Maigeng Zhou1, Haidong Wang2, Jun Zhu3, Wanqing Chen4, Linhong Wang5, Shiwei Liu5, Yichong Li5, Lijun Wang6, Yunning Liu5, Peng Yin6, Jiangmei Liu6, Shicheng Yu6, Feng Tan7, Ryan M Barber2, Matthew M Coates2, Daniel Dicker2, Maya Fraser2, Diego González-Medina2, Hannah Hamavid2, Yuantao Hao8, Guoqing Hu9, Guohong Jiang10, Haidong Kan11, Alan D Lopez12, Michael R Phillips13, Jun She14, Theo Vos2, Xia Wan15, Gelin Xu16, Lijing L Yan17, Chuanhua Yu18, Yong Zhao19, Yingfeng Zheng20, Xiaonong Zou4, Mohsen Naghavi2, Yu Wang6, Christopher J L Murray21, Gonghuan Yang22, Xiaofeng Liang23. 1. National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing, China; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA. 2. Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA. 3. National Office of MCH Surveillance of China, Chengdu, China. 4. Cancer Institute, Chinese Academy of Medical Sciences, Beijing, China. 5. National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing, China. 6. Chinese Center for Disease Control and Prevention, Beijing, China. 7. National Institute of Occupational Health and Poison Control, Beijing, China. 8. School of Public Health, Sun Yat-sen University, Guangzhou, China. 9. Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, China. 10. Tianjin Centers for Disease Control and Prevention, Tianjin, China. 11. Fudan University, Shanghai, China. 12. University of Melbourne, Melbourne, VIC, Australia. 13. School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Emory University, Atlanta, GA, USA. 14. Zhongshan Hospital, Shanghai, China. 15. Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, China. 16. Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China. 17. Duke Kunshan University, Kunshan, China. 18. Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China; Global Health Institute, Wuhan University, Wuhan, China. 19. Chongqing Medical University, Chongqing, China. 20. Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China. 21. Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA. Electronic address: cjlm@uw.edu. 22. Peking Union Medical College, Beijing, China. Electronic address: yangghuan@vip.sina.com. 23. Chinese Center for Disease Control and Prevention, Beijing, China. Electronic address: liangxf@hotmail.com.
Abstract
BACKGROUND: China has experienced a remarkable epidemiological and demographic transition during the past three decades. Far less is known about this transition at the subnational level. Timely and accurate assessment of the provincial burden of disease is needed for evidence-based priority setting at the local level in China. METHODS: Following the methods of the Global Burden of Disease Study 2013 (GBD 2013), we have systematically analysed all available demographic and epidemiological data sources for China at the provincial level. We developed methods to aggregate county-level surveillance data to inform provincial-level analysis, and we used local data to develop specific garbage code redistribution procedures for China. We assessed levels of and trends in all-cause mortality, causes of death, and years of life lost (YLL) in all 33 province-level administrative units in mainland China, all of which we refer to as provinces, for the years between 1990 and 2013. FINDINGS: All provinces in mainland China have made substantial strides to improve life expectancy at birth between 1990 and 2013. Increases ranged from 4.0 years in Hebei province to 14.2 years in Tibet. Improvements in female life expectancy exceeded those in male life expectancy in all provinces except Shanghai, Macao, and Hong Kong. We saw significant heterogeneity among provinces in life expectancy at birth and probability of death at ages 0-14, 15-49, and 50-74 years. Such heterogeneity is also present in cause of death structures between sexes and provinces. From 1990 to 2013, leading causes of YLLs changed substantially. In 1990, 16 of 33 provinces had lower respiratory infections or preterm birth complications as the leading causes of YLLs. 15 provinces had cerebrovascular disease and two (Hong Kong and Macao) had ischaemic heart disease. By 2013, 27 provinces had cerebrovascular disease as the leading cause, five had ischaemic heart disease, and one had lung cancer (Hong Kong). Road injuries have become a top ten cause of death in all provinces in mainland China. The most common non-communicable diseases, including ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and cancers (liver, stomach, and lung), contributed much more to YLLs in 2013 compared with 1990. INTERPRETATION: Rapid transitions are occurring across China, but the leading health problems and the challenges imposed on the health system by epidemiological and demographic change differ between groups of Chinese provinces. Localised health policies need to be implemented to tackle the diverse challenges faced by local health-care systems. FUNDING: China National Science & Technology Pillar Program 2013 (2013BAI04B02) and Bill & Melinda Gates Foundation.
BACKGROUND: China has experienced a remarkable epidemiological and demographic transition during the past three decades. Far less is known about this transition at the subnational level. Timely and accurate assessment of the provincial burden of disease is needed for evidence-based priority setting at the local level in China. METHODS: Following the methods of the Global Burden of Disease Study 2013 (GBD 2013), we have systematically analysed all available demographic and epidemiological data sources for China at the provincial level. We developed methods to aggregate county-level surveillance data to inform provincial-level analysis, and we used local data to develop specific garbage code redistribution procedures for China. We assessed levels of and trends in all-cause mortality, causes of death, and years of life lost (YLL) in all 33 province-level administrative units in mainland China, all of which we refer to as provinces, for the years between 1990 and 2013. FINDINGS: All provinces in mainland China have made substantial strides to improve life expectancy at birth between 1990 and 2013. Increases ranged from 4.0 years in Hebei province to 14.2 years in Tibet. Improvements in female life expectancy exceeded those in male life expectancy in all provinces except Shanghai, Macao, and Hong Kong. We saw significant heterogeneity among provinces in life expectancy at birth and probability of death at ages 0-14, 15-49, and 50-74 years. Such heterogeneity is also present in cause of death structures between sexes and provinces. From 1990 to 2013, leading causes of YLLs changed substantially. In 1990, 16 of 33 provinces had lower respiratory infections or preterm birth complications as the leading causes of YLLs. 15 provinces had cerebrovascular disease and two (Hong Kong and Macao) had ischaemic heart disease. By 2013, 27 provinces had cerebrovascular disease as the leading cause, five had ischaemic heart disease, and one had lung cancer (Hong Kong). Road injuries have become a top ten cause of death in all provinces in mainland China. The most common non-communicable diseases, including ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and cancers (liver, stomach, and lung), contributed much more to YLLs in 2013 compared with 1990. INTERPRETATION: Rapid transitions are occurring across China, but the leading health problems and the challenges imposed on the health system by epidemiological and demographic change differ between groups of Chinese provinces. Localised health policies need to be implemented to tackle the diverse challenges faced by local health-care systems. FUNDING: China National Science & Technology Pillar Program 2013 (2013BAI04B02) and Bill & Melinda Gates Foundation.
Authors: Jill Koshiol; Yu-Tang Gao; Michael Dean; Patricia Egner; Chirag Nepal; Kristine Jones; Bingsheng Wang; Asif Rashid; Wen Luo; Alison L Van Dyke; Catterina Ferreccio; Michael Malasky; Ming-Chang Shen; Bin Zhu; Jesper B Andersen; Allan Hildesheim; Ann W Hsing; John Groopman Journal: Gastroenterology Date: 2017-04-17 Impact factor: 22.682