Geographic disparities in pneumonia-specific under-five mortality rates in Mainland China from 1996 to 2015: a population-based study.
OBJECTIVE
This study aimed to investigate the disparities in pneumonia-specific under-five mortality rates (U5MRs) among and within three geographic regions in Mainland China from 1996 to 2015.


METHODS
Data were obtained from the national Under-Five Child Mortality Surveillance System and grouped into 2-year periods. The Cochran-Armitage trend test and Cochran-Mantel-Haenszel test were used to assess trends and differences in the pneumonia-specific U5MRs among and within geographic regions. Relative risks (RRs) and 95% confidence intervals (95% CIs) were calculated.


RESULTS
The pneumonia-specific U5MR decreased by 90.6%, 89.0%, and 83.5% in East, Middle, and West China, respectively, with a larger decrease in rural areas. The pneumonia-specific U5MR was highest in West China, and was 7.2 (95% CI 5.9-8.7) times higher than that in East China in 2014-2015. In 2014-2015, the RRs were 1.7 (95% CI 1.2-2.5), 1.6 (95% CI 1.1-2.1), and 3.4 (95% CI 2.8-4.0) between rural and urban areas in East, Middle, and West China, respectively.


CONCLUSIONS
Pneumonia-specific U5MRs decreased from 1996 to 2015 across China, particularly in rural areas. However, disparities remained among and within geographic regions. Additional strategies and interventions should be introduced in West China, especially the rural areas, to further reduce the pneumonia-specific U5MR.
National Office for Maternal and Child Health Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China.
Leni
L
Kang
National Office for Maternal and Child Health Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China. Electronic address: hch7646@163.com.
Chunhua
C
He
National Office for Maternal and Child Health Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
Lei
L
Miao
National Office for Maternal and Child Health Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
Juan
J
Liang
National Office for Maternal and Child Health Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China.
Jun
J
Zhu
National Office for Maternal and Child Health Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
Xiaohong
X
Li
National Office for Maternal and Child Health Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China. Electronic address: liqi210@126.com.
Qi
Q
Li
National Office for Maternal and Child Health Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
Yanping
Y
Wang
D046688:Child Mortality; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D054624:Health Status Disparities; D006801:Humans; D011014:Pneumonia / Q000382:microbiology / Q000401:mortality*; D012424:Rural Population; D014505:Urban Population
Childhood pneumonia; Geographic disparities; Time trend; Under-five mortality rate