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VOLUME 6: NO.

4 OCTOBER 2009

REVIEW

All-Cause Mortality in Tianjin, China,
1999-2004
Xiexiu Wang, MD; Guohong Jiang, MD; Dezheng Wang, MD; Yi Pan, MD; Matthew Boulton, MD

Suggested citation for this article: Wang X, Jiang G, Wang Tianjin, China. China should commit additional resources
D, Pan Y, Boulton M. All-cause mortality in Tianjin, to supporting chronic disease prevention and control pro-
China, 1999-2004. Prev Chronic Dis 2009;6(4). http://www. grams, including proven special health promotion projects.
cdc.gov/pcd/issues/2009/oct/08_0109.htm. Accessed [date].

PEER REVIEWED Introduction
 
Changes in the rate and causes of death are indicators
Abstract of population health status and reveal changes in the
  spectrum of diseases that affect a population. Measuring
Introduction these changes provides a scientific basis for establishing
We analyzed trends of major causes of death in Tianjin, health policies and understanding health changes that
China, from 1999 through 2004 to better inform disease occur in population groups (1). Collecting and analyzing
prevention and control programs and policies. all-cause mortality data over time help establish appropri-
  ate disease control plans, rationally allot health resources,
Methods and promote sustained social and economic development.
To report all-cause deaths among Tianjin residents from The goal of this study was to describe patterns of all-cause
1999 through 2004, we standardized mortality rates to the mortality among residents of Tianjin, China.
world population in 2000. We analyzed age, sex, and geo-
graphic distribution of deaths from different causes and
the leading causes of death in Tianjin. Methods
   
Results Tianjin is the third largest city in China, and its popu-
The 5 leading causes of death in Tianjin were car- lation (10 million) is approximately 40% urban and 60%
diovascular disease, cerebrovascular disease, malignant rural. In 1984, the Tianjin Centers for Disease Control and
neoplasm, chronic lower respiratory disease, and injuries Prevention (TJCDC) established an all-cause mortality
and poisoning. Mortality in Tianjin declined from 0.60% reporting system for the city. We assessed 342,988 death
in 1999 to 0.48% in 2004. Noncommunicable diseases reports of Tianjin residents collected from January 1, 1999,
accounted for more than 80% of all deaths. Infant and through December 31, 2004. Cause of death was classified
maternal mortality in Tianjin were low. Life expectancy of according to the International Classification of Diseases,
Tianjin residents increased every year but was consistent- Ninth Revision (ICD-9), for 1999 through 2002 and the
ly longer in women. When deaths from the main chronic 10th revision (ICD-10) for 2003 and 2004. We analyzed the
diseases are not considered, life expectancy lengthens change and distribution of mortality, maternal mortality,
substantially. infant mortality, life expectancy, and years of potential life
  lost.
Conclusion  
Chronic diseases are the leading cause of death in Records were included of all people who died from 1999

The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the US Department of Health and Human Services, the
Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only and
does not imply endorsement by any of the groups named above.
www.cdc.gov/pcd/issues/2009/oct/08_0109.htm • Centers for Disease Control and Prevention 

significantly between urban and rural areas (Table 3). and analyzes submitted data. Practicing clinicians in hospitals and community medical Infant mortality decreased from 0. all-cause mortality most common causes of death from infectious diseases to declined for both men (from 686. and uted to lifestyle factors (diet. The 5 lead. access to treatment for infec- 57.gov/pcd/issues/2009/oct/08_0109. tality in Tianjin for cerebrovascular disease.2 per 100. and the population ages. Unfortunately. From 1999 through 2004. 4 OCTOBER 2009 through 2004 if they had formal residential household puerperal infections (16%). was con- the data into a computer linked with the local disease pre. Results Discussion     We recorded 54. The years (3). disease. 56.77% per year).05) to compare the change and difference between the 79 to 82 years (0.5 (SPSS. The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the US Department of Health and Human Services.   ing to improve the quality of death certificate reporting. Because much chronic disease is attrib- nant neoplasm. except for 2003 and 2004. and falls (4%). 59. eases have begun to dominate causes of death in Tianjin. tious diseases increases.001).4% during the centers in Tianjin complete death certificates and enter study (P < . and malignant neoplasm all decreased from becomes more prevalent (6). ICD-10 classification. TJCDC screens. TJCDC holds periodic train. sedentary lifestyles become more common. sorts.000) chronic diseases (4). Use of trade names is for identification only and does not imply endorsement by any of the groups named above. respectively increased from 75 to 78 years (0. although years of potential life lost postpartum hemorrhage (30%). worsen.575. Maternal mortality differed registration in Tianjin and a completed death certificate. cardiovascular disease. 56.1 to 407. dietary and exercise patterns 2004).78% per year). cardiovascular deaths from infectious and parasitic diseases. sistently lower in urban than in rural areas (Table 4). Deaths outside a hospital 3 leading causes of infant death were prematurity (31%). and from injuries and poisoning are difficult to estimate (8.  Centers for Disease Control and Prevention • www. chronic lower respiratory disease. it would have Deaths from noncommunicable diseases were far more increased by an additional 11 years if no one died from common in Tianjin during the study period than were chronic diseases (cerebrovascular disease. Injuries and poi-   soning are the most common causes of death among people The 3 leading causes of maternal death in Tianjin were aged 45 or younger. cardiovascu.408 during the study. Chicago.659. VOLUME 6: NO. exercise. age-standardized mortality rates are accidental poisoning (12%).000) (P < . and hyperlipidemia and 30% are obese (7). and congenital conducted by community doctors. 1999 through 2004. as economic conditions improve. the Centers for Disease Control and Prevention. based on the World Health Organization world standard Life expectancy of women exceeded that of men for all population in 2000 (2).068. We found that noncommunicable dis- and women (from 509.988 deaths for the 6. All analyses were done in SPSS version 11. which collectively accounted for of these deaths could have been prevented. many injuries and poisoning). drowning (7%). are added to the database on the basis of home surveys newborn birth injuries and asphyxia (24%). The vention station and the TJCDC. and men’s life expectancy mortality trend and mortality distribution.001).001) and. suicide (14%). decreased in both urban and rural areas.8% to 0. Illinois). Among Tianjin residents aged 1999 through 2004 (P < .001).081 deaths in Tianjin for each year of the survey (1999. all of which shift the year period. The leading We calculated mortality rates according to ICD-9 or causes of injury were traffic accidents (50%).cdc. although mortality was consistently higher among men the 5 leading causes of death are all chronic and account than among women (P < . Women’s life expectancy increased from = .9). and diabetes). for a total of 342. of potential life lost from the most common chronic diseas- Inc.111. more than 80% of all deaths (Table 2). but the decline   was steeper in urban areas (Table 1).6 to 551. malig. and As cultures industrialize. All-cause mortality also for more than 80% of all deaths (5). Deaths from injuries and poisoning were twice as com-   mon among men as among women in Tianjin. preeclampsia (16%). but mortality for diabetes 18 years or older. Years of poten- ing causes of death were all noncommunicable diseases tial life lost from chronic diseases increased every year from (cerebrovascular disease. We used χ2 tests for significance (α years of the study. 59. respectively. or the authors’ affiliated institutions. diets become less healthy.2 per 100.001). Although life expectancy increased by 3 years in both   men and women from 1999 through 2004. heart disease (12%).494. es increased from 592.htm . and smoking). approximately 37% have hypertension increased (P < . malignant neoplasm.641 to 654. the Public Health Service. and smoking lar disease. Standardized mor.

China health statistics digest. the Public Health Service. rural areas to decrease the disparity. Michigan. in 2003. of Tianjin. China. 3. It provides basic information MMWR Surveill Summ 2004. National Bureau of Statistics of China. China’s government population). for developing health policy and health promotion activi. and Body Weight has been developed in urban communi. A final data for 2004. Accessed June 9. however. Dezheng Wang. The world health report 2002 — reducing risks. www. but most of it has gone toward preventing infec. Beijing (CN): China Statistics Publishing Corresponding Author: Xiexiu Wang. Geneva (CH): World Health   Organization. 2005. this study pres. 9.gov/pcd/issues/2009/oct/08_0109. 10. He Dong District. Funding.9(2):124-7.htm • Centers for Disease Control and Prevention  . Nevertheless. Use of trade names is for identification only and does not imply endorsement by any of the groups named above. http://www. Rao C. Milbank Mem inadequate for the program to benefit the large population Fund Q 1971. China. Health and Nutrition Examination Survey in marily from deaths reported by hospitals. E-mail: wjsttigo@126. p. the Centers for Disease Control and Prevention.83(3):171-7.53(7):1-57. Miniño AM. has increased funding for disease prevention in the after. 2001. and mortality Tianjin (year 2002).   Author Affiliations: Guohong Jiang.who. Author Information 11. Chinese people.cdc. 53-7. or the authors’ affiliated institutions. and because our findings show higher mortality 5.com. 2004. Surveillance for ents the first data from a provincial surveillance system on fatal and nonfatal injuries — United States. Heron MP. 2009. Geneva (CH): World Health Organization. Age-standardized mortality rates by cause (per 100 000 similar to those in Tianjin (10. Li G. Rao K. Ann Arbor. China Ministry of Health. Jiang G. Fat DM. Murphy SL. Beijing (CN): Peking Union Medical College Publishing House. Tianjin Centers for Disease Control and Prevention and Tianjin Medical University. Mathers CD. promoting healthy life.49(4):509-38. 224-63. tious diseases.11). all-cause mortality in China.html. University of Michigan. Tianjin 300011. 2004. Productivity losses ties that can improve the health and life expectancy of the from injury in China. system (unpublished data). China must dedicate more resources to Centers for Disease Control and Prevention. 7. Counting the dead and what they died from: as assess- ment of the global status of causes of death data. is the epidemiology of population change. The epidemiologic transition: theory of ties to help control chronic disease. Beijing (CN): Chemical Industry is approximately 10% underreported outside the hospital Press. Inj Prev 2003. Zhou Y. China statistics   yearbook. Baker TD. Matthew Boulton. 79-81. Yi Pan. References 1. Bull World Health Organ 2005. The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the US Department of Health and Human Services. Deaths: support health promotion and chronic disease control. p. MD. Telephone: 86-22-2433-3528. Our study is limited in that mortality was derived pri. Inoue M. p. Tianjin. Ryan GW. Tianjin Centers for Disease Control and Prevention. Natl Vital Stat Rep 2007. 2002. health Ministry of Health. Beijing (CN): China from chronic disease in rural than in urban areas. Centers for Disease Control and Prevention. Omaran A. 2005. Kochanek KD.55(19):1- pilot program called Maintaining Normal Blood Pressure 119. education and promotion programs must be developed for 6. VOLUME 6: NO. 4 OCTOBER 2009  The leading causes of death in China as a whole are 2. 4. Annest JL. p. Lopez AD. Tianjin House.int/whosis/indicators/compendium/ math of the severe acute respiratory syndrome outbreak 2008/1mst/en/index. 20-53. Tianjin. China hygiene statistics yearly book. China. Vyrostek SB. 76 Hualong Rd. 8.

1 686. The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the US Department of Health and Human Services.8 551.5 507.000 Population) Standardized to the World Standard Population.0 619. I&P. a Percentages may not total 100 because of rounding. changes over time) significant at P < .2 517.7 594. the Public Health Service.  Centers for Disease Control and Prevention • www. 4 OCTOBER 2009 Tables Table 1.190.629 590.761 638.1 445.321. central nervous system.htm .6 512. VOLUME 6: NO. Table 2.6 523. 1999-2004 Cause of Death (%)a Rank 1999 2000 2001 2002 2003 2004 Total 1 CbVD (26) CbVD (26) CbVD (26) CVD (24) CVD (25) CVD (25) CbVD (25) 2 CVD (25) CVD (24) CVD (24) CbVD (23) CbVD (23) CbVD (24) CVD (24) 3 Neoplasm (19) Neoplasm (19) Neoplasm (20) Neoplasm (21) Neoplasm (20) Neoplasm (21) Neoplasm (20) 4 CLRD (8) CLRD (10) CLRD (10) CLRD (10) CLRD (9) CLRD (9) CLRD (9) 5 I&P (5) I&P (5) I&P (4) I&P (4) I&P (5) I&P (5) I&P (5) 6 GI disease (2) Diabetes (2) Diabetes (3) Diabetes (3) GI disease (3) Diabetes (3) Diabetes (3) 7 Diabetes (2) GI disease (2) GI disease (3) GI disease (3) Diabetes (3) GI disease (3) GI disease (3) 8 GU disease (2) GU disease (2) GU disease (2) GU disease (2) GU disease (2) GU disease (2) GU disease (2) 9 CNS disease (1) CNS disease (1) CNS disease (1) CNS disease (1) CNS disease (1) CNS disease (1) CNS disease (1) 10 Perinatal death Perinatal death Infection (<1) Infection (<1) Hereditary malfor.3 447.530 589.493 525.4 593. Tianjin.1 586.6 676.8 591.1 449. injuries and poisoning.3 600. chronic lower respiratory disease.2 407.6 525. GI.001 (χ2 test).101.9 604. GU.712 685.4 563.0 511. cardiovascular disease.7 512.gov/pcd/issues/2009/oct/08_0109.7 517.1 460.5 476.7 587.2 479.4 445.8 2000 9.4 2004 9.7 595. the Centers for Disease Control and Prevention. China.7 686.2 a All differences (men vs women. CVD.325. Ten Leading Causes of Death.6 487.1 422.7 2002 9.3 681.8 589. or the authors’ affiliated institutions.8 548.0 522.5 502.120. CLRD. by Sex and Urban vs Rural Residence. urban vs rural. Mortality (per 100.5 487.8 450.0 395. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.6 509. genitourinary. CNS.2 484.2 631.2 557. Tianjin.007 669. gastroin- testinal. 1999-2004a Urban Rural Total Year Population Men Women Total Men Women Total Men Women Total 1999 9.0 439. cerebrovascular disease.1 2003 9.9 519. China. Perinatal death Infection (<1) (<1) (<1) mation (<1) (<1) Abbreviations: CbVD.1 597.cdc.139.7 2001 9.1 583.

6 12.7 11.5 14. or the authors’ affiliated institutions.04.6 10.6 5.3 2003 4. VOLUME 6: NO.2 2001 4.9 5.5 2. 1999-2004 Maternal Mortality (per 100.001.7 4.1 2002 4.htm • Centers for Disease Control and Prevention  .8 12.6 7.000 Population)a Year Urban Rural Total 1999 7. 4 OCTOBER 2009 Table 3.9 7. Trends in Maternal Mortality. Tianjin.cdc. The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the US Department of Health and Human Services. China.03. between urban and rural residence.4 4. Tianjin.5 5. Table 4.8 2004 4. Trends in Infant Mortality. P = .5 8.9 2002 6.2 4.4 a χ2 test for annual trend.1 4. the Centers for Disease Control and Prevention.0 13.4 10.000 Births)a Year Urban Rural Total 1999 6. www.4 2003 5.9 4. P = .5 2000 10.gov/pcd/issues/2009/oct/08_0109.2 a χ2 tests between urban and rural residence. the Public Health Service.7 6. China.7 2000 4.3 11.1 2001 18. P < . 1999-2004 Infant Mortality (per 1.9 4. by Urban vs Rural Residence. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.2 13.3 5.6 2004 15. by Urban vs Rural Residence.