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A social change perspective on injury prevention in China
  1. Joan Ozanne-Smith1,
  2. Qingfeng Li2
  1. 1 Department of Forensic Medicine, Monash University, Victorian Institute of Forensic Medicine, Melbourne, Victoria, Australia
  2. 2 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to Professor Joan Ozanne-Smith, Department of Forensic Medicine, Monash University, Victorian Institute of Forensic Medicine, Melbourne, Victoria 3006, Australia; joan.ozanne-smith{at}


Introduction China has undergone massive social change over the past four decades. Since national estimates became available in 1987, the overall fatal injury rate has decreased. This paper investigates targeted interventions and sociodemographic factors that may have contributed to fatal injury rate changes particularly for road traffic fatality (RTF), suicide and drowning.

Aims (1) To review the recent epidemiology of injury in China.

(2)To investigate factors influencing trends in overall and specific cause injury mortality rates.

Methods Published injury mortality statistics and related literature were reviewed. Factors potentially influencing trends were investigated in the context of rapid development based on literature reviews of targeted interventions, macrolevel and microlevel contextual factors and changes specific to RTF, suicide and drowning.

Results Overall estimated national injury mortality rates in China decreased between 1987 and 2015, despite a rapid rise in RTF. Suicide and drowning rates decreased significantly and falls displaced drowning among the leading causes. The higher female to male suicide ratio reversed. Differences were observed in frequencies and proportions of deaths by major cause by age group and over time.

Discussion Economic and structural development and related social change in this period include: urbanisation, changes in demographics, life choices (eg, internal migration), education, poverty alleviation, health insurance and relevant regulations/legislation. These factors potentially explain much of the change in fatal injury rates in China. Data limitations persist. Increased investment in data and research would provide realistic opportunities for accelerated progress in implementing effective targeted interventions to further reduce China’s injury burden.

  • low-middle income country
  • mortality
  • economic development
  • epidemiology
  • suicide/self?harm
  • drowning

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  • Contributors JOS conceived of the study design, wrote the first draft and prepared the final version of the paper. QL contributed to acquisition and interpretation of data, provided critical input to drafting of the paper and approved the final version for publication.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Data sharing statement No additional data. New analyses of data in this paper could be conducted from published data by any other researcher.