Unintentional Injuries Among Children with Developmental Disabilities in China: An Estimate from a Micro-Insurance Program

Background and Objective: Child injury is a significant global health problem contributing to child morbidity and mortality. It can have long-lasting consequences on children’s lives (e.g., disability and chronic pain) and families’ quality of life (e.g., caregiving and economic burden). With limited data, estimates are that unintentional injuries occur to at least 10 million (5%) Chinese children per year, a prevalence rate much lower than those in other countries. Fewer studies have examined the prevalence rate among Chinese children with developmental disabilities, who may face a high risk of injuries due to the combination of environmental barriers and health conditions. The injury incidents among children with developmental disabilities call for a comprehensive national health strategy to prevent unintentional injuries among children with developmental disabilities in China. We use administrative data from a micro-insurance program to assess the prevalence rate of unintentional injuries among children with developmental disabilities.

Methods: We used the 2017-2020 de-identified administrative data from a micro-insurance program to assess the risk of unintentional injuries reported in insurance claims. The program was initiated in 2017, and by the end of 2020, it had served 36,157 children younger than age 19 in all 34 provinces of the mainland China. The program provided a micro insurance plan for individuals with developmental disabilities to pay for medical and other costs incurred from an accidental injury, such as emergency room visits, hospital stays, and medical treatments. This program mainly covers disabilities of autism, intellectual disability, cerebral palsy, and Down syndrome. The dependent variable is insurance claims reporting nonfatal unintentional injuries between 2017 and 2020 (Yes/No). We apply survival analysis to assess the risk of unintentional injuries during the insurance period.

Results: The mean age of children is 10.12 (SD = 4.31). Nearly 80% are male, probably due to the high male-to-female ratio in autism, the largest group in the plan. There are 190 insurance claims (.53%) reporting nonfatal unintentional injuries and six reporting fatal injuries between 2017 and 2020. Unintentional injuries in the data are mainly caused by falls; other reasons include animal bites, being hurt or stuck by an object, swallowing toys, transportation-related injuries, and poisoning. The cumulative hazard rate of unintentional injuries is nearly .40% at the end of three months and 1.21% by the end of one year. Age (Hazard ratio = 0·93, 95% Confidence Interval: 0·90-0·97) is statistically and negatively associated with the risk of injuries, but gender is not.

Conclusion and Implications: This is the first large-scale assessment of unintentional injuries among Chinese children with developmental disabilities based on reliable insurance claims data. It suggests that 64 thousand among 12 million children with developmental disabilities (an underestimated population number) need medical attention on their injury incidents per year. Findings suggest increasing safety support especially in early childhood, such as the micro-insurance program examined in this study.