Introduction
Globally, non-transport unintentional injuries (NTUIs), namely drowning , falls, burns, poisoning , and so on, are major public concerns, accounting for nearly 1.8 million deaths annually in 2019.[1,2] Children and adolescents , especially those in low- and middle-income countries (LMICs), suffered huge losses from them.[3–9] children and adolescents and their families to bear heavy medical burdens as well as physical and mental disorders.[3] [10] [10,11]
Even though abundant studies focused on NTUIs worldwide, most of them only analyzed the trend within limited regions or countries across all ages, or they recognized NTUIs as a part of injuries without detailed analysis.[8,12,13] children and adolescents aged 5 to 24 years, who have been understudied for a long time.[14] children and adolescents aged 5 to 24 years old.
In this study, we hypothesized that the mortality of NTUIs has decreased in recent decades. We additionally hypothesized that inequality existed in different genders, age groups, and regions, which also declined during 1990 to 2019. The purpose of this study was to analyze the trends of NTUIs mortality among children and adolescents aged 5 to 24 years between 1990 and 2019 and find regional differences by using data from Global Burden of Disease (GBD) 2019. In addition to the trend of mortality, our group had a special offer to evaluate the relationship between NTUIs mortality and social development among children and adolescents aged 5 to 24 years. Moreover, we used three representative indexes to evaluate the regional difference and its trend between 1990 and 2019. The results of this study might highlight the focus of intervention and provide insight for future policymaking.
Methods
Data sources
GBD 2019 provided the estimation of the age-specific mortality of 369 diseases and injuries for 204 countries and territories from 1990 to 2019.[15] [15] children and adolescents aged 5 to 24 years from GBD 2019. The children and adolescents aged 5 to 24 years were divided into four groups by their age (5–9 years, 10–14 years, 15–19 years, 20–24 years). Socio-demographic-index (SDI) data, which combined information from the economy, education, and fertility rate of countries, were also accessed via GBD 2019.[16]
The human development index (HDI), as a substitute for SDI, was also collected from Human Development Reports published by the United Nations Development Programme. The HDI, which is similar to the SDI, is a summary measure of average achievement in three key dimensions of human development — a long and healthy life, being knowledgeable, and having a decent living standard.[17]
Analysis of mortality rate and death trends
We used the mortality data and global standard population from GBD 2019 to calculate the age-standardized mortality rate (ASMR) between 1990 and 2019. Then, the annual change percentage between 1990 and 2019 was calculated using log-transformed linear regression. We also analyzed the trends of ASMR and the number of deaths in different regions and SDI levels. Considering the instability and incapable of intervening in the death caused by “exposure to forces of nature” and “other unintentional injuries”, we also displayed the trends of ASMR and the number of deaths caused by nine other kinds of NTUIs except “exposure to forces of nature” and “other unintentional injuries.”
In addition, we utilized the age-period-cohort (APC) model to detect the age effect, period effect, cohort effect for NTUIs except “exposure to forces of nature” and “other unintentional injuries” at each SDI level by using a well-designed web tool (https://analysistools.cancer.gov/apc/ [18]
Analysis of the cause of death
We used the cause-specific mortality data of NTUIs except “exposure to forces of nature” and “other unintentional injuries” and calculated the proportion of each cause of death in each gender and age group globally for children and adolescents aged 5 to 24 years in 2019. A similar analysis was conducted at each SDI level.
Panel data regression
To identify the association between mortality and SDI with panel data, we used panel data regression to adjust the cluster effect of countries and territories. In this model, we used countries and territories as the group variable and used year as the time variable, and deaths caused by “exposure to forces of nature” and “other unintentional injuries” were also excluded. Log transformation was used to improve the model fitness. The Hausman test was used to identify what model we should choose, and we chose the fix effect model if the P value of the Hausman test was <0.05; otherwise, we chose the random-effect model. Subgroup analysis was used to detect the association by sex, age group, and region.
Inequality analysis To test the inequality of death caused by NTUIs except “exposure to forces of nature” and “other unintentional injuries” between different countries and territories, we calculated the slope index of inequality (SII) and the relative index of inequality (RII), which could be used to measure the absolute and relative inequality between countries and territories, respectively.[19,20] [19,21]
Sensitivity analysis
To increase the credibility of our results, we also utilized the APC model, panel data regression, and inequality analysis for death caused by all kinds of NTUIs. In addition, we collected data on the HDI from Human Development Reports published by the United Nations Development Programme. We used it as a substitute for SDI and conducted a sensitivity analysis of panel data regression and inequality analysis . APC analysis was conducted in APC web tool (National Cancer Institute, Maryland Bethesda, United States), and the remaining analyses were conducted in R program version 4.0.3 (R Development Core Team, Vienna, Austria).
Results
Global ASMR and death trends by gender and age group
Globally, in 2019, there were 205,000 deaths due to NTUIs among children and adolescents aged 5 to 24 years, which declined from 375,000 in 1990, and the ASMR was 8.13 per 100,000, ranging from the lowest in the Netherlands (0.90 per 100,000) to the highest in the Solomon Islands (29.34 per 100,000) [Supplementary Table 1, https://links.lww.com/CM9/B219 https://links.lww.com/CM9/B219 https://links.lww.com/CM9/B219 https://links.lww.com/CM9/B219
Globally, children aged 5 to 9 years had the highest risk of death (rate ratio was 1.56 [95% CI: 1.50–1.63] for males and 1.81 [95% CI: 1.73–1.89] for females vs. children aged 10–14 years) [Figure 2 A]. The risk of death declined with the period and cohort. Children and adolescents in the 1990 to 1994 period had the highest risk of death (rate ratio was 1.35 [95% CI: 1.28–1.42] for males and 1.30 [95% CI: 1.23–1.37] for females vs. children and adolescents in 2000–2004), while children and adolescents in the 2015 to 2019 period had the lowest (rate ratio was 0.67 [95% CI: 0.64–0.72] for males and 0.71 [95% CI: 0.66–0.75] for females vs. children and adolescents in 2000–2004) [Figure 2 B]. Children and adolescents born in 1970 had higher risk of dying from NTUIs compared with those born in 1990 (rate ratio was 1.38 [95%CI:1.26–1.51] for males and 1.30 [95%CI:1.17–1.44] for females), while children and adolescents born in 2010 had lower risk (rate ratio was 0.42 [95% CI: 0.38–0.47] for males and 0.43 [95% CI: 0.39–0.48] for females) [Figure 2 C]. The net drifts were −2.78% (95% CI: −2.95% to −2.60%) for males and −2.58% (95% CI: −2.77% to −2.40%) for females globally, and the annual percentage change decreased with age in both males and females [Figure 2 D].
Global ASMR and death trends by SDI group
The trend of each SDI level was also consistent with the overall trend [Figure 1 ]. The ASMR of NTUIs dropped fastest in the high SDI group (for nearly 63%) and dropped slowest in the low SDI group (almost 42%) during the past decades. The low–middle SDI group had the highest ASMR of NTUIs (10.46 per 100,000) among the five SDI groups in 2019, while the high SDI group had the lowest (2.59 per 100,000). The number of deaths decreased in each SDI group except the low SDI group, where the number of deaths increased from 38,000 to 47,000 [Figure 1 ].
Figure 1: Global age-standardized mortality rate and number of deaths for NTUIs among children and adolescents aged 5 to 24 years, by SDI levels, 1990 to 2019. (A) Age-standardized mortality for NTUIs. (B) Number of deaths for NTUIs. (C) Age-standardized mortality for NTUIs excluded the death caused by “exposure to forces of nature” and “other unintentional injuries.” (D) Number of deaths for NTUIs excluded the death caused by “exposure to forces of nature” and “other unintentional injuries.” NTUIs: Non-transport unintentional injuries ; SDI: Socio-demographic index.
Unlike the overall, for males in the high SDI group, adolescents aged 20 to 24 years were most vulnerable (rate ratio was 2.03 [95% CI: 1.96–2.11] vs. children aged 10–14 years), while in other SDI groups, children aged 5 to 9 years had the highest risk of death for NTUIs [Figure 2 A]. The changes in risk of deaths for different periods and cohorts in each SDI level were basically consistent with the global results [Figures 2 B, C]. In the high SDI group and high–middle SDI group, the mortality rate of males declined faster than that of females, which was consistent with the global situation, but the situation in the remaining three groups was reversed [Figure 2 D].
Figure 2: Trends in NTUIs mortality by SDI quintiles, 1990 to 2019. (A) Age rate ratio of NTUIs in 1990 cohort by SDI levels, adjusted for period effect. (B) Mortality rate ratio of NTUIs by SDI levels and period from 1990 to 2020. (C) Mortality rate ratio of NTUIs by SDI levels and birth cohort from 1970 to 2010. (D) Age-specific annual percent change of NTUIs mortality rate by SDI levels, 1990 to 2019. Death due to “exposure to forces of nature” and “other unintentional injuries” was excluded. NTUIs: Non-transport unintentional injuries ; SDI: Socio-demographic Index.
Global main causes of death by sex and age group
Globally, we found that drowning had the highest proportion of deaths in all subgroups except for females aged 20 to 24 years. Males’ proportions fell from 49.12% to 30.28%, while females’ proportions fell from 33.63% to 15.56% as they grew older. Falls and exposure to mechanical forces were also leading causes of death for children and adolescents aged 5 to 24 years, with older adolescents, particularly males, suffering the most. The proportion of death in male adolescents aged 20 to 24 years was 22.27% and 18.32%, while the proportion in male children aged 5 to 9 years was 14.17% and 7.07%, respectively. The burden of fire, heat, and hot substances increased with age in females, changing from 9.72% to 24.16%. Furthermore, we discovered that death due to animal contact was more severe in females, especially in children aged 5 to 14 years [Figure 3 , Supplementary Table 2, https://links.lww.com/CM9/B219
Figure 3: Cause-specific proportion in each gender and age group by SDI quintiles in 2019. Death due to “exposure to forces of nature” and “other unintentional injuries” was excluded. SDI: Socio-demographic index.
Global main causes of death by SDI group
We also discovered that drowning , falls, exposure to mechanical forces were leading causes in every SDI group, and the distribution in each subgroup was largely consistent with the overall distribution. However, the children and adolescents in low and low–middle SDI groups suffered many times higher than those in high and high–middle SDI groups. Drowning claimed the lives of 11,000 and 23,000 deaths in low and low–middle SDI groups, respectively, while it claimed the lives of 2000 and 8000 deaths in high and high–middle SDI groups, respectively, despite the fact that the proportion was similar across all five SDI groups. Besides that, animal contact was a leading cause in low (the proportion ranging from 9.92% to 20.13% in each subgroup) and low–middle SDI groups (ranging from 10.97% to 23.37%), but less in high SDI groups (ranging from 0.29% to 1.77%). The proportion of deaths for foreign body and poisonings in high (ranging from 6.30% to 13.73% and from 3.22% to 11.50%, respectively) and high–middle SDI groups (ranging from 4.99% to 8.31% and from 5.24% to 15.47%, respectively) were higher than those in low (ranging from 4.73% to 8.03% and from 5.91% to 8.85%, respectively) and low–middle groups (ranging from 2.60% to 5.71% and from 3.64% to 7.54%, respectively) [Figure 3 , Supplementary Table 2, https://links.lww.com/CM9/B219
Association between ASMR and SDI
Globally, we found that for every 0.1 increase in SDI, the ASMR of NTUIs decreased by approximately 29%. We discovered that the mortality rate of children aged 5 to 9 years was the group most affected by SDI, the mortality rate decreased by nearly 37% for every 0.1 increase in SDI, and the effect declined with age [Table 1 ]. The results analyzed by region showed that the declining percentage in mortality of children and adolescents in Europe and Central Asia would drop fastest for the improving of the economy, education, and fertility rate of these countries. We also found that NTUIs ASMRs drop fast when the SDI improves in countries and territories with low SDI levels, such as the countries and territories in Latin America and the Caribbean, Sub-Saharan Africa, and South Asia [Table 1 , Figure 4 ].
Table 1 -
The association between NTUIs mortality rate and SDI, by gender, age group, and region.
Group (n )
β-coefficient (95% CI)
SE
P value
Global (6120)
−3.49 (−3.58 to −3.41)
0.043
<0.001
Male (6120)
−3.53 (−3.61 to −3.44)
0.044
<0.001
Female (6120)
−3.49 (−3.57 to −3.40)
0.042
<0.001
Age
5–9 years (6120)
−4.65 (−4.76 to −4.55)
0.053
<0.001
10–14 years (6120)
−3.75 (−3.84 to −3.66)
0.047
<0.001
15–19 years (6120)
−3.12 (−3.21 to −3.03)
0.047
<0.001
20–24 years (6120)
−2.86 (−2.95 to −2.77)
0.045
<0.001
Regions
East Asia and Pacific∗ (1110)
−3.88 (−4.07 to −3.69)
0.097
<0.001
Europe and Central Asia∗ (1560)
−7.26 (−7.47 to −7.04)
0.109
<0.001
Latin America and Caribbean (1050)
−3.66 (−3.87 to −3.45)
0.106
<0.001
Middle East and North Africa∗ (630)
−2.72 (−2.85 to −2.60)
0.064
<0.001
North America∗ (90)
−6.76 (−7.41 to −6.11)
0.331
<0.001
South Asia (240)
−3.05 (−3.26 to −2.84)
0.109
<0.001
Sub-Saharan Africa (1440)
−1.88 (−1.98 to −1.77)
0.054
<0.001
N indicates sample size of association analysis. Death due to “exposure to forces of nature” and “other unintentional injuries” was excluded. The β-coefficient represents that the ASMR will decline for (1 − e0.1 × β -coefficient ) × 100% for every 0.1 increase in SDI.
∗ In East Asia and Pacific, Europe and Central Asia, Middle East and North Africa, and North America, we chose the random-effect model because the P value of the Hausman test >0.05, while in all remain group we chose the fix effect model. ASMR: Age-standardized mortality rate; CI: Concentration index; NTUIs: Non-transport unintentional injuries ; SDI: Socio-demographic index; SE: Standard error.
Figure 4: Country-level association between ASMRs of NTUIs and SDI in 1990–2019, by region. Death due to “exposure to forces of nature” and “other unintentional injuries” was excluded. Only one point which represents Tuvalu in 2000, with ASMR 115.48 per 100,000, was not shown in the figure. ASMR: Age-standardized mortality rate; NTUIs: Non-transport unintentional injuries ; SDI: Socio-demographic index.
Inequality analysis For both males and females, the SII was negative, meaning that children and adolescents in countries with lower SDI had higher ASMR. The female group (9.63 per 100,000) had a higher “−SII” than the male group (5.97 per 100,000) in 1990, which indicated that female mortality was more relevant to SDI than male mortality, and the gap narrowed in 2019. The degree of inequality rose with age and decreased in 2019. The overall trend of “−SII” declined from 7.77 (95% CI: 4.61–10.93) per 100,000 to 3.61 (95% CI: 2.29–4.93) per 100,000, and the obvious downward trend was consistent in all subgroups except Latin America and Caribbean and Sub-Saharan Africa. However, as we observed in “1/RII,” CI was not as optimistic as SII. The “1/RII” and CI were relatively stable in global trends and all subgroups [Table 2 , Supplementary Figure 3, https://links.lww.com/CM9/B219 https://links.lww.com/CM9/B219
Table 2 -
The changes of SII, RII, and CI, by gender, age group, and region, in 1990 and 2019.
1990
2019
Group
−SII (95% CI) (1/100,000)
1/RII
CI
−SII (95% CI) (1/100,000)
1/RII
CI∗
Total
7.77 (4.61–10.93)
1.69
−0.09
3.61 (2.29–4.93)
1.67
−0.08
Male
5.97 (1.54–10.40)
1.33
−0.05
3.52 (1.75–5.28)
1.45
−0.06
Female
9.63 (7.23–12.03)
3.11
−0.18
3.96 (2.75–5.18)
2.46
−0.14
Age
5–9 years
12.52 (7.03–18.01)
1.92
−0.10
5.33 (3.89–6.76)
2.21
−0.12
10–14 years
6.27 (3.44–9.09)
1.68
−0.08
4.03 (2.81–5.25)
2.02
−0.11
15–19 years
5.32 (2.67–7.97)
1.51
−0.07
2.24 (0.88–3.61)
1.39
−0.05
20–24 years
5.79 (2.65–8.93)
1.50
−0.06
3.32 (1.40–5.23)
1.45
−0.06
Regions
East Asia and Pacific
17.06 (12.23–21.90)
2.86
−0.12
3.95 (0.94–6.96)
1.73
−0.08
Europe and Central Asia
8.91 (2.44–15.37)
2.48
−0.14
6.57 (3.44–9.70)
5.71
−0.23
Latin America and Caribbean
4.19 (−0.30–8.68)
1.39
−0.05
4.94 (1.76–8.12)
2.34
−0.13
Middle East and North Africa
−2.82 (−12.32–6.68)
0.82
0.03
−1.30 (−5.85–3.25)
0.82
0.04
North America
2.13 (1.57–2.68)
1.45
−0.02
0.82 (−0.05–1.70)
1.40
−0.01
South Asia
−12.07 (−26.25–2.11)
0.52
0.06
−2.71 (−7.07–1.66)
0.75
0.03
Sub-Saharan Africa
3.32 (−0.07–6.72)
1.43
−0.06
2.97 (1.45–4.49)
1.62
−0.08
SII represents the absolute mortality rate difference between the lowest SDI group and the highest SDI group, RII and CI represent relative mortality rate difference. Death due to “exposure to forces of nature” and “other unintentional injuries” was excluded. CI: Concentration index; RII: Relative index of inequality; SDI: Socio-demographic index; SII: Slope index of inequality.
Sensitivity analysis
When we used all kinds of NTUIs in the APC model, panel data regression, and inequality analysis , the results were similar [Supplementary Figures 5–7, https://links.lww.com/CM9/B219 https://links.lww.com/CM9/B219 https://links.lww.com/CM9/B219 https://links.lww.com/CM9/B219 https://links.lww.com/CM9/B219
Discussion
Our study reported the trends of NTUIs mortality globally and the regional differences across countries by using data from the GBD 2019 study. An over 50% reduction in ASMR of NTUIs among children and adolescents aged 5 to 24 years was found during the past decades. The degree of absolute inequality also declined by over 50% during the past decades. However, the situation among children and adolescents living in low and low–middle SDI countries was not optimistic for the huge loss from NTUIs. In addition, the degree of relative inequality remained stable during the past 30 years, which indicated that we should still take intervention measures for those suffering social-economic disadvantages.
Globally, the ASMR of NTUIs among children and adolescents aged 5 to 24 years showed declining trends with fluctuation, which was consistent in each SDI group and almost every country. The significant increase in ASMR in 1991, 2004, 2008, and 2010 might correspond to several severe natural disasters, such as cyclone, earthquake, and tsunami.[22–25]
In our study, males had a higher ASMR of NTUIs than females, which was consistent with most previous studies.[1,26–28] drowning , falls, and exposure to mechanical forces than females, while females were more vulnerable to fire, heat, and hot substances. The prefrontal cortex immaturity was the basis for the rise in risk-taking behavior, which was a product of an imbalance between biologically driven increases in novelty and immature self-regulation.[29] [30] [4,6,26] children and adolescents of different genders.
Globally, we found that children aged 5 to 9 years had the highest mortality rate and highest annual change percent of mortality rate, and they both decreased with age. We also found that the mortality of children aged 5 to 9 years was most affected by SDI. They were the most vulnerable group among the four age groups,[14]
Most of the previous studies indicated that children and adolescents in LMICs suffered huge losses from NTUIs.[3–9] children and adolescents from low and low–middle SDI countries and territories suffered greater losses than those from high and high–middle SDI countries and territories. In addition, we further discovered that children and adolescents from the low–middle SDI group instead of the low SDI group had the highest ASMR of NTUIs, but the estimates dropped rapidly, while the low SDI group had the second highest ASMR and the lowest annual change percent of ASMR during the past decades. In addition, the number of deaths in the low SDI group showed an increasing trend in the past three decades. There were multifactorial reasons for these interesting phenomena. The six of the top ten causes of death in low-income countries were communicable diseases, and neonatal conditions,[31] children and adolescents in the low SDI countries and territories had lower ASMR and annual change percent of NTUIs than those in low–middle SDI countries and territories. A reduction in death would be the result of measures preventing injuries and better access to medical care after an injury. However, the increasing number of deaths reminded us that we should pay more attention to children and adolescents in low SDI countries and territories and take action to minimize the likelihood that they would suffer larger losses from NTUIs with social development and the decline in communicable diseases.[32]
In comparison to the high and high–middle groups, although the low and low–middle groups had the similar proportions of drowning , falls, and exposure to mechanical forces, they undertook substantially greater death burden, which might be attributable to precarious living and working conditions, inadequate adult supervision, limited first aid awareness, insufficient safety equipment, and inadequate health service.[3] foreign body and poisonings occupied a higher proportion in the high and high–middle SDI group. Therefore, we should provide safer living and working conditions to those in low and low–middle groups, as well as provide easier access to quality emergency trauma care, animal vaccination, and vaccine stockpile.[3,33] children and adolescents and their guardians was required in all SDI groups, which would promote the awareness of injury prevention and reduce the occurrence of NTUIs, such as foreign body and poisonings.
The relative inequality has persisted for the past decades, although most countries and territories had made great achievements in regard to the prevention of NTUIs in children and adolescents , and thus the absolute gap between different countries and territories has narrowed. The ASMR of children and adolescents was negatively correlated with the SDI because a higher SDI value represented a stronger national economy and a higher average educational level, which has been proven to be related to the decline in mortality by existing research.[34–36] children and adolescents , such as China and India. A significant improvement in the global average health level could be observed if we take more actions to decrease the NTUIs among those from low and low–middle SDI regions.
Previous studies have indicated the precaution we should take to reduce death, and there are different interventions for each type of NTUIs.[28,37] children and adolescents from low SDI countries and territories to prevent the rebound of mortality. Moreover, males suffered more from NTUIs than females, while children aged 5 to 9 years suffered the most, and the ASMR was most affected by the SDI in the four age groups, which reminded us that it might be effective to reduce the overall NTUIs mortality rate and further promote the whole health status of children and adolescents if we could pay more attention to these children and adolescents .
To the best of our knowledge, our study provided the first descriptions of NTUIs mortality trends globally and regional differences across countries, focusing on children and adolescents aged 5 to 24 years old. We used the data from GBD 2019, which estimated the mortality data for 204 countries and territories from 1990 to 2019, so we could explore the trend of mortality and inequality across countries. An additional strength was that we used several statistical models, which could prove each other and increase the credibility of our results.
This study had several limitations. First, we used the data of NTUIs from GBD 2019, and previous studies proposed that the injury data from LMICs were inaccurate because of the low or absent coverage of vital registration.[1,15,27,38] [1] children and adolescents , we only used SDI, a complex index combined with information on the economy, education, and fertility rate, to explore whether it is associated with the mortality rate. HDI was used for the sensitivity analysis, which showed consistent results with SDI. More relevant social determinants should be included to explore the specific and overall profiles in future research.
In conclusion, despite the declining trend of the mortality rate and the narrowing gap between countries, there were still a large number of children and adolescents dying from NTUIs, and those experiencing social-economic disadvantages remained at high mortality, which indicated that inequality still existed. We should pay more attention to those who suffer huge losses from NTUIs, such as males, children aged 5 to 9 years, and children and adolescents in low and low–middle SDI countries. We should especially focus on the low SDI group. Although they had a lower ASMR than the low–middle SDI group, they might have a higher ASMR for NTUIs when the burden of other diseases dropped. A global research agenda on injury prevention, such as embedding injury prevention into the SDGs, might contribute to the efforts and implementation of NTUIs in countries with low and low–middle SDI, which would be beneficial to reducing the overall NTUIs mortality, promoting a safe and healthy life among children and adolescents , and further reducing inequalities to ensure that no one is left behind.
Acknowledgements
The authors are grateful to the project staff of the team in Global Burden of Diseases.
Funding
This study was supported by grants from the National Statistical Scientific Research Program (No. 2021LY052), the China Medical Board (21-434 to YS) and the National Natural Science Foundation of China (No. 82073573).
Conflicts of interest
None.
References
1. Haagsma JA, Graetz N, Bolliger I, Naghavi M, Higashi H, Mullany EC, et al. The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the
Global Burden of Disease study 2013.
Inj Prev 2016; 22:3–18. doi: 10.1136/injuryprev-2015-041616.
2. GBD Results Tool. USA: Global Health Data Exchange, 2019. Available from:
http://ghdx.healthdata.org/gbd-results-tool . [Accessed on November 10, 2021].
3. Injuries and Violence. Geneva: World Health Organization, 2021. Available from:
https://www.who.int/news-room/fact-sheets/detail/injuries-and-violence . [Accessed on November 10, 2021].
4.
Drowning . Geneva: World Health Organization, 2021. Available from:
https://www.who.int/news-room/fact-sheets/detail/drowning . [Accessed on November 10, 2021].
5. Burns. Geneva: World Health Organization, 2018. Available from:
https://www.who.int/news-room/fact-sheets/detail/burns . [Accessed on November 10, 2021].
6. Falls. Geneva: World Health Organization, 2021. Available from:
https://www.who.int/news-room/fact-sheets/detail/falls . [Accessed on November 10, 2021].
7. Adolescent and Young Adult Health. Geneva: World Health Organization, 2021. Available from:
https://www.who.int/news-room/fact-sheets/detail/adolescents-health-risks-and-solutions . [Accessed on November 10, 2021].
8. Norton R, Ahuja RB, Hoe C, Hyder AA, Ivers R, Keay L,
et al . Nontransport unintentional injuries. In: Mock CN, Nugent R, Kobusingye O, Smith KR, eds. Injury Prevention and Environmental Health. Washington (DC); 2017.
9. Hyder AA, Puvanachandra P, Tran NH. Child and adolescent injuries: a new agenda for child health.
Inj Prev 2008; 14:67doi: 10.1136/ip.2007.018085.
10. Goals to Transform Our World. United Nations. 2015. Available from:
https://www.un.org/sustainabledevelopment/ . [Accessed on August 10, 2021].
11. Ma T, Peden AE, Peden M, Hyder AA, Jagnoor J, Duan L, et al. Out of the silos: embedding injury prevention into the sustainable development goals.
Inj Prev 2021; 27:166–171. doi: 10.1136/injuryprev-2020-043850.
12. Híjar M, Pérez-Núñez R, Hidalgo-Solórzano E, Hernández Prado B, Valdez-Santiago R, Hamilton EB, et al. Unintentional injuries in Mexico, 1990-2017: findings from the
Global Burden of Disease Study 2017.
Inj Prev 2020; 26: (Suppl 1): i154–i161. doi: 10.1136/injuryprev-2019-043532.
13. Leilei D, Pengpeng Y, Haagsma JA, Ye J, Yuan W, Yuliang E, et al. The burden of injury in China, 1990-2017: findings from the
Global Burden of Disease Study 2017.
Lancet Public Health 2019; 4:e449–e461. doi: 10.1016/S2468-2667(19)30125-2.
14. Ali S, Destaw Z, Misganaw A, Worku A, Negash L, Bekele A, et al. The burden of injuries in Ethiopia from 1990-2017: evidence from the
global burden of disease study.
Inj Epidemiol 2020; 7:67doi: 10.1186/s40621-020-00292-9.
15. Vos T, Lim SS, Abbafati C, Abbas KM, Abbasi M, Abbasifard M, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the
Global Burden of Disease Study 2019.
Lancet 2020; 396:1204–1222. doi: 10.1016/S0140-6736(20)30925-9.
16. A New Way of Measuring Development Helps Assess Health System Performance. USA: Institute for Health Metrics and Evaluation, 2017. Available from:
http://www.healthdata.org/acting-data/new-way-measuring-development-helps-assess-health-system-performance . [Accessed on August 31, 2021].
17. Human Development Reports, Human Development Index (HDI). United Nations Development Programme, 2020. Available from:
http://hdr.undp.org/en/content/human-development-index-hdi . [Accessed on August 01, 2021].
18. Rosenberg PS, Check DP, Anderson WF. A web tool for age-period-cohort analysis of cancer incidence and mortality rates.
Cancer Epidemiol Biomarkers Prev 2014; 23:2296–2302. doi: 10.1158/1055-9965.EPI-14-0300.
19. Wagstaff A, Paci P, van Doorslaer E. On the measurement of inequalities in health.
Soc Sci Med 1991; 33:545–557. doi: 10.1016/0277-9536(91)90212-U.
20. Moreno-Betancur M, Latouche A, Menvielle G, Kunst AE, Rey G. Relative index of inequality and slope index of inequality: a structured regression framework for estimation.
Epidemiology 2015; 26:518–527. doi: 10.1097/EDE.0000000000000311.
21. Wagstaff A. The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality.
Health Econ 2005; 14:429–432. doi: 10.1002/hec.953.
22. Bern C, Sniezek J, Mathbor GM, Siddiqi MS, Ronsmans C, Chowdhury AM, et al. Risk factors for mortality in the Bangladesh cyclone of 1991.
Bull World Health Organ 1993; 71:73–78. doi: NODOI.
23. Lateef F. Cyclone Nargis and Myanmar: a wake up call.
J Emerg Trauma Shock 2009; 2:106–113. doi: 10.4103/0974-2700.50745.
24. DesRoches R, Comerio M, Eberhard MO, Mooney W, Rix GJ. Overview of the 2010 Haiti earthquake.
Earthquake Spectra 2011; 27: (1_suppl1): S1–S21. doi: 10.1193/1.3630129.
25. 2004 Indian Ocean Earthquake and Tsunami: Facts, FAQs, and How to Help. World Vision, 2019. Available from:
https://www.worldvision.org/disaster-relief-news-stories/2004-indian-ocean-earthquake-tsunami-facts . [Accessed on September 06, 2021].
26. Balan B, Lingam L. Unintentional injuries among children in resource poor settings: where do the fingers point?
Arch Dis Child 2012; 97:35–38. doi: 10.1136/archdischild-2011-300589.
27. Alonge O, Hyder AA. Reducing the global burden of childhood unintentional injuries.
Arch Dis Child 2014; 99:62–69. doi: 10.1136/archdischild-2013-304177.
28. de Ramirez SS, Hyder AA, Herbert HK, Stevens K. Unintentional injuries: magnitude, prevention, and control.
Annu Rev Public Health 2012; 33:175–191. doi: 10.1146/annurev-publhealth-031811-124558.
29. Casey BJ, Jones RM, Hare TA. The adolescent brain.
Ann N Y Acad Sci 2008; 1124:111–126. doi: 10.1196/annals.1440.010.
30. Gomes MGS, Tractenberg SG, Orso R, Viola TW, Grassi-Oliveira R. Sex differences in risk behavior parameters in adolescent mice: relationship with brain-derived neurotrophic factor in the medial prefrontal cortex.
Neurosci Lett 2022; 766:136339doi: 10.1016/j.neulet.2021.136339.
31. The Top 10 Causes of Death. Geneva: World Health Organization, 2020. Available from:
https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death . [Accessed on August 09, 2021].
32. Plitponkarnpim A, Andersson R, Jansson B, Svanstrom L. Unintentional injury mortality in children: a priority for middle income countries in the advanced stage of epidemiological transition.
Inj Prev 1999; 5:98–103. doi: 10.1136/ip.5.2.98.
33. Abela-Ridder B, Martin S, Gongal G, Engels D. Rabies vaccine stockpile: fixing the supply chain.
Bull World Health Organ 2016; 94:635-Adoi: 10.2471/BLT.16.183012.
34. Brenner MH. Commentary: economic growth is the basis of mortality rate decline in the 20th century - experience of the United States 1901-2000.
Int J Epidemiol 2005; 34:1214–1221. doi: 10.1093/ije/dyi146.
35. Renton A, Wall M, Lintott J. Economic growth and decline in mortality in
developing countries : an analysis of the World Bank development datasets.
Public Health 2012; 126:551–560. doi: 10.1016/j.puhe.2012.03.011.
36. Viner RM, Ozer EM, Denny S, Marmot M, Resnick M, Fatusi A, et al. Adolescence and the social determinants of health.
Lancet 2012; 379:1641–1652. doi: 10.1016/S0140-6736(12)60149-4.
37. Patel D, Sandell JMJP, Health C. Prevention of unintentional injury in children.
Paediatr Child Health 2013; 23:402–408. Doi: 10.1016/j.paed.2013.06.001.
38. Institute for Health Metrics and Evaluation, Human Development Network, The World Bank. The
Global Burden of Disease : Generating Evidence, Guiding Policy - Latin America and Caribbean Regional Edition. Seattle, WA: IHME, 2013.
