伤害流行病学与预防控制课件.ppt
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1、伤害流行病学和预防控制俞 敏浙江省疾病预防控制中心慢性非传染性疾病防制所伤害的定义 伤害是指造成身体的损伤,影响了正常工作,需要医治或看护。伤害必须到医疗部门诊断或活动受限1天。-1986年美国国家统计中心 2019年王声涌教授提出的统计标准:到医疗单位就诊,诊断为某种损伤;由家人、老师、同事或同伴对受伤者作紧急处置或看护;因伤请假(休工、休学、休息)半日以上。美国CDC定义:“由于运动、热量、化学、电或放射线的能量交换,在机体组织无法耐受的水平上,所造成的组织损伤或由于窒息而引起的缺氧称为伤害”。WHO 定义 Injury is a bodily lesion at the organic
2、level resulting from acute exposure to energy(this energy can be mechanical,thermal,electrical,chemical,or radiant)interacting with the body in amounts or rates that exceed the threshold of physiological tolerance.In some cases an Injury results from an insufficiency of any of the vital elements(in
3、drowning,strangulation,or freezing).The time between exposure and the appearance of the injury needs to be short(a few minutes).Baker,S.P.,B.ONeill,R.S.Karpf,The Injury Fact Book.Lexington Books,D.C.Health and Company/Lexington,Massachusetts/Toronto,1984 Unintentional or intentional damage to the bo
4、dy resulting from acute exposure to thermal,mechanical,electrical,or chemical energy or from the absence of such essentials as heat or oxygen.Injury or Trauma are used interchangeably.What defines injury may vary but in vital statistics this is reflected in either death from trauma,the need to seek
5、medical attention,or the inability to perform usual activities for a day or longer.Sleet,D.A.,Albany,P.,Lee,N.et.al.Injury in Western Australia.Health Department of Western Australia,1991Injury Definition Damage to the body caused by(acute)exchanges with environmental energy that are beyond the body
6、s resilience(Haddon,1986).The energy may be mechanical,thermal,electrical,ionising radiation or chemical(poisoning,asphyxiation).Definition:Any specific and identifiable bodily impairment or damage resulting from exposure to:Thermal energy Mechanical/kinetic energy Electrical energy Chemical energy
7、Absence of essential elements heat&oxygenInjury-ACICR伤害的分类(伤害的分类(Etiology mechanism and external cause)性质分类:分温度、机械能、化学能、电能以及基本能量缺乏;外因分类:交通伤害等,参照ICD分类伤害的分类(伤害的分类(Intent of Injury)伤害故意伤害非故意伤害自伤他人伤害伤害的分类(伤害的分类(Nature of injury):脑和脊柱、骨折、面部受伤、背部脑和脊柱、骨折、面部受伤、背部受伤等受伤等 伤害的分类(伤害的分类(Place of occurrence):道路,家中
8、,学校,运动时等道路,家中,学校,运动时等伤害的严重程度伤害的严重程度死亡死亡严重伤害严重伤害住院住院急诊室抢救急诊室抢救门诊治疗或自己处理及不治疗门诊治疗或自己处理及不治疗Severity:Injury Pyramid1Death18Hospitalizations292TREATMENT IN EMERGENCY ROOM OR PHYSICIANS OFFICETreatment at home or never treated*Alberta data,ACICRInjury Triangle:EpidemiologyHost:Youth driver,inexperiencedAge
9、nt:Motor vehicleEnvironment:Friends in car,nighttime,alcohol involvedEs of preventionEducationEngineeringEnforcementEconomics2019年全球死因构成年全球死因构成慢病慢病3300万万传染病传染病1800万万伤害伤害500万万2019年中国死因构成年中国死因构成11.1%77.8%11.1%慢病慢病700万万传染病传染病100万万伤害伤害100万万伤害的流行情况伤害的流行情况伤害的流行情况 Rank AUD$3.3 billionPrevention Injury resu
10、lts from a chain of events.Interruption at any point in this chain will potentially prevent or control injuries.YearDeaths per 100,000OthersTotalTrafficDrowningChild Injury Mortality,Sweden,0-14 years,1951-86Berfenstam,1987Australian child injury deaths,all intents,ages 0-14 yrs(ABS 1970-2019).05101
11、5202519701975198019851990199119921993199419951996199719981999200020012002year of deathrate per 100,000TransportOtherAllMajor Successes Road traffic injury(child restraints,speed cameras,pedestrian barriers)Drowning Fire Poisoning Asphyxia05101520253035196019621964196619681970197219741976197819801982
12、1984198619881990199219942019201920002019YearVictoriaAustraliaCanadaGermanyJapanNew ZealandSwedenUnited KingdomU.S.A.Road Fatalities per 100,000 populationEffective Measures seat belts(all occupants)vehicle design motor-cycle helmets speed control alcohol control road designInternational Comparison o
13、f Drowning Rates15181916-41Rank(all causes)111091512Rate/100,000135,00056,00092,00093,0002455000DeathsChinaSEARIndiaAFRAust.AMR Country or Region(Source:WHO 2019&ABS)051015202530351900192019401960198020002020YearDeaths per 100,000ASR M alesASR Fem alesDeaths from accidental drowning(ICD-9 E910,E984)
14、in Australia,1907-2019中国伤害概况 世界卫生组织估计在2019年因伤害而死亡的人数超过了994,000人 中国几乎承担了全球伤害负担的20 68的伤害死亡属于意外伤害 32的是故意伤害中国伤害死亡的特征居死因第五位,每年伤害死亡约居死因第五位,每年伤害死亡约8585万,其中:万,其中:自杀自杀 2727万万 占占30%30%死亡率居全球之首死亡率居全球之首车祸车祸 1818万万 占占20%20%死亡率居世界前列死亡率居世界前列溺水溺水 1212万万 占占13%13%农村高于城市(农村高于城市(72.19/1072.19/10万万38.51/1038.51/10万)万)农村
15、农村以自杀为第一位以自杀为第一位占占32%32%城市城市以车祸为第一位以车祸为第一位占占32%32%中国交通伤害死亡的特征l 我国每天300人死于车轮之下 车祸死亡率为14/10 万每年以10%的增幅上升l 到2020 年车祸的DALY 在疾病顺位中将由现在的第10 位跃为第3 位 淹死是第三位伤害死因,1 14 岁首位致死原因中国道路交通伤害流行情况公安部统计数字(公安部统计数字(20192019年):年):l 共发生交通事故:667507起l 死亡:104372人l 受伤:494174人l 直接经济损失:33.7亿元l 万车死亡率:10.8道路交通伤害已经成为我国男性和城市居民的第一位死亡
16、原因!浙江省伤害现状浙江省伤害现状Causes of death in Zhejiang province-200024%22%17%10%10%4%1%12%neoplasmasCOPDcerebrovascular disHeart disinjurydigestive discommunicable disother cause浙江省城市居民浙江省城市居民1990-2019年伤害死亡变化趋势年伤害死亡变化趋势0510152025303540455090929496980002交通伤坠落溺水自杀城市合计浙江省农村居民浙江省农村居民1990-2019年伤害死亡变化趋势年伤害死亡变化趋势020
17、40608010090929496980002交通伤坠落溺水自杀农村合计010020030040050060070080090010000-51525354555657585-agegroupmortalitytotal-Urbantotal-rural浙江省伤害死亡年龄分布0204060801001201400-51525354555657585-agegroupmortalitymotorvehicle-Rmotorvehicle-U浙江省道路交通伤害死亡年龄分布伤害死亡外部原因情况城市农村小计小计刺伤/割伤00.260.660.9200.110.780.93溺水1.440.1301.57
18、7.880.7108.67坠落7.210.2607.4711.380.26011.64火灾/烫伤0.52000.521.1900.041.23枪伤000000.040.040.12机械工具伤00000.33000.33交通伤6.42006.4219.560019.56乘客/驾驶员*3.67003.6711.460011.46摩托车0.13000.131.91001.91自行车1.97001.971.76001.76步行者0.39000.393.54003.54其他交通伤0.26000.260.89000.89自然环境造成1.31001.310.6000.6叮咬伤00000.11000.11中毒
19、0.390.5300.932.1915.550.0417.85击伤000.130.131.3400.221.56窒息0.521.0501.571.642.640.114.5其他种类3.280.120.524.042.460.040.113.05医疗药物导致0000.270000.3合合 计计21.112.361.3125.1748.6819.341.3470.44外部原因外部原因城城 市市农农 村村非故意伤害自杀他杀非故意伤害自杀他杀浙江省城市农村年龄组伤害死亡比较1-5-10-15-20-25-35-45-55-65-75-85-合计合计城城 市市男男性性10.116.925.067.211
20、1.2427.7325.8436.0422.2531.88154.44559.8428.37溺水溺水10.116.920003.472.8703.183.5420.5902.87坠落坠落005.0600008.0112.713.5441.18419.885.73交通伤交通伤000011.2415.611.4914.02010.6320.5909.17中毒中毒0000000200000.29窒息窒息0003.6002.8723.180001.43城城 市市女女性性0005.523.1810.5612.5113.5114.7740.42133.94693.7921.83溺水溺水0002.76000
21、1.6900000.47坠落坠落00000001.697.388.0887.06512.88.69交通伤交通伤000001.513.751.694.9218.866.703.52中毒中毒0002.7601.512.51.69006.701.41窒息窒息000003.02002.468.086.701.64农农 村村男男性性44.6642.4615.7832.6642.7469.1396.95142.74109.97212.15401.92587.2490.19溺水溺水32.125.897.438.167.127.776.2314.6713.0910.4835.3736.712.13坠落坠落2.
22、794.1400.912.377.7713.7924.0118.3349.7677.17275.2714.15交通伤交通伤4.1910.364.6411.7917.4127.5732.9149.3623.5752.3861.0973.4126.14中毒中毒001.868.1610.2913.9821.3528.0135.7969.41122.1855.0520.58窒息窒息5.5800001.5545.347.8610.4867.5218.355.34农农 村村女女性性38.2915.0811.17.8721.5130.8540.8955.8773.09102.29273.97822.3549
23、.78溺水18.389.285.0402.482.031.435.962.968.0824.4138.555.02坠落3.0601.010.980.831.622.385.2113.8317.5105.79385.489.03交通伤12.253.4800.983.317.7115.2114.1514.8226.9251.54010.81中毒01.162.025.912.4114.6114.2620.8631.6130.9648.8351.415.05窒息1.531.161.0100.832.032.852.231.989.4213.5677.13.63浙江省浙江省2019-20192019-2
24、019年不同类别地区年不同类别地区伤害死亡率(伤害死亡率(1/101/10万)和减寿率万)和减寿率()()死亡率死亡率YPLL率YPLL率死亡率死亡率YPLL率YPLL率死亡率死亡率YPLL率YPLL率死亡率死亡率YPLL率YPLL率车辆交通车辆交通9.229.222.092.0919.819.85.565.5619.6819.685.545.5418.8618.865.675.67意外中毒意外中毒0.490.490.170.170.970.970.230.232.132.130.510.512.432.430.570.57意外跌落意外跌落9.549.540.640.6410.5810.581
25、.571.576.966.960.960.9612.3212.321.71.7淹 溺淹 溺1.321.320.50.57.077.072.852.857.487.482.912.917.987.983.513.51窒窒 息息0.10.10.040.040.830.830.090.090.920.920.050.051.971.970.30.3砸 死砸 死0.10.10.050.050.590.590.140.140.290.290.090.091.811.810.550.55自 杀自 杀3.033.030.790.7915.5915.593.093.0918.9318.934.054.0526
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