{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T20:30:17Z","timestamp":1791232217628,"version":"4.1.0"},"reference-count":30,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2024,9,24]],"date-time":"2024-09-24T00:00:00Z","timestamp":1727136000000},"content-version":"unspecified","delay-in-days":23,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"the Xi\u2019an Science and Technology Plan Project","award":["23YXYJ0122"],"award-info":[{"award-number":["23YXYJ0122"]}]},{"DOI":"10.13039\/501100007128","name":"Natural Science Foundation of Shaanxi Province","doi-asserted-by":"publisher","award":["2024JC-YBMS-736"],"award-info":[{"award-number":["2024JC-YBMS-736"]}],"id":[{"id":"10.13039\/501100007128","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,8,29]]},"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To analyse annual trends of the under-five mortality rate (U5MR) and main cause-specific U5MR in China from 1996 to 2020 and to assess the potential correlation of the healthcare system and health expenditure with the U5MR in China.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A retrospective observational study using national data from 1996 to 2020. Joinpoint regression was employed to model U5MR trends and Pearson correlation analysis was conducted to examine the relationship between healthcare system factors, health expenditure and U5MR.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Nationwide study covering both rural and urban populations across China over a 25-year period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The U5MR in China experienced a three-stage decline from 1996 to 2020 with an average annual percentage rate change (AAPC) of \u22127.27 (p&lt;0.001). The AAPC of the rural U5MR (\u22127.07, p&lt;0.001) was higher than that in urban areas (\u22125.57, p&lt;0.001). Among the five main causes, the decrease in pneumonia-caused U5MR was the fastest while the decreases in congenital heart disease and accidental asphyxia were relatively slow. The rates of hospital delivery (r=\u22120.981, p&lt;0.001), neonatal visits (r=\u22120.848, p&lt;0.001) and systematic health management (r=\u22120.893, p&lt;0.001) correlated negatively with U5MR. The proportion of government health expenditure in the total health expenditure (THE) correlated negatively with the national U5MR (r=\u22120.892, p&lt;0.001) while the proportion of out-of-pocket health expenditure in THE correlated positively (r=0.902, p&lt;0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>China made significant advances in reducing U5MR from 1996 to 2020. The rural\u2013urban gap in U5MR has narrowed, though rural areas remain a key concern. To further reduce U5MR, China should focus on rural areas, pay more attention to congenital heart disease and accidental asphyxia, further improve its health policies, and continue to increase the government health expenditure.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2023-077461","type":"journal-article","created":{"date-parts":[[2024,9,24]],"date-time":"2024-09-24T17:50:56Z","timestamp":1727200256000},"page":"e077461","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Trends in under-five mortality rate in China, 1996\u20132020: a Joinpoint regression and correlation analysis"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9693-4200","authenticated-orcid":false,"given":"Jian-Min","family":"Lv","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nan","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xi-Ning","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ya-Feng","family":"Tian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiao-Rong","family":"Fan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiong","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong-Xia","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,9,24]]},"reference":[{"key":"2024092410502110000_14.9.e077461.1","doi-asserted-by":"crossref","first-page":"e186","DOI":"10.1016\/S2214-109X(16)30334-5","article-title":"National and subnational all-cause and cause-specific child mortality in China, 1996-2015: a systematic analysis with implications for the Sustainable Development Goals","volume":"5","author":"He","year":"2017","journal-title":"Lancet Glob Health"},{"key":"2024092410502110000_14.9.e077461.2","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(16)31593-8"},{"key":"2024092410502110000_14.9.e077461.3","unstructured":"National Health Commission of the People\u2019s Republic of China . 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