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Temporal Trends and Geographic Variations in Dementia Mortality in China Between 2006 and 2012: Multilevel Evidence From a Nationally Representative Sample

Yin, Peng PhD; Feng, Xiaoqi PhD; Astell-Burt, Thomas PhD; Page, Andrew PhD; Liu, Jiangmei MS; Liu, Yunning MS; Liu, Shiwei PhD; Wang, Lijun MD; Wang, Limin MD; Zhou, Maigeng PhD

Alzheimer Disease & Associated Disorders: October-December 2016 - Volume 30 - Issue 4 - p 348–353
doi: 10.1097/WAD.0000000000000147
Original Articles

Objectives: We aimed to explore the temporal trends and geographic variations in dementia mortality in China.

Materials and Methods: Annual dementia mortality counts (years 2006 to 2012) in 161 counties and districts (Disease Surveillance Points, DSP) were extracted from the nationally representative China Mortality Surveillance System and stratified by 5-year age group (aged >65), sex, and time. These counts were linked to annually adjusted denominator populations. Multilevel negative binomial regression with random intercepts and slopes were used to investigate spatiotemporal variation in dementia mortality.

Results: Dementia mortality varied over 2-fold between DSPs (median rate ratio: 2.59). Significant variation in DSP slopes through time (variance 0.075, SE 0.020) indicated spatiotemporal variations. Mortality rates were significantly higher in the east (rate ratio 2.28; 95% confidence intervals, 1.45-3.60) compared with the north. There was a declining trend in 2 (east and northwest) of the 7 regions. Dementia mortality decreased by 15% in urban areas but increased by 24% in rural areas.

Conclusions: Our findings indicate that regional inequalities in dementia mortality are salient, and the increase in mortality rates in rural areas is an emerging public health challenge in China. Tailored preventive health strategies should be in place to narrow down this avoidable and wholly unnecessary inequality.

*National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China

School of Health and Society, University of Wollongong

School of Science and Health, University of Western Sydney, Sydney, Australia

Supported by China National Science & Technology Pillar Program 2013 (2013BAI04B02) from Ministry of Science and Technology and the Australia-China Science and Research Fund (ACSRF17120). T.A.B. was supported by the National Heart Foundation of Australia.

The authors declare no conflicts of interest.

Reprints: Maigeng Zhou, PhD, National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, 100050 Beijing, China (e-mail:

Received June 8, 2015

Accepted February 16, 2016

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