【作者】 王荣；

【导师】 武鸣；

【作者基本信息】 东南大学 ， 公共卫生与预防医学， 2024， 硕士

【摘要】 研究目的:本研究利用2019年全球疾病负担研究(Global burden of disease study 2019,GBD2019)数据,采用发生率、死亡率、伤残调整寿命年(Disability-adjusted life years,DALYs)、伤残所致生命损失年(Years lived with disability,YLDs)和早死所致生命损失年(Years of life lost,YLLs)等疾病负担指标,系统性地分析了1990-2019年间中国及江苏省0-19岁儿童青少年道路交通伤害(Road traffic injuries,RTIs)的疾病负担特征;运用年龄-时期-队列模型分析年龄、时期、队列对江苏省儿童青少年RTIs发生率及死亡率的影响;最后,评估了二次修订的《江苏省道路交通安全条例》对江苏省儿童青少年RTIs发生率和YLLs率的影响,为道路交通安全行政干预及决策提供依据。研究方法:本研究以中国和江苏省儿童青少年为研究对象,利用GBD2019数据从以下几个方面进行分析:1.采用Joinpoint回归分析模型对1990-2019年中国和江苏省儿童青少年不同性别、年龄组和道路使用者类型的RTIs疾病负担进行趋势分析,将中国与各级社会人口指数(Socio-Demographic index,SDI)国家平均水平比较,并估计其趋势变化的年度变化百分比和平均年度变化百分比。2.描述1990-2019年江苏省不同性别儿童青少年RTIs发生率和死亡率的年龄、时期和队列趋势,并采用内生因子法算法的年龄-时期-队列模型,评估年龄、时期与队列对RTIs发生率和死亡率的独立影响。3.采用中断时间序列分析法,以江苏省儿童青少年RTIs发生率和YLLs率作为评价指标,评价《江苏省道路交通安全条例》二次修订后,对江苏省儿童青少年道路交通伤害的影响。研究结果:1.2019年高SDI和中高SDI等级国家儿童青少年机动车使用者DALYs率最高,中等SDI等级国家行人DALYs率最高,中国行人DALYs率是高SDI等级国家的4.4倍。中国儿童青少年RTIs的YLDs率由1990年的11.56/10~5升至2019年的15.21/10~5,年平均增长0.96%;YLLs率由1990年的1070.10/10~5降至2019年的423.70/10~5,年平均下降3.11%;DALYs率由1990年的1081.65/10~5下降至2019年的438.91/10~5,年平均下降3.03%,其中DALYs率在1990-2001年、2001-2010年和2010-2019年的分别以1.57%、2.21%、5.60%的速度下降。男性RTIs疾病负担高于女性,15-19岁年龄组RTIs疾病负担高于其他年龄组。1990-2019年高SDI等级国家RTIs的DALYs率年平均下降3.68%,中等SDI等级国家年平均下降3.16%,中国儿童青少年RTIs的DALYs率下降幅度小于高SDI等级国家和中等SDI等级国家。除其他道路使用者以外,所有类型的道路使用者在高SDI等级国家的DALYs率下降幅度更大。2.2019年江苏省儿童青少年RTIs发生率为659.84/10~5,比1990年增加了51.76%;死亡率为3.25/10~5,比1990年降低了65.28%,DALYs率为276.69/10~5,比1990年降低了63.92%。1990-2019年发生率年平均增长1.38%、死亡率年平均下降3.51%、DALYs率年平均下降3.44%。在1990-2019年,江苏省儿童青少年RTIs发生率整体呈“下降-上升-下降”的趋势。Joinpoint结果显示RTIs发生率有五段有统计学意义的趋势变化:1990-1995年、1995-2000年、2000-2005年、2005-2009年和2012-2019年。其中,1990-1995年和2012-2019年发生率分别以每年1.60%和6.17%的速度下降,1995-2000年、2000-2005年和2005-2009年分别以2.66%、12.75%和6.75%的速度上升。死亡率呈现持续下降的趋势,有四段有统计学意义的趋势变化:2000-2005年、2005-2010年、2010-2015年和2015-2019年,分别以每年2.32%、4.90%、7.70%、6.09%的速度下降。DALYs率也呈持续下降的趋势,有三段有统计学意义的趋势变化:1990-2001年、2001-2009年和2009-2019年,分别以每年0.51%、3.21%和6.74%的速度下降。1990-2019年,男性和女性RTIs疾病负担的变化趋势与总人群大体一致,男性RTIs的发生率、死亡率和DALYs率均高于女性。不同道路使用者的疾病负担趋势与总体相似,其中自行车使用者发生率最高,行人的死亡率和DALYs率最高。3.年龄-时期-队列模型分析结果显示,1990-2019年江苏省儿童青少年RTIs发生率的年龄效应总体上随年龄的增长呈上升趋势,发生风险在15-19岁年龄组达到高峰。时期效应显示,随着时间的推移,RTIs发生风险呈先升后降的趋势,发生风险最高的时期是2010-2014年。队列效应显示,出生年代越晚,RTIs发生风险越高,在2010-2014年出生的儿童青少年RTIs发生风险最高。1990-2019年江苏省儿童青少年RTIs死亡率的年龄效应总体上随年龄的增长呈现先降后升的趋势,10-14岁年龄组死亡风险最低,15-19岁年龄组死亡风险最高。时期效应显示,随着时间的推移,RTIs死亡风险呈下降趋势,死亡风险最高的时期是2010-2014年。队列效应显示,出生年代越晚,RTIs死亡风险越高,在1990-1994年出生的儿童青少年死亡风险最高。4.中断时间序列分析结果显示,自2011年《江苏省道路交通安全条例》二次修订后,江苏省儿童青少年RTIs在总人群、男性、女性、0-4岁年龄组、5-9岁年龄组、10-14岁年龄组、15-19岁年龄组、行人、自行车使用者、摩托车使用者、机动车使用者以及其他道路使用者中的发生率均由上升趋势转为下降趋势;RTIs总人群、机动车使用者和行人干预前后RTIs的YLLs率均下降,且干预后YLLs率下降幅度更显著(P<0.05);10-14岁年龄组RTIs的YLLs率在干预后由上升趋势转为下降趋势;15-19岁YLLs率和摩托车使用者YLLs率在干预后下降趋势变缓。研究结论:1.1990-2019年中国儿童青少年道路交通伤害疾病负担整体得到改善,但改善程度均低于中等SDI和高SDI等级国家,且YLDs率呈上升趋势,行人疾病负担严重,儿童青少年道路交通伤害仍然是我国重要的公共卫生问题。应当加强对道路交通伤害危险因素的研究,建立适合我国的道路交通安全干预方案。2.1990-2019年间,江苏省儿童青少年道路交通伤害防控取得了显著成效,期间道路交通伤害死亡率、DALYs率和YLLs率呈下降趋势,但道路交通伤害发生率和YLDs率呈上升趋势,需重点关注男性、15-19岁年龄组、行人和自行车使用者的道路交通伤害防控。3.江苏省儿童青少年道路交通伤害发生风险和死亡风险均受年龄效应、时期效应及队列效应的影响。应采取有针对性的措施进行及时的干预,特别是加强对较早出生的年龄较大的重点人群的防护。4.基于GBD2019数据发现,《江苏省道路交通安全条例》二次修订后,江苏省儿童青少年道路交通伤害发生率由上升趋势转为下降趋势;道路交通伤害YLLs率下降幅度更为显著。应在立法的同时,细化地方性法规,加强执法力度,确保法律法规有效落实和执行。本文的研究成果可以为卫生部门制定相关政策措施提供数据支持,同时为未来儿童青少年道路交通伤害防控工作和优化卫生资源分配的开展提供科学依据。更多还原

【Abstract】 Objectives:In this study,we systematically analyzed the burden characteristics of road traffic injuries(RTIs)among children and adolescents aged 0-19 in China and Jiangsu Province from 1990 to2019,using disease burden indicators such as incidence,mortality,disability-adjusted life years(DALYs),years lived with disability(YLDs),and years of life lost(YLLs)from the data of Global Burden of Disease Study 2019(GBD 2019).The age-period-cohort model was also used to analyze the age-effect,time-effect and cohort-effect on the incidence and mortality of RTIs among children and adolescents in Jiangsu Province.Finally,the impact of the second revision of Jiangsu Provincial Road Traffic Safety Regulations on the incidence and YLLs rate of RTIs among children and adolescents in Jiangsu Province was evaluated,aimed to provide a basis for administrative intervention and decision-making.Methods:This study focused on children and adolescents in China and Jiangsu Province,utilizing GBD2019 data for analysis in the following aspects:1.Joinpoint regression analysis model was used to analyze the trend of RTIs disease burden of children and adolescents in China and Jiangsu Province from 1990 to 2019 by sex,age group and road user type,and the RTIs burden in China was compared with countries that have different socio-demographic index(SDI),then estimate the annual percentage change(APC)and average annual percent change(AAPC).2.The age,period and cohort trends of the incidence and mortality of RTIs in 1990-2019among children and adolescents in different genders in Jiangsu Province were described,and the age-period-cohort model with the intrinsic estimator was used to assess the independent effects of age,period and cohort on RTIs incidence and mortality.3.Using incidence and YLLs rate as the evaluation index,an interrupted time series analysis was carried out to evaluate the impact of the second revision of Jiangsu Provincial Road Traffic Safety Regulations on road traffic incidence and YLLs rate among children and adolescents in Jiangsu.Results:1.In 2019,in countries with high SDI and high-middle SDI,the DALYs rate of children and adolescent motor vehicle users was the highest,while in countries with middle SDI,the DALYs rate of pedestrians was the highest.The DALYs rate of pedestrians in China was 4.4 times that of high SDI countries.The YLDs rate of RTIs among Chinese children and adolescents increased from 11.56/10~5in 1990 to 15.21/10~5in 2019,with an average annual increase of 0.96%,meanwhile,the YLLs rate decreased from 1070.10/10~5to 423.70/10~5,with an average annual decrease of 3.11%.The DALYs rate decreased from 1081.65/10~5in 1990 to 438.91/10~5in 2019,with an average annual decrease of 3.03%,among which the DALYs rate decreased at a rate of 1.57%,2.21%and5.60%in 1990-2001,2001-2010 and 2010-2019 respectively.The disease burden of RTIs was higher in males than in females,and higher in the 15-19 age group than in other age groups.From1990 to 2019,DALYs rate of RTIs decreased by 3.68%each year in high SDI countries and 3.16%in medium SDI countries.Such decrease among Chinese children and adolescents were less than that of high SDI and medium SDI countries.All types of road users had more reduction in the DALYs rates in high SDI countries compared with any other SDI countries,except other road injuries users.2.In 2019,the incidence,mortality and DALYs rate of RTIs among children and adolescents in Jiangsu Province were 659.84/10~5,3.25/10~5and 276.69/10~5respectively,with a change of51.76%,-65.28%and-63.92%compared with the situation in 1990.From 1990 to 2019,the incidence of RTIs among children and adolescents in Jiangsu Province increased by 1.38%,the mortality decreased by 3.51%,and the DALYs rate decreased by 3.44%.The RTIs incidence rate of RTIs showed a tendency to decrease-increase-then decrease from 1990 to 2019.The results of Joinpoint regression showed that the trend of RTIs incidence had five significant segments:1990-1995,1995-2000,2000-2005,2005-2009 and 2012-2019.The Incidence decreased at a rate of1.60%and 6.17%per year in 1990-1995 and 2012-2019,respectively.The Incidence increased at a rate of 2.66%,12.75%and 6.75%per year in 1995-2000,2000-2005 and 2005-2009,respectively.Mortality showed a continuous downward trend,with four significant segments:2000-2005,2005-2010,2010-2015 and 2015-2019,and mortality rate decreased at a rate of 2.32%,4.90%,7.70%and 6.09%per year in the four time periods,respectively.DALYs rate showed a continuous downward trend,with three significant segments:1990-2001,2001-2009 and 2009-2019.The DALYs rate decreased at a rate of 0.51%、3.21%and 6.74%per year in the three time periods,respectively.From 1990 to 2019,the trends in the burden of disease for RTIs in males and females were consistent with that in the whole population.The incidence,mortality,and DALYs rate for RTIs were consistently higher among males as compared to females.The disease burden trends among different road users were similar to the overall population,with cyclists exhibiting the highest incidence,while pedestrians had the highest mortality and DALYs rate.3.The results of age-period-cohort model showed that the age effect of the incidence of RTIs among children and adolescents in Jiangsu Province in 1990-2019 generally tended to increase with age,with the risk of incidence peaking in the 15-19 age group.The period effect showed that the risk of RTIs tended to increase and then decrease over time,with the highest risk occurring in the period 2010-2014.Cohort effects showed that the later birth year accompanied higher risk of RTIs,children and adolescents born in 2010-2014 had the highest risk.Regarding the age effect of the mortality rate of RTIs in 1990-2019,a decreasing and then increasing trend was observed with age,the lowest risk of death was in the age group of 10-14 years and the highest risk of death was in the age group of 15-19 years.The period effect showed a decreasing trend in the risk of death for RTIs over time,with the highest risk of death was found in the 2010-2014 period.Cohort effects showed that the later the birth year,the higher the risk of death for RTIs,with the highest risk of death for children and adolescents born in 1990-1994.4.The results of the interrupted time series analysis showed that since the second revision of Jiangsu Provincial Road Traffic Safety Regulations in 2011,the incidence of RTIs among total population,of children and adolescents in Jiangsu,males,females,0-4 years,5-9 years,10-14 years,15-19 years,pedestrians,cyclist users,motorcyclist users,motor vehicle users,and other road users have changed from an increasing trend to a decreasing trend.The YLLs rate of RTIs before and after the intervention decreased in the total population,pedestrians and motor vehicle users and the magnitude of the decline after intervention was more significant.After the intervention,the YLLs rate of RTIs among individuals aged 10-14 years has changed from an increasing trend to a decreasing trend,while the downward trend in YLLs rate among individuals aged 15-19 years and motorcycle users slowed down.Conclusion:1.The disease burden of road traffic injuries among children and adolescents in China decreased as a whole from 1990 to 2019,but the degree of improvement was lower than that of countries in both the medium SDI and high SDI countries,and the rate of YLDs was on the rise,so road traffic injuries among children and adolescents in China are still a major public health problem.It is necessary to strengthen the research on risk factors of road traffic injuries and establish intervention programs for road traffic safety in China.2.During the period 1990-2019,the prevention and control of road traffic injuries among children and adolescents in Jiangsu Province achieved remarkable results,during which the road traffic injury mortality,DALYs rate and YLLs rate showed a decreasing trend,and the incidence rate of road traffic injuries and YLDs rate showed an increasing trend.More attention should be paid to the prevention and control of road traffic injuries among males,the age group of 15-19years,as well as pedestrians and cyclist users.3.The changes of RTIs incidence and mortality among children and adolescents in Jiangsu Province were all affected by age,period and cohort factors.Targeted measures should be taken to provide timely interventions,especially to strengthen the protection of older key populations born earlier.4.Based on GBD2019 data,after the second revision of Jiangsu Provincial Road Traffic Safety Regulations,the incidence of RTIs among children and adolescents in Jiangsu Province has changed from an increasing trend to a decreasing trend,while more significant reductions in rates of YLLs for RTIs.In addition to legislation,local regulations should be refined and law enforcement should be strengthened to ensure the effective implementation and enforcement of laws and regulations.The findings of this paper can provide data support for the health sector to formulate relevant policy measures,as well as provide a scientific basis for future road traffic injury prevention and control work for children and adolescents and the development of optimal health resource allocation.更多还原