Under-5-Years Child Mortality Due to Congenital Anomalies A Retrospective Study in Urban and Rural China in 1996-2013

Introduction: Congenital anomalies (CAs) contribute significantly to under-5-years child mortality (U5M) throughout the world. This study analyzed trends in the CA-specific U5M rate in urban and rural China. Methods: This population-based epidemiologic study used data obtained by China's National U5M Surveillance System from 1996 to 2013. Data from national surveillance sites were used to examine CA-specific U5M rates by year, urban and rural habitation, and sex. Mixed effect negative binomial regression models were used to assess the trends in CA-specific U5M rates and differences in those trends between urban and rural areas. Results: The CA-specific U5M rate decreased from 407.7 per 100,000 live births in 1996 to 217.4 per 100,000 live births in 2013, with average annual decline rates of 6.4% (95% CI=5.6%, 7.1%) and 3.8% (95% CI=-3.3%, 4.3%) in urban and rural areas, respectively. The CA-specific U5M rate was the same in both rural and urban areas in 1996, but the U5M rate of the rural areas was 1.621-fold of that of urban areas in 2013. In urban and rural China, cardiovascular anomalies were the most frequent CAs, accounting for 50.3% and 58.2% of U5M due to CA, respectively. Conclusions: CAs have become one of the leading causes of U5M in both urban and rural China and the difference between the CA-specific U5M rates in two areas is gradually increasing. Reduction of child mortality due to CAs and elimination of the geographic disparity in child mortality rates should be major public health concerns in China. (C) 2016 American Journal of Preventive Medicine