The Lancet, Volume 387, 16 January 2016,
Background China has experienced a remarkable epidemiological and demographic transition during the past three decades. Far less is known about this transition at the subnational level. Timely and accurate assessment of the provincial burden of disease is needed for evidence-based priority setting at the local level in China. Methods Following the methods of the Global Burden of Disease Study 2013 (GBD 2013), we have systematically analysed all available demographic and epidemiological data sources for China at the provincial level. We developed methods to aggregate county-level surveillance data to inform provincial-level analysis, and we used local data to develop specific garbage code redistribution procedures for China. We assessed levels of and trends in all-cause mortality, causes of death, and years of life lost (YLL) in all 33 province-level administrative units in mainland China, all of which we refer to as provinces, for the years between 1990 and 2013. Findings All provinces in mainland China have made substantial strides to improve life expectancy at birth between 1990 and 2013. Increases ranged from 4·0 years in Hebei province to 14·2 years in Tibet. Improvements in female life expectancy exceeded those in male life expectancy in all provinces except Shanghai, Macao, and Hong Kong. We saw significant heterogeneity among provinces in life expectancy at birth and probability of death at ages 0-14, 15-49, and 50-74 years. Such heterogeneity is also present in cause of death structures between sexes and provinces. From 1990 to 2013, leading causes of YLLs changed substantially. In 1990, 16 of 33 provinces had lower respiratory infections or preterm birth complications as the leading causes of YLLs. 15 provinces had cerebrovascular disease and two (Hong Kong and Macao) had ischaemic heart disease. By 2013, 27 provinces had cerebrovascular disease as the leading cause, five had ischaemic heart disease, and one had lung cancer (Hong Kong). Road injuries have become a top ten cause of death in all provinces in mainland China. The most common non-communicable diseases, including ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and cancers (liver, stomach, and lung), contributed much more to YLLs in 2013 compared with 1990. Interpretation Rapid transitions are occurring across China, but the leading health problems and the challenges imposed on the health system by epidemiological and demographic change differ between groups of Chinese provinces. Localised health policies need to be implemented to tackle the diverse challenges faced by local health-care systems. Funding China National Science & Technology Pillar Program 2013 (2013BAI04B02) and Bill & Melinda Gates Foundation.
Abdominal Wall Hernia; Acquired Immune Deficiency Syndrome; Acute Glomerulonephritis; Acute Hepatitis; Acute Hepatitis B; Acute Hepatitis C; Adolescent; Adult; Age; Age Factors; Aged; Alzheimer Disease; Anemia; Anorexia Nervosa; Aorta Aneurysm; Appendicitis; Asbestosis; Ascariasis; Asthma; Atrial Fibrillation; Biliary Tract Cancer; Biliary Tract Disease; Birth; Bladder Cancer; Bleeding; Brain Disease; Brain Hemorrhage; Brain Ischemia; Breast Cancer; Cardiomyopathy; Cause Of Death; Cellulitis; Cerebrovascular Accident; Cerebrovascular Disease; Chickenpox; Child; Child, Preschool; China; Chronic Kidney Disease; Chronic Obstructive Lung Disease; Chronic Respiratory Tract Disease; Cocaine Dependence; Colon Cancer; Congenital Heart Malformation; Congenital Malformation; Cost Of Illness; Cysticercosis; Decubitus; Dementia; Demography; Dengue; Diabetes Mellitus; Diarrhea; Diphtheria; Disease Surveillance; Down Syndrome; Drowning; Eating Disorder; Echinococcosis; Encephalitis; Endocarditis; Endometriosis; Enteropathy; Epidemiological Data; Epidemiology; Esophagus Cancer; Female; Femoral Hernia; Gallbladder Cancer; Glucose 6 Phosphate Dehydrogenase Deficiency; Gonorrhea; Gunshot Injury; Gynecologic Disease; Hemoglobinopathy; Hemolytic Anemia; Hepatitis A; Hepatitis B; Hepatitis C; Herpes Zoster; History; History, 20th Century; History, 21st Century; Hodgkin Disease; Hong Kong; Human; Humans; Infant; Infant, Newborn; Infection; Inflammatory Bowel Disease; Influenza; Inguinal Hernia; Interstitial Lung Disease; Interstitial Nephritis; Intestine Obstruction; Intoxication; Iodine Deficiency; Iron Deficiency Anemia; Ischemic Heart Disease; Kidney Cancer; Larynx Cancer; Leukemia; Life Expectancy; Lip Cancer; Liver Cancer; Liver Cirrhosis; Lower Respiratory Tract Infection; Lung Cancer; Lung Sarcoidosis; Major Clinical Study; Malaria; Male; Measles; Melanoma; Meningitis; Meningococcosis; Mesothelioma; Middle Aged; Mortality; Mouth Cancer; Multiple Myeloma; Multiple Sclerosis; Musculoskeletal Disease; Myocarditis; Nasopharynx Cancer; Nematodiasis; Neoplasm; Neural Tube Defect; Neurologic Disease; Newborn; Newborn Disease; Newborn Infection; Newborn Jaundice; Non Communicable Disease; Non Melanoma Skin Cancer; Nonhodgkin Lymphoma; Nutritional Deficiency; Opiate Addiction; Otitis Media; Ovary Cancer; Ovary Polycystic Disease; Pancreas Cancer; Pancreatitis; Paralytic Ileus; Paratyphoid Fever; Parkinson Disease; Pelvic Organ Prolapse; Peptic Ulcer; Peripheral Vascular Disease; Pertussis; Pharynx Cancer; Pneumococcal Infection; Pneumoconiosis; Premature Labor; Preschool Child; Priority Journal; Probability; Prostate Cancer; Protein Calorie Malnutrition; Pyoderma; Rabies; Rectum Cancer; Review; Rheumatic Heart Disease; Rheumatoid Arthritis; Schistosomiasis; Schizophrenia; School Child; Sepsis; Sexually Transmitted Disease; Silicosis; Stomach Cancer; Sudden Infant Death Syndrome; Suffocation; Syphilis; Testis Cancer; Tetanus; Thyroid Cancer; Traffic Accident; Tropical Disease; Tuberculosis; Typhoid Fever; Upper Respiratory Tract Infection; Urinary Tract Infection; Urolithiasis; Uterine Cervix Cancer; Uterus Cancer; Uterus Myoma; Visceral Leishmaniasis; Young Adult; Asia