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

Area of Science:

• Public Health
• Epidemiology
• Health Economics

Background:

• Under-five mortality rate (U5MR) remains a critical global health indicator.
• China has made substantial progress in child survival over recent decades.
• Understanding trends and determinants of U5MR is crucial for targeted interventions.

Purpose of the Study:

• To analyze annual trends of U5MR and cause-specific U5MR in China from 1996 to 2020.
• To assess the correlation between healthcare system factors, health expenditure, and U5MR in China.
• To identify key areas for future U5MR reduction strategies.

Main Methods:

• Retrospective observational study utilizing national data from 1996 to 2020.
• Joinpoint regression analysis to model U5MR trends and calculate average annual percentage change (AAPC).
• Pearson correlation analysis to examine relationships between U5MR and healthcare system/expenditure indicators.

Main Results:

• China's U5MR declined significantly with an AAPC of -7.27% (p<0.001), with rural U5MR declining faster than urban.
• Pneumonia showed the fastest U5MR decrease; congenital heart disease and accidental asphyxia decreased slowest.
• Hospital delivery rates, neonatal visits, and health management correlated negatively with U5MR; government health expenditure showed a negative correlation, while out-of-pocket expenditure showed a positive correlation.

Conclusions:

• Significant advancements in reducing U5MR in China between 1996 and 2020.
• The rural-urban gap in U5MR has narrowed, but rural areas require continued focus.
• Future strategies should prioritize rural health, address specific causes like congenital heart disease and accidental asphyxia, enhance health policies, and increase government health expenditure.