Analysis of regional characteristics in mortality trends of three chronic infectious diseases among the elderly in China, 2004-2021.

Abstract

Background: HIV/AIDS, hepatitis B, and tuberculosis (TB) are chronic infectious diseases prioritized by the United Nations Sustainable Development Goals (SDGs) and China's "Healthy China Initiative (2019-2030)," posing persistent challenges to global and Chinese public health systems. This study analyzed mortality trends and regional/urban-rural disparities of these three diseases among Chinese elderly individuals aged 60 years and older from 2004 to 2021 to identify priority areas for targeted prevention strategies.

Methods: Data were sourced from the "China Cause-of-Death Surveillance Dataset (2004-2021)" published by the Chinese Center for Disease Control and Prevention. The study population comprised Chinese elderly individuals aged 60 years and older from 2004 to 2021. Joinpoint 4.9.0.1 software was used for joinpoint regression analysis to characterize dynamic mortality trends, calculating average annual percentage change (AAPC), annual percentage change (APC), and 95% confidence intervals (CIs).

Results: From 2004 to 2021, 100,934 deaths from the three chronic infectious diseases occurred among Chinese elderly. The overall age-standardized mortality rate (ASMR) decreased from 51.00 to 13.37 per 100,000 (AAPC: - 7.54%, 95% CI: - 9.38%, - 5.67%). Notably, the ASMR for HIV/AIDS increased from 0.11 to 0.85 per 100,000 population, while the ASMR for hepatitis B declined from 17.96 to 6.84 per 100,000 population and TB declined from 32.92 to 5.68 per 100,000 population. The three chronic infectious diseases collectively demonstrated the most significant ASMR reduction in central China (AAPC: - 7.85%, 95% CI: - 12.11%, - 3.39%), followed by eastern China (- 7.57%, 95% CI: - 9.02%, - 6.09%) and western China (- 7.10%, 95% CI: - 9.52%, - 4.62%). Rural areas experienced substantially steeper ASMR declines compared to urban areas (AAPC: - 7.81%, 95% CI: - 9.40%, - 6.18% vs. AAPC: - 6.05%, 95% CI: - 8.20%, - 3.85%).

Conclusion: China achieved a continuous decline in the overall ASMR for the three chronic infectious diseases among elderly populations during 2004-2021, suggesting initial success in prevention efforts. However, the rising ASMR for HIV/AIDS necessitates disease-specific strategies. Notable regional disparities persist: hepatitis B and TB remain concentrated in western/rural areas, while the ASMR for HIV/AIDS is higher in urban regions. Future efforts should tailor resource allocation to local contexts to enhance intervention outcomes and protect elderly health.