{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T06:05:19Z","timestamp":1784613919998,"version":"3.55.0"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>While China has achieved significant milestones in controlling infectious diseases, how mortality patterns have shifted across different life stages remains poorly understood. This study aims to delineate the evolving burden of infectious disease mortality to inform age-specific public health strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed national death surveillance data from China spanning 2004 to 2021. \u201cCombined infectious mortality\u201d was defined as the aggregate of communicable and parasitic diseases plus respiratory infections. Focusing on four key categories\u2014respiratory infections, tuberculosis, viral hepatitis, and HIV\/AIDS\u2014we calculated crude and age-standardized mortality rates (ASMR). Log-linear regression models estimated annual percentage changes (EAPCs). Primary trend inferences were restricted to 2013\u20132019 (stable post-expansion period); 2020\u20132021 was treated separately due to the absence of a COVID-19 code.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During 2013\u20132019, mortality declined substantially faster in younger than in older age groups: EAPC was \u221214.70% (95% CI \u201316.96 to \u221212.38) for children aged 0\u20134\u202fyears, but only \u22121.62% (95% CI \u20133.66 to 0.46) for adults aged 75\u202f+\u202f(interaction\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.0001). In 2021, over half (55.04%) of combined infectious deaths occurred in adults aged 75+. Cause hierarchy varied by age: respiratory infections dominated at both extremes; HIV\/AIDS ranked highest among young adults (20\u201339\u202fyears), though its advantage was narrow; viral hepatitis predominated in middle-aged adults (40\u201359\u202fyears). HIV\/AIDS mortality rose among 60\u201374\u202fyear-olds (EAPC 5.90% per year), with higher burden in rural and western regions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>China is undergoing a distinctive epidemiological transition: infectious deaths are increasingly concentrated in older age groups, driven primarily by divergent age-specific mortality trends rather than population ageing alone. Public health strategies must extend beyond maternal-child health frameworks to address growing vulnerabilities in older populations\u2014particularly respiratory infections and HIV in ageing rural communities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1881091","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T05:36:13Z","timestamp":1784612173000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Life-course restructuring of infectious mortality in China, 2004\u20132021: a national surveillance study"],"prefix":"10.3389","volume":"14","author":[{"given":"Liu","family":"Binglian","sequence":"first","affiliation":[{"name":"Sichuan University Affiliated Chengdu Second People's Hospital, Chengdu Second People's Hospital, West China School of Medicine, Sichuan University","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Aowen","sequence":"additional","affiliation":[{"name":"Sichuan University Affiliated Chengdu Second People's Hospital, Chengdu Second People's Hospital, West China School of Medicine, Sichuan University","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Yuting","sequence":"additional","affiliation":[{"name":"Sichuan University Affiliated Chengdu Second People's Hospital, Chengdu Second People's Hospital, West China School of Medicine, Sichuan University","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huang","family":"Changquan","sequence":"additional","affiliation":[{"name":"Sichuan University Affiliated Chengdu Second People's Hospital, Chengdu Second People's Hospital, West China School of Medicine, Sichuan University","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhang","family":"Xingping","sequence":"additional","affiliation":[{"name":"Sichuan University Affiliated Chengdu Second People's Hospital, Chengdu Second People's Hospital, West China School of Medicine, Sichuan University","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1523","DOI":"10.1016\/S1473-3099(22)00445-5","article-title":"Trends in the global burden of lower respiratory infections: the knowns and the unknowns","volume":"22","author":"Li","year":"2022","journal-title":"Lancet Infect Dis"},{"key":"ref2","volume-title":"Global tuberculosis report 2025","year":"2025"},{"key":"ref3","volume-title":"Global Hepatitis Report 2024","year":"2024"},{"key":"ref4","volume-title":"The AIDS Response may be in Crisis, but we have the power to Transform: Global AIDS Update 2025","year":"2025"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"2799","DOI":"10.1097\/CM9.0000000000001842","article-title":"Prevention and control of HIV\/AIDS in China: lessons from the past three decades","volume":"134","author":"Xu","year":"2021","journal-title":"Chin Med J"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"46","DOI":"10.2471\/BLT.15.153148","article-title":"An integrated national mortality surveillance system for death registration and mortality surveillance, China","volume":"94","author":"Liu","year":"2016","journal-title":"Bull World Health Organ"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1186\/s12939-016-0343-7","article-title":"Age-period-cohort analysis of infectious disease mortality in urban-rural China, 1990-2010","volume":"15","author":"Li","year":"2016","journal-title":"Int J Equity Health"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"7065","DOI":"10.1038\/s41598-020-63141-1","article-title":"Age-period-cohort analysis of HIV mortality in China: data from the Global Burden of Disease Study 2016","volume":"10","author":"Gao","year":"2020","journal-title":"Sci Rep"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e35785","DOI":"10.2196\/35785","article-title":"Patterns of HIV or AIDS mortality among older people from 1990 to 2019 in China: age-period-cohort analysis","volume":"8","author":"Ren","year":"2022","journal-title":"JMIR Public Health Surveill"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"933","DOI":"10.46234\/ccdcw2023.175","article-title":"Changing patterns of mortality in viral hepatitis - 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