Global burden and trends of severe chest injury

In 2019, the estimated global incidence of severe chest injury was 7,953,386 cases (95% UI 6,132,771–10,165,826) across both genders, with an ASIR of 102 per 100,000 individuals (95% UI 78.66–130.57). A notable decreasing trend in ASIR for severe chest injury was observed from 1990 to 2019, with an EAPC of − 0.41 (95% UI − 0.54, − 0.28). The prevalence estimates for 2019 revealed 1,976,282 cases (95% UI 1,659,145–2,372,715) with an ASPR of 24.88 per 100,000 individuals (95% UI 20.79–29.88). The ASPR of severe chest injury has shown a decreasing trend since 1990, as indicated by an EAPC of − 0.26 (95% CI − 0.35, − 0.17). Additionally, the YLD for severe chest injury in 2019 were estimated at 392,996 cases (95% UI 244,235–599,630), with an ASYR of 5.02 per 100,000 individuals (95% UI 3.11–7.69). The ASYR has also demonstrated a declining trend since 1990, with an EAPC of − 0.37 (95% CI − 0.49, − 0.25) (Table 1). The number of incident cases increased from 6.4 million (95% UI 4.9–8.4 million) in 1990 to 8.0 million (95% UI 6.1–10.2 million) in 2019, reflecting a 24.14% increase. Similarly, the number of prevalent cases rose from 1.3 million (95% UI 1.0–1.6 million) in 1990 to 2.0 million (95% UI 1.7–2.4 million) in 2019, reflecting a 53.14% increase. Additionally, the number of YLD cases increased from 302,179 (95% UI 181,236–458,699) in 1990 to 392,996 (95% UI 244,235–599,630) in 2019, reflecting a 30.06% increase (Table S1).

Table 1 The ASIR, ASPR, and ASYR with EAPC in severe chest injury from 1990 to 2019Regional burden and trends of severe chest injury

At the regional level, the ASIR of severe chest injury was highest in Australasia (247.36, 95% UI 176.45–358.3) and Central Europe (209.61, 95% UI 152.09–297.79). In contrast, Central Sub-Saharan Africa (53.99, 95% UI 41.48–71.82), Commonwealth low-income countries (73.28, 95% UI 56.56–93.24), and Oceania (66.13, 95% UI 50.37–86.16) exhibited the lowest ASIRs. The ASPR was highest in Australasia (43.94, 95% UI 32.64–61.17) and Central Europe (40.02, 95% UI 30.73–53.43), whereas Andean Latin America (15.1, 95% UI 11.97–19.47) and Oceania (15.43, 95% UI: 12.7–19.04) had the lowest rates. Similarly, the ASYR of severe chest injury was highest in Central Europe (9.74, 95% UI 5.62–16.03) and Eastern Europe (8.95, 95% UI 5.38–13.98). In contrast, Central Sub-Saharan Africa (2.77, 95% UI 1.74–4.17) and Oceania (3.21, 95% UI 1.99–4.94) had the lowest ASYRs (Fig. 1, Table 1). Furthermore, ASIR, ASPR, and ASYR demonstrated substantial increasing trends in Middle East and North Africa (WB), Eastern Mediterranean Region, and North Africa and Middle East, whereas considerably decreased trends were observed in Central Eastern Sub-Saharan Africa (Fig. S2, Table 1; Fig. 3, Table 1).

Fig. 1

GBD regional distribution of ASIR, ASPR, and ASYR of severe chest injury in 2019. A ASIR. B ASPR. C ASYR. D the number of incidence cases. E the number of prevalent cases. F the number of YLD cases. YLD Years lived with disability, ASIR Age-standardized incidence rate, ASPR Age-standardized prevalence rate. ASYR Age-standardized YLDs rate

National burden and trends of severe chest injury

In 2019, significant global health disparities were evident in the ASRs across countries. The ASIRs of Afghanistan (317.63, 95% UI 139.63–721.49), New Zealand (277.52, 95% UI 198.9–398.65), and Yemen (266.52, 95% UI 120.94–589.5) were among the highest, while the Democratic People’s Republic of Korea (41.02, 95% UI 31.74–52.69), Kiribati (42.76, 95% UI 33.03–54.86), and Taiwan (Province of China) (42.36, 95% UI 33.03–54.01) had the lowest ASIRs. In terms of ASPRs, Rwanda (52.38, 95% UI 29.11–119.96), the Syrian Arab Republic (66.29, 95% UI 27.01–157.35), and Afghanistan (89.25, 95% UI 34.39–222.24) reported the highest rates, significantly higher than the Democratic People’s Republic of Korea (9.26, 95% UI 7.6–11.45), Kiribati (9.62, 95% UI 7.91–11.84), and Taiwan (province of China) (9.86, 95% UI 8.19–12.01), which had the lowest ASPRs. Regarding ASYRs, Afghanistan (16.1, 95% UI 6.54–35.63), New Zealand (12.7, 95% UI 7.17–21.03), and Yemen (12.19, 95% UI 5.15–26.74) reported the highest rates, while the Democratic People’s Republic of Korea (1.99, 95% UI 1.22–3.03), Kiribati (2.06, 95% UI 1.27–3.15), and Taiwan (province of China) (2.07, 95% UI 1.26–3.18) had the lowest values (Fig. 2, Table S2). Besides, from 1990 to 2019, the Syrian Arab Republic, Central African Republic, and Yemen experienced the most significant increases in ASIR, ASPR, and ASYR, whereas Burundi, Timor-Leste, and Liberia showed the most notable declines in these metrics. These trends highlight substantial regional variations in severe chest injury rates (Fig. 3, Table S2).

Fig. 2

Geographical distribution of ASIR, ASPR, and ASYR of severe chest injury in 2019. A ASIR. B ASPR. C ASYR. D the number of incidence cases. E the number of prevalent cases. F the number of YLD cases. YLD Years lived with disability, ASIR Age-standardized incidence rate, ASPR Age-standardized prevalence rate, ASYR Age-standardized YLDs rate

Fig. 3

Geographical distribution of ASIR, ASPR, and ASYR of severe chest injury from 1990 to 2019. A EPACs in the ASIR. B EPACs in the ASPR. C EPACs in the ASYR. D the number of incidence cases. E the number of prevalent cases. F the number of YLD cases. EAPCs Estimated annual percentage changes. YLD Years lived with disability, ASIR Age-standardized incidence rate, ASPR Age-standardized prevalence rate. ASYR Age-standardized YLDs rate

Social demographic index-specific trends of severe chest injury

The data analysis revealed no direct correlation between disease rates and socioeconomic development, as indicated by the SDI. While ASRs were similar across different SDI levels, regions with higher SDIs reported more incidence and prevalence cases in 2019, which may be attributed to the differences in health reporting systems or lifestyle-related risk factors. Additionally, the increase in long-duration cases in higher SDI regions may reflect better chronic disease management. These findings suggest a complex relationship between socioeconomic status and health outcomes (Fig. S3, Table S3).

The ASIR showed a noticeable decrease in high-, high-middle-, low-middle-, and low-SDI regions, with EPACs of − 0.57%, − 0.73%, − 0.37%, and − 0.8%, respectively. In contrast, the middle-SDI region experienced a slight increase in ASIR, with an EPAC of 0.35%. The global trend from 1990 to 2019 highlights the increasing disease burden across regions with varying socioeconomic statuses, with high-SDI regions showing a decrease in ASIR and low-SDI regions exhibiting fluctuating incidence rates. Prevalence rates and long-duration cases rose across all SDI categories, signaling a global challenge in managing chronic diseases (Fig. 4, Table S3).

Fig. 4

ASIR, ASPR, and ASYR of severe chest injury among SDI quintiles from 1990 to 2019. A EPACs in the ASIR. B EPACs in the ASPR. C EPACs in the ASYR. D the number of incidence cases. E the number of prevalent cases. F the number of YLD cases. SDI Social Demographic Index, EAPCs Estimated annual percentage changes. YLD = years lived with disability. ASIR = age-standardized incidence rate, ASPR Age-standardized prevalence rate. ASYR Age-standardized YLDs rate

Severe chest injury burden and trends globally and in China

Globally, the number of new severe chest injury cases has remained relatively stable from 1990 to 2019, with the ASIR decreasing slightly from 118.66 (95% UI 90.89–154.47) to 102 (95% UI 78.66–130.57), indicating effective control of new cases relative to population size (EAPC: − 0.41%, 95% CI: − 0.54, − 0.28). Similarly, the ASPR showed a declining trend from 26.79 (95% UI 22.08–32.61) to 24.88 (95% UI 20.79–29.88), with an EAPC of − 0.26% (95% CI − 0.35, − 0.17). In contrast, China experienced increasing trends in ASIR, ASPR, and ASYR, with respective EAPCs of 0.11% (95% CI − 0.25, 0.47), 0.43% (95% CI 0.11–0.76), and 0.21% (95% CI − 0.14, 0.56). The rise in these rates suggests a growing challenge in managing both new and existing cases, emphasizing the need for enhanced healthcare infrastructure and policies (Fig. S4). In 2019, globally, the ASIR, ASPR, and ASYR increased with age, peaking at age 95 and above. Incidence and YLD peaked in the 20–34 age group, with a normal distribution pattern peaking in the 45–54 age group. In China, these rates also increased with age, with peak incidence in the 45–54 age group and YLD following a similar pattern (Fig. S5, Table S4). Both globally and in China, the ASIR and ASPR increased with age, with notable peaks in the oldest age cohorts and significant case numbers in younger age groups, reflecting the broad impact of disability (Fig. 5, Table S4). When comparing global trends to those in China, distinct patterns emerge. Globally, the ASIR, ASPR, and ASYR remained stable over time for both genders, with females generally having higher rates. However, in China, a pronounced surge in these rates occurred around the mid-2000s, particularly among males, indicating a rapidly escalating disease burden and highlighting the need for targeted interventions (Figs. 6 and S6, Table S5). To understand the GBD in severe chest injury, factors influencing the EAPC, including the ASIR, ASPR, and ASYR, were analyzed along with the HDI. A strong negative correlation between EAPC and ASIR, ASPR, and ASYR in 1990 (r =  − 0.422, − 0.423, and − 0.243; all p < 0.001) weakened by 2019, with slight positive correlations for ASIR and ASYR (r = 0.202, p = 0.003; r = 0.175, p = 0.011). No significant correlation with ASPR was found (r = 0.130, p = 0.063) nor between EPAC and HDI (Fig. 7).

Fig. 5

Age distribution of ASIR, ASPR, and ASYR of severe chest injury from 1990 to 2019 globally and in China. A ASIR. B ASPR. C ASYR. D the number of incidence cases. E the number of prevalent cases. F the number of YLD cases. YLD Years lived with disability, ASIR Age-standardized incidence rate, ASPR Age-standardized prevalence rate, ASYR Age-standardized YLDs rate

Fig. 6

Gender distribution of ASIR, ASPR, and ASYR of severe chest injury from 1990 to 2019 globally and in China. A ASIR. B ASPR. C ASYR. D the number of incidence cases. E the number of prevalent cases. F the number of YLD cases. YLD Years lived with disability, ASIR Age-standardized incidence rate, ASPR Age-standardized prevalence rate, ASYR Age-standardized YLDs rate

Fig. 7

Influential factors affecting EAPC in the GBD. A correlation of EAPC with ASIR, ASPR, and ASYR in 1990. B correlation of EAPC with ASIR, ASPR, and ASYR in 2019. C correlation of EAPC with HDI in 2019. r and P values were obtained using Pearson correlation. EAPCs Estimated annual percentage changes, YLD Years lived with disability, ASIR Age-standardized incidence rate, ASPR Age-standardized prevalence rate, ASYR Age-standardized YLDs rate

Causes of severe chest injury

The GBD study presents a comprehensive framework for analyzing the global landscape of morbidity and mortality from 1990 to 2019, organized into four hierarchical levels for detailed cause analysis. This framework enables a detailed examination of causes ranging from broad categories like communicable diseases, noncommunicable diseases, and injuries at Level 1 to highly specific conditions at Level 4. This study employed the SDI to assess changes in injury metrics globally, revealing decreasing trends in ASIR, ASPR, and ASYR, particularly in high-SDI regions. Conversely, low-SDI regions experienced an increase. Despite these trends, global incidences, prevalence cases, and YLD have shown an upward trajectory, mainly concentrated in low-SDI areas. Analysis at Level 2 demonstrated shifts in injury metrics globally, with improvements in high-SDI regions contrasted by challenges faced in low-SDI regions. China mirrors these trends with reductions in rates but a rise in absolute injury cases (Fig. S7, Table S6). At Level 3, the study highlights “falls” and “road injuries” as enduring global health challenges, including China (Fig. S8, Table S6). At Level 4, the study identified falls, road injuries, and interpersonal violence as the top global causes of injuries in 2019, with a specific mention of poisoning in China, indicating unique regional health challenges. This detailed analysis highlights shifts in the epidemiological landscape from 1990 to 2019, offering insights into evolving public health priorities and the necessity for targeted intervention strategies (Fig. 8, Table S7).

Fig. 8

Level 4 causes of severe chest injury in various SDI regions and globally versus China. A ASIR. B ASPR. C ASYR. D the number of incidence cases. E the number of prevalent cases. F the number of YLD cases. YLD Years lived with disability, ASIR Age-standardized incidence rate, ASPR Age-standardized prevalence rate, ASYR Age-standardized YLDs rate, SDI Social Demographic Index

On the global Level 4, young adults (around 20–30 years old) were the most affected age group by severe chest injuries in 1990, primarily due to road injuries, notably motor vehicle accidents. By 2019, while the peak burden still fell on young adults, there was a notable increase in the middle-aged population experiencing severe chest injuries. The incidence and prevalence of chest injuries from road accidents showed a decrease. Notably, self-harm from firearms and sharp objects emerged as a more prominent cause of chest injuries over time. In China, motor vehicle road injuries were a major cause of chest injuries in 1990, with decreasing incidence rates observed by 2019. The distribution of causes became more diversified in 2019 than in 1990, and the age groups affected by severe chest injuries broadened, with a notable burden seen in the 40–60-year-old age bracket (Fig. 9, Tables S8 and S9). For further detailed information on Level 2 and Level 3 analyses, please refer to Figure S9, Tables S12 and S13, Figure S10, and Tables S10 and S11.

Fig. 9

Level 4 causes of severe chest injury globally and in China, stratified by age group and gender, between 1990 and 2019. A global stacked pyramid charts of the ASIR, ASPR, and ASYR along with the number of incidence, prevalence, and YLD. B China stacked pyramid charts of the ASIR, ASPR, and ASYR along with the number of incidence, prevalence, and YLD. YLD Years lived with disability, ASIR Age-standardized incidence rate, ASPR Age-standardized prevalence rate, ASYR Age-standardized YLDs rate, SDI Social Demographic Index

Age, period, and cohort analysis of the ASIR, ASPR, and ASYR in severe chest injury globally and in China

The APC-IE method provided coefficients for age, period, and cohort effects, which were transformed into exponential values (exp(coef.) = e coef.), representing the relative risk (RR) of a specific age, period, or birth cohort compared to the average level [25, 26]. For the global analysis, after adjusting for period and cohort influences, incidence rate’s age effect exhibited a minor peak at ages 20–24 (RR = 1.36), followed by a gradual decline, reaching its lowest at ages 65–69 (RR = 0.69), before increasing again. Period effect on incidence, after controlling for cohort and age effects, exhibited a slight decrease from 1990–1994 (RR = 1.02) to 2005–2009 (RR = 0.96), followed by an increase up to 2019 (RR = 1.02). Moreover, the cohort effect indicated a steady rise in incidence risk from 1895–1899 (RR = 0.84) to a peak in 1950–1954 (RR = 1.12), followed by a decrease to 2000–2004 (RR = 0.90) in birth cohorts. In China, age effect on incidence rate’s RR peaked at ages 25–29 (RR = 1.05), then gradually declined, reaching its lowest at 65–69 (RR = 0.79), before rising again. The period effect showed a slight increase from 1990 to 1999 (RR = 0.94) and a dip in 2005–2009 (RR = 0.91), followed by a gradual rise through 2019 (RR = 1.17). Similarly, cohort effect in China increased from 1895–1899 (RR = 0.84) to 1950–1954 (RR = 1.12), with a subsequent decline in 2000–2004 (RR = 0.90). These trends were consistent across both ASPR and ASYR (Figs. 10 and S2, Table S14).

Fig. 10

Age, period, and cohort effect relative risk of severe chest injury incidence, prevalence, and YLD globally and in China, 1990–2019. A ASIR. B ASPR. C ASYR. D ASIR. E ASPR. F ASYR. YLD Years lived with disability, ASIR Age-standardized incidence rate, ASPR Age-standardized prevalence rate, ASYR Age-standardized YLDs rate

The ARIMA model can predict the severe chest injury trend from 2020 to 2050 globally and in China

The estimated numbers for incidence, prevalence, and YLD, along with the ASIR, ASPR, and ASYR for severe chest injury, were analyzed. According to the ARIMA predictive models, a consistent trend is forecasted globally from 2020 to 2050. ASIR, ASPR, and ASYR demonstrate no significant deviations in trend from 2020 onward, with the numbers continuing to rise steadily. In the context of China, the ARIMA model suggests a continuous upward trend in the incidence, prevalence, and YLD of severe chest injury. However, the ASIR and ASYR have been decreasing since 2020, while the ASPR shows an upward trend (Fig. 11, Table S15).

Fig. 11

Predicted trends of severe chest injury in 2020–2050 by the ARIMA model. A Global ARIMA model. B China ARIMA model. ARIMA Autoregressive integrated moving average