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      Secular trends in HIV/AIDS mortality in China from 1990 to 2016: Gender disparities

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          Abstract

          Objectives

          HIV/AIDS has become the leading cause of death by infectious disease in China since 2009. However, the trend of gender disparities in HIV/AIDS has not been reported in China since 1990. Our study aimed to explore the secular trend of HIV/AIDS mortality in China from 1990 to 2016 and to identify its gender disparities over the past 27 years.

          Method

          The mortality data of HIV/AIDS were obtained from the Global Burden of Disease Study 2016 (GBD 2016). Logistic regression was used to estimate the prevalence odds ratio (POR) of gender for HIV/AIDS mortality in different surveys.

          Results

          The standardized mortality of HIV/AIDS in China rose dramatically from 0.33 per 100,000 people in 1990 to 2.50 per 100,000 people in 2016. The rate of HIV/AIDS mortality increased more quickly in men than in women, and the sex gap of mortality of HIV/AIDS widened. By 2016, the HIV/AIDS mortality in men was 3 times that in women and was 5.74 times that in women within the 75- to 79-year-old age group.

          Conclusions

          The mortality of HIV/AIDS in China is increasing, with a widening gender disparity. It is critical for policymakers to develop policies to eliminate these disparities and to ensure that everyone can live a long life in full health.

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          Most cited references36

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          Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970–2016: a systematic analysis for the Global Burden of Disease Study 2016

          Summary Background Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016. Methods We have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15–60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0·5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations into development quintiles based on the Socio-demographic Index (SDI) and analysed mortality trends by quintile. Using spline regression, we estimated the expected mortality rate for each age-sex group as a function of SDI. We identified countries with higher life expectancy than expected by comparing observed life expectancy to anticipated life expectancy on the basis of development status alone. Findings Completeness in the registration of deaths increased from 28% in 1970 to a peak of 45% in 2013; completeness was lower after 2013 because of lags in reporting. Total deaths in children younger than 5 years decreased from 1970 to 2016, and slower decreases occurred at ages 5–24 years. By contrast, numbers of adult deaths increased in each 5-year age bracket above the age of 25 years. The distribution of annualised rates of change in age-specific mortality rate differed over the period 2000 to 2016 compared with earlier decades: increasing annualised rates of change were less frequent, although rising annualised rates of change still occurred in some locations, particularly for adolescent and younger adult age groups. Rates of stillbirths and under-5 mortality both decreased globally from 1970. Evidence for global convergence of death rates was mixed; although the absolute difference between age-standardised death rates narrowed between countries at the lowest and highest levels of SDI, the ratio of these death rates—a measure of relative inequality—increased slightly. There was a strong shift between 1970 and 2016 toward higher life expectancy, most noticeably at higher levels of SDI. Among countries with populations greater than 1 million in 2016, life expectancy at birth was highest for women in Japan, at 86·9 years (95% UI 86·7–87·2), and for men in Singapore, at 81·3 years (78·8–83·7) in 2016. Male life expectancy was generally lower than female life expectancy between 1970 and 2016, and the gap between male and female life expectancy increased with progression to higher levels of SDI. Some countries with exceptional health performance in 1990 in terms of the difference in observed to expected life expectancy at birth had slower progress on the same measure in 2016. Interpretation Globally, mortality rates have decreased across all age groups over the past five decades, with the largest improvements occurring among children younger than 5 years. However, at the national level, considerable heterogeneity remains in terms of both level and rate of changes in age-specific mortality; increases in mortality for certain age groups occurred in some locations. We found evidence that the absolute gap between countries in age-specific death rates has declined, although the relative gap for some age-sex groups increased. Countries that now lead in terms of having higher observed life expectancy than that expected on the basis of development alone, or locations that have either increased this advantage or rapidly decreased the deficit from expected levels, could provide insight into the means to accelerate progress in nations where progress has stalled. Funding Bill & Melinda Gates Foundation, and the National Institute on Aging and the National Institute of Mental Health of the National Institutes of Health.
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            Evolution of China's response to HIV/AIDS

            Summary Four factors have driven China's response to the HIV/AIDS pandemic: (1) existing government structures and networks of relationships; (2) increasing scientific information; (3) external influences that underscored the potential consequences of an HIV/AIDS pandemic and thus accelerated strategic planning; and (4) increasing political commitment at the highest levels. China's response culminated in legislation to control HIV/AIDS—the AIDS Prevention and Control Regulations. Three major initiatives are being scaled up concurrently. First, the government has prioritised interventions to control the epidemic in injection drug users, sex workers, men who have sex with men, and plasma donors. Second, routine HIV testing is being implemented in populations at high risk of infection. Third, the government is providing treatment for infected individuals. These bold programmes have emerged from a process of gradual and prolonged dialogue and collaboration between officials at every level of government, researchers, service providers, policymakers, and politicians, and have led to decisive action.
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              The Burden of Cardiovascular Diseases Among US States, 1990-2016

              Key Points Question How does the total burden of cardiovascular diseases vary across US states? Findings In this study using the Global Burden of Disease methodology, large disparities in total burden of CVD were found between US states despite marked improvements in CVD burden. Meaning These estimates can provide a benchmark for states working to focus on key risk factors, improve health care quality, and lower health care costs.
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                Author and article information

                Contributors
                Role: Writing – original draft
                Role: Supervision
                Role: Writing – review & editing
                Role: Resources
                Role: Resources
                Role: Resources
                Role: Supervision
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                18 July 2019
                2019
                : 14
                : 7
                : e0219689
                Affiliations
                [001]Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, Beijing, China
                University of South Carolina Arnold School of Public Health, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-5616-7438
                Article
                PONE-D-18-37115
                10.1371/journal.pone.0219689
                6638923
                31318900
                aaf1d58f-8e81-4428-a080-57e2fb5a0521
                © 2019 Gao et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 31 December 2018
                : 29 June 2019
                Page count
                Figures: 4, Tables: 0, Pages: 10
                Funding
                Funded by: National Natural Science Foundation of China
                Award ID: 81673245
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: 81773454
                Award Recipient :
                This work was supported by the National Natural Science Foundation of China (No. 81673245 to YM, No 81773454 to ZZ) and China Scholarship Council (No 201806015008 to ZZ). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology and Life Sciences
                Population Biology
                Population Metrics
                Death Rates
                People and Places
                Population Groupings
                Age Groups
                Biology and Life Sciences
                Microbiology
                Medical Microbiology
                Microbial Pathogens
                Viral Pathogens
                Immunodeficiency Viruses
                HIV
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Pathogens
                Microbial Pathogens
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                HIV
                Biology and Life Sciences
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                HIV
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                HIV
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                Organisms
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                Retroviruses
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                Biology and Life Sciences
                Microbiology
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                Microbial Pathogens
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                Lentivirus
                HIV
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                Pathogens
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                Viral Pathogens
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                HIV
                Biology and Life Sciences
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                Viruses
                Viral Pathogens
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                Lentivirus
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                Medicine and Health Sciences
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                Global Health
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                Geographical Locations
                Asia
                China
                Medicine and health sciences
                Epidemiology
                HIV epidemiology
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                Population Groupings
                Sexuality Groupings
                Men WHO Have Sex with Men
                Biology and Life Sciences
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                Immunology
                Vaccination and Immunization
                Antiviral Therapy
                Antiretroviral Therapy
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                Preventive Medicine
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                Custom metadata
                Data were extracted from the GBD 2016 ( http://ghdx.healthdata.org/gbd-2016).

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