1. Demographic characteristics of participants
A total of 152,553 participants were included in the present study (male vs female= 88,289:64,264; outpatients vs inpatients=108,615:43,938). Among the participants, 36.89% aged 15-44 and 36.46% aged 45-64. Among the hospitalized patients, 22,218 were hospitalized for 1-3 days, 6,245 for 4-7 days, 9,383 for 8-15 days, and 6,092 for more than 15 days. Individuals with injury mean expenditures of 3661.268 RMB [95%CI: 3610.479-3712.057].
2. Injury mortality and its percentage of all causes of death in China (2006-2016)
Table 1 illustrates the changes of injury-related mortality and composition ratio from 2006 to 2016 in China. In terms of mortality, there increased from 32.36/100,000 in 2006 to 37.34/100,000 in 2017 and from 46.12/100,000 in 2006 to 54.48/100,000 in 2017 for urban and rural residents, respectively. Injuries, as the fifth leading cause of death, contributed a lot to the burden on families and society. Moreover, the mortality and composition ratio of injuries in rural were greater than that in urban (Table 1).
3. General situation of CCE
In 2016, the CCE for all diseases in Dalian was 21.109 billion RMB, including 7421.92 million RMB (35.16%) for outpatient service and 13686.90 million RMB (64.84%) for inpatient service. The CCE of injury in Dalian had reached 1572.73 million RMB, accounting for 7.45% of the total curative care expenditure, 0.23% of gross domestic product (GDP).
To identify the distribution of CCE of different age groups, the data were divided into 8 groups and we calculated the CCE both in outpatient and inpatient. The CCE of injuries in outpatient was 356.26 million RMB , accounting for 4.80% of total curative care expenditure in outpatient. The CCE of injury in inpatient was much higher than outpatient, which was 1216.47 million RMB, accounting for 8.89% of total curative care expenditure in inpatient. Overall, injuries were responsible for 7.45% of Dalian’s total burden of disease expenditure.
3.1 The CCE of injuries in different age groups
The CCE of injuries was gradually increasing from newborns to 65 years old, and the age group of 45-64 had the highest CCE of injuries, while the age group less than 1 had the lowest figure. Compared with the other age groups, the CCE of injuries accounted for a larger proportion of total curative care expenditure in the 15-64 age group (Table 2).
3.2 CCE for different injuries regions
To further understand the distribution of CCE of different types of injuries in the population, we divided injuries into 13 types of according to the injuries on body parts. In terms of injuries of outpatient, the highest expenditure happened in injuries to the head, followed by injuries to the lower limb and injuries to the spine, skin or blood vessel and effects of foreign body insertion. The top three types accounted for 73.39% of the CCE (Fig. 1). However, the top three cost categories of injuries in inpatients care were different, which were injuries to the spine, skin or blood vessel and effects of foreign body insertion, injuries to the lower limb and injuries to the head in inpatient. A total of these three was about 733.60 million RMB, occupying 63.59% of the total in inpatient’s injuries (Fig. 2). The CCE of injuries was 1572.74 million RMB after the outpatient and inpatient were combined, the highest of which was injuries to the spine, skin or blood vessel and effects of foreign body insertion.
3.3 The CCE of different types of injuries for each age group
Table 3 provided a comparison of the CCE of different types of injuries by age groups in outpatient. After analyzing these data, we found that the most costly type of injury in the 0-14 age group was injuries to the spine, skin or blood vessel and effects of foreign body insertion, following by injuries to the head. The most costly type of injury in the 15-64 age group was injuries to the head, following by injuries to the lower limb. In the 65 and above age group, the top two were injuries to the lower limb and injuries to the head (Table 3).
As shown in in Table 4, the most costly type of injury in the age group 0-14, 15-24 were injuries to the head and injuries to the spine, skin or blood vessel and effects of foreign body insertion, respectively. In addition, the CCE of injuries to the shoulder, upper arm and lower limb should by noticed by the government (Table 4).