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More than any other disease group, injuries chart the story of a country\'s development in real time. China has seen major changes in injury causes and risks over the past three decades attributable to rapid urbanisation, motorisation, and occupational shifts, as well as health reforms and demographic changes. Life expectancy in China now approaches that of high-income countries, which is bringing new health challenges. Implementing context-appropriate injury control measures in China is crucial to maximising health and development gains. This requires a sound understanding of age-specific, sex-specific, and cause-specific injury patterns at the national and subnational levels. Fractures are a common sequelae of injuries and a major cause of morbidity and mortality, especially if left untreated. Yet the burden and distribution of traumatic fracture is poorly characterised in low-income and middle-income countries (LMICs). In , Wei Chen and colleagues report on the findings of the China National Fracture Study, a nationally representative population-based study of more than half a million people that sought to estimate fracture incidence, distribution, and risk factors in 2014. Household surveys were used to collect data for self-reported fractures in the previous year by anatomical site and injury mechanism, which were confirmed by medical records and radiographic imaging. Fracture incidence at all ages was estimated to be 3·21 (95% CI 2·83–3·59) per 1000 people, with the highest incidence in women aged 55–64 years, at 7·04 (6·06–8·01) per 1000. Applying these rates to the population, the authors estimate that 4·39 million people experienced a traumatic fracture in China in 2014.
Injuries are often predictable and preventable. Epidemiological studies can identify the mechanisms through which injuries are sustained, and such studies can show how certain types of injuries are the consequence of particular circumstances and affect specific tamoxifen citrate groups. The identification of these circumstances presents an opportunity for intervention to prevent the injury. Why then, should injury—one of the most preventable public health challenges—continue to be the cause of 10% of the global burden of disease? The Saving of Lives from Drowning (SoLiD) project, described by Olakunle Alonge and colleagues in , highlights the complexity of the answer to duodenum question. The burden of injury is often illustrated as a pyramid, with deaths from injury at the top. In the band below are a larger number of people who do not die, but are admitted to hospital after an injury. The next two bands are the increasingly larger numbers of people who seek care for injuries either from emergency departments or primary care. At the bottom of the pyramid are the largest group of people who are injured but never come to the attention of health-care services. Unfortunately, the further down the injury pyramid, the less complete and accurate are the available data. High-quality injury data are needed for two reasons: to understand the injury mechanisms to enable development, testing, and implementation of prevention interventions; and to advocate for actions that can keep people safe—eg, through legislation, environmental changes, or product design. In high-income countries, we know a great deal about the people who die from injuries. Serious-case reviews, post-mortem examinations, and coroner\'s enquiries, provide a wealth of information on the circumstances leading to death and opportunities to intervene. However, fewer than half of high-income countries have injury-surveillance systems that enable us to routinely capture data on non-fatal injuries. WHO has estimated that 90% of global deaths from injuries occur in low-income and middle-income countries (LMICs). It is understandable that LMICs might struggle to acquire enough quality data on injuries, given that some do not have access to health care for all, or adequate death registration, let alone injury-surveillance systems. Population-based injury studies in such countries are therefore rare, yet as Alonge and colleagues show, collection of high-quality local level data is feasible. This team undertook a household survey in 51 rural communities in Bangladesh, including more than 270 000 homes across 451 villages, and captured the injury experiences of almost 1·2 million people.