Building China’s Burden of Disease Research System: Priorities and Pathways

Burden of disease research plays a pivotal role in global and national health policy by quantifying the impact of illnesses, injuries, and risk factors on populations. Through metrics such as disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs), it provides a comprehensive assessment of health loss, enabling evidence-based decision-making^[1].

In this issue, three studies were published based on the global burden of disease (GBD) study, focusing on lower respiratory infections (LRI) in the elderly^[2], headache disorders^[3], and chronic obstructive pulmonary disease (COPD)^[4]. These studies provide valuable insights from different aspects in terms of trend assessment, projection of future burdens, and informing public health strategies. Zhang et al. predicted a rising burden of LRI among Chinese elderly (≥ 70 years) from 2020 to 2050, despite past declines^[2]. Scenario analyses suggested that improved nutrition and vaccination could mitigate this trend, highlighting the growing challenge of aging-related respiratory infections and the need for targeted preventive measures. Liu et al. identified middle-aged groups and women bear a disproportionate burden of headache disorders with regional disparities and emphasized the need for better diagnosis, treatment, and health education, especially for high-risk demographics^[3]. Ma et al. reported the declining burden of COPD in most Asia-Pacific countries and indicated that older males remained the most affected with widening gender disparities^[4]. All three studies employ GBD’s rigorous, comparable metrics, enabling cross-country and temporal comparisons. The scenario analyses (e.g., LRI interventions) and long-term predictions (e.g., COPD to 2034) provide actionable insights for policymakers.

The studies are indispensable for evidence-based health governance as they enable societies to prevent unnecessary deaths and disabilities, reduce health disparities, optimize limited resources and help build resilient health systems. As global health challenges evolve—from pandemics to chronic noncommunicable diseases and climate-related health risks, robust burden of disease studies will remain essential for saving lives, improving well-being, and achieving equitable health outcomes worldwide. However, their reliance on GBD data also introduces limitations, particularly for China-specific contexts.

GBD relies on modeling and imputation for regions with sparse local data, which may not fully capture China’s unique epidemiological, environmental, and healthcare system characteristics. Long-term predictions are sensitive to model assumptions, which may not account for rapid societal changes (e.g., aging demographics, pollution controls). Additionally, urban-rural disparities cannot be identified from GBD study^[5]. Therefore, a China-specific burden of disease research framework needs to be established to address these gaps. In this system, China should prioritize in strengthening localized data infrastructure, enhancing methodological capabilities, building institutional and human capacity, enhancing policy translation and stakeholder engagement, and ensuring transparency and global contribution.

China has a solid foundation for burden of disease study, reflected by the huge amount of data accumulated in the past few decades. These included a number of well-established national surveillance system, such as national mortality surveillance system, national chronic disease and risk factor surveillance system, national maternal and child health surveillance and cancer registry. Numerous data were generated from hospital electronic health records and high quality cohorts such as China Kadoorie Biobank. All the relevant existing databases should be integrated to establish a national health data platform that links mortality, morbidity, and risk factor data across provinces to supplement the burden of disease estimates.

China-specific disease models should be developed for more accurate estimates of disease burden. Adaptation of global methodology and application of China-based parameters are important to better reflect China’s unique epidemiology, demographics, and healthcare access. For example, garbage code redistribution method that are suited for the mortality pattern and coding practices in China should be adopted in the estimates for mortality and YLL. The disability weights that are generated from the survey carried out in China should be used in the non-fatal burden estimates^[6]. Advanced forecasting techniques using machine learning and dynamic modeling may be utilized to predict disease trends under different policy scenarios (e.g., aging population, risk factor interventions). Adaptive burden projections should incorporate China’s rapid socio-economic transitions (e.g., urbanization, healthcare reforms) and local characteristics for risk factors (e.g., different indoor air pollution, dietary habits, occupational exposures).

The official national burden of disease research center, a dedicated government-academia collaborative body should be established to standardize methodologies, validate data, and publish annual reports authorized by government. This center can be led by Chinese Center for Disease Control and Prevention (Chinese Academy of Preventive Medicine) in partnership with leading universities and research institutes for expertise. Training programs should be developed for new generation of researchers, covering burden of disease epidemiology, health economics, and data science. International exchanges should be promoted to adopt best practices while tailoring approaches to China’s context.

Aligning research with national health priorities is important. We should ensure burden of disease study findings inform Healthy China 2030 goals, precision public health, and universal health coverage strategies. The findings should also provide strong support for evidence-based legislation (e.g., tobacco control and environmental regulations). Multi-sectoral collaboration should be fostered to engage health, environmental, agricultural, and urban planning agencies for holistic interventions, and for partnership with private sector and non-governmental organizations for scalable solutions (e.g., digital health tools, workplace wellness programs).

Publications of the findings from burden estimates should be encouraged in Chinese and international journals for scrutiny and benchmarking. Anonymized datasets should be shared to support national and global health research, provided that regulatory and ethical requirements are met. We should also participate global health governance by contributing China’s disease burden methodologies to World Health Organization and GBD collaborations, and advocating for low- and middle-income country representation in global health metrics.

In conclusion, building an independent, world-class burden of disease research system is essential for China to enhance the precision of health estimates beyond GBD limitations, better inform national policies, and ultimately improve health outcomes in a rapidly evolving demographic and epidemiological landscape.