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Heart disease, cancer, cerebrovascular diseases, respiratory diseases, and endocrine, nutritional, and metabolic disorders are the top five leading non-communicable disease causes among Chinese residents.
Max
Roser (2021) - “Causes of death globally: what do people die from?” Published online at OurWorldinData.org. Retrieved from:
'https://ourworldindata.org/causes-of-death-treemap'[Online Resource]
Sources:https://ourworldindata.org/causes-of-death-treemap
https://ourworldindata.org/causes-of-death
Data
analysis is one of my areas of interest, and understanding the world and China
through data and facts is a commitment I have been pursuing. Over the past few
years, I have been teaching the course Understanding China With Data, using
publicly available data to analyze and understand the realities of Chinese
society. I have decided to share the lecture materials I’ve
written on CityReads.A
few months ago, I published an essay on CityReads analyzing China’s
college entrance examination (Gaokao) with data, shedding light on the
transformation of China’s higher education system (For
more details, see CityReads | Higher Education Transitions in China) Today, I
am using data to analyze the composition and changes in the causes of death
among Chinese residents, providing insights into China’s
health transition.To
move toward a healthier world and a healthier China, we must fully understand
the health challenges we face today. Among these challenges, understanding how
we die is a particularly meaningful question, as it helps identify effective ways
to save lives and improve public health.Epidemiologists
classify causes of death into three major categories: non-communicable
diseases, communicable diseases, and injuries. Injuries form a broad category
that includes both accidents, such as car crashes and falls, and intentional
harm, such as homicide, war-related deaths, and suicide. Globally,
non-communicable diseases are the leading causes of death.The
chart below shows the number and distribution of deaths worldwide in 2019. Each
rectangle in the chart represents a cause of death, with the size of the
rectangle proportional to its share. In 2019, approximately 55 million people
died worldwide. Of these, 74% died from non-communicable diseases, 14% from
communicable diseases, and about 8% from injuries. (Note that the total does
not add up to 100% due to other causes not included in the chart.)![]()
Source:https://ourworldindata.org/causes-of-death-treemap
In
the chart, the blue section represents non-communicable diseases, which are the
most common causes of death. Cardiovascular diseases rank first, accounting for
one-third of all deaths globally. Cancer comes second, responsible for 18% of
deaths worldwide, followed by chronic respiratory diseases, which account for
7% of deaths. Digestive diseases, neurodegenerative diseases, and diabetes
follow, contributing to 4.5%, 3.9%, and 2.9% of deaths, respectively.The
red section in the chart represents communicable diseases, which are caused by
pathogens that can spread from person to person. In 2019, about one in seven
deaths globally was due to communicable diseases, including pneumonia,
diarrhea, tuberculosis, HIV/AIDS, and malaria.The
green section of the chart represents injuries. In 2019, traffic accidents
accounted for 2.3% of all deaths, other accidents (such as falls, drowning, and
fires) made up 3.1%, suicides accounted for 1.3%, and deaths from interpersonal
violence, including homicide or war-related fatalities, were less than 1%.The
proportions of causes of death differ significantly from media coverage and
public perception. Some major causes of death receive little attention, while
causes heavily reported in the media often account for a relatively small
proportion. For instance, globally, deaths from diarrhea account for 2.7%—much
higher than the total share of deaths from all forms of violence (homicide,
war, and terrorism), which is less than 1%.How Chinese Residents Die?According
to data from the National Health Commission of China, the causes of death among
Chinese residents are categorized into 19 specific subtypes, which can
generally be grouped into three major categories: non-communicable diseases,
communicable diseases, and injuries/poisoning due to external causes.Non-communicable
diseases include 14 types of illnesses: heart disease, malignant tumors
(cancer), cerebrovascular diseases, respiratory diseases, endocrine,
nutritional, and metabolic disorders, digestive system diseases, nervous system
diseases, genitourinary system diseases, mental disorders, musculoskeletal and
connective tissue diseases, blood, hematopoietic, and immune diseases,
congenital malformations, deformations, and chromosomal abnormalities,
perinatal diseases, and complications of pregnancy, childbirth, and the
postpartum period.Communicable
diseases consist of infectious and parasitic diseases. Infectious diseases
include dysentery, other bacterial intestinal infections, respiratory
tuberculosis, tetanus, meningococcal infections, sepsis, sexually transmitted
diseases, rabies, epidemic Japanese encephalitis, viral hepatitis, and
HIV/AIDS. Parasitic diseases primarily include schistosomiasis.Injuries
and poisoning include traffic accidents, accidental poisoning, accidental
falls, fires, drowning, mechanical asphyxiation, being crushed to death,
electrocution, suicide, and homicide.Other
causes include undiagnosed and miscellaneous diseases, and it is worth noting
that the sum of all 19 causes does not add up to 100%.Similar
to global trends, non-communicable diseases are the leading cause of death
among Chinese residents, accounting for an overwhelming majority. As shown in
the charts below, in 2021, non-communicable diseases accounted for 88.89% of
deaths among rural residents and 90.34% among urban residents.The
proportion of deaths caused by communicable diseases in China is far lower than
the global average (14%). In 2021, communicable diseases accounted for 0.89%
and 0.83% of deaths among rural and urban residents, respectively. Injuries and
poisoning accounted for 7.13% of deaths in rural areas and 5.46% in urban
areas.![]()
Source:
calculated based on data from National Health Commission of China
![]()
Source:
calculated based on data from National Health Commission of China
Now
let’s look at the detailed composition of non-communicable disease (NCD) deaths
among Chinese residents. In 2021, the leading causes of NCD deaths among rural
residents in China, ranked from highest to lowest, were as follows:1.Heart
disease, accounting for 25.36%
2.Cerebrovascular
diseases, accounting for 23.62%
3.Cancer,
accounting for 22.47%
4.Respiratory
diseases, accounting for 8.77%
5.Endocrine,
nutritional, and metabolic disorders, accounting for
2.84%
6.Digestive
system diseases, accounting for 2.15%
7.Nervous
system diseases, accounting for 1.37%
8.Genitourinary
system diseases, accounting for 1.06%
9.Mental
disorders, accounting for 0.48%
10.Musculoskeletal
and connective tissue diseases, accounting for
0.33%
11.Diseases
of the blood, hematopoietic organs, and immune system,
accounting for 0.18%
12.Congenital
malformations, deformations, and chromosomal abnormalities,
accounting for 0.14%
13.Perinatal
diseases, accounting for 0.11%
14.Complications
of pregnancy, childbirth, and the postpartum period,
accounting for 0.01%
![]()
Source：National
Health Commission of ChinaNote: The chart only includes causes of death with a
proportion exceeding 1%.In
2021, the leading causes of non-communicable disease (NCD) deaths among urban
residents in China, ranked from highest to lowest, were as follows:1.Heart
disease, accounting for 25.64%
2.Cancer,
accounting for 24.61%
3.Cerebrovascular
diseases, accounting for 21.71%
4.Respiratory
diseases, accounting for 8.45%
5.Endocrine,
nutritional, and metabolic disorders, accounting for
3.74%
6.Digestive
system diseases, accounting for 2.39%
7.Nervous
system diseases, accounting for 1.46%
8.Genitourinary
system diseases, accounting for 1.05%
9.Mental
disorders, accounting for 0.54%
10.Musculoskeletal
and connective tissue diseases, accounting for
0.3%
11.Diseases
of the blood, hematopoietic organs, and immune system,
accounting for 0.21%
12.Congenital
malformations, deformations, and chromosomal abnormalities,
accounting for 0.13%
13.Perinatal
diseases, accounting for 0.11%.
![]()
Source：National
Health Commission of ChinaNote: The chart only includes causes of death with a
proportion exceeding 1%.Comparing Differences in Non-Communicable Disease Death
Causes Between Urban and Rural Residents in China (2021)The
proportion of urban residents dying from cancer is slightly higher than that of
rural residents (24.61% vs. 22.47%). Conversely, the proportion of urban
residents dying from cerebrovascular diseases is slightly lower than that of
rural residents (21.71% vs. 23.62%). The proportion of deaths caused by
endocrine, nutritional, and metabolic disorders is higher among urban residents
than rural residents (3.74% vs. 2.84%). Urban residents have a lower proportion
of deaths from complications of pregnancy, childbirth, and the postpartum
period; while rural residents' proportion stands at 0.01%, this figure is so
low among urban residents that it is statistically recorded as zero.These
differences in non-communicable disease mortality between urban and rural
residents highlight disparities in healthcare access and lifestyle between the
two populations.Changes in the Composition of Causes of Death in China (1990
vs. 2021)Comparing
1990 with 2021, non-communicable diseases (especially chronic and degenerative
diseases) remain the leading causes of death among Chinese residents, and their
proportion has increased over time. Among urban residents, the proportion rose
from 86.29% in 1990 to 90.34% in 2021. For rural residents, the figure
increased from 82.01% in 1990 to 88.89% in 2021.In
contrast, the proportion of deaths caused by communicable diseases has
significantly declined. Among urban residents, it dropped from 3.57% in 1990 to
0.83% in 2021, while for rural residents, it fell from 5.66% to 0.89%.
Similarly, the proportion of deaths caused by injuries and poisoning has also
decreased. For urban residents, it declined from 6.91% in 1990 to 5.46% in
2021, and for rural residents, it fell from 10.65% to 7.13%.Epidemiological Transition in China (1949–2023)Since
1949, China has undergone demographic and epidemiological transitions, moving
from a high birth rate and high mortality rate to a low birth rate and low
mortality rate. Causes of death have shifted from predominantly infectious
diseases to non-communicable diseases. Life expectancy has more than doubled,
rising from 35 years before 1949 to 78.6 years in 2023. Chronic and
degenerative diseases have become the dominant causes of death in this evolving
health landscape.![]()
Source：National
Health Commission of China
Composition of Non-Communicable Disease Mortality CausesIn
1990, the top five causes of death from non-communicable diseases among urban
residents in China were cancer, cerebrovascular diseases, heart disease,
respiratory diseases, and digestive system diseases. Among rural residents, the
top five causes were respiratory diseases, cancer, cerebrovascular diseases,
heart disease, and digestive system diseases.By
2021, the top five non-communicable disease causes of death among urban
residents had shifted to heart disease, cancer, cerebrovascular diseases,
respiratory diseases, and endocrine, nutritional, and metabolic disorders.
Among rural residents, the top five non-communicable disease causes were heart
disease, cerebrovascular diseases, cancer, respiratory diseases, and endocrine,
nutritional, and metabolic disorders.With
rapid urbanization, heart disease, cancer, and cerebrovascular diseases have
become the leading non-communicable disease causes of death for both urban and
rural residents in China.![]()
Source：National
Health Commission of China
In
his book Outlive: The Science and Art of Longevity, Dr. Peter Attia explains
how the world has transitioned from a "fast death" to a "slow
death" society since 1900. In 1900, the global average life expectancy was
less than 50 years, and most people died from "fast" causes such as
accidents, injuries, and various infectious diseases. By 2021, the global
average life expectancy had risen to 71 years, with chronic diseases of aging
becoming the primary causes of death.Dr.
Attia categorizes these chronic diseases into what he calls the "Four
Horsemen of Death": cardiovascular disease (CVD), cancer,
neurodegenerative diseases, and diabetes along with related metabolic disorders
(for more details, see CityReads | Outlive: How to Extend Healthspan?).Today,
the primary non-communicable disease causes of death among Chinese residents
align closely with the "Four Horsemen." Achieving healthy longevity
requires understanding and addressing the root causes of these chronic diseases
as early as possible.
1.“P53
may also hold the key to Peto’s paradox, an oddity observed in the 1970s
by the British epidemiologist Richard Peto. Large animals such as elephants or
whales can have a hundred times as many cells as we do. Even accounting for
their slower metabolism, this means there is a much greater chance that one of
their cells will mutate to become cancerous. Yet these large mammals are
remarkably resistant to cancer and live almost as long or even longer than us.
Humans inherit one copy of the gene for p53 from each of our parents, but it
turns out that elephants have twenty copies. Therefore their cells are
exquisitely sensitive to DNA damage and commit suicide when it is detected.” - Venki
Ramakrishnan, Why We Die: The New Science of Aging and the Quest for
Immortality![]()
2.“Toward
the end of World War II, between September 1944 and May 1945, the Netherlands
suffered from a devastating famine that would claim the lives of more than
20,000 people. A later study showed that despite the relatively brief duration
of the famine, the children of women who were pregnant during the mass
starvation suffered adverse physical and mental health consequences throughout
their lives. They experienced higher rates of obesity, diabetes, and
schizophrenia, and had a higher mortality than children who were not in utero
during the famine. The effects were even different depending on whether the
famine occurred in the early or late stages of pregnancy. Comparing the DNA of
subjects who had experienced starvation in utero with those of their older and
younger siblings was revealing: the famine had imposed on the fetus a
methylation pattern that had consequences over the course of its life and
accelerated both aging-related diseases and mortality. It is a striking example
of how an external stress can cause epigenetic changes to DNA that last a
lifetime.”- Venki Ramakrishnan, Why We Die: The New Science of Aging and the
Quest for Immortality
