Causes of death in children younger than five years in China in 2015: an updated analysis

Abstract

BackgroundSubstantial progress in reducing the child mortality rate has been made globally in the last two decades. However, for China, the number of children dying from preventable diseases is still very large. It is important to have regularly updated information on the distribution of causes of death (COD) in children to inform policy and research. In this study, we aim to estimate the COD spectrum in children younger than five years old from 2009 to 2015 with a focus on the year 2015 and to provide an updated COD prediction model for China.MethodsUpdated data of under–five mortality rates (U5MRs) and the number of live births at national and provincial levels were obtained from United Nation's Inter–agency Group for Child Mortality Estimation (UN IGME), Institute for Health Metrics and Evaluation (IHME), and United Nations Population Division (UNPD). Then, we conducted a systematic review across four Chinese and English bibliographic databases and identified high–quality community–based longitudinal studies of COD in children younger than five years in China. We developed a number of single–cause models to predict the number of child death for main COD in different age groups at both national and provincial levels. The jackknife procedure was applied to construct the 95% Uncertainty Ranges (URs).ResultsFrom 2009 to 2015, the under–five mortality rates have declined by 37.1%. The leading causes of death in 2015 were preterm birth complications (17.4%), birth asphyxia (15.2%), congenital abnormalities (14.1%), accidents (13.5%) and pneumonia (12.4%) for children under five years old. The COD spectrum varied substantially across Chinese provinces with different development levels. The leading cause in children under five years in the wealthier provinces (with lower U5MRs) was congenital abnormalities (up to 18.9%), while in the poorer provinces (with higher U5MRs), pneumonia was the dominant COD (up to 23.4%).ConclusionsThis study updates and validates the accuracy of the findings of our previous COD study and proposes a new modelling method to predict proportions for the most common causes of child death in China. These updated COD estimates suggest that current strategies to reduce child mortality should prioritise action on neonatal deaths and target interventions against the top COD according to the local COD spectrum. Special attention should also be given to reducing differences between Chinese provinces and regions with differing development levels.

National and subnational all-cause and cause-specific child mortality in China, 1996–2015: a systematic analysis with implications for the Sustainable Development Goals

“…The accuracy of the cause-specific mortality fractions was estimated to be 0·92. One exception was the fraction of congenital abnormalities, which was estimated to be 20% in this study compared with 14% by Song and colleagues 16 . More discrepancies are noted in the neonatal period; despite overall good agreement between the two sets of estimates (cause-specific mortality fractions accuracy of 0·96), the fraction of congenital abnormalities was greater in our study than that in Song and colleagues' study (18% vs 11%).…”

“…Our MCHSS based cause-specific mortality fractions estimates for 2015 in children younger than 5 years were similar to those derived by Song and colleagues 16 (appendix p 20). The accuracy of the cause-specific mortality fractions was estimated to be 0·92.…”

“…We compared our estimates with those produced by systematic analysis 16 for the period 2009–15. The analysis 16 was based on a systematic review of Chinese scientific literature that included all published studies meeting prespecified inclusion criteria on causes of child mortality, 16 and was an update of our previous estimates applying single-cause models to derive cause-specific mortality fractions for the period 2000–08 3, 14.…”

“…The analysis 16 was based on a systematic review of Chinese scientific literature that included all published studies meeting prespecified inclusion criteria on causes of child mortality, 16 and was an update of our previous estimates applying single-cause models to derive cause-specific mortality fractions for the period 2000–08 3, 14. These estimates are based on nearly 300 studies published from a subset of MCHSS sites 1 .…”

Trend analysis of mortality rates and causes of death in children under 5 years old in Beijing, China from 1992 to 2015 and forecast of mortality into the future: an entire population-based epidemiological study

“…The distribution of the causes of death is influenced by development of the social economy and healthcare. 6 Some changes have been noted in the nationwide distribution of the causes of death; pneumonia has dropped from the leading cause to fifth place whereas congenital heart disease climbed from sixth place to third place from 1996 to 2015. 3 6 7 Beijing, the capital city of China, is currently experiencing the most rapid developments in the economy and healthcare.…”