Background
The analysis on life expectancy and causes of death is the primary project to reflect the health level of residents, which is helpful to evaluate the effectiveness of disease prevention and control, and to determine the next step in public health work. With the rapid growth of economy since 1979, mortality rates of infants and infectious diseases have declined sharply and the health status of Chinese people has been improved dramatically. The Human Development Index (HDI) is an important metric, representing the basic components of human well-being, which integrates health, education and income. According to the United Nations Development Programme (UNDP) report, in 2015, life expectancy in China reached 76.00 years and HDI reached 0.74 [
1]. However, as the changes of environment, medical technique, population structure and national health policies, the disease-specific mortality rates have undergone great changes in China. In 2016, World Health Organization (WHO) researched on global cause-of-death patterns, and stated that non-communicable diseases (NCDs) kill 40 million people each year, equivalent to 70% of all deaths globally [
2]. Moreover, significant differences persist among countries, nearly 80% of NCDs deaths occurred in low- and middle-income countries. As one of the most populated countries in the world, trends in Chinese residents’ mortality may serve as early markers to support worldwide progress in public health initiatives to improve life expectancy and quality of life.
In this study, we illustrate the mortality pattern changes and calculated the annual percentage changes (APC) in China during 2004–2016. In addition, we revealed and compared age-specific and disease-specific mortality rates of men and women in 2016. According to these findings, we could provide a scientific basis for the government to formulate policies and improve the health status of residents.
Discussion
Few studies have reported age-specific and cause-specific mortality in China. This study focused on mortality patterns change and death disparities among Chinese men and women. With improvements of disease control and residents’ health condition, the decline of mortality rates of Chinese population is obvious. Chronic non-communicable diseases were the most serious threat to the health of Chinese population in 2004–2016. The age-specific death pattern and mortality rate of men and women vary.
Historically, the main causes of death and disability in developing countries were infectious diseases and infant mortality [
8]. In view of this situation, China has published laws to control infectious diseases and great achievements have been made [
9]. Besides, to prevent the death of infants and young children, we should strengthen the perinatal health care and the screening of congenital anomalies. The results also indicated that prevention of deaths of malignant neoplasms and cardio-cerebrovascular diseases in 45 years and above have become the public health priorities in China.
According to Cancer Statistics in China in 2016, lung cancer, stomach cancer, liver cancer, esophageal cancer, and rectal cancer accounted the top five neoplasms for men, while lung cancer, stomach cancer, liver cancer, breast cancer, and esophageal cancer for women [
10]. A great number of studies showed that air pollution and smoking are the main causes of lung cancer as well as chronic obstructive pulmonary disease. There were 316 million smokers in China, and the smoking rate reached a whopping 52.10% for men and 2.70% for women reported by Chinese center for disease control and prevention [
11]. Lung cancer mortality rate was respectively 61.25 and 27.69 per 100,000 per year people for men and women. The following reasons explained this situation. Firstly, most Chinese women cook daily for their families, and specific cooking habits lead to indoor air pollution (using poorly ventilated coal stoves and kitchen fumes). Secondly, women’s exposure to passive smoking was extremely severe. Previous study showed that the number of non-smokers exposed to second-hand smoke was approximate 2.50 times of smokers [
12]. The premature mortality rates in United States have a great decline, especially cancer death rate dropped 25% from 1991 to 2014 by tobacco control, disease screening and developing new therapies [
13]. To reduce the mortality of malignant neoplasms effectively, China should also establish a systematic environmental protection system and implement large-scale tobacco control urgently. Fortunately, the government has devoted to following the Paris Agreement on climate change and the 2030 Agenda for Sustainable Development to provide a sustainable living environment [
14].
The mortality rates of cerebrovascular diseases and cardiovascular diseases (mainly including heart diseases and hypertension) were on the rise especially in the twenty-first century [
15]. In 2016, the mortality of cerebrovascular diseases was higher than that of malignant neoplasms in both men and women aged 65 years and above. As the study of Jiang He, hypertension was the leading preventable risk factor for death among Chinese adults [
16]. However, the control rate of cardio-cerebrovascular diseases was low in Chinese population. Numerous studies indicated that dietary and life style were important factors to cardiovascular health [
17,
18]. The INTERHEART China study showed that sodium rich foods as dietary patterns were positively associated with cardiovascular diseases [
19]. The Chinese Longitudinal Healthy Longevity Survey (CLHLS) showed that frequency intake of fruit and vegetables were inversely associated with all-cause mortality and physical activity was beneficial for the prevention of premature death [
20]. We suggest people increase the intake of vegetables, fruits and legume, reduce the intake of other foods and drinks, such as sugar sweetened beverages, red and processed meats, saturated and trans fat, refined cereals, sugar-rich desserts, and sodium rich foods.
Diabetes mellitus had become the 7th leading cause of death both in Chinese men and women in 2016, which was earlier than the prediction in WHO projects that diabetes would be the 7th leading cause of death in 2030 [
21]. In addition, WHO estimated 1.6 million deaths were directly caused by diabetes in the world, and most patients lived in developing countries [
22]. Thus, it is urgent for Chinese population to avoid or delay diabetes by healthy diet, physical activity, medication, regular screening and treatment for complications. Risk scores based on risk factors without invasive tests have been demonstrated as an effective and low cost tool for identifying the high-risk individuals of diabetes mellitus. A risk score model of diabetes mellitus had been developed according to the data of a nationwide study in China [
23]. Risk score based on demographic, anthropometric, and clinical information without a laboratory test was a useful and cheap tool for a stepwise screening strategy for undiagnosed type 2 diabetes. This approach was cost effective in China.
Alzheimer’s disease was the 10th and 9th leading cause of death among men and women of 65 years old and above respectively. Moreover, with the aging population increasing, Alzheimer’s disease has become a serious family and social problem. It is necessary to strengthen the health management and improve the life quality of Alzheimer’s patients [
24]. However, the etiology of Alzheimer’s disease is largely unclear, and there is no effective therapy for prevention or treatment. The search for common and rare genetic variants that contribute to Alzheimer’s disease risk has provided significant insights into the molecular pathways involved in Alzheimer’s disease pathogenesis and hinted at potential novel therapeutic targets. More than 30 loci have been implicated in Alzheimer’s disease by genome-wide association studies (GWAS) and whole genome/exome sequencing [
25,
26].
Because injury was not given priority as a health problem in the early years, the corresponding control and prevention were not soundly developed [
27]. In 2003, China launched a nationwide injury monitoring pilot program and optimized its management model in practice, working with US National Center for Injury Prevention and Control to reduce the damage caused to the masses [
28]. The proportion of injury death has been gradually reduced since 2004. Accidental and intentional injuries were the major causes of death for young and middle-aged Chinese residents, with a much higher rate for men than women. Road injury and falls were the main contributors to accidental injury. Criminal law on drink driving has made some progress in China [
28]. The increase in the number of automobiles and in traffic congestion has created a need for additional effective policies. Safety belts and helmets are the most practical way to reduce the risk of death in road injury. Exercise programs, rehabilitation, medication management, and treatment of vitamin D deficiency are the most efficient single interventions to prevent falls death [
29]. Intentional injury violence was a complex phenomenon influenced by psychological and social perspective [
30]. Self-harm and interpersonal violence were the major contributors to intentional injury. The first recommendation is to strengthen the policies addressing the social determinants of violence, such as education, poverty and economic inequality. The second recommendation is to ensure that existing laws for violence prevention are fully enforced. The third recommendation is to widely implement comprehensive services for victims of violence, for instance, to lessen psychological trauma.
The China Death Surveillance system provides data for people’s health, which is an important information source for the design of prevention strategies and policies. However, China still needs to learn from other countries to improve the survey methods and enrich the research content [
31,
32]. For instance, we could expand the death surveillance points by setting up personal health record. Additionally, with the development of globalization, each nation should cooperate to fight against communicable diseases and non-communicable diseases. The prevention measures should be formulated to reduce disease burden and boost health development.
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