Research in context
Evidence before this study
China has been undergoing tremendous demographic and epidemiological transitions during the past three decades. Although overall population health, as represented by under-5 mortality rates and life expectancy at birth, has been improving at impressive speed, increasing burden from non-communicable diseases and an ageing population have presented great health-care challenges for the country. Although such challenges are much discussed at the national level, relatively little is known about the subnational level in China.
Added value of this study
To our knowledge, our study is the first ever systematic analysis of provincial level burden of disease in China. In this analysis, we took advantage of the largest demographic and epidemiological datasets assembled, including censuses, demographic surveys, the Disease Surveillance Points system, the Maternal and Child Health Surveillance systems, Cancer Registries, the newly established Death Registration System, Notifiable Infectious Disease Reporting System, and the National Surveillance System on Injuries. In addition to using the updated analytical tools of the GBD 2013, in order to fully utilise the data, we developed methods specific to this study, including China-specific garbage code redistribution and rural and urban weighting. We report high levels of heterogeneity in terms of both level and rate of change in both all-cause mortality and specific causes of death at the provincial level in China.
Implications of all the available evidence
The differential trends and composition of disease burdens we have identified at the provincial level have important implications for the health system in China. There is an ongoing effort by the Chinese Government to reform the health-care system. Consideration of subnational trends will be crucial to tackle the diverse health challenges faced by provincial governments, and localised health policies will likely be the key for overall success at the national level.