Archives of Public Health (Apr 2025)

Changes and trends in mortality, disability-adjusted life years, life expectancy, and healthy life expectancy in China from 1990 to 2021: a secondary analysis of the global burden of disease 2021

  • Xuelin Cheng,
  • Wenchang Jia,
  • Jing Zhou,
  • Yaxin Xu,
  • Jian Zou,
  • Ming Liu,
  • Sunfang Jiang,
  • Xiaopan Li

DOI
https://doi.org/10.1186/s13690-025-01558-8
Journal volume & issue
Vol. 83, no. 1
pp. 1 – 15

Abstract

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Abstract Background The aging population in China is increasingly evident, leading to a shift in the patterns of disease burden. This study aims to investigate changes and trends in mortality, disability-adjusted life years (DALYs), life expectancy (LE), and health-adjusted life expectancy (HALE) in China from 1990 to 2021. Methods This study presents a secondary analysis of data from the Global Burden of Disease Study 2021, with a focus on mortality, DALYs, LE, and HALE. We examined changes in these indicators in China from 1990 to 2021, comparing them with global averages and across five SDI regions. Using Joinpoint Regression Software, we analyzed trends in the top ten cause-specific DALY rates in 2021. Furthermore, we employed the Bayesian Age-Period-Cohort model to forecast age-standardized rates (ASR) of mortality for the next decade. Results China witnessed a decrease in the ASRs of mortality (1198.16/100,000 [1098.61–1294.10] to 644.68/100,000 [555.12–735.51]) and DALYs (43085.42/100,000 [39330.62–47273.39] to 22717.19/100,000 [19748.18–25903.34]) from 1990 to 2021. During the COVID-19 pandemic, the ASRs of mortality and DALY declined in China (23009.47/100,000 [19661.21–26495.58] in 2019), but global rates and those across the five SDI (Socio-demographic Index) regions increased. Projections indicate a continued decline in the ASRs of mortality over the next decade, from 2019 to 2035 and 2021 to 2035. Notably, DALY rates for the top 10 level 2 causes in 2021 decreased over the past three decades, except for musculoskeletal disorders (AAPC% 95%CI, 0.10 [0.07–0.14], men; 0.05 [-0.02–0.13], women) and sense organ diseases (AAPC% 95%CI, 0.38 [0.33–0.43], men; 0.35 [0.30–0.41], women). LE and HALE increased across all age groups in China over the same period, although there was no significant change in the HALE/LE ratio. Conclusion Effective policy implementation and technological advancements could play a crucial role in alleviating disease burdens associated with aging in China, thereby reducing the country's all-cause mortality rate and enhancing the quality of life for its residents.

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