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Secular trends and rural-urban differences in endocrine and metabolic disease mortality in China: an age-period-cohort modeling of National Data

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International Journal of Diabetes in Developing Countries Aims and scope Submit manuscript

Abstract

Objectives

Annual mortality of endocrine and metabolic diseases (EMD) in a population reflects levels of economy-related lifestyles and medical care, both of which have changed substantially in China in the last hundred years. Linking these two factors with historical trends of EMD will enhance our understanding of the EMD epidemiology.

Methods

Age-specific annual mortality rates of EMD from 1991 to 2016 were derived from the Health Statistics Yearbook of China and analyzed by rural and urban using age-period-cohort (APC) method. Intrinsic estimator was performed for parameter estimation.

Results

The data fit APC models well. After controlling the influence of age, the estimated period effect increased rapidly from 1991 to 2001 before it leveled off. The risk for urban area increased faster than for rural area before 2006. Contrarily, the estimated cohort effects across 100 years from 1911 to 2016 showed an overall declining trend. For urban area, the cohort effect declined progressively since the 1911–1915 birth cohort with small fluctuations, while the same effect for rural area increased slowly from the 1911–1915 cohort to the 1951–1956 cohort before it declined, intercepting twice with that of urban one at cohort 1941–45 and another at 1996–2000.

Conclusion

Increases in EMD mortality in China since 1991 can be explained primarily by the period effect, reflecting unhealthy lifestyles adapted along with rapid economic growth. The 100-year declines in cohort effect and the rural-urban differences could be largely attributed to the overall progress and rural-urban inequity in medical and healthcare. Future public health planning and decision-making must emphasize these two factors.

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Acknowledgments

We thank city and local health departments for reporting endocrine and metabolic diseases mortality to CDC.

Author information

Author notes

  1. Ying Li and Qi Pan contributed equally to this work.

Authors and Affiliations

  1. School of Health Sciences, Wuhan University, Wuhan, Hubei, China

    Ying Li, Hong Yan & Shiyue Li

  2. Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Beijing, China

    Qi Pan & Lixin Guo

  3. Renmin Hospital, Wuhan University, Hubei, China

    Mengting Gao

Authors
  1. Ying Li
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  2. Qi Pan
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Contributions

Study and design: all authors.

Acquisition, analysis, or interpretation of data: Ying Li and Qi Pan.

Drafting of the manuscript: all authors.

Critical revision of the manuscript for important intellectual content: all authors Statistical analysis: Ying Li, Lixin Guo, and Hong Yan.

Administrative, technical, or material support: all authors.

Study supervision: all authors.

Corresponding authors

Correspondence to Lixin Guo or Hong Yan.

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Li, Y., Pan, Q., Gao, M. et al. Secular trends and rural-urban differences in endocrine and metabolic disease mortality in China: an age-period-cohort modeling of National Data. Int J Diabetes Dev Ctries 40, 422–430 (2020). https://doi.org/10.1007/s13410-020-00803-w

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  • DOI: https://doi.org/10.1007/s13410-020-00803-w

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