Spatial, temporal and demographic patterns in asthma mortality in China: A systematic analysis from 2014 to 2020

Background: Asthma is an important contributor to the burden of non-communicable diseases in China. Understanding spatial, temporal, and demographic patterns in asthma mortality is relevant to the design and implementation of targeted interventions.Methods: This study collected information on asthma deaths occurring across 605 disease sur-veillance points (DSPs) as recorded in the population-based national mortality surveillance system (NMSS) of China. Asthma was defined according to the International Classification of Diseases, 10th Revision code J45-J46. Estimates of age-standardized mortality rates and total national asthma deaths were calculated based on yearly population data. Statistical analysis was performed to investigate the influence of various factors on asthma mortality.Results: Between 2014 and 2020, a total of 40 116 asthma deaths occurred in DSPs. Standard-ized asthma mortality per 100 000 people decreased from 1.79 (95% CI: 1.74-1.83) in 2014 to 1.07 (95% CI: 1.03-1.10) in 2020 in China. In 2020, the overall asthma mortality rate was higher for male patients than for female patients, and asthma mortality rates increased substantially with age. Age-standardized asthma mortality per 100,000 people exhibited significant geographic variation, ranging from 0.93 (95% CI: 0.89-0.98) in Eastern China to 1.04 (95% CI: 0.98-1.10) in Central China and 1.37 (95% CI: 1.29-1.45) in Western China in 2020. Asthma mortality in urban areas appeared to be higher than in rural areas. Socioeconomic factors, including gross domestic product per capita and density of hospital beds per 10,000 population, may be related to asthma mortality. Male asthma patients who lived in rural areas and were aged 65 years and above were generally at high risk of asthma-related mortality.Conclusions: This study found a spatial and temporal trend for a reduction in asthma deaths over seven years in China; however, there remain important sociodemographic groups that have not secured the same decrease in mortality rates.Trial registration: This was a purely observational study and thus registration was not required.