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Life Expectancy, Causes of Death, Risk Factors in China and the U.S Annals of Global Health VOL. 83, NO. 3–4, 2017 © 2017 Icahn School of Medicine at Mount Sinai. ISSN 2214-9996/$36.00 Published by Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.aogh.2017.10.003 VIEWPOINT Life Expectancy, Causes of Death, Risk Factors in China and the U.S. Zhengjun Li, BS,1 Yaoyao Bian, MD,1 Li Zeng, MD, Wenlin Li, MD, Lili Yang,MM Bailrigg, United Kingdom; and Nanjing, China INTRODUCTION LIFE EXPECTANCY AND HALE AT BIRTH The series of studies on the global burden of disease (GBD) is conducted by multinational re- The disease and the cause of death spectra have searchers and is organized by the Institute for changed significantly with the development of medical Health Metrics and Evaluation for multinational socialization; infectious and cardiovascular disease population-related data. These researchers can dy- mortalities have decreased considerably, and the life namically monitor and comprehensively evaluate expectancy of the world’s population is much longer disease incidence, mortality, disability-adjusted life than that 23 years ago.5 The GBD 2015 data indi- years (DALYs), and healthy life expectancy (HALE). cate that global life expectancy at birth increased by These researchers also analyze the burden of disease 7.1 years from 64.8 years in 1990 to 71.9 years in in different countries or regions, populations, and 2015. The life expectancy of men is less than that diseases; ascertain the main major disease, high- of women, which increased by 6 and 7.1 years, re- risk groups, and high-prevalence areas; and identify spectively. The life expectancy at birth of Chinese the main risk factors.1 The GBD series of studies people is growing at a steady level and is higher than plays a crucial role in enacting public health poli- the global average. Although the growth trend of the cies, assessing the progress of millennium development Chinese life expectancy is significantly higher than goals, and promoting the implementation of sus- that of the United States, a certain gap remains in tainable development goals. life expectancy (Fig. 1). Since the 1960s, the growth The current GBD series of studies was devel- trend of life expectancy at birth in China has been oped from GBD 1990 to GBD 2015, which covered prominent. The life expectancy at birth in China was all previous GBD results, comprehensively assess- 76.3 years in 2015, which increased by 9.6 years from ing 315 diseases and injuries, 249 causes of death, that in 1990 (66.7 years). The life expectancy at birth and 79 risk factors.2-4 Meanwhile, a summary metric of men and women were 73.2 and 79.9 years, which referred to as the sociodemographic index (SDI) was increased by 7.2 and 9.7 years from 1990, respec- constructed through the GBD 2015 to estimate the tively. In the past 25 years, the life expectancy at birth HALE and DALYs. The evaluation of the health in the United States has increased by 3.7 years. Al- status of countries or regions is crucial. though the trend is continuous and gradual, the life On the basis of the latest GBD 2015 data, the expectancy at birth in the United States has in- present study analyzes the life expectancy, causes of creased modestly. The life expectancy at birth in the death, and risk factors; investigates the health status United States is 79.1 years, which is 2.9 years higher and quality of life; and evaluates the current situa- than that in China in 2015. The current mortality tion and development trend of the disease burden in level of Chinese population is low, the health level China and the United States to provide a scientific of the population has significantly improved, and the basis for health decision making in China. life expectancy has been significantly extended. The authors declare no actual or potential conflicts of interest. 1 Zhengjun Li and Yaoyao Bian contributed equally to this study. From the Management School, Lancaster University, Bailrigg, Lancaster, United Kingdom (ZL); School of Nursing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China (YB); School of First Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China (LZ, LY); and Jingwen Library, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China (LZ, WL, LY). Address correspondence to L. Yang ([email protected]). 408 Li et al. Annals of Global Health, VOL. 83, NO. 3–4, 2017 May–August 2017: 407–414 Life Expectancy, Causes of Death, and Risk Factors Figure 1. Life expectancy and HALE at birth in 1990-2015 in the populations of China and the United States. Abbreviations: HALE, healthy life expectancy. The HALE at birth in 2015 was 62.8 years— From the DALYs in 1990, low back and neck pain, that is, 64.9 and 60.9 years in females and male sense organ disease, and HIV/AIDS climbed to the populations, respectively. Since 1990, the HALE at top 10 in the past 25 years, whereas malaria and con- birth increased by 6.4 and 5.5 years for female and genital malformations were removed from the list. male populations, respectively. The HALE at birth In 2015, the total mortality in China was 6.8 per of people older than age 65 increased by 1.9 years thousand. Cerebrovascular disease, ischemic heart from 11.2 to 13.1 years from 1990 to 2015. The disease (IHD), chronic obstructive pulmonary disease, HALE at birth in China and the United States has and cancer (lung and liver) were the leading causes been a growing trend, but that in China increased of death in China, accounting for 20.1%, 15.5%, 9.7%, significantly higher than that in the United States. 6.2%, and 4.2% of the total deaths, respectively. In In 2015, the HALE at birth in China was close to addition, IHD, Alzheimer’s disease, and lung cancer that in the United States, with a difference of only were the 3 leading causes of death in the United 0.1 years, 0.9 years between those of the population States, and the total mortality was 8.3 per thou- of older than 65 years, and 0.3 years between female sand. The 10 leading causes of death and disability populations. The health and functional status of the in 2015 in China and the United States are listed in Chinese population, especially women, is approach- Tables 1–3. ing the health level of the American population, and From 2005 to 2015, the cerebrovascular disease the health gap is narrowing. remained the leading cause of death in China even with the improvement of medical care, but the life CAUSE OF DEATH AND DISABILITY loss caused by cerebrovascular disease decreased by 16.2% and 11.0% in China and the United States, Based on the SDI, the top 10 diseases and injuries respectively.The epidemic of chronic disease in China of global DALYs in 2015 included ischemic heart reported by the World Bank in 2011 indicated that disease, cerebrovascular disease, lower respiratory in- the number of cases of cerebrovascular disease by the fection, low back and neck pain, neonatal preterm age of 40 would increase 2 to 3 times and mainly con- birth, diarrheal disease, sense organ disease, neona- centrated in the next 10 years.6 The incidence of tal encephalopathy, road injuries, and HIV/AIDS. cerebrovascular disease is much higher than the level Among these diseases, 59.7% of the DALY loss was in developing countries, and the incidence in the urban caused by noncommunicable diseases. A total of 54% areas is higher than that in the rural areas. The loss of the world’s countries or regions suffered either from of DALYs caused by cerebrovascular diseases in- ischemic heart or cerebrovascular disease or from both. creased by 11% in 2015. The morbidity and mortality Annals of Global Health, VOL. 83, NO. 3–4, 2017 Li et al. 409 May–August 2017: 407–414 Life Expectancy, Causes of Death, and Risk Factors Table 1. Causes of DALYs in China and the United States Ten Leading Causes of DALYs China Stroke IHD Back and COPD Road Sense organ Lung Liver Depression Diabetes neck injuries disease cancer cancer United States IHD Back and Diabetes Lung Depression COPD Drug Alzheimer’s Sense organ Other MSK neck cancer disease From left to right, ranked 1-10. COPD, chronic obstructive pulmonary disease; DALYs, disability-adjusted life years; IHD, ischemic heart disease; MSK, musculoskeletal disorder. Table 2. Causes of YLL in China and the United States Ten Leading Causes of YLL China Stroke IHD Road Lung cancer COPD Liver Stomach LRI Congenital Self-harm injuries cancer cancer United States IHD Lung COPD Alzheimer’s Stroke Self-harm Road injuries Drugs Colorectal LRI cancer cancer From left to right, ranked 1-10. COPD, chronic obstructive pulmonary disease; IHD, ischemic heart disease; LRI, lower respiratory infection; MSK, musculoskeletal disorder; YLL, years of life lost. Table 3. Causes of YLD in China and the United States Ten Leading Causes of YLD China Back and Sense organ Depression Skin Diabetes Other Iron Schizophrenia Migraine Anxiety neck disease MSK United States Back and Depression Diabetes Sense organ Other Skin Anxiety Migraine Drugs Iron neck disease MSK From left to right, ranked 1-10. COPD, chronic obstructive pulmonary disease; IHD, ischemic heart disease; MSK, musculoskeletal disorder; YLD, years lived with disability. rates in China simultaneously indicated an increas- lence of IHD in low-income areas was significantly ing trend that was far greater than those in developed greater than in the middle- and high-income areas.9 countries, such as the United States, and those for Compared with developed countries, such as the men were higher than those for women.
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