Trends in major non-communicable diseases and related risk factors in China 2002-2019: an analysis of nationally representative survey data

Abstract

Background: Prevention and control of non-communicable diseases (NCDs) are prioritized in both the Sustainable Development Goal and the Healthy China 2030 Initiatives. Efforts have been devoted to combating NCDs in China. This study examined changes in NCD trajectory.

Methods: We described and analyzed the trends in prevalence and control of major NCDs including obesity, hypertension, diabetes, and dyslipidemia and examined selected main behavioral risk factors in China by sex, age group, and residence using nationally representative CDC survey data. Data included were from the China Chronic Disease Risk Factor Surveillance (CCDRFS, 2013 and 2018) and China National Nutrition Survey (CNNS, 2002, 2010-2013, 2015, and 2020). Annual and relative changes in rates were used. Rural-urban ratio of related indicators was assessed.

Findings: NCD-attributed deaths increased from 80.0% in 2002 to 86.6% in 2012, and 88.5% in 2019, with cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes accounted for 47.1%, 24.1%, 8.8%, and 2.5% of deaths in 2019, respectively. Prevalence of obesity (7.1%-16.4%), overweight/obesity (29.9%-50.7%), hypertension (18.8%-27.5%), diabetes (2.6%-11.9%), and dyslipidemia (18.6%-35.6%) all increased from 2002 to 2018. These rates increased faster in rural areas than in urban areas. Rates of awareness, treatment and control of hypertension and diabetes increased very slowly from 2012 to 2018. Most rates were between 30 and 40% with the lowest rate of 11% for hypertension control even in 2018. The rates were worse for rural residents compared to urban residents. Furthermore, many modifiable behavioral risk factors showed little improvement and some became worse over time, including smoking, excessive alcohol use, inadequate vegetable/fruit intake, excessive red meat intake, and physical inactivity.

Interpretation: NCD burden in China increased during 2002-2019 despite of the intervention efforts. To reach the global and national targets, China must strengthen its actions, especially in rural areas, including improvement of NCD screening and management and reduction of behavioral risk factors.

Funding: The study was supported in part by research grants of National Key R&D Program of China (2017YFC0907200, 2017YFC0907201), International Collaboration Project from the Chinese Ministry of Science and Technology-Prevention and control of chronic diseases and health promotion (G2021170007L), Natural Scientific Foundation of China (82103846), Key R&D and Transformation Program of Qinghai (2023-QY-204).

Keywords: Behavioral risk factors; Control; Diabetes; Dyslipidemia; Hypertension; Non-communicable diseases; Obesity; Prevalence; Trends.

Fig. 1

Trends in prevalence (%) of overweight and obesity in 2002–2018, adults 18 years and older, China. Overweight was defined as 24.0≤ BMI <28.0 kg/m²; obesity, as BMI ≥28.0 kg/m². The data published in 2002, 2012 and 2018 were from the "Report on Nutrition and Chronic Diseases of Chinese Residents". The target values in 2030 were derived from the "Global Action Plan for the Prevention and Control of Non-communicable Diseases (2013–2020)” by WHO. Based on the 2013 data, the target is to halt the rise of the prevalence of overweight and obesity.

Fig. 1

Trends in prevalence (%) of overweight and obesity in 2002–2018, adults 18 years and older, China. Overweight was defined as 24.0≤ BMI <28.0 kg/m²; obesity, as BMI ≥28.0 kg/m². The data published in 2002, 2012 and 2018 were from the "Report on Nutrition and Chronic Diseases of Chinese Residents". The target values in 2030 were derived from the "Global Action Plan for the Prevention and Control of Non-communicable Diseases (2013–2020)” by WHO. Based on the 2013 data, the target is to halt the rise of the prevalence of overweight and obesity.

Fig. 1

Trends in prevalence (%) of overweight and obesity in 2002–2018, adults 18 years and older, China. Overweight was defined as 24.0≤ BMI <28.0 kg/m²; obesity, as BMI ≥28.0 kg/m². The data published in 2002, 2012 and 2018 were from the "Report on Nutrition and Chronic Diseases of Chinese Residents". The target values in 2030 were derived from the "Global Action Plan for the Prevention and Control of Non-communicable Diseases (2013–2020)” by WHO. Based on the 2013 data, the target is to halt the rise of the prevalence of overweight and obesity.

Fig. 2

Trends in prevalence (%) of hypertension and diabetes in 2002–2018, adults 18 years and older, China. Hypertension was defined as SBP ≥140 mmHg or DBP ≥90 mmHg or taking antihypertensive drugs within the past two weeks. Diabetes was defined as fasting blood glucose ≥7.0 mmol/L or OGTT-2h ≥ 11.1 mmol/L or had been diagnosed with diabetes by physicians. The data published in 2002, 2012 and 2018 were from the “Report on Nutrition and Chronic Diseases of Chinese Residents”. The target values in 2030 were derived from the “Global Action Plan for the Prevention and Control of Non-communicable Diseases (2013–2020)” by WHO. Based on the 2013 data, the targets are to reduce the prevalence of hypertension by 25% and halt the rise of the prevalence of diabetes, respectively.

Fig. 2

Trends in prevalence (%) of hypertension and diabetes in 2002–2018, adults 18 years and older, China. Hypertension was defined as SBP ≥140 mmHg or DBP ≥90 mmHg or taking antihypertensive drugs within the past two weeks. Diabetes was defined as fasting blood glucose ≥7.0 mmol/L or OGTT-2h ≥ 11.1 mmol/L or had been diagnosed with diabetes by physicians. The data published in 2002, 2012 and 2018 were from the “Report on Nutrition and Chronic Diseases of Chinese Residents”. The target values in 2030 were derived from the “Global Action Plan for the Prevention and Control of Non-communicable Diseases (2013–2020)” by WHO. Based on the 2013 data, the targets are to reduce the prevalence of hypertension by 25% and halt the rise of the prevalence of diabetes, respectively.

Fig. 3

Disparities (ratios) in increasing rates in prevalence (%) of obesity, hypertension and diabetes in 2002–2018. ov/ob = overweight and obesity. (a) Ref = Women; (b) Ref = 18–44 y; (c) Ref = Urban; (d) Ref = Women Urban. Ratio = Annual change/Annual change (ref). Annual change was calculated as the absolute difference in these measures between the first and last year divided by the duration in years. The red dotted line represented a ratio value of 1.