Geographic disparities in pneumonia-specific under-five mortality rates in Mainland China from 1996 to 2015: a population-based study

•Death from pneumonia decreased significantly, but still represents more than one in seven of total under-five deaths.•Disparities in pneumonia-specific under-five mortality rates still exist among and within geographic regions in China, with a consistently higher rate in rural areas.•Ending deaths from pneumonia and reducing the geographic disparities remain unresolved issues in Mainland China.

SummaryObjectivesThis study aimed to investigate the disparities in pneumonia-specific under-five mortality rates (U5MRs) among and within three geographic regions in Mainland China from 1996 to 2015.MethodsData were obtained from the national Under-Five Child Mortality Surveillance System and grouped into 2-year periods. The Cochran-Armitage trend test and Cochran-Mantel-Haenszel test were used to assess trends and differences in the pneumonia-specific U5MRs among and within geographic regions. Relative risks (RRs) and 95% confidence intervals (95% CIs) were calculated.ResultsThe pneumonia-specific U5MR decreased by 90.6%, 89.0%, and 83.5% in East, Middle, and West China, respectively, with a larger decrease in rural areas. The pneumonia-specific U5MR was highest in West China, and was 7.2 (95% CI 5.9-8.7) times higher than that in East China in 2014-2015. In 2014-2015, the RRs were 1.7 (95% CI 1.2-2.5), 1.6 (95% CI 1.1-2.1), and 3.4 (95% CI 2.8-4.0) between rural and urban areas in East, Middle, and West China, respectively.ConclusionsPneumonia-specific U5MRs decreased from 1996 to 2015 across China, particularly in rural areas. However, disparities remained among and within geographic regions. Additional strategies and interventions should be introduced in West China, especially the rural areas, to further reduce the pneumonia-specific U5MR.