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Background  Injury is an important cause of childhood mortality in China. We described the epidemiology and trends of injury-related deaths of children <5 years of age in Hunan province, and discussed several policy implications.    Methods  Injury-related deaths of children <5 years of age in 2009–2014 were identified from surveillance data. All specific injury mortality and mortality rates in urban and rural area were calculated from census data; Cochran-armitage trend test was used to assess the time trends.    Results  Injury was the leading cause of death in children <5 years of age. Overall injury mortality was 48.96 per 100,000 persons, gradually declined with the year ( Z  = -18.75,  P <0.001), and accounted for 27.14% of all deaths. Injury mortality in rural areas was 64.66 per 100,000 persons, which was more than 3.73 times higher than the rate in urban areas. The three leading causes of injury-related death were drowning (43.63%), suffocation (27.57%), and traffic accidents (14.34%). Suffocation was the leading cause in children <1 year of age (79.49%). Suffocation has high incidence in the winter and spring, and drowning has high incidence in the summer season. Drowning was the leading cause in children 1–4 years of age (62.80%). Drowning and suffocation accounted for 67.74% and 65.11%, of injury-related deaths that occurred at home; while the traffic injury deaths (54.12%) occurred mainly in transit.    Conclusions  Injury-related fatalities in children <5 years of age followed time trends that were different in rural and urban areas. Effective childhood injury prevention may require different prevention policies combination depending on epidemiological characteristics such as development of injury surveillance and public education on injury knowledge. There is a need for evidence-based surveillance of risk factors for development of effective injury prevention programs.

Epidemiology of Injury-Related Death in Children under 5 Years of Age in Hunan Province, China, 2009–2014