The National Injury Surveillance System in China: A six-year review
Introduction
Injury is an important public health problem in China [1]. Injuries account for more than 10% of all deaths and more than 30% of all potentially productive years of life lost (PPYLL) due to premature mortality in China [2]. In fact injury was reported as the leading cause of death for Chinese people aged from 1 to 59 years [3]. Meanwhile, disability and medical care costs caused by injuries bring great burden to Chinese society. The productivity of the injured person is affected. As well, there is the increased possibility that those who are severely injured will fall into poverty due to excessive medical bills. It is estimated that every year in China, there are at least 200 million injuries, including about 60 million people needing emergency medical care, 14 million people needing hospitalisation and 1 million left temporarily or permanently disabled [4].
An understanding of the burden of injuries and violence in a country like China is essential for developing effective policies and strategies to address the public health problem [5]. The establishment of a specially designed injury surveillance system is widely advocated as a key strategy for the development and evaluation of injury prevention interventions. Many industrialised countries now have National Injury Surveillance Systems often based at emergency departments (EDs) at hospitals to monitor injury events. Examples of such systems exist in the United States, Australia, Canada, and elsewhere in Europe [6].
To explore the establishment of an injury surveillance system in China, the National Center for Chronic and Noncommunicable Disease Control and Prevention (NCNCD) at the Center for Disease Control and Prevention (CDC) in China carried out a pilot study from 2003 to 2005 [7]. Following this successful pilot, a mandatory document – the Notice of the Ministry of Health on the Work of National Injury Surveillance – was issued in August 2005 by the Ministry of Health of China, which formally established the hospital-based National Injury Surveillance System (NISS) effective in January 2006 [8]. All hospitals involved in the NISS must work in accordance with this mandatory document.
This paper describes the approach and methods of NISS and presents detailed analysis of data from the first six years of the NISS. This paper is one of the first to introduce the national system in China and approved by the Ethical Review Committee of the National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention. Beijing, PR China.
Section snippets
Pilot study and establishment of NISS
Injury prevention and control is one of the main functions of NCNCD. Soon after its establishment in 2003, the NCNCD started a pilot study of national injury surveillance in order to explore the feasibility of a nation-wide injury surveillance system in China. Based on WHO guidelines for injury surveillance, as well as the experiences of other countries (United States, Australia, Canada, and several European countries), NCNCD developed a programme for the pilot study. A notice was delivered by
Overall trends
From 2006 to 2011, the total number of annual injury cases reported by NISS increased from 345,851 to over 632,537 (see Fig. 4). A total of 3,068,205 injury cases were recorded over 6 years or 42,614 per month over 126 hospitals (336 per facility on average). In each year, males outnumbered females by 1.96:1 on average.
Main findings
Most of the injury cases collected by NISS each year were aged 15–64 years. In 2011 for example, over 65% of injury cases were male, and over 80% were aged 15–44 (58%) (see Fig. 5
Discussion
There are several major injury surveillance systems in high income countries, including the US Consumer Product Safety Commission's (CPSC) National Electronic Injury Surveillance System, the European Home and Leisure Accident Surveillance System, and the Canadian Hospital Injury Reporting and Prevention Program [13], [14], [15]. Some developing countries in Asia, such as Thailand and Vietnam, have carried out injury surveillance in recent years [16], [17]. However, there was no independent data
Conclusions
Through constant improvement, NISS has been able to better monitor the distribution and trends of injury events. It has allowed better collecting and sharing of injury data in China and provides evidence for policy-making in injury prevention. As one of the important countries with an injury burden, NISS also facilitates the construction of a foundation for research and work for global injury prevention.
Funding
None.
Conflict of interest statement
There are no conflicts of interest.
Contributors
All authors meet the uniform requirements for manuscript submitted to medical journals. L.L.D. had the initial idea of the study and drafted the article; X.D. and Y.W. were responsible for the data analysis; C.M.W. and W.J. contributed to the literature research; S.R.H. contributed to the data analysis and interpretations of the findings; L.H.W. participated in revising the article; A.A.H. developed the analysis plan and oversaw the study design. All authors have seen and approved the final
Acknowledgements
Sincere gratitude to the Ministry of Health of the People's Republic of China and China CDC for their great support in the establishment and development of NISS. Deep gratitude to the 31 provincial, five cities’ specifically designated in the provincial plan and the 43 local health administrative departments and CDCs, as well as the 127 surveillance hospitals for their support and hard work in NISS. The authors would like to acknowledge the editorial assistance provided by Bobbi J. Nicotera at
References (35)
- et al.
Injury-related fatalities in China: an under-recognised public-health problem
Lancet
(2008) - et al.
Expanding the National Electronic Injury Surveillance System to monitor all nonfatal injuries treated in US Hospital Emergency Departments
Ann Emerg Med
(1999) - et al.
Study on the trend and disease burden of injury deaths in Chinese population, 1991–2000
Zhonghua Liu Xing Bing Xue Za Zhi
(2004) - et al.
National report on injury prevention in China
(2007) - et al.
Preventing injuries and violence: a guide for ministries of health
(2007) - et al.
Developing injury surveillance in accident emergency departments
Arch Dis Child
(1998) - et al.
Descriptive analysis of situation of injury occurring in Emergency Department of hospitals of the 7 Provinces/Municipalities in China
Zhongguo Jian Kang Jiao Yu Za Zhi
(2005) - et al.
Analysis on the characteristics of injuries from the Chinese National Injury Surveillance System
Zhonghua Liu Xing Bing Xue Za Zhi
(2010) - et al.
Quality control and operation of an injury surveillance in emergency rooms
Zhongguo Gong Gong Wei Sheng Za Zhi
(2006)
Injury surveillance guidelines
Mortaility registration and surveillance in China: history, current situation and challenges
Popul Health Metr
Work manual of National Injury Surveillance System
EHLASS report for Ireland 2000 [Internet]
CHIRPP: Canada's principal injury surveillance program
Inj Prev
The establishment of injury surveillance in Thailand
Int J Consum Prod Saf
Vietnam profile on traffic related injury: facts and figures from recent studies and their implications for road traffic injury policy
Cited by (45)
Association between meteorological factors and elderly falls in injury surveillance from 2014 to 2018 in Guangzhou, China
2022, HeliyonCitation Excerpt :All injury cases of the first visit to the sentinel hospital and diagnosis of injury are reported to the Guangzhou Injury Monitoring System. The reports include general information about patients, basic information about injury events, and clinical injury information (Duan et al., 2015). In this study, the data were from elderly patients (≥60 years old) diagnosed with falls injury in cases reported by the Guangzhou Injury Monitoring System between January 1, 2014, and December 31, 2018.
Injury surveillance information system: A review of the system requirements
2020, Chinese Journal of Traumatology - English EditionCitation Excerpt :In other countries, a majority of these systems aim to report the proportion and characteristics of injuries in the at-risk population,15,16 and there is no global standard for collecting injury data or a unique list of functional requirements for developing this system.9,19 In fact, as essential data may be lost and misinterpreted in the manual and non-electronic documentation systems and this in turn may lead to leave policymakers facing a shortage of information, the electronic collection and transfer of injury data has been recommended.20–22 As noted in WHO's injury surveillance guideline, the amount and types of the data collected by an ISIS depend upon the country's health system priorities as well as available resources.
The burden of injury in China, 1990–2017: findings from the Global Burden of Disease Study 2017
2019, The Lancet Public HealthCitation Excerpt :One of the main limitations of measuring injury burden in China was a lack of reliable injury incidence data. Although the NISS13 and the China Zhuhai injury patient follow-up study14 are important sources of injury data in China, these data are not nationally representative and data from before 2006 were unavailable. Data on injuries before 2006 could only be derived from sparse existing literature sources, which caused the modelling process for injuries to depend more heavily on cause of death estimates, covariates, and data from surrounding countries.
Unintentional injuries: A profile of hospitalization and risk factors for in-hospital mortality in Beijing, China
2019, InjuryCitation Excerpt :Although much is known about fatal injuries via the vital registry system, there are limited data on nonfatal injuries in LMICs, with most information being based on questionnaire surveys and trauma registries or focused on a select group of injuries or population [8–12]. Although the National Injury Surveillance System (NISS) was built in China since 2006, it includes only 126 hospitals with limited representation and collects information using hard-copy forms, which leads to poor availability of real-time data [13]. Hospital discharge abstract data (DAD) could be an alternative and cost-effective data source with good availability for epidemiological studies of UIs.
Trends in injury morbidity in China, 1993–2013: A longitudinal analysis of population-based survey data
2018, Accident Analysis and PreventionCitation Excerpt :The shorter recall period is likely to reduce recall bias (Moshiro et al., 2005). Further, GBD 2016 injury prevalence estimates rely on discontinuous hospital-based surveillance for China (note: surveillance data were non-existent before 2006) and fragmented local publications (Duan et al., 2015), while this study used the population-based data from five-rounds of NHSS surveys, offering comparatively reliable prevalence estimates. Considering the methodological advantages of NHSS estimates, the findings from this study might be considered more reliable estimates of injury morbidity rates in China.
Emergency department-based injury surveillance information system: a conceptual model
2023, BMC Emergency Medicine