Trends in under-five mortality rate in China, 1996–2020: a Joinpoint regression and correlation analysis

ObjectivesTo analyse annual trends of the under-five mortality rate (U5MR) and main cause-specific U5MR in China from 1996 to 2020 and to assess the potential correlation of the healthcare system and health expenditure with the U5MR in China.DesignA retrospective observational study using national data from 1996 to 2020. Joinpoint regression was employed to model U5MR trends and Pearson correlation analysis was conducted to examine the relationship between healthcare system factors, health expenditure and U5MR.SettingNationwide study covering both rural and urban populations across China over a 25-year period.ResultsThe U5MR in China experienced a three-stage decline from 1996 to 2020 with an average annual percentage rate change (AAPC) of −7.27 (p