Infant and child mortality trends in China: a longitudinal study for the period 1950-2016

This study examined the decline in the infant mortality rate (IMR) and child mortality rate aged 1-4 (CMR1-4) in China from 1950 to 2016. It also quantified the yearly gradient of this decline, adjusting for key determinants including gross domestic product (GDP) per capita, gross enrolment ratio of primary and secondary education and doctor density.

By breaking the province-level longitudinal data into three temporal periods (1950-1964, 1965-1980, 2000-2016) and applying fractional polynomials in the regression models, we estimated the unadjusted and adjusted yearly relative risk of the outcomes within each period.

The most rapid decline in the IMR and the CMR1-4 occurred in 1950, with 35% (95% CI 29% to 41%) yearly decline in the IMR and 41% (95% CI 11% to 61%) in the CMR1-4. There was a generally increasing ratio of the IMR to the CMR1-4 between 1950 and 1980 and a decreasing trend from 2000 afterwards. Primary and secondary education enrolment, along with doctor density, was associated with the yearly gradients in the IMR and the CMR1-4 when mortality was very high. In contrast, GDP per capita only showed an association with the yearly gradients in the IMR and the CMR1-4 from 2000 onwards.

The rapid decline in child mortality demonstrated that accelerated progress is achievable through efforts to expand primary and secondary education and investment in health workforce.