Global trends in the incidence and mortality of asthma from 1990 to 2019: An age-period-cohort analysis using the global burden of disease study 2019.

Background: Asthma is a major global health challenge. The global strategic management and prevention of asthma report has been published, but health system planning for asthma requires a careful assessment of asthma epidemiology. This study described the incidence and mortality of global asthma from 1990 to 2019. Methods: Based on data from the global burden of disease study (GBD) 2019, we present spatial and temporal trends in asthma incidence and mortality for the world and its 204 countries and territories from 1990 to 2019. Meanwhile, age-period-cohort analysis was used to explore factors influencing asthma incidence and mortality. Results: From 1990 to 2019, the incidence of asthma decreased from 601.20 per 1,00,000 to 477.92 per 1,00,000, and the mortality of asthma decreased from 8.60 per 1,00,000 to 5.96 per 1,00,000. High sociodemographic index (SDI) areas have higher age-standardised asthma incidence and low sociodemographic index areas have higher age-standardised asthma mortality. The age-period-cohort analysis results showed that the relative risk (RR) of incidence was high in children and the RR of mortality was high in elderly individuals. The RR of both asthma incidence and mortality showed a decreasing trend over time. The RR of asthma incidence in the recent birth cohort was higher than that in the previous birth cohort. The RR of asthma mortality continued to decline with the change in the birth cohort. Conclusions: Global asthma incidence and mortality decreased from 1990 to 2019. The decline in asthma incidence was mainly attributed to age effects and period effects, and the decline in asthma mortality was mainly attributed to period effects and cohort effects. Focusing on the risk of incidence in children and the risk of mortality in the elderly, promoting healthy lifestyles and controlling environmental risk factors can help to better control asthma.

Self-Rated Healthy Life Expectancy Changes in Jiangxi Province of China by Gender and Urban-Rural Differences, 2013-2018.

Background: Globalization has brought about rapid economic and technological development, and life expectancy (LE) is constantly increasing. However, it is not clear whether an increase in LE will result in an increase in healthy life expectancy (HLE). This study evaluates trends in the self-rated healthy life expectancy (SRHLE) of residents aged 15 and older in Jiangxi Province of China from 2013 to 2018 and analyzes gender differences and urban-rural differences. This study provides a basis for the formulation of relevant public health policies. Methods: Based on two National Health Services Survey databases of Jiangxi in 2013 and 2018 as well as infant mortality rates and under-5 mortality rates from the Health Commission of Jiangxi, the Sullivan method was used to calculate SRHLE. The changes in SRHLE were decomposed into health and mortality effects using the decomposition method. Results: SRHLE decreased from 56.55 to 55.54 years and from 60.00 to 57.87 years for men and women aged 15 from 2013 to 2018, respectively. The SRHLE of women aged 15 was 3.45 and 2.34 years longer than that of men in 2013 and 2018, respectively. The SRHLE of urban men aged 15 was 2.9 and 4.46 years longer than that of rural men in 2013 and 2018, respectively, and that of urban women aged 15 was 3.28 and 5.57 years longer than that of rural women. Conclusions: The decreased SRHLE indicated that the self-rated health (SRH) status of residents in Jiangxi has worsened, and it provided evidence for the expansion of morbidity, mainly due to the increased prevalence of chronic diseases and the improvement in residents' health awareness. Policy efforts are necessary to control the increased morbidity of chronic diseases and reduce gender and urban-rural differences in the quantity and quality of years lived.

Age-Period-Cohort Analysis of Trends in Mortality from Drowning in China: Data from the Global Burden of Disease Study 2015.

The studies on drowning mortality are very scarce in China, and the aim of this study is to identify the long-term patterns of drowning mortality in China between 1990 and 2015 to provide evidence for further prevention and control on drowning. The mortality data were derived from the Global Burden of Disease Study 2015 and were analyzed with the age-period-cohort framework. This study demonstrated that the age-standardized mortality rates for drowning in both sexes displayed general declining trends with a decrease in the drowning mortality rate for every age group. In the same birth cohort, both sexes witnessed a substantial decline followed by a slight increase in the risk of death from drowning with age after controlling for period deviations. The estimated period and cohort relative risks were found in similar monotonic downward patterns for both sexes, with more reduction for females than for males during the whole study period.

Age-Period-Cohort Analysis of Stroke Mortality in China: Data From the Global Burden of Disease Study 2013.

BACKGROUND AND PURPOSE: Stroke has been the leading cause of death in China. The aim of this study is to assess the long-term trends of stroke mortality in China between 1994 and 2013. METHODS: The mortality data were obtained from the GBD 2013 (Global Burden of Disease Study 2013) and were analyzed with the age-period-cohort framework. RESULTS: We found that the net drift was -2.665% (95% confidence interval, -2.854% to -2.474%) per year for men and -4.064% (95% confidence interval, -4.279% to -3.849%) per year for women, and the local drift values were below 0 in all age groups (P<0.05 for all) in both sexes during the period of 1994 to 2013. In the same birth cohort, the risk of death from stroke rose exponentially with age for both sexes after controlling for period deviations. The estimated period and cohort relative risks were found in similar monotonic downward patterns (significantly with P<0.05 for all) for both sexes, with more quickly decreasing for women than for men during the whole period (significantly with P<0.05 for both). CONCLUSIONS: The decreased mortality rates of stroke in China are likely to be related to improvements in medical care and techniques, spectacular economic growth and fast urbanization, and better early life nutrition conditions of Chinese people. Besides, better education and better awareness of stroke-related knowledge in successive generations could also probably play a role.

Estimation of the Disease Burden Attributable to 11 Risk Factors in Hubei Province, China: A Comparative Risk Assessment.

In order to estimate the health losses caused by common risk factors in the Hubei province, China, we calculated the deaths and disability-adjusted life years (DALYs) attributable to 11 risk factors. We estimated the exposure distributions of risk factors in Hubei Province in 2013 from the monitoring system on chronic disease and related risk factors, combined with relative risk (RR) in order to calculate the population attributable fraction. Deaths and DALYs attributed to the selected risk factors were then estimated together with cause-specific deaths and DALYs. In total, 53.39% of the total deaths and 36.23% of the total DALYs in Hubei were a result of the 11 selected risk factors. The top five risk factors were high blood pressure, smoking, high body mass index, diet low in fruits and alcohol use, accounting for 14.68%, 12.57%, 6.03%, 3.90% and 3.19% of total deaths, respectively, and 9.41%, 7.22%, 4.42%, 2.51% and 2.44% of total DALYs, respectively. These risk factors, especially high blood pressure, smoking and high body mass index, significantly influenced quality of life, causing a large number of deaths and DALYs. The burden of chronic disease could be substantially reduced if these risk factors were effectively controlled, which would allow people to enjoy healthier lives.

The application of model life table systems in China: assessment of system bias and error.

and projection. Although China is the world's most populous country with approximately a fifth of the world's population, none of the empirical tables from mainland China were used in calibrating the existing models. In this paper, we applied recent three model life table systems with different inputs to China mortality data to investigate whether or not these systems truly reflect Chinese mortality epidemiological patterns and whether or not system biases exist. The resulting residuals show that, in most cases, the male infant mortality rate (1q0), adult mortality rate (45q15) and old age mortality rate (20q60) have a strong bias towards being overestimated and the life expectancy at birth (e0) bias is underestimated. We also give the detailed results for each case. Furthermore, we found that the average relative errors (AREs) for females are more than those for males for e0, 45q15 and 20q60, but for 1q0, males have larger AREs in the Wilmoth and Murray systems. We also found that the urban population has more errors than the rural population in almost all cases. Finally, by comparing the AREs with 10 other countries, we found the errors for China are more than those for other countries in most cases. It is concluded that these existing model life table systems cannot accurately reflect Chinese mortality epidemiological situations and trajectories. Therefore, model life tables should be used with caution when applied to China on the basis of 5q0.