Abstract
To investigate the major causes and predictive factors of death in a middle-aged and elderly Chinese population. A total of 6591 residents aged ≥ 45 years from Shanghai Changfeng community were followed up for an average of 5.4 years. The causes of death were coded according to the 10th Revision of International Classification of Diseases. The mortality rate was calculated by person-years of follow up and age-standardized according to the 2010 Chinese census data. Multivariable-adjusted Cox proportional hazards model was performed to investigate the predictors of all-cause and cause-specific mortality. During the total follow-up of 35,739 person-years, 370 deaths were documented (157 from malignant neoplasms, 70 from heart diseases, 68 from cerebrovascular diseases, 75 from other causes). The age-standardized all-cause mortality rate was 798.2 per 100,000 person-years (927.9 among men and 716.7 among women). Results from multivariable analyses showed that aging, diabetes, and osteoporosis at baseline were independent predictors of all-cause mortality, with hazard ratios (HR) of 1.11 (95% CI 1.10–1.13), 1.91 (1.51–2.42), and 1.71 (1.24–2.35), respectively. The population attributable risk percent of diabetes and osteoporosis was 19.7% and 11.7%, respectively. Cigarette smoking was associated with a higher risk of all-cause mortality in men (HR and 95%CI 1.44, 1.01–2.06). In women, diabetes and osteoporosis were related to a higher risk of cardiovascular mortality (3.27, 1.82–5.88 and 1.89, 1.04–3.46, respectively). While in men, osteoporosis was related to a higher risk of malignant neoplasms mortality (2.39, 1.07–5.33). Malignant neoplasms, heart diseases, and cerebrovascular diseases are the leading causes of death. Aging, smoking, underweight, diabetes, and osteoporosis are independent predictors of premature death among middle-aged and elderly Chinese community population. Moreover, there may have been some differences in the causes and predictors of premature death between men and women.
Highlights
MethodsGlobally, rapid economic development and improvement in living conditions, nutrition, and health care have resulted in declines in infant mortality and deaths from infectious diseases and increases in life expectancy during the past three decades [1, 2]
The distribution of most cause-specific mortality was similar between men and women, except for mortality from respiratory diseases and accidents, which were higher in men than women
We found that malignant neoplasms, heart diseases, and cerebrovascular diseases were the three leading causes of death and together accounted for approximately four-fifths of the total mortality
Summary
Rapid economic development and improvement in living conditions, nutrition, and health care have resulted in declines in infant mortality and deaths from infectious diseases and increases in life expectancy during the past three decades [1, 2]. The Global Burden of Diseases Study 2016 (GBD 2016) reported that mortality due to NCDs increased from 57% of total mortality in 1990 to 72.3% in 2016 [1]. In China, with remarkable economic and social development, the life expectancy at birth increased by 8.5 years from 1990 to 2013 [4], and NCDs caused mortality has increased from 69.2 to 86.6% of the total annual deaths during the same period [5]. With the improvement of the death surveillance system, investigation of death causes and risk factors have become possible [6]
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