Temporal Trend in Mortality Due to Congenital Heart Disease in China from 2008 to 2021
Congenital heart disease (CHD) is one of the most common birth defects globally, with significant implications for public health. In China, CHD is a leading cause of birth defect-related mortality, accounting for approximately 40% of deaths in individuals with birth defects under the age of 20. Despite advancements in diagnostic and treatment capabilities, there remains a need for updated and comprehensive data on CHD mortality trends in China, particularly concerning sex, rural-urban, and region-specific disparities. This study aims to fill this gap by analyzing temporal trends in CHD mortality from 2008 to 2021, utilizing data from the Dataset of National Mortality Surveillance in China.
The study employed a population-based longitudinal design, leveraging data from the Dataset of National Mortality Surveillance in China, which covers nearly a quarter of the Chinese population through 605 surveillance points. The dataset, compiled and released annually by the Chinese Centre for Disease Control and Prevention (CDC), uses the International Classification of Diseases, 10th Revision (ICD-10) for coding causes of death. Age-adjusted CHD mortality rates were calculated using the sixth census data of China in 2010 as the standard population. Temporal trends in CHD mortality were assessed by age, sex, area, and region using the joinpoint regression model, which identifies significant changes in trends over time.
From 2008 to 2021, a total of 33,534 deaths were attributed to CHD in China. The age-adjusted CHD mortality rate decreased from 1.61 to 0.76 per 100,000 persons, representing an average annual percent change (AAPC) of -5.90%. Females exhibited lower age-adjusted CHD mortality rates than males, but both sexes experienced similar decline rates (females: AAPC = -6.15%; males: AAPC = -5.84%). Urban and rural areas also showed comparable AAPC values (urban: AAPC = -6.64%; rural: AAPC = -6.12%). However, regional disparities were evident, with eastern regions experiencing a more pronounced decrease in age-adjusted CHD mortality (AAPC = -7.86%) compared to central (AAPC = -5.83%) and western regions (AAPC = -3.71%).
Infants accounted for nearly half of all CHD-related deaths (46.19%). The CHD mortality rate in 2021 was lower than in 2008 for individuals aged 0-39 years, with the largest decrease observed among children aged 1-4 years (AAPC = -8.26%), followed by infants (AAPC = -7.01%). The study also highlighted significant disparities in infant mortality due to CHD, with faster declines in urban areas (AAPC = -10.69%) compared to rural areas (AAPC = -7.69%). Eastern regions saw the fastest decrease in infant mortality (AAPC = -12.18%), followed by central (AAPC = -7.69%) and western regions (AAPC = -5.75%).
The findings underscore the substantial progress in reducing CHD mortality in China over the past decade, attributed to advancements in medical care and public health interventions. However, the slower decline in CHD mortality in central and western regions compared to eastern regions suggests a need for targeted public health policies to address disparities in healthcare resources and health education. The study also emphasizes the importance of newborn screening programs for CHD, which have been implemented in Shanghai since 2016 and nationwide since 2018, in reducing infant mortality rates.
The study’s strengths include its comprehensive analysis of temporal trends in CHD mortality and its use of high-quality, nationally representative data. However, limitations include the inability to analyze mortality trends for different subtypes of CHD and potential miscoding of causes of death. Future research should focus on the mortality trends of specific CHD subtypes and the impact of newborn screening programs on infant mortality.
In conclusion, this study provides valuable insights into the temporal trends in CHD mortality in China from 2008 to 2021, highlighting significant progress in reducing mortality rates and identifying areas for targeted public health interventions. The findings underscore the importance of equitable healthcare resource allocation and the continued implementation of newborn screening programs to further reduce CHD mortality in China.
doi.org/10.1097/CM9.0000000000003057
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