Rapid transitions in cause-specific mortality in China from 1990-2013

1. The leading causes of years of life lost (YLL) changed dramatically between 1990 and 2013. 16 of 33 provinces had lower respiratory infections or preterm birth complications as the leading causes of YLL. 15 provinces had cerebrovascular disease as the leading cause, and 2 had ischemic heart disease.

2. In 2013, cerebrovascular disease was the leading cause of YLL in 27 provinces, 5 had ischemic heart disease, and 1 had lung cancer. The most common non-communicable diseases, including ischemic heart disease, stroke, chronic obstructive pulmonary disease, and cancers of the liver, stomach, and lung were much more contributory to YLLs.

Evidence Rating Level: 2 (Good)

Study Rundown: This study examined trends for 240 causes of death for all 33 province-level administrative units in China from 1990-2013 by using the Global Burden of Disease Study (GBD) 2013 analysis. All available epidemiological and demographic data sources for China at the provincial level were systematically analyzed following the methods of the GBD Study 2013. Levels of and trends in all-cause mortality, years of life lost (YLL), and cause of death in all 33 provinces were assessed for years between 1990 and 2013. All provinces in China significantly improved life expectancy at birth between 1990-2013, though there is substantial difference in life expectancy between provinces. These differences are also present in cause of death structures between sexes and provinces. In all but 3 provinces, improvements in female life expectancy exceeded that of men. Reductions in infectious diseases have contributed toward improved life expectancy in most provinces, and non-communicable diseases were much more contributory to YLLs in 2013. Though this study is the first systematic analysis of provincial causes of death in China, it is limited by quantity and quality of data available in 1990, as data have become increasingly more available. The study results may be of value in better understanding the interactions between socio-economic development and public health.

The study was funded by China National Science & Technology Pillar Program 2013 (2013BAI04B02) and Bill & Melinda Gates Foundation.

Click to read the study, published today in The Lancet

Relevant Reading: Global Burden of Disease, Injury and Risk Factor Study 2010: Its Policy Implications for China

In-Depth [retrospective cohort]: All provinces in China significantly improved life expectancy between 1990 and 2013. Such increases ranged from 4.0 years in Hebei province to 14.2 years in Tibet. In all but 3 provinces (Shanghai, Macao, and Hong Kong) improvements in female life expectancy exceeded those of men. The leading causes of YLL changed dramatically between 1990 and 2013. 16 of 33 provinces had lower respiratory infections or preterm birth complications as the leading causes of YLL. 15 provinces had cerebrovascular disease as the leading cause, and 2 had ischemic heart disease. In 2013, cerebrovascular disease was the leading cause of YLL in 27 provinces, five had ischemic heart disease, and one had lung cancer. In both men and women, reductions in diarrhea, lower respiratory infections, and other infections diseases have contributed toward improved life expectancy in most provinces. In 2013, the most common non-communicable diseases, including ischemic heart disease, stroke, chronic obstructive pulmonary disease, and cancers of the liver, stomach, and lung were much more contributory to YLLs.

Image: PD

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