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Publication date: 
June 24, 2019


Public health is a priority for the Chinese Government. Evidence-based decision-making for health at the province level in China, which is home to a fifth of the global population, is of paramount importance. This analysis uses data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to help inform decision-making and monitor progress on health at the province level.


We used the methods in GBD 2017 to analyze health patterns in the 34 province-level administrative units in China from 1990 to 2017. We estimated all-cause and cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life years (DALYs), summary exposure values (SEVs), and attributable risk. We compared the observed results with expected values estimated based on the Socio-demographic Index (SDI).


Stroke and ischemic heart disease were the leading causes of death and DALYs at the national level in China in 2017. Age-standardized DALYs per 100,000 population decreased by 33.1% (95% uncertainty interval [UI] 29.8 to 37.4) for stroke and increased by 4.6% (–3.3 to 10.7) for ischemic heart disease from 1990 to 2017. Age-standardized stroke, ischemic heart disease, lung cancer, chronic obstructive pulmonary disease, and liver cancer were the five leading causes of YLLs in 2017. Musculoskeletal disorders, mental health disorders, and sense organ diseases were the three leading causes of YLDs in 2017, and high systolic blood pressure, smoking, high-sodium diet, and ambient particulate matter pollution were among the leading four risk factors contributing to deaths and DALYs. All provinces had higher than expected DALYs per 100,000 population for liver cancer, with the observed to expected ratio ranging from 2.04 to 6.88. The all-cause age-standardized DALYs per 100,000 population were lower than expected in all provinces in 2017, and among the top 20 Level 3 causes were lower than expected for ischemic heart disease, Alzheimer’s disease, headache disorder, and low back pain. The largest percentage change at the national level in age-standardized SEVs among the top ten leading risk factors was in high body mass index (185%, 95% UI 113.1 to 247.7]), followed by ambient particulate matter pollution (88.5%, 66.4 to 116.4).


China has made substantial progress in reducing the burden of many diseases and disabilities. Strategies targeting chronic diseases, particularly in the elderly, should be prioritized in the expanding Chinese health care system.


Zhou M, Wang H, Zeng X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 24 June 2019. doi:10.1016/S0140-6736(19)30427-1.