Incidence of unintentional injuries among children aged 3–12 in China: a systematic review and meta-analysis

Abstract

OBJECTIVE: To investigate the occurrence of unintentional injuries among children aged 3 to 12 in China over the past 5 years, and to provide a scientific basis for the prevention and control of such injuries. DESIGN: A systematic review and meta-analysis. A random-effects model was specified a priori to synthesise study estimates given anticipated clinical and methodological heterogeneity across studies. DATA SOURCES: We searched CNKI, WanFang and PubMed for studies published between 1 January 2018 and 30 June 2024. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We included observational studies conducted in China with children aged 3-12 years, reporting incidence or person-time incidence of unintentional injuries and using clear injury definition criteria. Exclusion criteria included reviews, studies on special populations, duplicated datasets or incomplete data. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers screened studies, extracted data and assessed study quality using Loney's criteria. Heterogeneity was quantified with the I² statistic and Q test. Publication bias was assessed with funnel plots, Egger's regression and fail-safe N. Certainty of evidence for primary outcomes was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: A total of 16 studies involving 37 877 participants were included. The results indicated that the combined effect size of the incidence of unintentional injuries among children aged 3 to 12 in China was 14.0% (95% CI 9.5% to 20.3%), and the person-time incidence was 15.3% (95% CI 8.6% to 25.8%), with falls demonstrating the highest combined effect size. Further subgroup analysis revealed several trends: the incidence of unintentional injuries was higher in boys (16.1%) than in girls (11.2%), among children aged 3-6 years (15.2%) compared with those aged 6-12 years (12.4%), in the western region (14.3%) versus the eastern region (13.1%) and when applying the 1996 injury criteria (17.7%) compared with the 2004 criteria (15.6%). All differences were statistically significant (p<0.05). Study quality (Loney) ranged from 4-6 (median=6); Egger's test showed no evidence of small-study bias (p=0.87). GRADE assessment rated the certainty of evidence for both primary outcomes as very low, primarily due to observational design, high heterogeneity and imprecision. Sensitivity analyses excluding lower quality studies and leave-one-out analyses did not materially change effect direction or conclusions. CONCLUSIONS: The incidence of unintentional injuries among Chinese children aged 3-12 remains high, especially from falls. Injury rates differ significantly by gender, age, region and other factors. Future efforts should prioritise the safety of kindergarten children in western China, with a strong emphasis on preventing falls, which are a common type of injuries among children. PROSPERO REGISTRATION NUMBER: CRD42024604890.