Disease burden of ageing, sex and regional disparities and health resources allocation: a longitudinal analysis of 31 provinces in Mainland China (original) (raw)

Objectives To measure the disease burden of ageing based on age-related diseases (ARDs), the sex and regional disparities and the impact of health resources allocation on the burden in China. Design A national comparative study based on Global Burden of Diseases Study estimates and China's routine official statistics. Setting and participants Thirty-one provinces of Mainland China were included for analysis in the study. No individuals were involved. Methods We first identified the ARDs and calculated the disability-adjusted life years (DALYs) of ARDs in 2016. We assessed the ARD burden disparities by province and sex and calculated the provincial ARD burden-adjusted age. We assessed historical changes between 1990 and 2016. Fixed effects regression models were adopted to evaluate the impact of health expenditures and health workforce indicators on the ARD burden in 2010-2016. Results In 2016, China's total burden of ARDs was 15 703.7 DALYs (95% uncertainty intervals: 12 628.5, 18 406.2) per 100 000 population. Non-communicable diseases accounted for 91.9% of the burden. There were significant regional disparities. The leading five youngest provinces were Beijing, Guangdong, Shanghai, Zhejiang and Fujian, located on the east coast of China with an ARD burden-adjusted age below 40 years. After standardising the age structure, western provinces, including Tibet, Qinghai, Guizhou and Xinjiang, had the highest burden of ARDs. Males were disproportionately affected by ARDs. China's overall age-standardised ARD burden has decreased since 1990, and females and eastern provinces experienced the largest decline. Regression results showed that the urban-rural gap in health workforce density was positively associated with the ARD burdens. Conclusion Chronological age alone does not provide a strong enough basis for appropriate ageing resource planning or policymaking. In China, concerted efforts should be made to reduce the ARDs burden and its disparities. Health resources should be deliberately allocated to western provinces facing the greatest health challenges due to future ageing. ⇒ This study uses longitudinal data from 1990 to 2016 in 31 provinces of Mainland China to assess the age-related disease (ARD) burdens. ⇒ The study generates high-quality evidence on disparities in ARD burdens across provinces, sexes and disease categories in China. ⇒ The study adopts robust fixed effects regression models to assess the impact of health expenditures and human resources for health indicators on the ARD burden. ⇒ Although the study has used the best data sources available for the analysis, future research could generate more up-to-date results once more recent data become available.

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