{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T17:32:48Z","timestamp":1786383168436,"version":"build-2736575974"},"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Open Research Fund of National Health Commission Key Laboratory of Birth Defects Prevention","award":["ZD202308"],"award-info":[{"award-number":["ZD202308"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Objectives<\/jats:title>\n Our study aimed to analyze congenital heart disease (CHD) mortality trends among Chinese residents aged 0\u201364 years from 2002 to 2021 and assess the impact of implementing the medical insurance policy (MIP) for rural children on CHD mortality.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Data on CHD mortality in urban and rural regions of China from 2002 and 2021 were collected from the China Health Statistics Yearbook. Because mortality data for individuals aged \u226565 years were incomplete and lacked specificity for CHD, the analysis was restricted to those aged 0\u201364 years. Joinpoint regression was used to analyze trends in CHD mortality by region, sex, and age group, and interrupted time series analysis was used to evaluate the impact of the MIP on CHD mortality.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Between 2002 and 2021, the standardized CHD mortality among Chinese residents was higher in rural areas than in urban areas, and higher in males than in females. CHD mortality for rural and urban residents declined at an average annual percentage change (AAPC) of \u22123.63% (95% CI: \u22124.84%\u2009~\u2009\u22122.40%) and \u22124.99% (95% CI: \u22128.38%\u2009~\u2009\u22121.47%), respectively. Male mortality decreased more than female mortality. Mortality in the\u2009<\u20091, 1\u22124, 5\u22129, 35\u221239, and 40\u221244 age groups have been declining over the past 20 years; Furthermore, CHD mortality in rural areas has gradually decreased since the implementation of MIP (\n \u03b2<\/jats:italic>\n \n 3<\/jats:italic>\n <\/jats:sub>\n \u2009=\u2009\u22120.073,95% CI: \u22120.100\u2009~\u2009\u22120.045).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n In China, CHD mortality declined from 2002 to 2021, with variations still present based on gender, age, and region. Future prevention and control measures should be strengthened for specific populations in different regions.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0354694","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T17:26:18Z","timestamp":1786382778000},"page":"e0354694","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Trends and interrupted time series analysis of congenital heart disease mortality among the Chinese population aged 0\u201364 years, 2002\u20132021"],"prefix":"10.1371","volume":"21","author":[{"given":"Runfang","family":"Tian","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yucan","family":"Deng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinfeng","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panpan","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8924-0761","authenticated-orcid":true,"given":"Zhiguang","family":"Ping","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"pone.0354694.ref001","year":"2023"},{"issue":"5","key":"pone.0354694.ref002","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1016\/j.amepre.2015.12.013","article-title":"Under-5-years child mortality due to congenital anomalies: A retrospective study in urban and rural China in 1996-2013","volume":"50","author":"H Cui","year":"2016","journal-title":"Am J Prev Med"},{"issue":"4","key":"pone.0354694.ref003","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1007\/s12519-018-0174-2","article-title":"Current status of screening, diagnosis, and treatment of neonatal congenital heart disease in China","volume":"14","author":"X-J Ma","year":"2018","journal-title":"World J Pediatr"},{"key":"pone.0354694.ref004","first-page":"100623","article-title":"Inpatient costs of congenital heart surgery in China: Results from the National Centre for Cardiovascular Diseases","volume":"31","author":"Q He","year":"2022","journal-title":"Lancet Reg Health West Pac"},{"issue":"10204","key":"pone.0354694.ref005","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1016\/S0140-6736(19)30427-1","article-title":"Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017","volume":"394","author":"M Zhou","year":"2019","journal-title":"Lancet"},{"key":"pone.0354694.ref006","volume-title":"China Health Statistical Yearbook","author":"National Health Commission","year":"2003"},{"issue":"10","key":"pone.0354694.ref007","first-page":"756","article-title":"Suicide rate trends in China from 2002 to 2015","volume":"31","author":"Z Liu","year":"2017","journal-title":"Chinese Mental Health Journal"},{"issue":"3","key":"pone.0354694.ref008","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1002\/(SICI)1097-0258(20000215)19:3<335::AID-SIM336>3.0.CO;2-Z","article-title":"Permutation tests for joinpoint regression with applications to cancer rates","volume":"19","author":"HJ Kim","year":"2000","journal-title":"Stat Med"},{"issue":"01","key":"pone.0354694.ref009","first-page":"41","article-title":"An introduction to interrupted time series design in evaluating the effect of public health interventions and its application","volume":"40","author":"X Xu","year":"2023","journal-title":"Chinese Journal of Health Statistics"},{"key":"pone.0354694.ref010","year":"2010"},{"issue":"3","key":"pone.0354694.ref011","first-page":"267","article-title":"Trends in the disease burden of congenital heart disease in China over the past three decades","volume":"51","author":"F Pan","year":"2022","journal-title":"Zhejiang Da Xue Xue Bao Yi Xue Ban"},{"key":"pone.0354694.ref012","doi-asserted-by":"crossref","first-page":"101249","DOI":"10.1016\/j.eclinm.2021.101249","article-title":"Global, regional, and national time trends in mortality for congenital heart disease, 1990-2019: An age-period-cohort analysis for the Global Burden of Disease 2019 study","volume":"43","author":"Z Su","year":"2022","journal-title":"EClinicalMedicine"},{"issue":"3","key":"pone.0354694.ref013","first-page":"269","article-title":"Comparison of trends in congenital heart disease mortality from 1990 to 2017 between China and North America","volume":"49","author":"ZH Su","year":"2021","journal-title":"Zhonghua Xin Xue Guan Bing Za Zhi"},{"key":"pone.0354694.ref014","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.amjcard.2020.10.040","article-title":"Associations between socioeconomic context and congenital heart disease related outcomes in adolescents and adults","volume":"139","author":"AR Tillman","year":"2021","journal-title":"Am J Cardiol"},{"issue":"1","key":"pone.0354694.ref015","article-title":"Pediatric heart surgery in China: Progress and challenges","volume":"2","author":"X Mo","year":"2019","journal-title":"World Jnl Ped Surgery"},{"issue":"7","key":"pone.0354694.ref016","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1016\/S2352-4642(23)00051-2","article-title":"Current status and challenges in prenatal and neonatal screening, diagnosis, and management of congenital heart disease in China","volume":"7","author":"Y Zhang","year":"2023","journal-title":"Lancet Child Adolesc Health"},{"key":"pone.0354694.ref017","year":"2018"},{"key":"pone.0354694.ref018","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCULATIONAHA.109.928325","article-title":"Sex differences in mortality in children undergoing congenital heart disease surgery: a United States population-based study","volume":"122","author":"A Marelli","year":"2010","journal-title":"Circulation"},{"issue":"2","key":"pone.0354694.ref019","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1002\/bdra.23218","article-title":"Sex prevalence of major congenital anomalies in the United Kingdom: A national population-based study and international comparison meta-analysis","volume":"100","author":"R Sokal","year":"2014","journal-title":"Birth Defects Res A Clin Mol Teratol"},{"issue":"19","key":"pone.0354694.ref020","doi-asserted-by":"crossref","first-page":"2376","DOI":"10.1161\/01.CIR.103.19.2376","article-title":"Mortality associated with congenital heart defects in the United States: Trends and racial disparities, 1979-1997","volume":"103","author":"RS Boneva","year":"2001","journal-title":"Circulation"},{"issue":"20","key":"pone.0354694.ref021","doi-asserted-by":"crossref","first-page":"2195","DOI":"10.1161\/CIRCULATIONAHA.111.027763","article-title":"Surgery in adults with congenital heart disease","volume":"124","author":"AC Zomer","year":"2011","journal-title":"Circulation"},{"issue":"10355","key":"pone.0354694.ref022","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1016\/S0140-6736(22)01441-6","article-title":"Metabolic, behavioural, and psychosocial risk factors and cardiovascular disease in women compared with men in 21 high-income, middle-income, and low-income countries: An analysis of the PURE study","volume":"400","author":"M Walli-Attaei","year":"2022","journal-title":"Lancet"},{"issue":"14","key":"pone.0354694.ref023","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.3390\/healthcare12141405","article-title":"An assessment of health behaviours in primary care patients: A cross-sectional study","volume":"12","author":"B Gaw\u0142owska","year":"2024","journal-title":"Healthcare (Basel)"},{"issue":"12","key":"pone.0354694.ref024","doi-asserted-by":"crossref","first-page":"1132","DOI":"10.1161\/CIRCULATIONAHA.120.046822","article-title":"US mortality attributable to congenital heart disease across the lifespan from 1999 through 2017 exposes persistent racial\/ethnic disparities","volume":"142","author":"KN Lopez","year":"2020","journal-title":"Circulation"},{"key":"pone.0354694.ref025","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.ijcard.2019.05.010","article-title":"Does gender affect the prognosis and risk of complications in patients with congenital heart disease in the modern era?","volume":"290","author":"M D\u2019Alto","year":"2019","journal-title":"Int J Cardiol"},{"issue":"6","key":"pone.0354694.ref026","first-page":"1063","article-title":"Analysis of under-5 mortality in Henan, 2000-2020","volume":"50","author":"L Jia","year":"2023","journal-title":"Modern Preventive Medicine"},{"issue":"9","key":"pone.0354694.ref027","first-page":"1019","article-title":"Analysis of mortality monitoring results of children under 5 years old in Shaanxi Province from 2010 to 2020","volume":"27","author":"M Li","year":"2023","journal-title":"Chinese Journal of Disease Control and Prevention"},{"issue":"11","key":"pone.0354694.ref028","first-page":"1249","article-title":"The analysis on the change and trend of the congenital heart disease mortality rate in children aged 0-1 in China from 2004 to 2018","volume":"54","author":"WJ Shang","year":"2020","journal-title":"Zhonghua Yu Fang Yi Xue Za Zhi"},{"issue":"12","key":"pone.0354694.ref029","doi-asserted-by":"crossref","first-page":"879","DOI":"10.3390\/biom9120879","article-title":"Genetics of congenital heart disease","volume":"9","author":"K Williams","year":"2019","journal-title":"Biomolecules"},{"issue":"1","key":"pone.0354694.ref030","doi-asserted-by":"crossref","DOI":"10.1016\/j.ajog.2009.08.005","article-title":"Association between prepregnancy body mass index and congenital heart defects","volume":"202","author":"SM Gilboa","year":"2010","journal-title":"Am J Obstet Gynecol"},{"issue":"1","key":"pone.0354694.ref031","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1186\/s12884-024-06529-5","article-title":"Maternal cardiovascular health in early pregnancy and the risk of congenital heart defects in offspring","volume":"24","author":"D-W Zhang","year":"2024","journal-title":"BMC Pregnancy Childbirth"},{"issue":"7","key":"pone.0354694.ref032","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1161\/CIRCULATIONAHA.122.061245","article-title":"Maternal exposure to PM2.5 and the risk of congenital heart defects in 1.4 million births: A nationwide surveillance-based study","volume":"147","author":"X Yuan","year":"2023","journal-title":"Circulation"},{"issue":"11","key":"pone.0354694.ref033","doi-asserted-by":"crossref","first-page":"101341","DOI":"10.1016\/j.cpcardiol.2022.101341","article-title":"Geographical and socioeconomic factors influence the birth prevalence of congenital heart disease: A population-based cross-sectional study in Eastern China","volume":"47","author":"F Pan","year":"2022","journal-title":"Curr Probl Cardiol"},{"issue":"4","key":"pone.0354694.ref034","doi-asserted-by":"crossref","DOI":"10.1016\/j.jpeds.2014.11.042","article-title":"Risk of congenital heart defects in the offspring of smoking mothers: A population-based study","volume":"166","author":"PM Sullivan","year":"2015","journal-title":"J Pediatr"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0354694","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T17:26:23Z","timestamp":1786382783000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0354694"}},"subtitle":[],"editor":[{"given":"Sameer Sheshrao","family":"Gajghate","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,8,10]]},"references-count":34,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,10]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0354694","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,10]]}}}