Elsevier

Injury

Volume 46, Issue 4, April 2015, Pages 572-579
Injury

The National Injury Surveillance System in China: A six-year review

https://doi.org/10.1016/j.injury.2014.12.013Get rights and content

Abstract

Introduction

This article aims to describe the National Injury Surveillance System (NISS) in China from its establishment in 2006 to the methods used and some key findings from 2006 to 2011.

Methods

From 2003 to 2005, based upon specific injury case definitions, a pilot study was conducted to explore the feasibility of a National Injury Surveillance System (NISS) in China. The NISS formally started operations in January 2006, and 126 hospitals from 43 sample points (23 rural, 20 urban) were selected to participate. Doctors and nurses in participating hospitals were trained to administer standardised data collection forms. Chinese Center for Disease Control and Prevention is in charge of analysing data and releasing findings.

Results

From 2006 to 2011, the annual recorded injury cases increased from 340,000 to 630,000, the majority being male (65%) and over 80% aged 15–64 years. Falls (32%), road traffic injuries (23%) and blunt injuries (19%) were the most common causes. More than 70% of cases were of minor severity, and over 75% of cases were discharged after treatment in the emergency department.

Conclusions

The NISS is the first hospital-based national system in China, therefore considered an important source of injury data. It has the potential to describe injury morbidity in China and to be utilised to develop national technical and policy documents.

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)

  • S.Y. Wang et al.

    Injury-related fatalities in China: an under-recognised public-health problem

    Lancet

    (2008)
  • K.P. Quinlan et al.

    Expanding the National Electronic Injury Surveillance System to monitor all nonfatal injuries treated in US Hospital Emergency Departments

    Ann Emerg Med

    (1999)
  • G.H. Yang 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)
  • Disease Control and Prevention Bureau of the Ministry of Health of P.R. China et al.

    National report on injury prevention in China

    (2007)
  • A. Butchart et al.

    Preventing injuries and violence: a guide for ministries of health

    (2007)
  • D.H. Stone et al.

    Developing injury surveillance in accident emergency departments

    Arch Dis Child

    (1998)
  • D. Li 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)
  • L.L. Duan et al.

    Analysis on the characteristics of injuries from the Chinese National Injury Surveillance System

    Zhonghua Liu Xing Bing Xue Za Zhi

    (2010)
  • T. Xie et al.

    Quality control and operation of an injury surveillance in emergency rooms

    Zhongguo Gong Gong Wei Sheng Za Zhi

    (2006)
  • Y. Holder et al.

    Injury surveillance guidelines

    (2001)
  • G.H. Yang et al.

    Mortaility registration and surveillance in China: history, current situation and challenges

    Popul Health Metr

    (2005)
  • Anon

    Work manual of National Injury Surveillance System

    (2005)
  • Department of Health and Children

    EHLASS report for Ireland 2000 [Internet]

    (2001)
  • S.G. Mackenzie et al.

    CHIRPP: Canada's principal injury surveillance program

    Inj Prev

    (1999)
  • C. Santikarn et al.

    The establishment of injury surveillance in Thailand

    Int J Consum Prod Saf

    (1999)
  • L. Le et al.

    Vietnam profile on traffic related injury: facts and figures from recent studies and their implications for road traffic injury policy

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