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Overall, the IMR of China underwent a notable decrease from 1990 to 2019, with variations in cause-specific IMRs and proportions of infant deaths being observed over the period.
Table 1 shows the numbers of infant deaths in 1990, 2000, 2010, and 2019, and percentage changes over the period 1990–2019. In 2019, a total of 101.9 (95% UI: 88.6–116.4) thousand deaths occurred in the infant period, which decreased by 89.9% from 1990 to 2019. China’s IMR decreased by 84.3% from 43.2 deaths per 1,000 live births in 1990 to 6.8 deaths per 1,000 live births in 2019, with the rate in males being consistently higher than females. The IMR in China was considerably lower than the global level (Figure 1A).
Item Deaths ( thousand) (95% uncertainty intervals) YLLs ( thousand) (95% uncertainty intervals) 1990 2000 2010 2019 Percentage change (%), 1990–2019 1990 2000 2010 2019 Percentage change (%), 1990–2019 Early neonatal
(0–6 days)258.7
(231.1−287.0)178.2
(162.4−194.0)77.9
(70.9−85.2)43.0
(37.4−49.0)−83.4 22,988.8
(20,538.8−25,505.2)15,831.6
(14,429.6−17,239.7)6,919.8
(6,296.9−7571.2)3,821.5
(3,325.5−4358.2)−83.4 Late neonatal
(7–28 days)109.8
(98.3−121.6)50.5
(46.0−55.0)21.0
(19.2−22.9)13.4
(11.7−15.3)−87.8 9,755
(8,727.7−10,803.1)4,489.1
(4,088.5−4,886.6)1,868.4
(1,703.1−2,038.3)1,193.9
(1,040.3−1,362.5)−87.8 Post neonatal
(29–364 days)645.1
(579.2−713.5)250.6
(228.4−273.4)81.1
(74.0−88.7)45.5
(39.6−51.9)−92.9 57,029
(51,203.4−63,076.7)22,152.4
(20,187.2−24,167.4)7,169.1
(6,539.6,7844.0)4,021.9
(3,497.3−4,583.8)−92.9 <1 year 1,013.6
(908.0−1,121.6)479.3
(436.7−522.3)180.0
(164.2−196.7)101.9
(88.6−116.4)−89.9 89,772.8
(80,422.4−99,338.2)42,473.0
(38,695.5−46,286.8)15,957.2
(14,556.4,17437.6)9,037.3
(7,857.3−10,322.3)−89.9 Abbreviation: YLL=years of life lost. Table 1. Number of infant deaths and YLLs and percentage change (%) from 1990 to 2019, China.
Figure 1.The trends of infant mortality rates by sex and cause in China, 1990–2019. (A) The trend of infant mortality rates by sex; (B) The trend of infant mortality rates by five main causes.
YLLs caused by infant deaths decreased considerably from 89.8 (80.4–99.3) million in 1990 to 9.0 (7.9–10.3) million in 2019. Relative changes in YLLs and deaths in infants between 1990 and 2019 were homogeneous (Table 1).
In 2019, 55.4% of infant deaths occurred in the neonatal (early and late) period. The age composition of infant deaths has progressively changed during the past 30 years. In 1990, 36.4% (25.5% early-neonatal and 10.9% late-neonatal) of total infant deaths occurred during the neonatal period, and the proportion increased from 47.7% (37.2% early-neonatal and 10.5% late neonatal) in 2000 to 54.9% (43.3% early-neonatal and 11.6% late-neonatal) in 2010. By 2019, the age composition of infant deaths shifted to 42.2% for early-neonatal and 13.2% for late-neonatal. The trend of infant YLLs by age group was similar to that of deaths (Table 1).
Figure 1B focuses on IMRs for five main causes of infant death. In 2019, the 2 leading causes of deaths in infancy were preterm birth and congenital heart anomalies. Lower respiratory infection was the leading cause of infant death in both 1990 and 2000, whereas it fell in the fourth rank in 2019, with its IMR decreasing by 93.9% from 13.6 per 1,000 live births in 1990 to 0.8 per 1,000 live births in 2019. From 1990 to 2019, preterm birth, congenital heart anomalies, pulmonary aspiration and foreign body in airway, and syphilis accounted for increasing proportions of deaths, whereas the proportions in neural tube defects and some infectious diseases, such as lower respiratory infection and diarrheal disease, showed an opposite downward trend. A diverging trend in proportions of deaths due to neonatal encephalopathy birth asphyxia and trauma between 1990–2000 and 2010–2019 was observed (Figure 2).
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