A just-released study of injury rates in China reports unexpectedly high levels of death by drowning and suicide and identifies injuries as the leading cause of mortality among people 40 and under.
The top three causes of injury death among the 100 million Chinese studied were suicide (33 percent), motor vehicle crashes (16 percent) and drowning (14 percent), according to researchers Susan P. Baker and Guohua Li of the Johns Hopkins School of Public Health, who had 1986 figures to use.
Those figures permit an unprecedented injury-rate comparison between a large Third World country and the United States, where the leading causes of injury death are motor vehicle crashes (31 percent), suicide (20 percent) and homicide (14 percent).
NB "We're seeing some big differences between the two countries,"
said Dr. Baker, professor of health policy and management, at a news conference at Johns Hopkins. "Particularly, the high suicide and drowning rates in China and the high motor vehicle and homicide rates in the U.S."
In both countries, injury death rates peak between ages 20 and 24, but there are gender differences. In the United States, that peak is found among males, largely due to homicides and motor vehicle accidents.
But in China, the peak is found among females, with a suicide rate more than 10 times the U.S. rate for females ages 15 to 24. The rate for women ages 25 to 29 is more than double that in the United States.
And Chinese females in rural areas commit suicide five times more often than those in urban areas, in contrast to the United States, where suicide rates are traditionally higher in crowded cities.
"The motivation and cause of suicide may be greatly different between Chinese and Americans," said Dr. Baker. "For young Chinese females, especially those living in rural areas, marriage problems and poverty may be the major causes."
Injuries are also the leading cause of death and disability for Americans under the age of 45, killing more than 143,000 people in the United States in 1985.
RF But Dr. Baker and Dr. Li, who was born in China, found that injury
profiles from the two countries differed widely in many instances according to sex, age, population density and cultural factors.
Homicides -- the third leading cause of injury death in the United States -- are dramatically lower in China.
The Chinese death rate per 100,000 vehicles is more than 10 times the U.S. rate but is a bit deceiving, since the majority of victims are bicyclists and pedestrians on busy byways. In America, the highest percentage of vehicle deaths occurs in rural areas.
For children under a year, the death rate is five times that in the United States, and for ages 85 and older, it's 2.5 times higher. The higher child mortality is attributed to falls, suffocating and drowning, the latter at a rate seven to 10 times higher than in the United States.
"There is little, if any, day care in rural China, where lakes, ponds and rivers abound and parents work from dawn until late at night in the summer," said Dr. Li.
Published in the May issue of The American Journal of Public Health, the study is based on data provided by the World Bank from an established network of "disease surveillance points" in 30 Chinese provinces, representing about 10 percent of the country's population.