 000-5 313.70/100 000) and standardized prevalence rate (5 433.90/100 000-5 821.88/100 000) of injury showed an increasing trend, and the standardized mortality rate (13.69/100 000-5.52/100 000) and the standardized DALYs rate (1 226.37/100 000-510.14/100 000) showed a decreasing trend during 2022-2031. The analysis of influencing factors found that children and adolescents who drank alcohol were at high risk of injury burden. Conclusions From 1990 to 2021, the injury burden of children and adolescents in China generally showed a downward trend. The standardized incidence rate and standardized prevalence rate of injuries are predicted to increase from 2022 to 2031. More targeted and individualized intervention measures should be developed to reduce the injury burden in children and adolescents.
- Wounds and injuries /
- Cost of illness /
- Regression analysis /
- Child /
- Adolescent
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

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图 1 中国儿童青少年1990—2021年不同类型伤害疾病负担变化

Figure 1. Changes in disease burden of different injuries types among children and adolescents in China from 1990 to 2021

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表 1 中国、亚洲和全球儿童青少年伤害疾病负担1990和2021年比较/10^-5

Table 1. Comparison of disease burden of injuries among children and adolescents in China, Asia and globally in 1990 and 2021/10^-5

指标	性别	中国		亚洲		全球
指标	性别	1990年	2021年	1990年	2021年	1990年	2021年
标化发生率	男	7 106.00(5 899.00~8 485.00)	5 388.00(4 422.00~6 478.00)	8 932.00(7 710.00~10 340.00)	6 621.00(5 730.00~7 637.00)	12 127.00(10 433.00~14 114.00)	8 035.00(6 927.00~9 313.00)
	女	5 188.00(4 356.00~6 105.00)	3 874.00(3 146.00~4 717.00)	7 141.00(6 105.00~8 343.00)	5 308.00(4 494.00~6 242.00)	8 703.00(7 426.00~10 162.00)	6 177.00(5 228.00~7 258.00)
	合计	6 180.96(5 163.73~7 335.88)	4 683.75(3 850.85~5 631.09)	8 061.64(6 937.93~9 357.34)	5 991.88(5 157.00~6 950.22)	10 449.36(8 960.22~12 159.93)	7 132.89(6 108.79~8 283.90)
标化患病率	男	5 991.00(5 291.00~6 896.00)	4 630.00(3 963.00~5 471.00)	6 100.00(5 477.00~6 853.00)	4 667.00(4 141.00~5 325.00)	7 291.00(6 616.00~8 142.00)	5 103.00(4 587.00~5 740.00)
	女	6 956.00(5 832.00~8 417.00)	5 792.00(4 680.00~7 259.00)	6 297.00(5 481.00~7 341.00)	4 820.00(4 140.00~5 658.00)	6 835.00(6 040.00~7 792.00)	5 128.00(4 468.00~5 940.00)
	合计	6 459.62(5 578.09~7 574.38)	5 169.93(4 315.48~6 265.35)	6 195.74(5 486.47~7 063.51)	4 739.93(4 158.36~5 465.59)	7 067.89(6 356.25~7 916.64)	5 114.82(4 540.63~5 822.08)
标化死亡率	男	92.00(78.00~108.00)	19.00(16.00~23.00)	73.00(65.00~81.00)	27.00(24.00~31.00)	72.00(65.00~79.00)	31.00(26.00~35.00)
	女	61.00(52.00~72.00)	10.00(8.00~12.00)	49.00(43.00~55.00)	16.00(13.00~18.00)	44.00(39.00~49.00)	17.00(14.00~20.00)
	合计	76.99(66.45~89.39)	14.97(12.54~17.63)	61.47(55.06~68.04)	21.69(19.08~24.50)	58.49(52.90~63.90)	23.95(20.20~27.68)
标化DALYs率	男	7 834.00(6 663.00~9 214.00)	1 673.00(1 393.00~1 993.00)	6 229.00(5 539.00~6 931.00)	2 308.00(2 042.00~2 611.00)	6 165.00(5 562.00~6 748.00)	2 613.00(2 228.00~3 000.00)
	女	5 398.00(4 631.00~6 300.00)	945.00(797.00~1 118.00)	4 315.00(3 826.00~4 845.00)	1 403.00(1 209.00~1 625.00)	3 936.00(3 511.00~4 367.00)	1 530.00(1 266.00~1 806.00)
	合计	6 663.79(5 751.29~7 729.08)	1 334.33(1 135.51~1 552.92)	5 302.94(4 760.78~5 879.22)	1 874.70(1 657.39~2 125.77)	5 075.89(4 591.14~5 560.91)	2 087.26(1 779.07~2 417.93)
注： ()内数字为95%UI/10^-5。

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表 2 中国儿童青少年1990—2021年伤害Joinpoint负担趋势分析

Table 2. Trend analysis of Joinpoint burden for children and adolescents injuries in China from 1990 to 2021

指标	趋势1		趋势2		趋势3		整体趋势
指标	年份	APC(95%CI)	年份	APC(95%CI)	年份	APC(95%CI)	年份	APC(95%CI)
标化发生率	1990—2001	-0.80(-2.06~0.49)	2001—2005	-8.81(-16.15~-0.83)	2005—2021	0.64(0.01~1.27)	1990—2021	-1.14(-2.28~0.01)
标化患病率	1990—2000	-0.58(-0.69~-0.46)	2000—2006	-3.44(-3.79~-3.09)	2006—2021	0.20(0.13~0.28)	1990—2021	-0.76(-0.84~-0.68)
标化死亡率	1990—2008	-4.07(-4.44~-3.69)	2008—2021	-7.24(-7.89~-6.59)	—	—	1990—2021	-5.41(-5.75~-5.08)
标化DALYs率	1990—1997	-2.14(-2.84~-1.44)	1997—2008	-4.80(-5.11~-4.47)	2008—2021	-6.76(-7.01~-6.50)	1990—2021	-5.03(-5.24~-4.82)
注： P值均 < 0.05。

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表 3 中国不同年龄组儿童青少年1990—2021伤害疾病负担情况/10^-5

Table 3. Disease burden of injuries in children and adolescents of different age groups in China from 1990 to 2021/10^-5

年龄组/岁	年份	发生率			患病率
年龄组/岁	年份	男	女	合计	男	女	合计
< 5	1990	8 573.73	7 766.25	8 194.26	2 139.87	1 985.44	2 061.95
	2021	4 591.80	3 768.18	4 209.65	1 068.37	901.24	990.82
5~9	1990	6 060.85	4 324.67	5 227.73	4 532.58	4 889.66	4 703.93
	2021	4 708.39	3 414.55	4 102.78	3 157.98	3 625.19	3 376.67
10~14	1990	6 128.19	4 082.14	5 138.23	7 235.07	8 371.90	7 785.11
	2021	5 360.74	3 881.84	4 670.98	5 686.01	7 097.19	6 344.19
15~19	1990	7 606.23	4 272.29	5 983.98	11 206.64	14 022.20	12 576.66
	2021	7 173.71	4 529.56	5 948.90	9 516.06	12 823.42	11 048.08

年龄组/岁	年份	死亡率			DALYs率
年龄组/岁	年份	男	女	合计	男	女	合计
< 5	1990	167.94	147.96	158.55	14 880.66	13 137.24	14 061.34
	2021	20.11	15.10	17.79	1 825.22	1 376.92	1 617.21
5~9	1990	74.40	34.12	55.07	6 342.53	3 003.05	4 740.05
	2021	15.69	7.97	12.08	1 389.67	746.80	1 088.76
10~14	1990	46.40	22.02	34.60	3 855.21	1 963.39	2 939.88
	2021	14.88	6.42	10.93	1 485.26	741.72	1 116.13
15~19	1990	68.52	29.84	49.70	5 352.85	2 539.65	3 983.98
	2021	27.38	9.93	19.30	2 222.16	971.10	1 642.65

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表 4 中国儿童青少年2022—2031年伤害疾病负担预测/10^-5

Table 4. Prediction of disease burden of injuries in children and adolescents in China from 2022 to 2031/10^-5

年份	标化发生率	标化患病率	标化死亡率	标化DALYs率
2022	4 833.05	5 433.90	13.69	1 226.37
2023	4 926.32	5 523.44	12.48	1 122.94
2024	5 006.88	5 599.84	11.34	1 024.60
2025	5 077.27	5 658.27	10.28	932.35
2026	5 136.75	5 696.18	9.30	846.81
2027	5 186.45	5 717.80	8.41	767.83
2028	5 227.84	5 733.77	7.59	695.31
2029	5 262.18	5 755.04	6.84	628.62
2030	5 290.61	5 784.68	6.15	567.04
2031	5 313.70	5 821.88	5.52	510.14

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表 5 中国儿童青少年1990和2021年伤害负担的影响因素

Table 5. Influence factors of injuries among children and adolescents in China in 1990 and 2021

影响因素	死亡率			DALYs率
影响因素	1990年/10^-5	2021年/10^-5	变化率/%	1990年/10^-5	2021年/10^-5	变化率/%
环境因素	-1.93	-0.30	-84.46	-182.03	-22.95	-87.39
非最佳温度	-7.06	-1.07	-84.84	-588.74	-85.67	-85.45
职业风险	4.72	0.72	-84.75	377.14	59.39	-84.25
行为因素	0.45	0.32	-28.89	45.58	32.51	-28.67
用药	0.04	< 0.01	-91.41	2.65	0.25	-90.57
饮酒	0.28	0.29	3.57	22.26	23.83	7.05
亲密伴侣间暴力	0.14	0.02	-85.71	20.72	8.44	-59.27
注：死亡率和DALYs率为负值表示该因素是伤害负担的保护因素，即减少了伤害的负担。

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参考文献(19)

[1]	GBD 2019 Adolescent Mortality Collaborators. Global, regional, and national mortality among young people aged 10-24 years, 1950-2019: a systematic analysis for the Global Burden of Disease Study 2019[J]. Lancet, 2021, 398(10311): 1593-1618.
[2]	RIVARA F P. Prevention of death and disability from injuries to children and adolescents[J]. Int J Inj Contr Saf Promot, 2012, 19(3): 226-230.
[3]	GBD 2017 Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017[J]. Lancet, 2018, 392(10159): 1736-1788.
[4]	AL-HAJJ S, FARRAN S, SIBAI A M, et al. Injury burden in individuals aged 50 years or older in the Eastern Mediterranean region, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019[J]. Lancet Healthy Longev, 2022, 3(4): e253-e262. doi: 10.1016/S2666-7568(22)00038-1
[5]	ALI S, DESTAW Z, MISGANAW A, et al. The burden of injuries in Ethiopia from 1990-2017: evidence from the global burden of disease study[J]. Inj Epidemiol, 2020, 7(1): 67.
[6]	PANT P R, BANSTOLA A, BHATTA S, et al. Burden of injuries in Nepal, 1990-2017: findings from the Global Burden of Disease Study 2017[J]. Inj Prev, 2020, 26(Supp 1): i57-i66.
[7]	HÍJAR M, PÉREZ-NúÑEZ R, HIDALGO-SOLÓRZANO E, et al. Unintentional injuries in Mexico, 1990-2017: findings from the Global Burden of Disease Study 2017[J]. Inj Prev, 2020, 26(Supp 1): i154-i161.
[8]	QUEIROGA A C, SEABRA R, FRANKLIN R C, et al. Trends in drowning mortality in Portugal from 1992 to 2019: comparing global burden of disease and national data[J]. Inj Prev, 2022, 28(4): 318-324.
[9]	任义涛, 朱荣芳, 林金雄, 等. 1990―2019年中国人群道路交通伤害的疾病负担及变化趋势[J]. 中华疾病控制杂志, 2023, 27(11): 1289-1295. REN Y T, ZHU R F, LIN J X, et al. Analysis of the disease burden and changing trends of road traffic injuries in Chinese population from 1990 to 2019[J]. Chin J Dis Control Prev, 2023, 27(11): 1289-1295. (in Chinese)
[10]	李阳, 任炼. 1990—2021年中国、日本、韩国慢性阻塞性肺疾病负担与变化趋势分析[J]. 中国循证心血管医学杂志, 2024, 16(11): 1289-1294. doi: 10.3969/j.issn.1674-4055.2024.11.03 LI Y, REN L. Analysis of the burden and trends of chronic obstructive pulmonary disease in China, Japan and Korea, 1990-2021[J]. Chin J Evid Based Cardiovasc Med, 2024, 16(11): 1289-1294. (in Chinese) doi: 10.3969/j.issn.1674-4055.2024.11.03
[11]	STEVENS G A, ALKEMA L, BLACK R E, et al. Guidelines for accurate and transparent health estimates reporting: the GATHER statement[J]. Lancet, 2016, 388(10062): e19-e23. doi: 10.1016/S0140-6736(16)30388-9
[12]	聂艳武, 马玉花, 王琛琛, 等. 基于Joinpoint和APC模型的2010—2019年新疆克拉玛依市队列人群HPV感染特征及趋势分析[J]. 现代预防医学, 2022, 49(11): 1921-1925. NIE Y W, MA Y H, WANG C C, et al. Analysis of HPV infection characteristics and trend of cohort population in Karamay City, Xinjiang, 2010-2019 based on Joinpoint and APC Model[J]. Mod Prev Med, 2022, 49(11): 1921-1925. (in Chinese)
[13]	GBD 2021 Risk Factors Collaborators. Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021[J]. Lancet, 2024, 403(10440): 2162-2203. doi: 10.1016/S0140-6736(24)00933-4
[14]	联合国儿童基金会. 2020年中国青少年人口状况[EB/OL]. (2023-08-21)[2025-01-06]. https://www.unicef.cn/reports/population-status-adolescents-china-2020.
[15]	共青团中央. 青年发展统计监测数据[EB/OL]. (2022-09-21)[2025-01-06]. https://www.gqt.org.cn/xxgk/qnfz/202209/t20220921_789722.htm.
[16]	彭小凡, 蔡婷婷, 桂腾娅, 等. 青少年心理素质在学习压力与自杀意念关系中的调节作用[J]. 中国心理卫生杂志, 2021, 35(11): 919-924. doi: 10.3969/j.issn.1000-6729.2021.11.006 PENG X F, CAI T T, GUI T Y, et al. Moderating effect of psychological quality on relationship between study stress and suicidal ideation in adolescents[J]. Chin Ment Health J, 2021, 35(11): 919-924. (in Chinese) doi: 10.3969/j.issn.1000-6729.2021.11.006
[17]	柏晓迪, 蒋运兰, 徐婷, 等. 基于中文文献的青少年伤害相关行为流行特征的Meta分析[J]. 上海预防医学, 2024, 36(10): 969-976. BAI X D, JIANG Y L, XU T, et al. A Meta-analysis of prevalent characteristics of injury-related behaviors among adolescents based on Chinese literature[J]. Shanghai J Prev Med, 2024, 36(10): 969-976. (in Chinese)
[18]	吴康敏. 我国儿童意外伤害现状及干预分析[J]. 中国儿童保健杂志, 2013, 21(10): 1009. WU K M. Current situation and intervention analysis of children unintentional injury in China[J]. Chin J Child Health Care, 2013, 21(10): 1009. (in Chinese)
[19]	IHME. Disease, injury, and risk factsheets[EB/OL]. (2024-05-16)[2025-01-13]. https://www.healthdata.org/research-analysis/diseases-injuries-risks/factsheets-hierarchy#injuries.