| Backgrounds:Traumatic brain injury(TBI)and Traumatic spinal cord injury(TSCI)refer to changes in brain or spinal cord function caused by direct or indirect mechanical force,mainly manifested by changes in consciousness,coma,epilepsy,bureaucracy,focal sensation or motor nerve defects.TBI and TSCI lead to disability and death,seriously endangering health and quality of life,and bringing huge disease burden and economic loss to families and society.Given that there is no breakthrough in the treatment of TBI and TSCI,therefore,understanding the prevalence,external causes and trends of TBI and TSCI is critical for identifying risk factors,developing prevention solutions,and evaluating interventions and policies.Objectives:To understand the trends in traumatic brain injury and spinal cord injury mortality,and analyze differences by age,gender,location and external cause of injury between 2014 and 2018.Our study would provide a scientific basis for the development and implementation of preventive measures for TBI and TSCI in Guangdong Province.Methods:The research data derived from Disease Surveillance Points(DSPs)from Chronic Non-communicable Disease Prevention and Control Institute of the Guangdong Provincial Center for Disease Control and Prevention.Mortality data was collected based on the registered system and 28 DSPs in Guangdong Province from 1 January,2014 to 31 December,2018,and encoded using the International Classification of Diseases Classification Code-Tenth Revision(ICD-10).Frequency and percentage were used to describe demographic characteristics.Crude and standard mortality of gender,age,urban and rural,year and external factors were calculated based on 2010 census data.The 95%confidence interval(CI)was estimated.The?~2 test was used to compare the differences in mortality among the subgroups,and the Cochran-Armitage trend test was used to analyze the trend of mortality between 2014 and 2018.This study used negative binomial regression model to explore the relationship between death for TBI and TSCI and sociodemographic factors.The external causes were further classified according to the vehicles,and subgroup analysis was conducted.Results:DSPs in Guangdong Province covered a population of 23.92 million,accounting for 22%of the province's total population.Among them,males accounted for 51%,rural population accounted for 56%,and older people over65 years old accounted for 10.6%of the total population.From 2014 to 2018,the total number of deaths from monitoring systems was about 600,000(about120,000 per year).TBI mortality:(1)The number of TBI deaths in DSPs ranged from 2,678to 3,925 each year,and the crude TBI mortality ranged from 119.7 to 163.0per million in Guangdong Province between 2014 and 2018.After adjusting for age,the standardized mortality increased from 115.5 per million in 2014 to154.3 per million in 2015,and then decreased.The 5-year average crude and standard mortality rate is 135.2 and 129.0 per million;(2)Compared with women and urban residents,male and rural residents have a higher risk of TBI death,with adjusted mortality ratios of 2.29 and 2.00,respectively.With the increase of age,the TBI mortality decreased first and then increased.The mortality of children aged 5-14 was the lowest(24.5 per million),and the distribution was like???;(3)Motor vehicle traffic accident(75.5 per million)and falling(43.6 per million)were the two main external causes for TBI death.The leading cause for TBI death under 75 is motor vehicle traffic accidents,while the main cause for elderly people aged 75 and over is falls;(4)Pedestrians were high-risk groups for traffic accident deaths.Among children under 14 and those over 65,pedestrian deaths accounted for more than 60%of the total deaths from traffic accidents.For people aged 15-64,motorcycle traffic accidents were the first leading cause of TBI death;(5)The TBI mortality of car passengers or drivers,motorcycle drivers and other vehicle passengers or drivers increased by 55.81%,14.08%and 43.08%,respectively,between 2014 and 2018.The TBI mortality caused by car traffic accidents and motorcycle traffic accidents rised sharply among people over 45 years old.TSCI mortality:(1)The number of TSCI deaths in DSPs ranged from 78to 199 each year,and the crude TSCI mortality ranged from 3.5 to 8.1 per million in Guangdong Province between 2014 and 2018.After adjusting for age,the standardized mortality increased year by year,from 2.9 per million in2014 to 7.2 per million in 2018,and the increase rate was 148.28%.The five-year average crude and standard mortality was 6.3 and 5.3 per million(SE=0.02);(2)The risk of TSCI death among male and rural residents was higher than that of female and urban residents,and the adjusted mortality ratio was 2.23 and 2.58,respectively.The mortality of TSCI increased with age(from 0.10 to 88.7 per million),and the distribution was like?/?;(3)Different from the external cause for TBI death,falling(2.80 per million)was the most important external cause for TSCI death for all age groups from 2014 to 2018,especially for those over 75 years old(accounting for 62.28%);(4)According to the classification of vehicles,motorcycles and pedestrians are the first and second external factors that cause TSCI death;(5)For people aged 75 and over,TSCI mortality increased during five years(P<0.05),and the TSCI mortality caused by falling changed from 33.70 to 73.80 per million,increasing by 104.15%.Conclusion:The TBI mortality in Guangdong Province has maintained a high level from 2014 to 2018,and the TSCI mortality increased year by year,becoming a huge threat to public health.Men and rural residents are at a higher risk of dying from brain and spinal cord injuries than women and urban residents.For young people,road traffic accidents are the leading cause of TBI death,whereas falling is the leading cause of death among people over 65.Both pedestrian's and motorcycle drivers'TBI and TSCI mortality increased during the period.Road safety policies should be considered(including wearing helmets,limiting speeds and prohibit drunk driving,etc.)and preventing falling(including doing sports and rehabilitation,etc.)to reduce mortality caused by TBI and TSCI. |
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