Communicable disease mortality trends and characteristics of infants in rural China, 1996-2015

Background More attention should be paid to communicable disease-specific infant mortality rate (CD-IMR) in rural China. However, few studies have examined specific geographic patterns and trends in CD-IMR in these areas. Our aims were to assess the epidemiological distribution and trends in CD-IMR in rural China for the period 1996-2015. Methods We used data from China's Under-5 Child Mortality Surveillance System (U5CMSS). The time trends in communicable disease-specific IMR (CD-IMR) were assessed by Poisson regression model, and the proportion of total infant deaths due to communicable disease was assessed by the Cochran Armitage trend test. Differences in CD-IMR among and within geographic regions were assessed for significance using the Cochran-Mantel-Haenszel test. Results The overall CD-IMR fell by 86.0% from 1444.3 to 201.5 per 100,000 live births in rural mainland China from 1996 to 2015. The proportion of total infant deaths related to communicable disease fell from 33.4 to 19.7%. Using eastern rural areas as the reference, rate ratios (RRs) of IMR due to all communicable diseases ranged between 1.7 and 3.1 in central rural areas and between 4.4 and 9.8 in western areas during the four study intervals. Acute respiratory infection (ARI) accounted for 71% of deaths, followed by diarrhea and septicemia. Conclusions IMR due to communicable disease remains a major public health issue. ARI is the leading cause of mortality, followed by diarrhea. A regional gap remains in the risk of infant exposure to communicable disease in rural China. More attention should be paid to western rural areas.