Abstract:

Objective To analyze the mortality trends of respiratory tract infections (RTIs) in China from 2004 to 2021, and to assess the impact of non-pharmaceutical interventions (NPIs) during COVID-19 epidemic on RTIs mortality, as well as to quantify the potential effect of RTIs on potential gains in life expectancy. Methods Data on the deaths from RTIs between 2004 and 2021 were collected from the Chinese National Cause of Death Surveillance Dataset. The crude mortality rate (CMR) of RTIs was standardized to calculate the age-standardized mortality rate (ASMR). The Joinpoint regression model was applied to analyze the temporal trends of RTIs mortality. The autoregressive integrated moving average with exogenous variables (ARIMAX) model was constructed to estimate the impact of NPIs. Potential gains in life expectancy (PGLEs) were used to quantify the impact of RTIs on life expectancy. Results From 2004 to 2021, both the CMR and ASMR of RTIs in China showed an overall declining trend (AAPC=-2.10%, -5.65%; t=-2.79, -2.94; all P<0.05), and the overall ASMRs tended to decline in both males and females (AAPC=-4.49%, -7.64%; t=-2.68, -4.57; all P<0.05) as well as in rural areas (AAPC=-7.37%, t=-5.46, P<0.001), whereas the overall trend remained no statistical significance in urban areas (AAPC=-3.10%, t=-1.63, P>0.05). The ASMRs in eastern, central and western regions all presented declining trends over the period (AAPC=-4.38%, -6.93%, -5.58%; t=-3.40, -4.67, -2.28; all P<0.05). The ARIMAX model revealed that NPIs were significantly associated with a 3.15-unit reduction in ASMR (P<0.05), and counterfactual analysis indicated that NPIs reduced ASMR by 33.80% and 41.16% in 2020 and 2021, respectively. PGLEs decreased from 0.38 years in 2004 to 0.15 years in 2021, with PGLEs being higher in females (0.30 years) than in males (0.17 years), and higher in rural areas (0.31 years) than in urban areas (0.03 years). Additionally, PGLEs were higher in western regions than those in eastern and central regions (0.47 years vs. 0.09 and 0.14 years, respectively). Conclusion RTIs mortality in China has generally declined, with NPIs significantly reducing the RTIs mortality burden during 2020-2021. The impact of RTIs on life expectancy has gradually weakened, yet significant disparities exist across regions and populations. These findings suggest that prevention and control efforts should be grounded among the elderly and rural residents, while normalizing the protective measures on a long-term basis.

Key words: Respiratory tract infections, Mortality, Joinpoint regression model, ARIMAX model, Potential gains in life expectancy