Academic journal article Bulletin of the World Health Organization

Poisoning Deaths in China, 2006-2016/empoisonnements Mortels En Chine, 2006-2016/ Muertes Por Intoxicacion En China, 2006-2016

Academic journal article Bulletin of the World Health Organization

Poisoning Deaths in China, 2006-2016/empoisonnements Mortels En Chine, 2006-2016/ Muertes Por Intoxicacion En China, 2006-2016

Article excerpt

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Introduction

According to the Global Burden of Disease 2015 update, approximately 86 353 people died from unintentional poisonings worldwide in 2015, with 78 054 (90%) deaths occurring in low- and middle-income countries. (1) However, if the global estimates of the numbers of intentional poisonings were freely accessible, the poisoning mortality numbers would be higher. (1)

Despite the implications for public health and the impact described in high-income countries, (2-10) poisonings in low- and middle-income countries are poorly understood. We are aware of just two published studies on the epidemiology of poisoning at the national level in low- and middle-income countries: from Fiji and the Islamic Republic of Iran. (11,12)

As the most populated country in the world, China had 16 179 unintentional poisoning deaths in 2016, 31% of the world's total of 52 077. (1) Available knowledge about poisoning incidents in China is scattered. A study using Global Burden of Disease 2015 update data examined trends in unintentional poisoning deaths. (13) The authors reported a substantial reduction in unintentional poisoning mortality from 1990 to 2015. A second study used the Chinese disease surveillance points system data and reported decreases in suicide by poisoning from 2006 to 2013. (14) The authors also reported that suicide by pesticide poisoning was the leading method of suicide. Other published studies have examined poisoning patterns within one hospital catchment area or one province (15,16) or focused on the epidemiology of a single cause of poisoning, such as pesticide poisoning. (17)

We found no recent, comprehensive published studies of the epidemiology of fatal poisonings in China. To address these gaps, we used national disease surveillance data to examine changes in poisoning mortality from 2006 to 2016 by location (urban or rural), age group, intent and type of substance. Analyses were conducted separately for males and females.

Methods

Data source

We designed a population-based longitudinal study based on the data from the national disease surveillance points system, initiated in 1978 by the Chinese government. The surveillance system has undergone three major improvements since 1978. First, it was expanded from 145 to 161 points in 2004-2006, yielding coverage of about 73 million residents. (18) Second, a web-based approach was introduced to report deaths in 2008, a development that greatly improved the timeliness of data reporting. (18) Third, the Chinese government combined the system with the national vital registration system in 2013, creating a data collection system from 605 surveillance points. (18) The population of China in the most recent census in 2010 was around 1332 million (682 million males and 650 million females).

The data for the disease surveillance points system are collected using a standard protocol by trained persons. (18) Trained staff members oversee data collection of all deaths occurring in the hospital. For deaths occurring outside the hospital, village health workers or community hospital professionals use verbal autopsy strategies to collect the relevant data. Local centres for disease prevention and control report all data to their next-level office (from county to prefectural to provincial to national) and routine quality checks are conducted by coders at each centre. Quality checks assess completeness, coding and internal logic across items reported on death certificates. (18) Any unqualified reports that are detected are corrected at each surveillance point through a review of detailed medical records or repeated verbal autopsies. (19) Additionally, a routine national sample survey is conducted every 3 years at all surveillance locations to adjust for any under-reporting overlooked by daily quality checks. (20)

We extracted the numbers of poisoning deaths and mortality per 100 000 people from 2006 to 2016. …

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