Secular trends in mortality and causes of death among children and adolescents aged 1–19 years in China from 1953 to 2016: a national and subnational variations systematic analysis

Abstract

BackgroundThe level and pace of mortality, and causes of death in children and adolescents might vary across regions within China. We aimed to analyse the national and subnational mortality trends, and the principal causes of deaths among Chinese children and adolescents aged 1–19 years from 1953 to 2016. MethodsData were drawn from the Global Burden of Disease study, Chinese Population Census, and China Health Statistics Yearbooks. National mortalities from 1953 to 2016 and subnational mortalities from 1981 to 2010 were calculated on the basis of data from the Chinese Population Census and China Health Statistics Yearbooks. The causes of deaths were taken from the Global Burden of Disease data for 1990 to 2016. FindingsMortality of Chinese children and adolescents aged 1–19 years declined steadily from 1953 to 2016, and there was a marked decline in mortality rates in children aged 1– 4 years during this period. Large subnational disparities in mortality (from all causes) existed across the 31 provinces, with higher mortality in western regions (eg, Xinjiang, Guizhou, and Yunnan). and lower mortality in eastern regions (eg, Beijing, Tianjin, and Hebei), but this gap narrowed with time from 1981 to 2010 (the period for which regional data were available). Injuries caused the highest number of deaths in children and adolescents (aged 1–19 years) each year from 1990 to 2016. Until 2016, the three factors that caused the highest numbers of deaths were road injuries (8·22 per 100 000 people), drowning (8·07 per 100 000 people), and congenital birth defects (3·22 per 100 000 people), but in 1990, they were drowning (31·21 per 100 000 people), lower respiratory infection (18·00 per 100 000 people), and road injuries (15·91 per 100 000 people). Drowning caused the most mortality in boys and in children aged 1–14 years, and road injury caused the most mortality in girls and in adolescents aged 15–19 years in 2016. InterpretationRemarkable improvements in the mortality rates of Chinese children and adolescents were observed from 1953 to 2016. There was also a reduction in the large subnational differences in mortality rates for this group in China, nevertheless disparities were still present in 2010. Our findings emphasise the need to strengthen measures to reduce the occurrence and severity of injuries, to establish subnational health systems across the nation, and to further reduce the subnational disparity in mortality rates across the provinces of China. FundingThe study was supported by the National Natural Science Foundation to JM (81673192).