Trends in traumatic brain injury mortality in China, 2006-2013: A population-based longitudinal study
Traumatic brain injury (TBI) is a significant global public health problem, but has received minimal attention from researchers and policy-makers in low- and middle-income countries (LMICs). Epidemiological evidence of TBI morbidity and mortality is absent at the national level for most LMICs, inclu...
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| Veröffentlicht in: | PLoS medicine 2017-07, Vol.14 (7), p.e1002332-e1002332 |
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| description | Traumatic brain injury (TBI) is a significant global public health problem, but has received minimal attention from researchers and policy-makers in low- and middle-income countries (LMICs). Epidemiological evidence of TBI morbidity and mortality is absent at the national level for most LMICs, including China. Using data from China's Disease Surveillance Points (DSPs) system, we conducted a population-based longitudinal analysis to examine TBI mortality, and mortality differences by sex, age group, location (urban/rural), and external cause of injury, from 1 January 2006 to 31 December 2013 in China.
Mortality data came from the national DSPs system of China, which has coded deaths using the International Classification of Diseases-10th Revision (ICD-10) since 2004. Crude and age-standardized mortality with 95% CIs were estimated using the census population in 2010 as a reference population. The Cochran-Armitage trend test was used to examine the significance of trends in mortality from 2006 to 2013. Negative binomial models were used to examine the associations of TBI mortality with location, sex, and age group. Subgroup analysis was performed by external cause of TBI. We found the following: (1) Age-adjusted TBI mortality increased from 13.23 per 100,000 population in 2006 to 17.06 per 100,000 population in 2008 and then began to fall slightly. In 2013, age-adjusted TBI mortality was 12.99 per 100,000 population (SE = 0.13). (2) Compared to females and urban residents, males and rural residents had higher TBI mortality risk, with adjusted mortality rate ratios of 2.57 and 1.71, respectively. TBI mortality increased substantially with older age. (3) Motor vehicle crashes and falls were the 2 leading causes of TBI mortality between 2006 and 2013. TBI deaths from motor vehicle crashes in children aged 0-14 years and adults aged 65 years and older were most often in pedestrians, and motorcyclists were the first or second leading category of road user for the other age groups. (4) TBI mortality attributed to motor vehicle crashes increased for pedestrians and motorcyclists in all 7 age groups from 2006 to 2013. Our analysis was limited by the availability and quality of data in the DSPs dataset, including lack of injury-related socio-economic factors, policy factors, and individual and behavioral factors. The dataset also may be incomplete in TBI death recording or contain misclassification of mortality data.
TBI constitutes a serious public health threat in |
| doi_str_mv | 10.1371/journal.pmed.1002332 |
| format | Article |
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Mortality data came from the national DSPs system of China, which has coded deaths using the International Classification of Diseases-10th Revision (ICD-10) since 2004. Crude and age-standardized mortality with 95% CIs were estimated using the census population in 2010 as a reference population. The Cochran-Armitage trend test was used to examine the significance of trends in mortality from 2006 to 2013. Negative binomial models were used to examine the associations of TBI mortality with location, sex, and age group. Subgroup analysis was performed by external cause of TBI. We found the following: (1) Age-adjusted TBI mortality increased from 13.23 per 100,000 population in 2006 to 17.06 per 100,000 population in 2008 and then began to fall slightly. In 2013, age-adjusted TBI mortality was 12.99 per 100,000 population (SE = 0.13). (2) Compared to females and urban residents, males and rural residents had higher TBI mortality risk, with adjusted mortality rate ratios of 2.57 and 1.71, respectively. TBI mortality increased substantially with older age. (3) Motor vehicle crashes and falls were the 2 leading causes of TBI mortality between 2006 and 2013. TBI deaths from motor vehicle crashes in children aged 0-14 years and adults aged 65 years and older were most often in pedestrians, and motorcyclists were the first or second leading category of road user for the other age groups. (4) TBI mortality attributed to motor vehicle crashes increased for pedestrians and motorcyclists in all 7 age groups from 2006 to 2013. Our analysis was limited by the availability and quality of data in the DSPs dataset, including lack of injury-related socio-economic factors, policy factors, and individual and behavioral factors. The dataset also may be incomplete in TBI death recording or contain misclassification of mortality data.
TBI constitutes a serious public health threat in China. Further studies should explore the reasons for the particularly high risk of TBI mortality among particular populations, as well as the reasons for recent increases in certain subgroups, and should develop solutions to address these challenges. Interventions proven to work in other cultures should be introduced and implemented nationwide. Examples of these in the domain of motor vehicle crashes include policy change and enforcement of laws concerning helmet use for motorcyclists and bicyclists, car seat and booster seat use for child motor vehicle passengers, speed limit and drunk driving laws, and alcohol ignition interlock use. Examples to prevent falls, especially among elderly individuals, include exercise programs, home modification to reduce fall risk, and multifaceted interventions to prevent falls in all age groups.</description><identifier>ISSN: 1549-1676</identifier><identifier>ISSN: 1549-1277</identifier><identifier>EISSN: 1549-1676</identifier><identifier>DOI: 10.1371/journal.pmed.1002332</identifier><identifier>PMID: 28700591</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Accidental Falls - mortality ; Accidental Falls - statistics & numerical data ; Accidents, Traffic - mortality ; Accidents, Traffic - statistics & numerical data ; Accidents, Traffic - trends ; Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Alcoholic beverages ; Alcohols ; Analysis ; Attention ; Brain ; Brain injuries ; Brain Injuries, Traumatic - epidemiology ; Brain Injuries, Traumatic - etiology ; Brain Injuries, Traumatic - mortality ; Census ; Child ; Child, Preschool ; Children ; China ; China - epidemiology ; Classification ; Complications and side effects ; Crashes ; Culture ; Driving ability ; Economic factors ; Enforcement ; Engineering and Technology ; Epidemiology ; Falls ; Fatalities ; Female ; Females ; Geography ; Geriatrics ; Group dynamics ; Humans ; Infant ; Infant, Newborn ; Longitudinal Studies ; Male ; Males ; Medicine and Health Sciences ; Middle Aged ; Morbidity ; Mortality ; Older people ; Passengers ; Pedestrians ; People and Places ; Population studies ; Population-based studies ; Protective equipment ; Public health ; Risk factors ; Rural populations ; Sex ; Sex Factors ; Traffic accidents & safety ; Traumatic brain injury ; Young Adult</subject><ispartof>PLoS medicine, 2017-07, Vol.14 (7), p.e1002332-e1002332</ispartof><rights>COPYRIGHT 2017 Public Library of Science</rights><rights>2017 Public Library of Science. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited: Cheng P, Yin P, Ning P, Wang L, Cheng X, Liu Y, et al. (2017) Trends in traumatic brain injury mortality in China, 2006-2013: A population-based longitudinal study. PLoS Med 14(7): e1002332. https://doi.org/10.1371/journal.pmed.1002332</rights><rights>2017 Cheng et al 2017 Cheng et al</rights><rights>2017 Public Library of Science. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited: Cheng P, Yin P, Ning P, Wang L, Cheng X, Liu Y, et al. (2017) Trends in traumatic brain injury mortality in China, 2006-2013: A population-based longitudinal study. PLoS Med 14(7): e1002332. https://doi.org/10.1371/journal.pmed.1002332</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c830t-dba68ef9803341ef3922575a329ccc88985843cab34c2adb5f84afe24f8566113</citedby><cites>FETCH-LOGICAL-c830t-dba68ef9803341ef3922575a329ccc88985843cab34c2adb5f84afe24f8566113</cites><orcidid>0000-0002-2141-8970</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5507407/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5507407/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28700591$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cheng, Peixia</creatorcontrib><creatorcontrib>Yin, Peng</creatorcontrib><creatorcontrib>Ning, Peishan</creatorcontrib><creatorcontrib>Wang, Lijun</creatorcontrib><creatorcontrib>Cheng, Xunjie</creatorcontrib><creatorcontrib>Liu, Yunning</creatorcontrib><creatorcontrib>Schwebel, David C</creatorcontrib><creatorcontrib>Liu, Jiangmei</creatorcontrib><creatorcontrib>Qi, Jinlei</creatorcontrib><creatorcontrib>Hu, Guoqing</creatorcontrib><creatorcontrib>Zhou, Maigeng</creatorcontrib><title>Trends in traumatic brain injury mortality in China, 2006-2013: A population-based longitudinal study</title><title>PLoS medicine</title><addtitle>PLoS Med</addtitle><description>Traumatic brain injury (TBI) is a significant global public health problem, but has received minimal attention from researchers and policy-makers in low- and middle-income countries (LMICs). Epidemiological evidence of TBI morbidity and mortality is absent at the national level for most LMICs, including China. Using data from China's Disease Surveillance Points (DSPs) system, we conducted a population-based longitudinal analysis to examine TBI mortality, and mortality differences by sex, age group, location (urban/rural), and external cause of injury, from 1 January 2006 to 31 December 2013 in China.
Mortality data came from the national DSPs system of China, which has coded deaths using the International Classification of Diseases-10th Revision (ICD-10) since 2004. Crude and age-standardized mortality with 95% CIs were estimated using the census population in 2010 as a reference population. The Cochran-Armitage trend test was used to examine the significance of trends in mortality from 2006 to 2013. Negative binomial models were used to examine the associations of TBI mortality with location, sex, and age group. Subgroup analysis was performed by external cause of TBI. We found the following: (1) Age-adjusted TBI mortality increased from 13.23 per 100,000 population in 2006 to 17.06 per 100,000 population in 2008 and then began to fall slightly. In 2013, age-adjusted TBI mortality was 12.99 per 100,000 population (SE = 0.13). (2) Compared to females and urban residents, males and rural residents had higher TBI mortality risk, with adjusted mortality rate ratios of 2.57 and 1.71, respectively. TBI mortality increased substantially with older age. (3) Motor vehicle crashes and falls were the 2 leading causes of TBI mortality between 2006 and 2013. TBI deaths from motor vehicle crashes in children aged 0-14 years and adults aged 65 years and older were most often in pedestrians, and motorcyclists were the first or second leading category of road user for the other age groups. (4) TBI mortality attributed to motor vehicle crashes increased for pedestrians and motorcyclists in all 7 age groups from 2006 to 2013. Our analysis was limited by the availability and quality of data in the DSPs dataset, including lack of injury-related socio-economic factors, policy factors, and individual and behavioral factors. The dataset also may be incomplete in TBI death recording or contain misclassification of mortality data.
TBI constitutes a serious public health threat in China. Further studies should explore the reasons for the particularly high risk of TBI mortality among particular populations, as well as the reasons for recent increases in certain subgroups, and should develop solutions to address these challenges. Interventions proven to work in other cultures should be introduced and implemented nationwide. Examples of these in the domain of motor vehicle crashes include policy change and enforcement of laws concerning helmet use for motorcyclists and bicyclists, car seat and booster seat use for child motor vehicle passengers, speed limit and drunk driving laws, and alcohol ignition interlock use. Examples to prevent falls, especially among elderly individuals, include exercise programs, home modification to reduce fall risk, and multifaceted interventions to prevent falls in all age groups.</description><subject>Accidental Falls - mortality</subject><subject>Accidental Falls - statistics & numerical data</subject><subject>Accidents, Traffic - mortality</subject><subject>Accidents, Traffic - statistics & numerical data</subject><subject>Accidents, Traffic - trends</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Alcoholic beverages</subject><subject>Alcohols</subject><subject>Analysis</subject><subject>Attention</subject><subject>Brain</subject><subject>Brain injuries</subject><subject>Brain Injuries, Traumatic - epidemiology</subject><subject>Brain Injuries, Traumatic - etiology</subject><subject>Brain Injuries, Traumatic - mortality</subject><subject>Census</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Children</subject><subject>China</subject><subject>China - epidemiology</subject><subject>Classification</subject><subject>Complications and side effects</subject><subject>Crashes</subject><subject>Culture</subject><subject>Driving ability</subject><subject>Economic factors</subject><subject>Enforcement</subject><subject>Engineering and Technology</subject><subject>Epidemiology</subject><subject>Falls</subject><subject>Fatalities</subject><subject>Female</subject><subject>Females</subject><subject>Geography</subject><subject>Geriatrics</subject><subject>Group dynamics</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Males</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Older people</subject><subject>Passengers</subject><subject>Pedestrians</subject><subject>People and Places</subject><subject>Population studies</subject><subject>Population-based studies</subject><subject>Protective equipment</subject><subject>Public health</subject><subject>Risk factors</subject><subject>Rural populations</subject><subject>Sex</subject><subject>Sex Factors</subject><subject>Traffic accidents & safety</subject><subject>Traumatic brain injury</subject><subject>Young Adult</subject><issn>1549-1676</issn><issn>1549-1277</issn><issn>1549-1676</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqVk12L1DAYhYso7rr6D0QLgijYMWnSNvFCGAY_BhYXdPU2pEnayZAms0krzr83dbrLVOZC6UWT9DknyXn7JslTCBYQVfDt1g3ecrPYdUouIAA5Qvm95BwWmGawrMr7R-Oz5FEI28hQQMHD5CwnFQAFheeJuvbKypBqm_aeDx3vtUhrz-Nc2-3g92nnfM-N7vcjs9poy9-kOQBllgOI3qXLdOd2g4k6Z7OaByVT42yr-0FG1KQhDvaPkwcNN0E9md4XyfePH65Xn7PLq0_r1fIyEwSBPpM1L4lqKAEIYagaRPO8qAqOciqEIISSgmAkeI2wyLmsi4Zg3qgcN6QoSwjRRfL84LszLrApocAgzSmGuKIjsT4Q0vEt23ndcb9njmv2Z8H5lnEfMzCKlRUvlJBYVljhplQcYCw5roCENURKRK_3025DHYsglI0Rmpnp_IvVG9a6n6woQIVBFQ1eTQbe3Qwq9KzTQShjuFVuGM8NCcFVDCOiL_5CT99uoloeL6Bt4-K-YjRlS0xpSTEqSKSyE1SrrIqHdFY1Oi7P-MUJPj5SdVqcFLyeCSLTq199y4cQ2Prb1_9gv_w7e_Vjzr48YjeKm34TnBnG_zTMQXwAhXcheNXcFRACNnbabdJs7DQ2dVqUPTsu_p3otrXQb_HCIRI</recordid><startdate>20170711</startdate><enddate>20170711</enddate><creator>Cheng, Peixia</creator><creator>Yin, Peng</creator><creator>Ning, Peishan</creator><creator>Wang, Lijun</creator><creator>Cheng, Xunjie</creator><creator>Liu, Yunning</creator><creator>Schwebel, David C</creator><creator>Liu, Jiangmei</creator><creator>Qi, Jinlei</creator><creator>Hu, Guoqing</creator><creator>Zhou, Maigeng</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISN</scope><scope>ISR</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><scope>CZK</scope><orcidid>https://orcid.org/0000-0002-2141-8970</orcidid></search><sort><creationdate>20170711</creationdate><title>Trends in traumatic brain injury mortality in China, 2006-2013: A population-based longitudinal study</title><author>Cheng, Peixia ; Yin, Peng ; Ning, Peishan ; Wang, Lijun ; Cheng, Xunjie ; Liu, Yunning ; Schwebel, David C ; Liu, Jiangmei ; Qi, Jinlei ; Hu, Guoqing ; Zhou, Maigeng</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c830t-dba68ef9803341ef3922575a329ccc88985843cab34c2adb5f84afe24f8566113</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Accidental Falls - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><collection>PLoS Medicine</collection><jtitle>PLoS medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cheng, Peixia</au><au>Yin, Peng</au><au>Ning, Peishan</au><au>Wang, Lijun</au><au>Cheng, Xunjie</au><au>Liu, Yunning</au><au>Schwebel, David C</au><au>Liu, Jiangmei</au><au>Qi, Jinlei</au><au>Hu, Guoqing</au><au>Zhou, Maigeng</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Trends in traumatic brain injury mortality in China, 2006-2013: A population-based longitudinal study</atitle><jtitle>PLoS medicine</jtitle><addtitle>PLoS Med</addtitle><date>2017-07-11</date><risdate>2017</risdate><volume>14</volume><issue>7</issue><spage>e1002332</spage><epage>e1002332</epage><pages>e1002332-e1002332</pages><issn>1549-1676</issn><issn>1549-1277</issn><eissn>1549-1676</eissn><abstract>Traumatic brain injury (TBI) is a significant global public health problem, but has received minimal attention from researchers and policy-makers in low- and middle-income countries (LMICs). Epidemiological evidence of TBI morbidity and mortality is absent at the national level for most LMICs, including China. Using data from China's Disease Surveillance Points (DSPs) system, we conducted a population-based longitudinal analysis to examine TBI mortality, and mortality differences by sex, age group, location (urban/rural), and external cause of injury, from 1 January 2006 to 31 December 2013 in China.
Mortality data came from the national DSPs system of China, which has coded deaths using the International Classification of Diseases-10th Revision (ICD-10) since 2004. Crude and age-standardized mortality with 95% CIs were estimated using the census population in 2010 as a reference population. The Cochran-Armitage trend test was used to examine the significance of trends in mortality from 2006 to 2013. Negative binomial models were used to examine the associations of TBI mortality with location, sex, and age group. Subgroup analysis was performed by external cause of TBI. We found the following: (1) Age-adjusted TBI mortality increased from 13.23 per 100,000 population in 2006 to 17.06 per 100,000 population in 2008 and then began to fall slightly. In 2013, age-adjusted TBI mortality was 12.99 per 100,000 population (SE = 0.13). (2) Compared to females and urban residents, males and rural residents had higher TBI mortality risk, with adjusted mortality rate ratios of 2.57 and 1.71, respectively. TBI mortality increased substantially with older age. (3) Motor vehicle crashes and falls were the 2 leading causes of TBI mortality between 2006 and 2013. TBI deaths from motor vehicle crashes in children aged 0-14 years and adults aged 65 years and older were most often in pedestrians, and motorcyclists were the first or second leading category of road user for the other age groups. (4) TBI mortality attributed to motor vehicle crashes increased for pedestrians and motorcyclists in all 7 age groups from 2006 to 2013. Our analysis was limited by the availability and quality of data in the DSPs dataset, including lack of injury-related socio-economic factors, policy factors, and individual and behavioral factors. The dataset also may be incomplete in TBI death recording or contain misclassification of mortality data.
TBI constitutes a serious public health threat in China. Further studies should explore the reasons for the particularly high risk of TBI mortality among particular populations, as well as the reasons for recent increases in certain subgroups, and should develop solutions to address these challenges. Interventions proven to work in other cultures should be introduced and implemented nationwide. Examples of these in the domain of motor vehicle crashes include policy change and enforcement of laws concerning helmet use for motorcyclists and bicyclists, car seat and booster seat use for child motor vehicle passengers, speed limit and drunk driving laws, and alcohol ignition interlock use. Examples to prevent falls, especially among elderly individuals, include exercise programs, home modification to reduce fall risk, and multifaceted interventions to prevent falls in all age groups.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>28700591</pmid><doi>10.1371/journal.pmed.1002332</doi><orcidid>https://orcid.org/0000-0002-2141-8970</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1549-1676 |
| ispartof | PLoS medicine, 2017-07, Vol.14 (7), p.e1002332-e1002332 |
| issn | 1549-1676 1549-1277 1549-1676 |
| language | eng |
| recordid | cdi_plos_journals_1929414791 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Public Library of Science (PLoS) |
| subjects | Accidental Falls - mortality Accidental Falls - statistics & numerical data Accidents, Traffic - mortality Accidents, Traffic - statistics & numerical data Accidents, Traffic - trends Adolescent Adult Age Factors Aged Aged, 80 and over Alcoholic beverages Alcohols Analysis Attention Brain Brain injuries Brain Injuries, Traumatic - epidemiology Brain Injuries, Traumatic - etiology Brain Injuries, Traumatic - mortality Census Child Child, Preschool Children China China - epidemiology Classification Complications and side effects Crashes Culture Driving ability Economic factors Enforcement Engineering and Technology Epidemiology Falls Fatalities Female Females Geography Geriatrics Group dynamics Humans Infant Infant, Newborn Longitudinal Studies Male Males Medicine and Health Sciences Middle Aged Morbidity Mortality Older people Passengers Pedestrians People and Places Population studies Population-based studies Protective equipment Public health Risk factors Rural populations Sex Sex Factors Traffic accidents & safety Traumatic brain injury Young Adult |
| title | Trends in traumatic brain injury mortality in China, 2006-2013: A population-based longitudinal study |
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