title: Temporal Trends and Geographic Variations in Dementia Mortality in China Between 2006 and 2012: Multilevel Evidence From a Nationally Representative Sample.
abstract: We aimed to explore the temporal trends and geographic variations in dementia mortality in China.
  
  
  
  Annual dementia mortality counts (years 2006 to 2012) in 161 counties and districts (Disease Surveillance Points, DSP) were extracted from the nationally representative China Mortality Surveillance System and stratified by 5-year age group (aged >65), sex, and time. These counts were linked to annually adjusted denominator populations. Multilevel negative binomial regression with random intercepts and slopes were used to investigate spatiotemporal variation in dementia mortality.
  
  
  
  Dementia mortality varied over 2-fold between DSPs (median rate ratio: 2.59). Significant variation in DSP slopes through time (variance 0.075, SE 0.020) indicated spatiotemporal variations. Mortality rates were significantly higher in the east (rate ratio 2.28; 95% confidence intervals, 1.45-3.60) compared with the north. There was a declining trend in 2 (east and northwest) of the 7 regions. Dementia mortality decreased by 15% in urban areas but increased by 24% in rural areas.
  
  
  
  Our findings indicate that regional inequalities in dementia mortality are salient, and the increase in mortality rates in rural areas is an emerging public health challenge in China. Tailored preventive health strategies should be in place to narrow down this avoidable and wholly unnecessary inequality.
authors.affiliation: *National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China †School of Health and Society, University of Wollongong ‡School of Science and Health, University of Western Sydney, Sydney, Australia.
authors.forename: Peng
authors.initials: P
authors.lastname: Yin
authors.forename: Xiaoqi
authors.initials: X
authors.lastname: Feng
authors.forename: Thomas
authors.initials: T
authors.lastname: Astell-Burt
authors.forename: Andrew
authors.initials: A
authors.lastname: Page
authors.forename: Jiangmei
authors.initials: J
authors.lastname: Liu
authors.forename: Yunning
authors.initials: Y
authors.lastname: Liu
authors.forename: Shiwei
authors.initials: S
authors.lastname: Liu
authors.forename: Lijun
authors.initials: L
authors.lastname: Wang
authors.forename: Limin
authors.initials: L
authors.lastname: Wang
authors.forename: Maigeng
authors.initials: M
authors.lastname: Zhou
mesh_terms: D000368:Aged; D002681:China / Q000453:epidemiology; D003704:Dementia / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D062306:Geography, Medical / Q000706:statistics & numerical data / Q000639:trends*; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D013997:Time Factors