title: Age-period-cohort analysis of infectious disease mortality in urban-rural China, 1990-2010.
abstract: BACKGROUND
  Although a number of studies on infectious disease trends in China exist, these studies have not distinguished the age, period, and cohort effects simultaneously. Here, we analyze infectious disease mortality trends among urban and rural residents in China and distinguish the age, period, and cohort effects simultaneously.
  
  
  METHODS
  Infectious disease mortality rates (1990-2010) of urban and rural residents (5-84 years old) were obtained from the China Health Statistical Yearbook and analyzed with an age-period-cohort (APC) model based on Intrinsic Estimator (IE).
  
  
  RESULTS
  Infectious disease mortality is relatively high at age group 5-9, reaches a minimum in adolescence (age group 10-19), then rises with age, with the growth rate gradually slowing down from approximately age 75. From 1990 to 2010, except for a slight rise among urban residents from 2000 to 2005, the mortality of Chinese residents experienced a substantial decline, though at a slower pace from 2005 to 2010. In contrast to the urban residents, rural residents experienced a rapid decline in mortality during 2000 to 2005. The mortality gap between urban and rural residents substantially narrowed during this period. Overall, later birth cohorts experienced lower infectious disease mortality risk. From the 1906-1910 to the 1941-1945 birth cohorts, the decrease of mortality among urban residents was significantly faster than that of subsequent birth cohorts and rural counterparts.
  
  
  CONCLUSIONS
  With the rapid aging of the Chinese population, the prevention and control of infectious disease in elderly people will present greater challenges. From 1990 to 2010, the infectious disease mortality of Chinese residents and the urban-rural disparity have experienced substantial declines. However, the re-emergence of previously prevalent diseases and the emergence of new infectious diseases created new challenges. It is necessary to further strengthen screening, immunization, and treatment for the elderly and for older cohorts at high risk.
authors.affiliation: School of Social and Behavioral Sciences, Nanjing University, Nanjing, China.
authors.forename: Zhi
authors.initials: Z
authors.lastname: Li
authors.affiliation: Global Health Institute, Wuhan University, Wuhan, China. wpg926@whu.edu.cn.
authors.forename: Peigang
authors.initials: P
authors.lastname: Wang
authors.affiliation: School of Social and Behavioral Sciences, Nanjing University, Nanjing, China.
authors.forename: Ge
authors.initials: G
authors.lastname: Gao
authors.affiliation: School of Basic Medical Sciences, Peking University, Beijing, China.
authors.forename: Chunling
authors.initials: C
authors.lastname: Xu
authors.affiliation: Department of Epidemiology, University of Florida, FLorida, USA.
authors.forename: Xinguang
authors.initials: X
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D003141:Communicable Diseases / Q000401:mortality*; D006801:Humans; D008017:Life Expectancy / Q000639:trends*; D008875:Middle Aged; D012424:Rural Population / Q000706:statistics & numerical data / Q000639:trends*; D014505:Urban Population / Q000706:statistics & numerical data / Q000639:trends*
keywords: APC Model; IE; Infectious disease; Mortality; Urban- rural China