Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

Maigeng Zhou, Haidong Wang, Xinying Zeng, Peng Yin, Jun Zhu, Wanqing Chen, Xiaohong Li, Lijun Wang, Limin Wang, Yunning Liu, Jiangmei Liu, Mei Zhang, Jinlei Qi, Shicheng Yu, Ashkan Afshin, Emmanuela Gakidou, Scott Glenn, Varsha Sarah Krish, Molly Katherine Miller-Petrie, W Cliff Mountjoy-Venning, Erin C Mullany, Sofia Boston Redford, Hongyan Liu, Mohsen Naghavi, Simon I Hay, Linhong Wang, Christopher J L Murray, Xiaofeng Liang, Maigeng Zhou, Haidong Wang, Xinying Zeng, Peng Yin, Jun Zhu, Wanqing Chen, Xiaohong Li, Lijun Wang, Limin Wang, Yunning Liu, Jiangmei Liu, Mei Zhang, Jinlei Qi, Shicheng Yu, Ashkan Afshin, Emmanuela Gakidou, Scott Glenn, Varsha Sarah Krish, Molly Katherine Miller-Petrie, W Cliff Mountjoy-Venning, Erin C Mullany, Sofia Boston Redford, Hongyan Liu, Mohsen Naghavi, Simon I Hay, Linhong Wang, Christopher J L Murray, Xiaofeng Liang

Abstract

Background: Public health is a priority for the Chinese Government. Evidence-based decision making for health at the province level in China, which is home to a fifth of the global population, is of paramount importance. This analysis uses data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to help inform decision making and monitor progress on health at the province level.

Methods: We used the methods in GBD 2017 to analyse health patterns in the 34 province-level administrative units in China from 1990 to 2017. We estimated all-cause and cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), summary exposure values (SEVs), and attributable risk. We compared the observed results with expected values estimated based on the Socio-demographic Index (SDI).

Findings: Stroke and ischaemic heart disease were the leading causes of death and DALYs at the national level in China in 2017. Age-standardised DALYs per 100 000 population decreased by 33·1% (95% uncertainty interval [UI] 29·8 to 37·4) for stroke and increased by 4·6% (-3·3 to 10·7) for ischaemic heart disease from 1990 to 2017. Age-standardised stroke, ischaemic heart disease, lung cancer, chronic obstructive pulmonary disease, and liver cancer were the five leading causes of YLLs in 2017. Musculoskeletal disorders, mental health disorders, and sense organ diseases were the three leading causes of YLDs in 2017, and high systolic blood pressure, smoking, high-sodium diet, and ambient particulate matter pollution were among the leading four risk factors contributing to deaths and DALYs. All provinces had higher than expected DALYs per 100 000 population for liver cancer, with the observed to expected ratio ranging from 2·04 to 6·88. The all-cause age-standardised DALYs per 100 000 population were lower than expected in all provinces in 2017, and among the top 20 level 3 causes were lower than expected for ischaemic heart disease, Alzheimer's disease, headache disorder, and low back pain. The largest percentage change at the national level in age-standardised SEVs among the top ten leading risk factors was in high body-mass index (185%, 95% UI 113·1 to 247·7]), followed by ambient particulate matter pollution (88·5%, 66·4 to 116·4).

Interpretation: China has made substantial progress in reducing the burden of many diseases and disabilities. Strategies targeting chronic diseases, particularly in the elderly, should be prioritised in the expanding Chinese health-care system.

Funding: China National Key Research and Development Program and Bill & Melinda Gates Foundation.

Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Figures

Figure 1
Figure 1
Top 25 causes of DALYs in China, 1990–2017 Causes are ranked by number of DALYs in 2017. COPD=chronic obstructive pulmonary disease. DALY=disability-adjusted life-years.
Figure 2
Figure 2
Number of deaths and percentage of DALYs related to the leading level 3 risk factors in China in 2017 (A) Risk factors and related deaths. (B) Risk factors as percentages of DALYs. Alcohol=alcohol use disorders. Asthmagens=occupational asthmagens. BMD=low bone mineral density. BMI=high body-mass index. Calcium=diet low in calcium. CKD=chronic kidney disease. Drugs=drug use disorders. Ergonomic=occupational ergonomic factors. Fibre=diet low in fibre. FPG=high fasting plasma glucose. Fruits=diet low in fruits. IPV=intimate partner violence. Iron=iron-deficiency anaemia. Milk=diet low in milk. Nuts and seeds=diet low in nuts and seeds. Lead=lead exposure. Legumes=diet low in legumes. Noise=occupational noise. Omega 3=diet low in seafood omega-3 fatty acids. Ozone=ambient ozone pollution. Physical activity=low physical activity. PM=particulate matter pollution. PM, gases, and fumes=occupational particulate matter, gases, and fumes. Processed meat=diet high in processed meat. PUFA=diet low in polyunsaturated fatty acids. Radon=residential radon. Red meat=diet high in red meat. Sanitation=unsafe sanitation. SBP=high systolic blood pressure. SHS=second hand smoke. Sodium=diet high in sodium. Sugar-sweetened beverages=diet high in sugar-sweetened beverages. TB=tuberculosis. Vegetables=diet low in vegetables. Water=unsafe water. Whole grains=diet low in whole grains. Zinc=zinc deficiency.
Figure 2
Figure 2
Number of deaths and percentage of DALYs related to the leading level 3 risk factors in China in 2017 (A) Risk factors and related deaths. (B) Risk factors as percentages of DALYs. Alcohol=alcohol use disorders. Asthmagens=occupational asthmagens. BMD=low bone mineral density. BMI=high body-mass index. Calcium=diet low in calcium. CKD=chronic kidney disease. Drugs=drug use disorders. Ergonomic=occupational ergonomic factors. Fibre=diet low in fibre. FPG=high fasting plasma glucose. Fruits=diet low in fruits. IPV=intimate partner violence. Iron=iron-deficiency anaemia. Milk=diet low in milk. Nuts and seeds=diet low in nuts and seeds. Lead=lead exposure. Legumes=diet low in legumes. Noise=occupational noise. Omega 3=diet low in seafood omega-3 fatty acids. Ozone=ambient ozone pollution. Physical activity=low physical activity. PM=particulate matter pollution. PM, gases, and fumes=occupational particulate matter, gases, and fumes. Processed meat=diet high in processed meat. PUFA=diet low in polyunsaturated fatty acids. Radon=residential radon. Red meat=diet high in red meat. Sanitation=unsafe sanitation. SBP=high systolic blood pressure. SHS=second hand smoke. Sodium=diet high in sodium. Sugar-sweetened beverages=diet high in sugar-sweetened beverages. TB=tuberculosis. Vegetables=diet low in vegetables. Water=unsafe water. Whole grains=diet low in whole grains. Zinc=zinc deficiency.
Figure 3
Figure 3
Age-standardised YLLs per 100 000 population for the top 20 level 3 causes in China, 2017, compared with the national averages SAR=special administration region.
Figure 4
Figure 4
Ratio of observed to expected age-standardised DALYs per 100 000 population for the top 20 level 3 causes in China and provinces in 2017 O:E=ratio of observed to expected. SAR=special administration region.

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