Rapid health transition in China, 1990–2010: findings from the Global Burden of Disease Study 2010

By Gonghuan Yang, Yu Wang, Yixin Zeng, George F. Gao, Xiaofeng Liang, Maigeng Zhou, X. Wan, Shicheng Yu, Yuhong Jiang, M. Naghavi and 4 more. The Lancet, 2013

1,895 citations recorded by the source corpus.

Summary Background China has undergone rapid demographic and epidemiological changes in the past few decades, including striking declines in fertility and child mortality and increases in life expectancy at birth. Popular discontent with the health system has led to major reforms. To help inform these reforms, we did a comprehensive assessment of disease burden in China, how it changed between 1990 and 2010, and how China's health burden compares with other nations. Methods We used results of the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) for 1990 and 2010 for China and 18 other countries in the G20 to assess rates and trends in mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE). We present results for 231 diseases and injuries and for 67 risk factors or clusters of risk factors relevant to China. We assessed relative performance of China against G20 countries (significantly better, worse, or indistinguishable from the G20 mean) with age-standardised rates and 95% uncertainty intervals. Findings The leading causes of death in China in 2010 were stroke (1·7 million deaths, 95% UI 1·5–1·8 million), ischaemic heart disease (948 700 deaths, 774 500–1 024 600), and chronic obstructive pulmonary disease (934 000 deaths, 846 600–1 032 300). Age-standardised YLLs in China were lower in 2010 than all emerging economies in the G20, and only slightly higher than noted in the USA. China had the lowest age-standardised YLD rate in the G20 in 2010. China also ranked tenth (95% UI eighth to tenth) for HALE and 12th (11th to 13th) for life expectancy. YLLs from neonatal causes, infectious diseases, and injuries in children declined substantially between 1990 and 2010. Mental and behavioural disorders, substance use disorders, and musculoskeletal disorders were responsible for almost half of all YLDs. The fraction of DALYs from YLDs rose from 28·1% (95% UI 24·2–32·5) in 1990 to 39·4% (34·9–43·8) in 2010. Leading causes of DALYs in 2010 were cardiovascular diseases (stroke and ischaemic heart disease), cancers (lung and liver cancer), low back pain, and depression. Dietary risk factors, high blood pressure, and tobacco exposure are the risk factors that constituted the largest number of attributable DALYs in China. Ambient air pollution ranked fourth (third to fifth; the second highest in the G20) and household air pollution ranked fifth (fourth to sixth; the third highest in the G20) in terms of the age-standardised DALY rate in 2010. Interpretation The rapid rise of non-communicable diseases driven by urbanisation, rising incomes, and ageing poses major challenges for China's health system, as does a shift to chronic disability. Reduction of population exposures from poor diet, high blood pressure, tobacco use, cholesterol, and fasting blood glucose are public policy priorities for China, as are the control of ambient and household air pollution. These changes will require an integrated government response to improve primary care and undertake required multisectoral action to tackle key risks. Analyses of disease burden provide a useful framework to guide policy responses to the changing disease spectrum in China. Funding Bill & Melinda Gates Foundation.

Subfields: Finance, Health, Pediatrics, Perinatology and Child Health

View Paper: https://www.semanticscholar.org/paper/efbadfd5b9f210eac1be23ff5cf28a3d4d21e1df

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Citations in the corpus

Air pollution and defensive expenditures: Evidence from particulate-filtering facemasks (2017, background): “The 2010 Global Burden of Disease Study reveals that air pollution is the 4th leading health risk factor for Chinese people (Yang et al., 2013).”
Activation of Nrf2/HO-1 signaling: An important molecular mechanism of herbal medicine in the treatment of atherosclerosis via the protection of vascular endothelial cells from oxidative stress (2021, background): “In China, Europe, the United States and other developed countries, the incidence and mortality of CVD rank first [3,4].”
Systematic review and meta-analysis of the adverse health effects of ambient PM2.5 and PM10 pollution in the Chinese population. (2015, background): “The Global Burden of Disease Study showed that in 2010, ambient PM pollution was the fourth leading risk factor for disability-adjusted life-years (DALYs) in China, resulting in 25.2 million DALYs (Yang et al., 2013).”
A Systematic Review and Meta-analysis (2011, neutral): “The burden of illness caused by mental disorders has increased rapidly, and the research conducted by Yang et al([4]) indicated that mental disorder has become the main cause of years lived with disability in China.”
The State of US Health, 1990-2010: Burden of Diseases, Injuries, and Risk Factors (2013, neutral): “3 (27-37) 32 Hypertensive heart disease 30.”