Analysis on all-cause mortality rate and life expectancy in China, 2005-2018

Abstract

Objective: To understand the geographical variations and temporal trends of all-cause mortality rate and life expectancy in China at national and subnational levels during 2005-2018. Methods: Using data from National Cause-of-death Reporting System, China National Maternal and Child Health Surveillance System, Under-reporting Surveys, and related social determinants covariates, we estimated all-cause mortality rate and life expectancy at national and subnational levels in China during 2005-2018. We depicted the geographical variations and temporal trends between provinces on mortality rate and life expectancy. We then decomposed changes in national and subnational deaths into three explanatory components: change due to age-specific mortality rate, change due to the population structure by age, and change due to growth of the total population. Results: In 2018, it was estimated that there were 10 482 297 total deaths (95%CI: 9 723 233-11 466 875 deaths) in China, with 6 113 926 men (95%CI: 5 773 158-6 572 407 men) and 4 368 241 women (95%CI: 3 950 075-4 894 468 women). The all-cause mortality rate was 755.54 per 100 000 (95%CI: 701.49 per 100 000-825.78 per 100 000), with 861.78 per 100 000 (95%CI: 813.75 per 100 000-926.40 per 100 000) in men and 642.73 per 100 000 (95%CI: 581.20 per 100 000-720.15 per 100 000) in women, while age-standardized all-cause mortality rate was 652.27 per 100 000 (95%CI: 599.22 per 100 000-721.71 per 100 000), with 806.38 per 100 000 (95%CI: 755.10 per 100 000-874.31 per 100 000) in men and 503.37 per 100 000 (95%CI: 450.50 per 100 000-572.01 per 100 000) in women. In 2018, it was estimated that the life expectancy in the whole country was 77.15 years old (95%CI: 75.92-78.11 years old), with 74.81 (95%CI: 73.57-75.76) in men and 79.87 (95%CI: 78.61-80.91) in women. Developed areas as Shanghai, Beijing, Jiangsu, and Zhejiang owned comparatively higher life expectancy, while undeveloped areas like Tibet, Guizhou, Xinjiang, and Qinghai showed lower levels. During 2005-2018, there was a 29.87% increase in total deaths at the national level, with 27.74% in men and 31.29% in women. Changes due to age-specific mortality rate, the population structure by age, and the growth of the total population constituted -35.74%, 7.34%, and 58.28% of the total increase, respectively. Conclusions: From 2005 to 2018, the all-cause mortality rate increased while the age-standardized mortality rate decreased substantially among Chinese residents. Change due to population structure by age was the dominant driver. An upward trend of life expectancy was observed in all provinces, with marked differences between the provinces.