Analysis of the characteristics of unintentional deaths in children under the age of five from 2018 to 2020 in Hangzhou, China Childhood Unintentional deaths

Analysis of the characteristics of unintentional deaths in children under the age of five from 2018 to 2020 in Hangzhou, China Childhood Unintentional deaths | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Analysis of the characteristics of unintentional deaths in children under the age of five from 2018 to 2020 in Hangzhou, China Childhood Unintentional deaths Xia Qian, Ye Hu, Jinqing Chen, Dan Huang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3910060/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Backgroundː This study analyzedthe current status of unintentional death among children under the age of five in Hangzhou from 2018 to 2020. Through the study of death characteristics and trend prediction, it is hoped that key populations, household registration, and seasons can be identified, thereby providing evidence for the development of intervention measures and effective prevention and control management of unintentional injury deaths. Methods: A total of 198 cases of deaths among children under the age of five in Hangzhou in China from 2018 to 2020 were collected. The occurrence of unintentional deaths among children was analyzed based on factors such as age, gender, household registration, season of occurrence, and causes of death. Resultsː The unintentional mortality rate among children under the age of five in Hangzhou in China from 2018 to 2020 was 0.65‰, with no significant trend change. Analysis of causes of death among different age groups showed that accidental suffocation was the main cause of death for infants, while drowning, traffic accidents, and accidental falls were the main causes of death for children aged one to four years, with statistically significant differences. Conclusion: The composition of child injury causes varies among different age groups, household registrations, and seasons. Targeted strategies and measures for child injury prevention should be developed based on these characteristics. children under the age of five injury unintentional deaths accidental suffocation Introduction under the age of five in China [ 1 ]. The United Nations Sustainable Development Goals state the objective of eliminating preventable deaths among newborns and children under the age of five by 2030 [ 2 ]. According to the "China Children's Development Outline (2021–2030)," it is necessary to strengthen child injury prevention and intervention, aiming to reduce the child injury mortality rate by 20% based on the data from 2020 [ 3 ]. To understand the current situation and characteristics of unintentional deaths among children under the age of five in Hangzhou in China and provide a basis for developing intervention measures for child injuries, an analysis of the unintentional death cases from 2018 to 2020 is now conducted. Materials and methods Data Sources The data were sourced from the "Child Death Report Card" and the "Monitoring Program for Deaths of Children Under 5" in Hangzhou City. The "Child Death Report Card" includes the number of live births and deaths for both local registered children and nonlocal migrant children. The "Monitoring Program for Deaths of Children Under 5" provides basic information such as parents' names, child's name, address or household registration, gender, date of birth, gestational weeks, and birth weight. It also includes death-related information such as date of death, age at death, and cause of death. The data collection involved household surveys and underwent strict review and verification at the street, district, and city levels to ensure accuracy and reliability. All children who met the criteria of being born after 28 weeks of gestation, having vital signs such as heartbeat, breathing, umbilical cord pulsation, or spontaneous muscle contractions, and dying before reaching five years old were included in the study. Data were collected for all children under the age of five who died in Hangzhou City from January 2018 to December 2020. Information related to unintentional deaths was extracted, following the common diagnostic and classification principles outlined in the "Monitoring Program for Deaths of Children Under 5 in China." Unintentional injuries were categorized into six types: drowning, traffic accidents, accidental suffocation, accidental poisoning, accidental falls, and other accidents. Descriptive analysis was conducted to examine the incidence of unintentional deaths among children under the age of five in Hangzhou, China, from 2018 to 2020, including urban‒rural differences and the distribution of causes of death. Data analysis Data were organized using Microsoft Excel 2007, and statistical analysis was performed using SPSS version 25 software. Rates were compared using the chi-square test or Fisher's exact probability test, with a significance level of P < 0.05 indicating statistical significance. Results Unintentional Deaths Among Children under the age of five in Hangzhou From 2018 to 2020, mortality surveillance in Hangzhou recorded a total of 303,530 live births. Among children under the age of five, there were 198 cases of unintentional deaths, resulting in an unintentional death rate of 0.65‰. Specifically, there were 63 cases of unintentional deaths among infants, with an infant unintentional death rate of 0.21‰. For children aged one to four years, there were 135 cases of unintentional deaths, corresponding to an unintentional death rate of 0.44‰. The unintentional death rate among children aged one to four years was higher than that among infants, and this difference was statistically significant ( χ2 = 26.268, P = 0.000). The overall trend in unintentional death rates among children under the age of five in Hangzhou from 2018 to 2020 did not show significant changes. There were no statistically significant differences in the trend changes of infant and one- to four-year-old unintentional death rates ( P > 0.05). Table 1 Unintentional Deaths Among Children Under 5 in Hangzhou City, 2018–2020 Year Number of live births Infant Age 1–4 Age under 5 mortality death rates (‰) mortality death rates (‰) mortality death rates (‰) 2018 108159 26 0.24 47 0.43 73 0.67 2019 108761 23 0.21 41 0.38 64 0.59 2020 86610 14 0.16 47 0.54 61 0.70 Total 303530 63 0.21 135 0.44 198 0.65 Comparison of Unintentional Death Causes by Different Factors From 2018 to 2020, the leading cause of unintentional deaths among children under the age of five was accidental suffocation, accounting for 33.84% of the total cases. The second leading cause was accidental falls, accounting for 13.70%. Drowning and traffic accidents were tied for the third leading cause, each accounting for 13.19% of the cases. For male children, the top three causes of unintentional deaths from 2018 to 2020 were accidental suffocation, drowning, and traffic accidents. For female children, the top three causes were accidental suffocation, accidental falls, and traffic accidents. Among children with local household registration, the top three causes of unintentional deaths were accidental suffocation, drowning, and accidental falls. Among migrant children, the top three causes were accidental suffocation, traffic accidents, and accidental falls. For infants, the top three causes of unintentional deaths were accidental suffocation, accidental falls, and other accidents. For children aged one to four years, the top three causes were drowning, traffic accidents, and accidental falls. Throughout all four seasons, accidental suffocation remained the leading cause of unintentional deaths. Drowning ranked second during the third and fourth quarters. Table 2 Ranking and Percentage of unintentional Death Causes Among Children Under 5 in Hangzhou, 2018–2020 [n (%)] Factors Number the first in line n(%) the second in line n(%) third in line n(%) Sex Boys 120 accidental suffocation 37(30.83) drowning 25(20.83) traffic accidents 24(20.00) Girls 78 accidental suffocation 30(33.46) accidental falls 16(20.51) traffic accidents 14(17.95) census register Local 113 accidental suffocation 45(33.82) drowning 24(21.24) accidental falls 19(16.81) floating 85 accidental suffocation 22(25.88) traffic accidents 22(25.88) accidental falls 20(23.53) Age Infant 63 accidental suffocation 54(85.71) accidental falls 4(6.35) other accidents 4(6.35) Age 1–4 135 drowning 38(28.15) traffic accidents 37(27.41) accidental falls 35(25.93) Time of occurrence the first quarter 43 accidental suffocation 21(43.84) traffic accidents 10(23.26) accidental falls 5(11.63) Second quarter 47 accidental suffocation 13(27.66) accidental falls 13(27.66) traffic accidents 12(25.53) third quarter 59 accidental suffocation 15(25.42) drowning 13(22.03) accidental falls 13(22.03) fourth quarter 49 accidental suffocation 18(36.73) drowning 14(28.57) accidental falls 8(16.33) Analysis of Unintentional Injury Death Causes From 2018 to 2020, the top three causes of unintentional injury deaths among children aged five and below in Hangzhou were as follows: suffocation, falls, drowning, and traffic accidents. The composition of the main causes of unintentional deaths varied among different factors. The occurrence of drowning in children aged one to four years was higher than that in infants, and this difference was statistically significant ( P < 0.05). The occurrence of traffic accidents in mobile children, full-term children, and children aged one to four was higher than that in local children, preterm infants, and infants, and this difference was statistically significant ( Fisher's P < 0.05). The occurrence of suffocation in local children, preterm infants, and infants was higher than that in mobile children, full-term children, and children aged one to four, and this difference was statistically significant. The occurrence of falls in children aged one to four was higher than that in infants, and this difference was statistically significant. The composition of other injuries and accidental poisonings varied across different seasons, and this difference was statistically significant. Other types of accidents included death from infusion reactions, sudden cardiac deaths, electric shocks, surgical accidents, mudslides, and violence. The occurrence of these accidents was significantly higher in the third quarter than in other seasons. Accidental poisonings were mainly due to carbon monoxide poisoning, and the occurrence rate was significantly higher in the first and fourth quarters compared to other seasons. Table 3 Composition of accidental causes of death by different factors from 2018 to 2020 [n (%)] drowning n(%) traffic accidents accidental suffocation accidental falls other accidents Poisoning Total number Sex Boys 25(20.83) 24(20.00) 37(30.83) 23(19.17) 6(5.00) 5(4.17) 120 Girls 13(16.67) 14(17.95) 30(38.46) 16(20.51) 5(6.41) 0(0.00) 78 X 2 = 0.529 P = 0.580 X 2 = .128 P = 0.854 X 2 = 1.229 P = 0.268 X 2 = 0.054 P = 0.856 X 2 = 0.179 P = 0.755 fisher P = 0.159 census register Local 24(21.24) 16(14.16) 45(39.82) 19(16.81) 5(4.42) 4(3.54) 113 floating 14(16.47) 22(25.88) 22(25.88) 20(23.53) 6(7.06) 1(1.18) 85 X 2 = 0.711 P = 0.468 X 2 = 4.299 P = 0.045 X 2 = 4.211 P = 0.040 X 2 = 1.383 P = 0.280 X 2 = 0.641 P = 0.535 fisher P = 0.394 premature 4(19.05) 0(0.00) 13(61.90) 3(14.29) 1(4.76) 0(0.00) 21 Mature 34(19.21) 38(21.47) 54(30.51) 36(20.34) 10(5.65) 5(2.82) 177 fisher P = 1.000 fisher P = 0.016 X 2 = 8.265 P = 0.004 fisher P = 0.772 fisher P = 1.000 fisher P = 1.000 Age Infant 0(0.00) 1(1.59) 54(85.71) 4(6.35) 4(6.35) 0(0.00) 63 Age 1–4 38(28.15) 37(27.41) 13(9.63) 35(25.93) 7(5.19) 5(3.70) 135 fisher P = 0.000 fisher P = 0.000 X 2 = 111.068 P = 0.000 fisher P = 0.001 fisher P = 0.746 fisher P = 0.180 Death time the first quarter 3(6.98) 10(23.26) 21(48.84) 5(11.63) 0(0.00) 4(9.30) 43 Second quarter 8(17.02) 12(25.53) 13(27.66) 13(27.66) 1(2.13) 0(0.00) 47 third quarter 13(22.03) 10(16.95) 15(25.42) 13(22.03) 8(13.56) 0(0.00) 59 fourth quarter 14(28.57) 6(12.24) 18(36.73) 8(16.33) 2(4.08) 1(2.04) 49 fisher P = 0.052 X 2 = 3.392 P = 0.337 X 2 = 7.172 P = 0.067 X 2 = 4.210 P = 0.240 fisher P = 0.015 fisher P = 0.009 Year 2018 14(19.18) 19(26.03) 26(35.62) 8(10.96) 4(5.48) 2(2.74) 73 2019 8(12.50) 9(14.06) 25(39.06) 18(28.13) 4(6.25) 0(0.00) 64 2020 16(26.23) 10(16.39) 16(26.23) 13(21.31) 3(4.92) 3(4.92) 61 X 2 = 3.796 P = 0.148 X 2 = 3.593 P = 0.170 X 2 = 2.461 P = 2.282 X 2 = 6.499 P = 0.039 fisher P = 1.000 fisher P = 0.234 Total 38 38 67 39 11 5 198 Discussion The results of this study indicate that the unintentional mortality rate among children aged five and below in Hangzhou from 2018 to 2020 showed no significant trend change. The average unintentional death rate was 0.65 per thousand, which is lower than the rate in Jinshan District, Shanghai, from 2011 to 2020 (0.92 per thousand) [ 4 ], lower than the rate in Suzhou from 2016 to 2020 (77.84 per 100,000) [ 5 ], and lower than the rate in Jiangsu Province from 2018 to 2020 (95.92 per 100,000) [ 6 ]. Possible reasons for this difference may be attributed to Hangzhou's reliance on a three-tier maternal and child health network, the establishment of a comprehensive unintentional injury surveillance system throughout the city, and the implementation of various measures for preventing and controlling childhood unintentional injuries. Childcare centers in various community health service centers have made child unintentional injury prevention a compulsory course in parenting schools. Child health physicians include unintentional injury education in their health guidance during every visit. Preschool institutions in the city incorporate child safety education as a mandatory subject every semester. Furthermore, an assessment mechanism has been established, incorporating unintentional injury mortality rate as a criterion for maternal and child health assessment in the entire city. Maternal and child health institutions within the jurisdiction will be required to prepare analysis reports and propose improvement measures if the unintentional injury mortality rate exceeds 0.3 per thousand. As a result, the unintentional injury mortality rate among children aged five and below in our city is controlled at a relatively low level. According to a World Health Organization report, the unintentional mortality rate among children aged 5 and below in high-income countries was 4.4 per 10,000 in 2013 [ 7 ]. Hangzhou still faces some gaps when compared with developed countries. Child injuries are preventable, and we still need to mobilize the attention and support of various sectors of society, encourage the use of new media and self-media for publicity, improve public awareness of unintentional injuries, and utilize multiple approaches to enhance the safety awareness and protective skills of caregivers to reduce the occurrence of childhood unintentional injuries. This study found that the leading cause of unintentional deaths among children aged five and below was accidental suffocation, with 67 cases reported. Among them, there were 54 cases in infants, accounting for 85.71% of unintentional infant deaths. This percentage is lower than the reported 94.44% in Jinshan District, Shanghai, from 2011 to 2020 [ 4 ] but falls within the range of 47–90% commonly reported in China [ 8 ]. The results of this study show no significant seasonal differences in accidental suffocation, and there is no difference between sexes. Local registered children had a higher occurrence rate compared to migrant children, while infants had a higher occurrence rate compared to children aged one to four. Premature infants had a higher occurrence rate than full-term infants. The majority of infant accidental suffocation cases were caused by choking during feeding or suffocation due to bedding. Therefore, it is important to strengthen public awareness through increased promotion and education. Starting from the prenatal period, pregnant women schools should enhance the dissemination of information. It is crucial to raise awareness among primary caregivers of infants and young children and collaborate with childcare centers to promote knowledge of on-site emergency response for choking incidents. This will ensure timely intervention and reduce the occurrence of severe consequences. This study revealed that out of the 198 cases of unintentional deaths, 135 occurred in the age group of one to four years. The top three causes of unintentional deaths in this age group were drowning (38 cases), traffic accidents (37 cases), and accidental falls (35 cases), accounting for 81.48% of the total. The incidence of drowning, traffic accidents, and accidental falls was significantly higher in the one- to four-year-old group compared to infants, indicating that these are the main causes of unintentional deaths in this age group. A similar age distribution of accidental causes has been reported in Suzhou [ 5 ], which may be attributed to the fact that children aged one to four learn to walk, have an increased range of activities, possess weaker hazard recognition abilities, and lack preventive measures. It also suggests that primary caregivers of children lack sufficient awareness of safety. The study further revealed that the occurrence rate of traffic accidents among migrant children was higher than that among local children, and this difference was statistically significant ( P < 0.05). This indicates that primary caregivers should adhere to traffic rules and ensure the use of safety helmets when carrying children on electric bicycles. Caregivers should also be vigilant and provide proper supervision during outdoor activities to prevent traffic accidents. Additionally, the study found that the incidence of accidental falls was significantly higher in 2019 and 2020 than in 2018. With economic development and an increase in high-rise buildings, it is important to strengthen home safety awareness for children. In particular, precautions should be taken to avoid placing climbable objects near windows and balconies, and children should not be left unattended indoors to prevent falls from heights. This study found that there were relatively more cases of drowning in the third and fourth quarters, but the difference was not statistically significant ( Fisher P = 0.052). Drowning did not show significant variations in terms of season, household registration, or gender, which is different from studies reported in Japan [ 9 ]. This suggests that injury prevention should challenge traditional beliefs, as drowning is not exclusively prevalent in summer. Any season involving water activities requires attention to prevent drowning. The study also identified 11 cases of other types of unintentional injuries, including 2 cases of electric shock, 1 case of debris flow disaster, 6 cases of accidental falls or collisions, 1 case of surgical accidents, and 1 case of sudden death due to infusion reactions. These cases showed seasonal variations, with higher occurrences in the third quarter compared to other quarters ( Fisher P = 0.015). This could be attributed to the increased occurrence of injuries during the summer due to thunderstorms, geological hazards, and slippery surfaces. Therefore, comprehensive injury prevention campaigns should be strengthened as summer approaches. Regarding accidental poisoning, the study reported 5 cases, with a higher incidence in the first quarter compared to other quarters ( Fisher P = 0.009). This indicates that winter remains a peak season for accidental poisoning. The study found no statistically significant differences in the incidence of different types of accidents between genders ( P > 0.05), which differs from other studies [ 10 ]. This highlights the need to target both boys and girls in our prevention efforts. CONCLUSION Infants, children aged one to four years, local children, migrant children, and different seasons all exhibit variations in the composition of accidental causes. Therefore, targeted injury prevention strategies and measures should be implemented based on these characteristics. Child injury prevention requires the participation of families, communities, schools, and traffic management departments, among others, in comprehensive interventions to prevent injuries, reduce the occurrence of child unintentional deaths, and safeguard children's health and well-being. Declarations Ethics approval and consent to participate The studies involving human participants were reviewed and approved by Hangzhou Women’s Hospital Ethics Committee. Waiver of the application for informed consent was included in the ethics approval statement. Consent for publication Not Applicable. Availability of data and materials The data supporting the findings of the study are available. The data supporting the findings of the study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no financial or non-financial competing interest. Funding This work received financial support from the Hangzhou Medical and Health Science and Technology Project (A20220566). The funding institution had no role in the design, data collection, analysis, interpretation and writing of the manuscript. Authors' contributions Xia Qian, Ye Hu, Jinqing Chen were responsible for data collection. Xia Qian and Ye Hu were responsible for writing the first draft of the article and analyzing the data with Dan Huang. Dan Huang revised and finalized the article. All authors contributed to the article and approved the submitted version. Acknowledgements Not Applicable. References National Maternal and Child Health Surveillance and Yearbook Communication. 2022. Retrieved from https://oss.motherchildren.com/20220801/092509751.pdf on October 23, 2022. United Nations. Resolution A/RES/70/1 of September 25. 2015. Retrieved from https://documents-dds-ny.un.org/doc/UNDOC/GEN/N15/291/88/PDF/N1529188.PDF/OpenElement on October 23, 2022. The State Council of the People's Republic of China. Notice of the State Council on the issuance of the Program for the Development of Women and the Program for the Development of Children in China. Retrieved from http://www.gov.cn/zhengce/content/2021-09/27/content_563969/j.issn.1004-5775.2021.12.029 on October 23, 2022. Tang XH. Analysis of accidental deaths among children under 5 years old in Jinshan District, Shanghai, from 2011 to 2020. Chin J Prim Health Care. 2022;36(10):73–6. Sun L, Shao Y, Xu R, et al. Characteristics and causes of accidental injury deaths in children under 5 years old in Suzhou from 2016 to 2020. J Public Health Prev Med. 2022;33(1):85–9. Xie TT, Zhang YF, Luo C. Analysis of causes of accidental deaths among children under 5 years old in Jiangsu Province from 2018 to 2020. Chin J Reproductive Health. 2023;34(2):144–9. World Health Organization. World Health Statistics 2015. Retrieved from http://www.who.int/gho/publications/world_health_statistics/2015/en/on October 23, 2022. Chen RH, Zhao ZY, Liu XY. Child Health Care[M]. Nanjing: Jiangsu Phoenix Science and Technology Publishing House; 2017. Chisa S, Andrew S, Shoko K. Seasonality of child and adolescent injury mortality in Japan, 2000–2010. Environ Health Prev Med. 2015;20(1):36–43. Wang MX, Liu YX, Kang LN, et al. Social and environmental risk factors for the accidental drowning of children under five in China. BMC Public Health. 2020;20(1):1553. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3910060","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":278375609,"identity":"fb205622-6178-40d6-aa53-2309e87ca960","order_by":0,"name":"Xia Qian","email":"","orcid":"","institution":"Hangzhou Women’s Hospital (Hangzhou Maternity and Child Care Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xia","middleName":"","lastName":"Qian","suffix":""},{"id":278375610,"identity":"9f5fd3f7-b793-443b-8fb0-22698ec767b4","order_by":1,"name":"Ye Hu","email":"","orcid":"","institution":"Hangzhou Women’s Hospital (Hangzhou Maternity and Child Care Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ye","middleName":"","lastName":"Hu","suffix":""},{"id":278375611,"identity":"98e5dfd2-f699-420c-bfc0-9178ac003088","order_by":2,"name":"Jinqing Chen","email":"","orcid":"","institution":"Hangzhou Women’s Hospital (Hangzhou Maternity and Child Care Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jinqing","middleName":"","lastName":"Chen","suffix":""},{"id":278375612,"identity":"d84e9733-bddf-4b34-8ae5-d09c0553c997","order_by":3,"name":"Dan Huang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIiWNgGAWjYBACAwjFDMIHDnz4QZoWtsSDM3tI08JjfJiDjQgt5hLJzx5+YbCWN5fu+XCYgYdBnl/sAH4tljPSzI1lGNINd845u+FwgQWD4czZCQQcdiPBTFqC4TDjhhu5Gw7P4GFIMLhNUEv6N5AW+w03ch4c5mEjSkuOmeQHhsOJQC0MRGo586ZMmoEhPXnDjTQDYCBLEOGX4+nbJH8wWNtuuJH8+MOHHzby/NIEtIAAM+8/OFuCsHIQYCQmmYyCUTAKRsEIBgDREEZxBUrz8gAAAABJRU5ErkJggg==","orcid":"","institution":"Hangzhou Women’s Hospital (Hangzhou Maternity and Child Care Hospital","correspondingAuthor":true,"prefix":"","firstName":"Dan","middleName":"","lastName":"Huang","suffix":""}],"badges":[],"createdAt":"2024-01-30 09:01:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3910060/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3910060/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":62585087,"identity":"0486b9f7-06f3-4589-9bc0-21f15afbd595","added_by":"auto","created_at":"2024-08-16 07:05:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":689016,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3910060/v1/a313dd35-7492-49ea-a854-3ecd200756d1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Analysis of the characteristics of unintentional deaths in children under the age of five from 2018 to 2020 in Hangzhou, China Childhood Unintentional deaths","fulltext":[{"header":"Introduction","content":"\u003cp\u003eunder the age of five in China [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The United Nations Sustainable Development Goals state the objective of eliminating preventable deaths among newborns and children under the age of five by 2030 [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. According to the \"China Children's Development Outline (2021\u0026ndash;2030),\" it is necessary to strengthen child injury prevention and intervention, aiming to reduce the child injury mortality rate by 20% based on the data from 2020 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. To understand the current situation and characteristics of unintentional deaths among children under the age of five in Hangzhou in China and provide a basis for developing intervention measures for child injuries, an analysis of the unintentional death cases from 2018 to 2020 is now conducted.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData Sources\u003c/h2\u003e \u003cp\u003eThe data were sourced from the \"Child Death Report Card\" and the \"Monitoring Program for Deaths of Children Under 5\" in Hangzhou City. The \"Child Death Report Card\" includes the number of live births and deaths for both local registered children and nonlocal migrant children. The \"Monitoring Program for Deaths of Children Under 5\" provides basic information such as parents' names, child's name, address or household registration, gender, date of birth, gestational weeks, and birth weight. It also includes death-related information such as date of death, age at death, and cause of death. The data collection involved household surveys and underwent strict review and verification at the street, district, and city levels to ensure accuracy and reliability. All children who met the criteria of being born after 28 weeks of gestation, having vital signs such as heartbeat, breathing, umbilical cord pulsation, or spontaneous muscle contractions, and dying before reaching five years old were included in the study.\u003c/p\u003e \u003cp\u003eData were collected for all children under the age of five who died in Hangzhou City from January 2018 to December 2020. Information related to unintentional deaths was extracted, following the common diagnostic and classification principles outlined in the \"Monitoring Program for Deaths of Children Under 5 in China.\" Unintentional injuries were categorized into six types: drowning, traffic accidents, accidental suffocation, accidental poisoning, accidental falls, and other accidents. Descriptive analysis was conducted to examine the incidence of unintentional deaths among children under the age of five in Hangzhou, China, from 2018 to 2020, including urban‒rural differences and the distribution of causes of death.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eData were organized using Microsoft Excel 2007, and statistical analysis was performed using SPSS version 25 software. Rates were compared using the chi-square test or Fisher's exact probability test, with a significance level of \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicating statistical significance.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eUnintentional Deaths Among Children under the age of five in Hangzhou\u003c/h2\u003e \u003cp\u003eFrom 2018 to 2020, mortality surveillance in Hangzhou recorded a total of 303,530 live births. Among children under the age of five, there were 198 cases of unintentional deaths, resulting in an unintentional death rate of 0.65\u0026permil;. Specifically, there were 63 cases of unintentional deaths among infants, with an infant unintentional death rate of 0.21\u0026permil;. For children aged one to four years, there were 135 cases of unintentional deaths, corresponding to an unintentional death rate of 0.44\u0026permil;. The unintentional death rate among children aged one to four years was higher than that among infants, and this difference was statistically significant (\u003cem\u003eχ2\u003c/em\u003e\u0026thinsp;=\u0026thinsp;26.268, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.000).\u003c/p\u003e \u003cp\u003eThe overall trend in unintentional death rates among children under the age of five in Hangzhou from 2018 to 2020 did not show significant changes. There were no statistically significant differences in the trend changes of infant and one- to four-year-old unintentional death rates (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnintentional Deaths Among Children Under 5 in Hangzhou City, 2018\u0026ndash;2020\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNumber of live births\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eInfant\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eAge 1\u0026ndash;4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eAge under 5\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003emortality\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003edeath rates (\u0026permil;)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003emortality\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003edeath rates (\u0026permil;)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003emortality\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003edeath rates (\u0026permil;)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e108159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e108761\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e86610\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e303530\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e198\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eComparison of Unintentional Death Causes by Different Factors\u003c/h2\u003e \u003cp\u003eFrom 2018 to 2020, the leading cause of unintentional deaths among children under the age of five was accidental suffocation, accounting for 33.84% of the total cases. The second leading cause was accidental falls, accounting for 13.70%. Drowning and traffic accidents were tied for the third leading cause, each accounting for 13.19% of the cases.\u003c/p\u003e \u003cp\u003eFor male children, the top three causes of unintentional deaths from 2018 to 2020 were accidental suffocation, drowning, and traffic accidents. For female children, the top three causes were accidental suffocation, accidental falls, and traffic accidents.\u003c/p\u003e \u003cp\u003eAmong children with local household registration, the top three causes of unintentional deaths were accidental suffocation, drowning, and accidental falls. Among migrant children, the top three causes were accidental suffocation, traffic accidents, and accidental falls.\u003c/p\u003e \u003cp\u003eFor infants, the top three causes of unintentional deaths were accidental suffocation, accidental falls, and other accidents. For children aged one to four years, the top three causes were drowning, traffic accidents, and accidental falls.\u003c/p\u003e \u003cp\u003eThroughout all four seasons, accidental suffocation remained the leading cause of unintentional deaths. Drowning ranked second during the third and fourth quarters.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRanking and Percentage of unintentional Death Causes Among Children Under 5 in Hangzhou, 2018\u0026ndash;2020 [n (%)]\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ethe first in line n(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ethe second in line n(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ethird in line n(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoys\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eaccidental suffocation 37(30.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003edrowning 25(20.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003etraffic accidents 24(20.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGirls\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eaccidental suffocation 30(33.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eaccidental falls 16(20.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003etraffic accidents 14(17.95)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ecensus register\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eaccidental suffocation 45(33.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003edrowning 24(21.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eaccidental falls 19(16.81)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efloating\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eaccidental suffocation 22(25.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003etraffic accidents 22(25.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eaccidental falls 20(23.53)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eaccidental suffocation 54(85.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eaccidental falls 4(6.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eother accidents 4(6.35)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge 1\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003edrowning 38(28.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003etraffic accidents 37(27.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eaccidental falls 35(25.93)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTime of occurrence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ethe first quarter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eaccidental suffocation 21(43.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003etraffic accidents 10(23.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eaccidental falls 5(11.63)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecond quarter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eaccidental suffocation 13(27.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eaccidental falls 13(27.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003etraffic accidents 12(25.53)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ethird quarter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eaccidental suffocation 15(25.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003edrowning 13(22.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eaccidental falls 13(22.03)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efourth quarter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eaccidental suffocation 18(36.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003edrowning 14(28.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eaccidental falls 8(16.33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eAnalysis of Unintentional Injury Death Causes\u003c/h2\u003e \u003cp\u003eFrom 2018 to 2020, the top three causes of unintentional injury deaths among children aged five and below in Hangzhou were as follows: suffocation, falls, drowning, and traffic accidents. The composition of the main causes of unintentional deaths varied among different factors. The occurrence of drowning in children aged one to four years was higher than that in infants, and this difference was statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The occurrence of traffic accidents in mobile children, full-term children, and children aged one to four was higher than that in local children, preterm infants, and infants, and this difference was statistically significant (\u003cem\u003eFisher's P\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The occurrence of suffocation in local children, preterm infants, and infants was higher than that in mobile children, full-term children, and children aged one to four, and this difference was statistically significant. The occurrence of falls in children aged one to four was higher than that in infants, and this difference was statistically significant. The composition of other injuries and accidental poisonings varied across different seasons, and this difference was statistically significant. Other types of accidents included death from infusion reactions, sudden cardiac deaths, electric shocks, surgical accidents, mudslides, and violence. The occurrence of these accidents was significantly higher in the third quarter than in other seasons. Accidental poisonings were mainly due to carbon monoxide poisoning, and the occurrence rate was significantly higher in the first and fourth quarters compared to other seasons.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComposition of accidental causes of death by different factors from 2018 to 2020 [n (%)]\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003edrowning n(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003etraffic accidents\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eaccidental suffocation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eaccidental falls\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eother accidents\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePoisoning\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eTotal number\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoys\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25(20.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24(20.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37(30.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23(19.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6(5.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5(4.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGirls\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13(16.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14(17.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30(38.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16(20.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5(6.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;\u003cem\u003e=\u0026thinsp;0.529\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.580\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;\u003cem\u003e=\u0026thinsp;.128\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.854\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;\u003cem\u003e=\u0026thinsp;1.229\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.268\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;\u003cem\u003e=\u0026thinsp;0.054\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.856\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;\u003cem\u003e=\u0026thinsp;0.179\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.755\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003efisher\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.159\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ecensus register\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24(21.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(14.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45(39.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19(16.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5(4.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4(3.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e113\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efloating\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14(16.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22(25.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22(25.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20(23.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6(7.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1(1.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;\u003cem\u003e=\u0026thinsp;0.711\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.468\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;\u003cem\u003e=\u0026thinsp;4.299\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.045\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;\u003cem\u003e=\u0026thinsp;4.211\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.040\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;\u003cem\u003e=\u0026thinsp;1.383\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.280\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;\u003cem\u003e=\u0026thinsp;0.641\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.535\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003efisher\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.394\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epremature\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(19.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13(61.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3(14.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(4.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMature\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34(19.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38(21.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54(30.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36(20.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10(5.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5(2.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e177\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003efisher\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;1.000\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003efisher\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.016\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;\u003cem\u003e=\u0026thinsp;8.265\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.004\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003efisher\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.772\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003efisher\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;1.000\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003efisher\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;1.000\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(1.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54(85.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4(6.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4(6.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge 1\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38(28.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37(27.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13(9.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35(25.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7(5.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5(3.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e135\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003efisher\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.000\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003efisher\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.000\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;\u003cem\u003e=\u0026thinsp;111.068\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.000\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003efisher\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003efisher\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.746\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003efisher\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.180\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDeath time\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ethe first quarter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(6.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(23.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21(48.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5(11.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4(9.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecond quarter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8(17.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12(25.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13(27.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13(27.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(2.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ethird quarter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13(22.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(16.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15(25.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13(22.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8(13.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efourth quarter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14(28.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(12.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18(36.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8(16.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2(4.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1(2.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003efisher\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.052\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;\u003cem\u003e=\u0026thinsp;3.392\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.337\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;\u003cem\u003e=\u0026thinsp;7.172\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.067\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;\u003cem\u003e=\u0026thinsp;4.210\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.240\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003efisher\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.015\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003efisher\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.009\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYear\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14(19.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19(26.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26(35.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8(10.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4(5.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2(2.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8(12.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(14.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25(39.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18(28.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4(6.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16(26.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(16.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16(26.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13(21.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3(4.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3(4.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;\u003cem\u003e=\u0026thinsp;3.796\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.148\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;\u003cem\u003e=\u0026thinsp;3.593\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.170\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;\u003cem\u003e=\u0026thinsp;2.461\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;2.282\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;\u003cem\u003e=\u0026thinsp;6.499\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.039\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003efisher\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;1.000\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003efisher\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;=\u0026thinsp;0.234\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e198\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe results of this study indicate that the unintentional mortality rate among children aged five and below in Hangzhou from 2018 to 2020 showed no significant trend change. The average unintentional death rate was 0.65 per thousand, which is lower than the rate in Jinshan District, Shanghai, from 2011 to 2020 (0.92 per thousand) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], lower than the rate in Suzhou from 2016 to 2020 (77.84 per 100,000) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], and lower than the rate in Jiangsu Province from 2018 to 2020 (95.92 per 100,000) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Possible reasons for this difference may be attributed to Hangzhou's reliance on a three-tier maternal and child health network, the establishment of a comprehensive unintentional injury surveillance system throughout the city, and the implementation of various measures for preventing and controlling childhood unintentional injuries. Childcare centers in various community health service centers have made child unintentional injury prevention a compulsory course in parenting schools. Child health physicians include unintentional injury education in their health guidance during every visit. Preschool institutions in the city incorporate child safety education as a mandatory subject every semester. Furthermore, an assessment mechanism has been established, incorporating unintentional injury mortality rate as a criterion for maternal and child health assessment in the entire city. Maternal and child health institutions within the jurisdiction will be required to prepare analysis reports and propose improvement measures if the unintentional injury mortality rate exceeds 0.3 per thousand. As a result, the unintentional injury mortality rate among children aged five and below in our city is controlled at a relatively low level. According to a World Health Organization report, the unintentional mortality rate among children aged 5 and below in high-income countries was 4.4 per 10,000 in 2013 [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Hangzhou still faces some gaps when compared with developed countries. Child injuries are preventable, and we still need to mobilize the attention and support of various sectors of society, encourage the use of new media and self-media for publicity, improve public awareness of unintentional injuries, and utilize multiple approaches to enhance the safety awareness and protective skills of caregivers to reduce the occurrence of childhood unintentional injuries.\u003c/p\u003e \u003cp\u003eThis study found that the leading cause of unintentional deaths among children aged five and below was accidental suffocation, with 67 cases reported. Among them, there were 54 cases in infants, accounting for 85.71% of unintentional infant deaths. This percentage is lower than the reported 94.44% in Jinshan District, Shanghai, from 2011 to 2020 [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] but falls within the range of 47\u0026ndash;90% commonly reported in China [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The results of this study show no significant seasonal differences in accidental suffocation, and there is no difference between sexes. Local registered children had a higher occurrence rate compared to migrant children, while infants had a higher occurrence rate compared to children aged one to four. Premature infants had a higher occurrence rate than full-term infants. The majority of infant accidental suffocation cases were caused by choking during feeding or suffocation due to bedding. Therefore, it is important to strengthen public awareness through increased promotion and education. Starting from the prenatal period, pregnant women schools should enhance the dissemination of information. It is crucial to raise awareness among primary caregivers of infants and young children and collaborate with childcare centers to promote knowledge of on-site emergency response for choking incidents. This will ensure timely intervention and reduce the occurrence of severe consequences.\u003c/p\u003e \u003cp\u003eThis study revealed that out of the 198 cases of unintentional deaths, 135 occurred in the age group of one to four years. The top three causes of unintentional deaths in this age group were drowning (38 cases), traffic accidents (37 cases), and accidental falls (35 cases), accounting for 81.48% of the total. The incidence of drowning, traffic accidents, and accidental falls was significantly higher in the one- to four-year-old group compared to infants, indicating that these are the main causes of unintentional deaths in this age group. A similar age distribution of accidental causes has been reported in Suzhou [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], which may be attributed to the fact that children aged one to four learn to walk, have an increased range of activities, possess weaker hazard recognition abilities, and lack preventive measures. It also suggests that primary caregivers of children lack sufficient awareness of safety.\u003c/p\u003e \u003cp\u003eThe study further revealed that the occurrence rate of traffic accidents among migrant children was higher than that among local children, and this difference was statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This indicates that primary caregivers should adhere to traffic rules and ensure the use of safety helmets when carrying children on electric bicycles. Caregivers should also be vigilant and provide proper supervision during outdoor activities to prevent traffic accidents.\u003c/p\u003e \u003cp\u003eAdditionally, the study found that the incidence of accidental falls was significantly higher in 2019 and 2020 than in 2018. With economic development and an increase in high-rise buildings, it is important to strengthen home safety awareness for children. In particular, precautions should be taken to avoid placing climbable objects near windows and balconies, and children should not be left unattended indoors to prevent falls from heights.\u003c/p\u003e \u003cp\u003eThis study found that there were relatively more cases of drowning in the third and fourth quarters, but the difference was not statistically significant (\u003cem\u003eFisher P\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.052). Drowning did not show significant variations in terms of season, household registration, or gender, which is different from studies reported in Japan [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This suggests that injury prevention should challenge traditional beliefs, as drowning is not exclusively prevalent in summer. Any season involving water activities requires attention to prevent drowning.\u003c/p\u003e \u003cp\u003eThe study also identified 11 cases of other types of unintentional injuries, including 2 cases of electric shock, 1 case of debris flow disaster, 6 cases of accidental falls or collisions, 1 case of surgical accidents, and 1 case of sudden death due to infusion reactions. These cases showed seasonal variations, with higher occurrences in the third quarter compared to other quarters (\u003cem\u003eFisher P\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.015). This could be attributed to the increased occurrence of injuries during the summer due to thunderstorms, geological hazards, and slippery surfaces. Therefore, comprehensive injury prevention campaigns should be strengthened as summer approaches.\u003c/p\u003e \u003cp\u003eRegarding accidental poisoning, the study reported 5 cases, with a higher incidence in the first quarter compared to other quarters (\u003cem\u003eFisher P\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009). This indicates that winter remains a peak season for accidental poisoning.\u003c/p\u003e \u003cp\u003eThe study found no statistically significant differences in the incidence of different types of accidents between genders (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05), which differs from other studies [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. This highlights the need to target both boys and girls in our prevention efforts.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eInfants, children aged one to four years, local children, migrant children, and different seasons all exhibit variations in the composition of accidental causes. Therefore, targeted injury prevention strategies and measures should be implemented based on these characteristics. Child injury prevention requires the participation of families, communities, schools, and traffic management departments, among others, in comprehensive interventions to prevent injuries, reduce the occurrence of child unintentional deaths, and safeguard children's health and well-being.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe studies involving human participants were reviewed and approved by Hangzhou Women\u0026rsquo;s Hospital Ethics Committee.\u003c/p\u003e\n\u003cp\u003eWaiver of the application for informed consent was included in the ethics approval statement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting the findings of the study are available. The data supporting the findings of the study are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no financial or non-financial competing interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work received financial support from the Hangzhou Medical and Health Science and Technology Project (A20220566). The funding institution had no role in the design, data collection, analysis, interpretation and writing of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXia Qian, Ye Hu, Jinqing Chen were responsible for data collection. Xia Qian and Ye Hu were responsible for writing the first draft of the article and analyzing the data with Dan Huang. Dan Huang revised and finalized the article. All authors contributed to the article and approved the submitted version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eNational Maternal and Child Health Surveillance and Yearbook Communication. 2022. Retrieved from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://oss.motherchildren.com/20220801/092509751.pdf\u003c/span\u003e\u003cspan address=\"https://oss.motherchildren.com/20220801/092509751.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e on October 23, 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUnited Nations. 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Analysis of causes of accidental deaths among children under 5 years old in Jiangsu Province from 2018 to 2020. Chin J Reproductive Health. 2023;34(2):144\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. World Health Statistics 2015. Retrieved from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.who.int/gho/publications/world_health_statistics/2015/en/on\u003c/span\u003e\u003cspan address=\"http://www.who.int/gho/publications/world_health_statistics/2015/en/on\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e October 23, 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen RH, Zhao ZY, Liu XY. Child Health Care[M]. Nanjing: Jiangsu Phoenix Science and Technology Publishing House; 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChisa S, Andrew S, Shoko K. Seasonality of child and adolescent injury mortality in Japan, 2000\u0026ndash;2010. Environ Health Prev Med. 2015;20(1):36\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang MX, Liu YX, Kang LN, et al. Social and environmental risk factors for the accidental drowning of children under five in China. BMC Public Health. 2020;20(1):1553.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"children under the age of five, injury, unintentional deaths, accidental suffocation","lastPublishedDoi":"10.21203/rs.3.rs-3910060/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3910060/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackgroundː \u003c/strong\u003eThis study analyzedthe current status of unintentional death among children under the age of five in Hangzhou from 2018 to 2020. Through the study of death characteristics and trend prediction, it is hoped that key populations, household registration, and seasons can be identified, thereby providing evidence for the development of intervention measures and effective prevention and control management of unintentional injury deaths.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A total of 198 cases of deaths among children under the age of five in Hangzhou in China from 2018 to 2020 were collected. The occurrence of unintentional deaths among children was analyzed based on factors such as age, gender, household registration, season of occurrence, and causes of death.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResultsː \u003c/strong\u003eThe unintentional mortality rate among children under the age of five in Hangzhou in China from 2018 to 2020 was 0.65‰, with no significant trend change. Analysis of causes of death among different age groups showed that accidental suffocation was the main cause of death for infants, while drowning, traffic accidents, and accidental falls were the main causes of death for children aged one to four years, with statistically significant differences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003eThe composition of child injury causes varies among different age groups, household registrations, and seasons. Targeted strategies and measures for child injury prevention should be developed based on these characteristics.\u003c/p\u003e","manuscriptTitle":"Analysis of the characteristics of unintentional deaths in children under the age of five from 2018 to 2020 in Hangzhou, China Childhood Unintentional deaths","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-13 19:22:06","doi":"10.21203/rs.3.rs-3910060/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9afde497-3cce-41c2-ad19-fc13467de1cf","owner":[],"postedDate":"March 13th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-08-16T06:57:03+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-13 19:22:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3910060","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3910060","identity":"rs-3910060","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}