Wang W, Yin P, Wang L J, Liu Y N, Liu J M, Qi J L, You J L, Lin L, Zhou M G
National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2021 Aug 10;42(8):1420-1428. doi: 10.3760/cma.j.cn112338-20200825-01095.
To understand the geographical variations and temporal trends of all-cause mortality rate and life expectancy in China at national and subnational levels during 2005-2018. Using data from National Cause-of-death Reporting System, China National Maternal and Child Health Surveillance System, Under-reporting Surveys, and related social determinants covariates, we estimated all-cause mortality rate and life expectancy at national and subnational levels in China during 2005-2018. We depicted the geographical variations and temporal trends between provinces on mortality rate and life expectancy. We then decomposed changes in national and subnational deaths into three explanatory components: change due to age-specific mortality rate, change due to the population structure by age, and change due to growth of the total population. In 2018, it was estimated that there were 10 482 297 total deaths (95%: 9 723 233-11 466 875 deaths) in China, with 6 113 926 men (95%: 5 773 158-6 572 407 men) and 4 368 241 women (95%: 3 950 075-4 894 468 women). The all-cause mortality rate was 755.54 per 100 000 (95%: 701.49 per 100 000-825.78 per 100 000), with 861.78 per 100 000 (95%: 813.75 per 100 000-926.40 per 100 000) in men and 642.73 per 100 000 (95%: 581.20 per 100 000-720.15 per 100 000) in women, while age-standardized all-cause mortality rate was 652.27 per 100 000 (95%: 599.22 per 100 000-721.71 per 100 000), with 806.38 per 100 000 (95%: 755.10 per 100 000-874.31 per 100 000) in men and 503.37 per 100 000 (95%: 450.50 per 100 000-572.01 per 100 000) in women. In 2018, it was estimated that the life expectancy in the whole country was 77.15 years old (95%: 75.92-78.11 years old), with 74.81 (95% 73.57-75.76) in men and 79.87 (95%: 78.61-80.91) in women. Developed areas as Shanghai, Beijing, Jiangsu, and Zhejiang owned comparatively higher life expectancy, while undeveloped areas like Tibet, Guizhou, Xinjiang, and Qinghai showed lower levels. During 2005-2018, there was a 29.87% increase in total deaths at the national level, with 27.74% in men and 31.29% in women. Changes due to age-specific mortality rate, the population structure by age, and the growth of the total population constituted -35.74%, 7.34%, and 58.28% of the total increase, respectively. From 2005 to 2018, the all-cause mortality rate increased while the age-standardized mortality rate decreased substantially among Chinese residents. Change due to population structure by age was the dominant driver. An upward trend of life expectancy was observed in all provinces, with marked differences between the provinces.
了解2005 - 2018年期间中国全国及各地区全因死亡率和预期寿命的地理差异及时间趋势。利用国家死因报告系统、中国国家妇幼卫生监测系统、漏报调查以及相关社会决定因素协变量的数据，我们估算了2005 - 2018年期间中国全国及各地区的全因死亡率和预期寿命。我们描绘了各省之间死亡率和预期寿命的地理差异及时间趋势。然后，我们将全国及各地区死亡人数的变化分解为三个解释性因素：特定年龄死亡率的变化、年龄别人口结构的变化以及总人口增长的变化。2018年，估计中国总死亡人数为10482297人（95%置信区间：9723233 - 11466875人），其中男性6113926人（95%置信区间：5773158 - 6572407人），女性4368241人（95%置信区间：3950075 - 4894468人）。全因死亡率为每10万人755.54人（95%置信区间：每10万人701.49人 - 每10万人825.78人），男性为每10万人861.78人（95%置信区间：每10万人813.75人 - 每10万人926.40人），女性为每10万人642.73人（95%置信区间：每10万人581.20人 - 每10万人720.15人），而年龄标准化全因死亡率为每10万人652.27人（95%置信区间：每10万人599.22人 - 每10万人721.71人），男性为每10万人806.38人（95%置信区间：每10万人755.10人 - 每10万人874.31人），女性为每10万人503.37人（95%置信区间：每10万人450.50人 - 每10万人572.01人）。2018年，估计全国预期寿命为77.15岁（95%置信区间：75.92 - 78.11岁），男性为74.81岁（95%置信区间73.57 - 75.76岁），女性为79.87岁（95%置信区间：78.6l - 80.91岁）。上海、北京、江苏和浙江等发达地区的预期寿命相对较高，而西藏、贵州、新疆和青海等欠发达地区的预期寿命较低。在2005 - 2018年期间，全国总死亡人数增加了29.87%，男性增加了27.74%，女性增加了31.29%。特定年龄死亡率的变化、年龄别人口结构变化以及总人口增长变化分别占总增长的 - 35.74%、7.34%和58.28%。从2005年到2018年，中国居民的全因死亡率上升，而年龄标准化死亡率大幅下降。年龄别人口结构变化是主要驱动因素。所有省份的预期寿命均呈上升趋势，各省之间存在显著差异。
