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Observational Study
. 2024 Sep 24;14(9):e077461.
doi: 10.1136/bmjopen-2023-077461.

Trends in under-five mortality rate in China, 1996-2020: a Joinpoint regression and correlation analysis

Jian-Min Lv  1 , Nan Chen  1 , Xi-Ning He  1 , Ya-Feng Tian  1 , Jie Zhang  1 , Qiao-Rong Fan  2 , Qiong Ma  3 , Hong-Xia Li  4
Affiliations
Observational Study

Trends in under-five mortality rate in China, 1996-2020: a Joinpoint regression and correlation analysis

Jian-Min Lv et al. BMJ Open. .

Abstract

Objectives: To analyse annual trends of the under-five mortality rate (U5MR) and main cause-specific U5MR in China from 1996 to 2020 and to assess the potential correlation of the healthcare system and health expenditure with the U5MR in China.

Design: A retrospective observational study using national data from 1996 to 2020. Joinpoint regression was employed to model U5MR trends and Pearson correlation analysis was conducted to examine the relationship between healthcare system factors, health expenditure and U5MR.

Setting: Nationwide study covering both rural and urban populations across China over a 25-year period.

Results: The U5MR in China experienced a three-stage decline from 1996 to 2020 with an average annual percentage rate change (AAPC) of -7.27 (p<0.001). The AAPC of the rural U5MR (-7.07, p<0.001) was higher than that in urban areas (-5.57, p<0.001). Among the five main causes, the decrease in pneumonia-caused U5MR was the fastest while the decreases in congenital heart disease and accidental asphyxia were relatively slow. The rates of hospital delivery (r=-0.981, p<0.001), neonatal visits (r=-0.848, p<0.001) and systematic health management (r=-0.893, p<0.001) correlated negatively with U5MR. The proportion of government health expenditure in the total health expenditure (THE) correlated negatively with the national U5MR (r=-0.892, p<0.001) while the proportion of out-of-pocket health expenditure in THE correlated positively (r=0.902, p<0.001).

Conclusion: China made significant advances in reducing U5MR from 1996 to 2020. The rural-urban gap in U5MR has narrowed, though rural areas remain a key concern. To further reduce U5MR, China should focus on rural areas, pay more attention to congenital heart disease and accidental asphyxia, further improve its health policies, and continue to increase the government health expenditure.

Keywords: health policy; paediatrics; public health.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1. Joinpoint regression model for China’s U5MR from 1996 to 2020. The national, urban and rural U5MR in China from 1996 to 2020 were analysed using the Joinpoint Regression Program. The numbers of Joinpoints and corresponding annual percentage rate change (APC) were indicated. *p<0.05. U5MR, under-five mortality rate.
Figure 2
Figure 2. Changing trends of five main cause-specific mortalities of children under 5 years old in China from 1996 to 2020. National (A), urban (B) and rural mortality (C) due to the following five main causes were shown: Preterm birth/low birth weight, birth asphyxia, pneumonia, congenital heart disease and accidental asphyxia.
See this image and copyright information in PMC

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