Cheng Xuelin, Jia Wenchang, Zhou Jing, Xu Yaxin, Zou Jian, Liu Ming, Jiang Sunfang, Li Xiaopan
Department of Health Management Center, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd., Xuhui, 200032, Shanghai, China.
Department of General Practice, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd., Xuhui, 200032, Shanghai, China.
Arch Public Health. 2025 Apr 7;83(1):93. doi: 10.1186/s13690-025-01558-8.
The aging population in China is increasingly evident, leading to a shift in the patterns of disease burden. This study aims to investigate changes and trends in mortality, disability-adjusted life years (DALYs), life expectancy (LE), and health-adjusted life expectancy (HALE) in China from 1990 to 2021.
This study presents a secondary analysis of data from the Global Burden of Disease Study 2021, with a focus on mortality, DALYs, LE, and HALE. We examined changes in these indicators in China from 1990 to 2021, comparing them with global averages and across five SDI regions. Using Joinpoint Regression Software, we analyzed trends in the top ten cause-specific DALY rates in 2021. Furthermore, we employed the Bayesian Age-Period-Cohort model to forecast age-standardized rates (ASR) of mortality for the next decade.
China witnessed a decrease in the ASRs of mortality (1198.16/100,000 [1098.61-1294.10] to 644.68/100,000 [555.12-735.51]) and DALYs (43085.42/100,000 [39330.62-47273.39] to 22717.19/100,000 [19748.18-25903.34]) from 1990 to 2021. During the COVID-19 pandemic, the ASRs of mortality and DALY declined in China (23009.47/100,000 [19661.21-26495.58] in 2019), but global rates and those across the five SDI (Socio-demographic Index) regions increased. Projections indicate a continued decline in the ASRs of mortality over the next decade, from 2019 to 2035 and 2021 to 2035. Notably, DALY rates for the top 10 level 2 causes in 2021 decreased over the past three decades, except for musculoskeletal disorders (AAPC% 95%CI, 0.10 [0.07-0.14], men; 0.05 [-0.02-0.13], women) and sense organ diseases (AAPC% 95%CI, 0.38 [0.33-0.43], men; 0.35 [0.30-0.41], women). LE and HALE increased across all age groups in China over the same period, although there was no significant change in the HALE/LE ratio.
Effective policy implementation and technological advancements could play a crucial role in alleviating disease burdens associated with aging in China, thereby reducing the country's all-cause mortality rate and enhancing the quality of life for its residents.
中国人口老龄化日益明显，导致疾病负担模式发生转变。本研究旨在调查1990年至2021年中国死亡率、伤残调整生命年（DALYs）、预期寿命（LE）和健康调整预期寿命（HALE）的变化及趋势。
本研究对《2021年全球疾病负担研究》的数据进行二次分析，重点关注死亡率、DALYs、LE和HALE。我们研究了1990年至2021年中国这些指标的变化，并将其与全球平均水平以及五个社会人口指数（SDI）区域进行比较。使用Joinpoint回归软件，我们分析了2021年十大特定病因DALY率的趋势。此外，我们采用贝叶斯年龄-时期-队列模型预测未来十年的年龄标准化死亡率（ASR）。
1990年至2021年，中国的年龄标准化死亡率（从1198.16/10万[1098.61 - 1294.10]降至644.68/10万[555.12 - 735.51]）和DALYs（从43085.42/10万[39330.62 - 47273.39]降至22717.19/10万[19748.18 - 25903.34]）有所下降。在新冠疫情期间，中国的死亡率和DALY年龄标准化率下降（2019年为23009.47/10万[19661.21 - 26495.58]），但全球以及五个SDI区域的相应比率上升。预测表明，从2019年到2035年以及从2021年到2035年，未来十年年龄标准化死亡率将持续下降。值得注意的是，2021年十大二级病因的DALY率在过去三十年中有所下降，但肌肉骨骼疾病（AAPC% 95%CI，0.10 [0.07 - 0.14]，男性；0.05 [-0.02 - 0.13]，女性）和感官器官疾病（AAPC% 95%CI，0.38 [0.33 - 0.43]，男性；0.35 [0.30 - 0.41]，女性）除外。同期，中国所有年龄组的LE和HALE均有所增加，尽管HALE/LE比率无显著变化。
有效实施政策和技术进步对于减轻中国与老龄化相关的疾病负担可能发挥关键作用，从而降低该国的全因死亡率并提高居民生活质量。
