The Healthy China 2030 Plan established a key target of cutting premature deaths from diabetes by 30% by 2030, yet no assessment of diabetes-related premature mortality has been conducted since the plan’s launch. To address this gap, data from the Global Burden of Disease Study 2021 was utilized to calculate diabetes-related premature deaths by sex, province, and disease subtype across China from 1990 to 2021. The average annual percent change (AAPC) was employed to analyze temporal trends in premature mortality for different groups over this period, and projections of such mortality up to 2030 for the entire country and its individual provinces were made based on the average annual change rate observed between 2010 and 2021. Findings revealed that diabetes-related premature mortality first rose slowly, from 0.5% in 1990 to 0.6% in 2004, before declining through 2021, when it reached 0.4%. By 2030, only Fujian Province is expected to achieve the 30% reduction target, with merely seven provinces meeting the goal for females and none for males. Significant disparities in the decline rate exist between inland and coastal regions, highlighting obvious geographic differences and underscoring the need to balance the distribution of medical resources.
Temporal trends in diabetes-related premature mortality over the past three decades reflect shifting patterns in public health and disease management. From 1990 to 2004, the gradual increase in premature mortality—rising from 0.5% to 0.6%—may be linked to factors such as limited access to early diabetes detection, insufficient awareness of disease prevention, and less advanced treatment options during that period. However, the subsequent decline from 2004 to 2021, which brought the rate down to 0.4%, likely stems from improvements in healthcare infrastructure, wider availability of diabetes medications, enhanced public health campaigns promoting healthy lifestyles, and better management of diabetes and its complications. This shift indicates progress in addressing diabetes-related health risks but also reveals that the pace of improvement has not been sufficient to meet the ambitious 2030 target nationwide.
Projections for 2030 paint a sobering picture of uneven progress across China’s provinces. Fujian’s expected 30.3% reduction stands out as the only province on track to hit the national goal, while seven provinces will meet the target exclusively for females. The complete absence of provinces projected to meet the target for males highlights a significant gender disparity in diabetes outcomes, which may be attributed to differences in healthcare-seeking behavior, lifestyle factors, or underlying biological variations that influence disease progression and mortality. Such disparities demand targeted interventions tailored to male populations, such as improved outreach programs to encourage regular screenings and adherence to treatment plans.
Geographic differences between inland and coastal regions further complicate efforts to achieve the Healthy China 2030 goal. Coastal provinces, which often have more robust economic development, better-equipped healthcare facilities, and higher levels of education and health literacy, tend to show greater declines in premature mortality. In contrast, inland regions frequently face challenges like shortages of healthcare professionals, limited access to specialized diabetes care, and lower public awareness of disease management, leading to slower progress in reducing mortality. These gaps emphasize the critical need to balance medical resources by investing in healthcare infrastructure in inland areas, training local medical staff in diabetes care, and expanding telemedicine services to connect rural and remote populations with specialized providers.
The use of data from the Global Burden of Disease Study 2021 and the AAPC method adds rigor to the analysis, providing a comprehensive overview of diabetes-related premature mortality trends at both the national and subnational levels. By focusing on sex, province, and subtype, the research captures nuanced variations that might otherwise be overlooked in broader national assessments. This detailed approach is essential for guiding policy decisions, as it allows policymakers to identify high-priority regions and populations that require additional support. For instance, provinces with minimal projected declines or persistent gender gaps can be targeted for increased funding, public health campaigns, or policy reforms aimed at improving diabetes prevention and care.
Ultimately, the findings serve as a call to action to accelerate efforts to reduce diabetes-related premature mortality. While the decline since 2004 demonstrates that progress is possible, the projected shortfall in meeting the 2030 goal—especially for males and in inland regions—highlights the need for more aggressive and equitable interventions. By addressing resource disparities, targeting underserved populations, and refining strategies to improve diabetes management, China can move closer to achieving its Healthy China 2030 objective and reducing the burden of diabetes on public health.
DOI：

10.1007/s11684-025-1141-7