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Advancing injury prevention in China
  1. Guoqing Hu1,
  2. Rebecca Q Ivers2,3,
  3. Henry Xiang4
  1. 1 Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
  2. 2 The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
  3. 3 School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
  4. 4 Center for Injury Research and Policy, The Research Institute at Nationwide Children’s Hospital. The Ohio State University College of Medicine, Columbus, Ohio, USA
  1. Correspondence to Professor Rebecca Q Ivers, School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia; rebecca.ivers{at}

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With an average gross domestic product (GDP) growth of nearly 10% per year over the past few decades, China has demonstrated the most rapid sustained economic growth of any major economy in history. However, with economic growth has also come growth in injuries. In 2016, China had 773 268 injury deaths, accounting for 17% of global injury deaths; the proportion of injury deaths in China was also significantly higher than that for combined deaths from communicable, maternal, neonatal and nutritional diseases in the same year (2%), according to the estimates by the Global Burden of Disease (GBD) study group.1 In China, deaths caused by injuries accounted for 8% of all-disease deaths in 2016.1

To highlight China’s challenges and achievements in injury control and research with international communities, we coordinated this China-themed issue of Injury Prevention. This specific issue includes 10 papers, covering a diverse range of topics. It is notable that most contributing authors are resident in China, highlighting the growing number of local researchers contributing to the generation of research evidence on injury prevention.

Four studies examined recent trends in injury mortality for specific causes at national or local level. Based on the data from the Nationwide Child Mortality Surveillance Network of China, Xiang et al 2 reported a decreasing trend in under-five unintentional injury mortality from 2009 to 2016, but their rates are much higher than the GBD estimates for the same time period.1 Wang et al 3 used the Disease Surveillance Points system (DSPs) of China and found the overall drowning mortality rate remained stable between 2006 and 2013 in China. Pan et al 4 found that indigenous communities had significantly higher unintentional injury mortality rates than the general population in Taiwan, China, between 2002 and 2013, although the gap reduced at a very slow speed. Another study by Wu et al reported on unintentional injuries and their risk factors in college students.5

Two studies focused on road traffic crashes. Xu et al 6 assessed the value of ‘safety in numbers’ in assessing the safety of road facilities for pedestrians and recommended considering environmental hazards of walking in using intersections prevalent of pedestrians to measure safety performance of road facilities. Zhang et al 7 studied the factors related to overloading and crash severity among crash-involved vehicles in China.

Another two studies, respectively, assessed the severity of problem and risk factors of falls for older community dwellers in Shenzhen.8 Zhou et al 8 reported that (1) there were 8.6%, 1.3% and 0.8% of surveyed community dwellers aged 60–98 years old reporting one, two and three or more falls in the past year, respectively and (2) the presence of a medical condition, living alone, visual impairment, use of a walking aid and impaired balance were risk factors for elderly falls. Peng et al 9 conducted a systematic review of incidence, risk factors and economic burden of fall-related injuries in older Chinese people, highlighting a need for more high-quality research on the economic burden of fall-related injury in China.

Two studies examined violence in China. Rao et al 10 found that 28.0% (725) of surveyed high school students reported as a cyberbullying perpetrators and 44.5% (1150) responded as cyberbullying victims during the previous 6 months, and risk factors varied between perpetrators and victims of cyberbullying. Gao reported on trends in violence-related deaths using routinely collected data, showing a 57% decrease between 2006 and 2015.11

There is no doubt that the research included in this edition contributes new knowledge to the field, and the reported findings are important in highlighting the significant burden of injuries, and known or new injury problems in China. However, it is notable, both from this special edition, and from previous literature, that while there are many studies reported on burden and risk factors, there are very few rigorously conducted randomised trials or intervention studies in the field of injury from China. A study that summarised injury research in China from 2001 to 2010 showed the majority of publications were descriptive studies based on surveillance data or local-sample surveys.12 Complete, continuous and strong research evidence can significantly accelerate the process from problems to solutions. However, analytic, experimental and policy studies are scarce for effective injury prevention in China. This may partially explain why injury control has been seriously underdeveloped in the past few decades in China.

Given the huge burden of injury in China, and also its rapidly ageing population, there remain enormous challenges in injury prevention and research. Clearly, it is very important to support researchers to generate high-quality research evidence to fill in the knowledge gaps in injury control in China, thus comprehensively and quickly advancing the field in China. A key to success is that injury research must be adequately supported by the government. This may involve generation of high-quality data on burden, funding of studies to examine risk factors, but most importantly, intervention and experimental studies and policy research to enable translation to practice. Having a centrally funded injury research agency that support capacity development, including research and policy training, and funds injury research, would benefit the field immensely.

Good science makes a difference. Numerous fatal and non-fatal injuries in China could be prevented if injury research and prevention is included on the top priority list in the national public health strategic agenda and coordinated efforts supported by rigorous research are devoted to tackle this significant public health problem.



  • Contributors All authors contributed to drafting and revision of this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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