Patterns of Disease

China has been witness to one of the most rapid and profound changes in health patterns that has ever occurred in recorded history. This chapter gives pri­mary consideration to the disease patterns present in China in the 1980s; however, to place current events in context, one must start with a brief descrip­tion of the social, economic, and health situations that prevailed in 1949, the year the People’s Repub­lic was proclaimed.

Midcentury China emerged from yet another of what must seem to the Chinese a near endless cycle of natural and human-made disasters, in this case, more than two decades of foreign invasion, occupa­tion, and civil war. The country was completely exhausted. The World Bank estimated that in 1950 the Chinese population was 603 million; the birth rate, 42 per 1,000; the death rate, 33.5; the infant mortality rate, 252; and life expectancy at birth, 32 years (World Development Report 1987). With a very low per capita income and an extremely lim­ited health-care system, the predominant diseases were those associated with malnutrition and com­municable disease.

China’s disease patterns have changed so rapidly since the 1950s that it is helpful to compare the present situation with that estimated, by much less complete statistics, at around the time of the declara­tion of the People’s Republic in 1949. The first two

sections look at the causes of mortality and morbid­ity, with a brief consideration of regional variations, and the last section looks at selected causes of dis­ease, especially those that are unusually prevalent in China. Unless otherwise indicated, disease­specific data are from the 1984 World Bank report entitled China: The Health Sector. This source, as well as the 1986 publication Public Health in the People’s Republic of China, relies primarily on offi­cial Ministry of Public Health data sources, which are still subject to numerous limitations in both cov­erage and quality despite many improvements since the 1950s.

Figure VI.3.1. Mortality rates for the urban population of Shanghai, 1949-83. (From Public Health in the Peo­ple’s Republic of China (1986), p. 86.)

Mortality

Good historical data on mortality for all of China are not available. Figure VI.3.1, based on data from the urban population of Shanghai, China’s largest city, dramatically depicts the shift from mortality due largely to communicable disease, to a situation in which cardiovascular disease and malignant tumors predominate. The 10 leading causes of death in selected cities in 1957 and in both urban and rural areas in 1984 are listed in Table VI.3.1. The top three causes of death in 1957, all communicable diseases, accounted for 32.3 percent of all deaths, whereas by 1984 they amounted to less than 10 percent. By 1984 the top three causes - heart disease, cancer, and stroke - accounted for 64.9 percent of urban deaths and 54.9 percent of those in rural areas. Collectively, the top 10 causes accounted for almost 90 percent of all deaths in 1984, as compared with only two- thirds of those in 1957.

Wide interprovincial variations exist in the death rates due to the top three causes (see Table VI.3.2). Although these are likely explained in part by re­porting errors and age differences, they are probably

Table VI.3.1. Leading causes of death, selected cities and counties of Shanghai, 1957 and 1984

“Deaths per 100,000 population. ^fcPercent of total deaths.

“Deaths per 1,000 newborns.

Source: Adapted from Public Health in the People’s Republic of China (1986), table 4, p. 86.

Table VI.3.2. Leading provincial causes of death in China, 1985

“The numbers in parentheses refer to the death rate per 100,000.

⁶The classification of causes of death in Guangxi differs from that in other regions; the leading cause of death in Guangxi in 1985 was “aging and feebleness,” and the deaths attributed to this cause were omitted from the source table. Source: Based on data in Public Health in the People’s Republic of China (1986), table 3, p. 94.

also due to regional differences in environmental, nutritional, and other factors. Heart disease death rates are highest in the northern provinces, ranging from a high of 188 per 100,000 population in Jilin Province down to 73 in Shandong. Cancer rates are highest in the east, ranging from 122 in Jiangsu to 57 in Guangdong.

Morbidity

Communicable diseases reported for 1985 are given in Table VI.3.3. Though these estimates, especially for the less serious illnesses, are likely very much underreported, they do give some notion of the rela­tive frequency with which the various conditions are reported to the authorities.

Table VI.3.3. Communicable diseases in China, 1985

Source: Excerpted from Public Health in the People’s Re­public of China (1986), table 13, p. 218.

No national data exist on causes of morbidity or reasons for seeking health care, but a 1981 study of 737 households in Shanghai County (Parker et al. 1982) provides some indication of what illness pat­terns may be like. On the basis of a 2-week recall it was estimated that area residents annually aver­aged 6.0 days of restricted activity, 2.4 days in bed, 7.6 days lost from work, and 2.6 days lost from school. There were 44 hospitalizations per 1,000 re­spondents per year, and every 2 weeks there were 156 morbidity conditions, 49 cases of acute disabil­ity, and 187 primary care visits. In a survey of 3,122 people, 499 ill persons experienced 487 conditions. The percentages reporting the five leading condi­tions were as follows: respiratory, 27.3; gastrointesti­nal, 14.4; cardiovascular, 13.3; musculoskeletal, 7.8; and nervous system, 5.1.