Changes in epidemiological profiles of AIDS in China: a systematic analysis

Abstract

BackgroundAIDS is a serious health burden globally. In China, despite great efforts, AIDS continues to be a substantial public health challenge. We aimed to provide a systematic analysis of changes in the epidemiology of AIDS by examining incidence and mortality of AIDS in China in the past decade. MethodsWe calculated crude incidence and mortality of AIDS in urban and rural areas in China from a publicly accessible Chinese Ministry of Health database between 1997 and 2017, specifically examining differences in mortality for men versus women (including children), rural versus urban, and differing age groups (<1 year, every 5 years, and ≥85 years old). Using locally weighted scatterplot smoothing (or LOWESS) regression curves and calculating p-values for each epidemiological profile, we analysed the changes in epidemiology over time. We compared specific mortality via Wilcoxon match-pairs signed-rank tests. FindingsThe incidence of patients with AIDS gradually increased from 0·01 to 4·15 (ptrend<0·0001) and mortality gradually increased from 0·01 to 1·11 (ptrend<0·0001). Meanwhile, the mortality–incidence ratio decreased from 1·00 to 0·27 (ptrend=0·0022), but has been relatively stable since 2002. Corresponding proportions of AIDS among all-cause mortality increased in both urban (ptrend=0·0002) and rural (ptrend=0·0065) areas. Men consistently had a higher AIDS mortality than women in urban (p=0·0017) and rural areas (p=0·0008). AIDS mortality for women was higher in rural areas (p=0·0021) and stable over time (ptrend=0·74), but mortality by region did not differ for men (p=0·20). AIDS mortality, especially among a younger population, has been increasing over time in the 15 years and older age groups (ptrend=0·018), whereas in the urban population, AIDS mortality has been increasing over time in the 20 years and older age groups (ptrend=0·0006). InterpretationThe burden of AIDS is increasing in China, with higher mortality among men, rural women, and youth. Understanding these epidemiological changes might allow for more focused prevention and treatment of AIDS in China. FundingThe 1-3-5 Project for Disciplines of Excellence, West China Hospital, Sichuan University (ZY2017304).