RT Journal Article
SR Electronic
T1 Influence of socioeconomic events on cause-specific mortality in urban Shanghai, China, from 1974 to 2015: a population-based longitudinal study
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP E1153
OP E1161
DO 10.1503/cmaj.180272
VO 190
IS 39
A1 Shuo Wang
A1 Xiaoyu Du
A1 Xue Han
A1 Fan Yang
A1 Jia Zhao
A1 Hui Li
A1 Mi Li
A1 Hongwei Zhang
A1 Wenbin Liu
A1 Jiahui Song
A1 Guangwen Cao
YR 2018
UL http://www.cmaj.ca/content/190/39/E1153.abstract
AB Background: Understanding how socioeconomic events influence cause-specific mortality is essential for optimizing disease-control strategies. We characterized long-term trends in cause-specific mortality in a stable population from a very large urban centre.Methods: We derived population data from 1974 to 2015 on vital status, demographics and causes of death from the death registration system in Yangpu District, Shanghai, China. We examined temporal trends in mortality and assessed the effects of age, period and birth cohort.Results: Over 41 879 864 person-years of follow-up, we analyzed 290 332 deaths: 3.80% from communicable conditions (group 1), 86.50% from noncommunicable diseases (group 2), and 5.56% from injuries (group 3). Age-standardized mortality decreased after 1988 for group 1 (average annual percentage change [AAPC] −6.7, 95% confidence interval [CI] −9.3 to −4.1), after 1995 for group 2 (AAPC −2.9, 95% CI −3.5 to −2.3), and after 1994 for group 3 (AAPC −5.4, 95% CI −6.3 to −4.5), after improvements in public health and clinical service infrastructure and the removal of polluting industries during the 1980s. We observed increased mortality from group 2 and group 3 causes in those born between 1955 and 1965, a period that included the Great Chinese Famine. Cause-specific mortality risks increased in those born after 1949 for cancer and diabetes only.Interpretation: Birth cohorts exposed to extreme starvation in early life had increased premature cause-specific mortality in later life. Decreased cause-specific mortality followed improvements in public health, medical infrastructure and pollution control, but not for cancer or diabetes, likely because of exposure to new risk factors.