Abstract
BackgroundChina's one-child-per-couple policy, introduced in 1979, led to profound demographic changes for nearly a quarter of the world's population. Several decades later, the consequences include decreased fertility rates, population aging, decreased household sizes, changes in family structure, and imbalanced sex ratios. The epidemiology of communicable diseases may have been affected by these changes since the transmission dynamics of infectious diseases depend on demographic characteristics of the population. Of particular interest is influenza because China and Southeast Asia lie at the center of a global transmission network of influenza. Moreover, changes in household structure may affect influenza transmission. Is it possible that the pronounced demographic changes that have occurred in China have affected influenza transmission?Methods and FindingsTo address this question, we developed a continuous-time, stochastic, individual-based simulation model for influenza transmission. With this model, we simulated 30 years of influenza transmission and compared influenza transmission rates in populations with and without the one-child policy control. We found that the average annual attack rate is reduced by 6.08% (SD 2.21%) in the presence of the one-child policy compared to a population in which no demographic changes occurred. There was no discernible difference in the secondary attack rate, −0.15% (SD 1.85%), between the populations with and without a one-child policy. We also forecasted influenza transmission over a ten-year time period in a population with a two-child policy under a hypothesis that a two-child-per-couple policy will be carried out in 2015, and found a negligible difference in the average annual attack rate compared to the population with the one-child policy.ConclusionsThis study found that the average annual attack rate is slightly lowered in a population with a one-child policy, which may have resulted from a decrease in household size and the proportion of children in the population.
Highlights
The one-child-per-couple policy in China was introduced in 1979 in an effort to raise living standards by slowing population growth
This study found that the average annual attack rate is slightly lowered in a population with a one-child policy, which may have resulted from a decrease in household size and the proportion of children in the population
To explore the influenza transmission factors that are likely affected by the one-child policy, we estimated the average differences in the annual attack rate (DAR) and the secondary attack rates (DSAR) in the populations without and with the onechild policy control
Summary
The one-child-per-couple policy in China was introduced in 1979 in an effort to raise living standards by slowing population growth. The policy reduced fertility rates [1,2] and household sizes, with only one dependent child found in most households. The total fertility rate decreased from 2.9 in 1979 to 1.7 in 2004, with a rate of 1.3 in urban areas and less than 2.0 in rural areas This trend has created a distinct demographic pattern for nearly a quarter of the world’s population, resulting in Chinese urban families with predominantly one child and rural families with predominantly two children [4]. China’s one-child-per-couple policy, introduced in 1979, led to profound demographic changes for nearly a quarter of the world’s population. The consequences include decreased fertility rates, population aging, decreased household sizes, changes in family structure, and imbalanced sex ratios. Is it possible that the pronounced demographic changes that have occurred in China have affected influenza transmission?
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