Trends of Cause-Specific Mortality and Association with Economic Status, Education Level, as Well as Health Investment among Adolescents Aged 10 to 24 Years in China, 2004–2019

Round 1

Reviewer 1 Report

The manuscript focus on the central idea of the work submitted. The analysis of the data and interpretation of the results are good. The author has taken care of ethical considerations while developing the manuscript. The writing style and language are good. The references are judiciously used in the manuscript. The article is captivating, but the authors need to address the following comments: 1) the reading of the manuscript has critical organizational issues, becoming cumbersome and not very fluent, despite the fact that the research objectives and the course of the same are clear (it is suggested to summarize the work more schematically or insert summary tables that focus on key points, as after a while the reading turns out to be boring); 2) Figure no. 3 (page 8) does not make clear the data obtained from the statistic (it is suggested to use another chart that better explicates in detail the results obtained); 3) the discussions should be separated from the limitations of the study, future reflections and conclusions (it is suggested to create additional paragraphs dedicated to the limitations and future reflections and then to the conclusions); 4) the notes should be written according to the editorial guidelines published on the website (it is suggested to correct editorial errors on the References).

Author Response

Dear Reviewer #1:

Thank you for your valuable comments on our manuscript. Those comments were helpful and made our manuscript more meaningful. Based on your comments, we have revised our manuscript. Please see the attachment, which is our description on revision according to your comments.

Author Response File: Author Response.pdf

Reviewer 2 Report

Thank you for the opportunity to review this manuscript. The manuscript is very relevant since it looks at mortality trends over time in China. I have several suggestions to help improve the manuscript.

Major Revisions

1. The authors refer to the 10-24 year olds as adolescents throughout the manuscript. This should be collected. Adolescents are between the ages of 10 and 19 years according to the World Health Organization. 20-24 year olds are referred to as young adults. This should be made clear in the manuscript.

2. Although the authors compared their studies with other studies, the manuscript can be strengthened by comparing these trends in China with some trends in other parts of the world, and explanations as to the causes of the similarities or differences.

3. Non-journal article references such as 1, 2, 26, 31, 32, 34, and 35 should be corrected.

Minor Revisions

4. Line 10: ‘Objectives’ subheading should be at the start of a line.

5. Line 10: You state, ‘To describe the secular trends of cause-specific mortality among adolescents 10 aged 10 to 24 years from 2004 to 2019…’ Add ‘and young adults’ to ‘adolescents’ throughout the manuscript.

6. line 16: You state, ‘number of health people per 1000…’ Change ‘health’ to ‘healthy’ throughout the manuscript.

7. Line 33: ‘Conclusion’ should be at the beginning of a new line.

8. Line 36:  You state, ‘and aged 15 to 24 years should be needed.’ Replace ‘should’ with ‘are’.

9. Line 37: You state, ‘such as HIV/AIDS, must be further concerned.’ Add ‘of’ after ‘be’.

10. Line 48-49: You state ‘The importance of paying attention to adolescent mortality is beginning to be recognized by the international community.’ Add reference to this statement……

11. Line 70: You state, ‘…to explore the trends and influence factors of cause-specific mortality among…’ Replace ‘influence’ with ‘influencing’.

12. Line 71: You state, ‘The purpose of this study is to describe the current status….’ Replace ‘is’ with ‘was’.

13. Line 98: You state, ‘…was collected from China’s Economic and Social Big Data Research Platform.’ Replace ‘was’ with ‘were’. We say data were, not data was.

14. Line 102: You state, ‘…and the causes that can not be matched by’. Replace ‘can not’ with ‘could not’.

15. Line 189: You state, ‘….no significant improved,….’ Replace ‘improved’ with ‘improvement’.

16. Line 224: You state, ‘….while the ASMR of lower respiratory infections raised in urban adolescents….’ Replace ‘raised’ with ‘increased’.

17. Line 233: You state, ‘…..tuberculosis (0.56 per 100,000) was the top 15 causes of death in 2019…’ Replace ‘causes’ with ‘cause’.

18. Line 278: You state, ‘…..such as HIV/AIDS, became more severe in 2019 than in 2004…’ Add ‘which’ before ‘became’.

19. Line 295: You state, ‘….and inflammatory heart disease were remaining the top 15 causes….’ Replace ‘were remaining’ with ‘remained’.

20. Line 302: You state, ‘…..as the ASMR for males approximately 1.9….’ Add ‘was’ before ‘approximately’.

21. Line 333: You state, ‘…Although great achievements have been got in tuberculosis prevention,…’ Rather say, ‘Although there were great achievements in tuberculosis prevention…’

22. Line 335: You state, ‘more attention still needed….’ Replace ‘needed’ with ‘needs’.

23. Line 363: Put a ‘conclusion’ subheading before Line 363.

24. Line 373: You state, ‘….showed raising trends in male adolescents.’ Replace ‘raising’ with ‘rising’.

Minor revisions required as stated in the authors' comments.

Author Response

Dear Reviewer #2:

Thank you for your valuable comments on our manuscript. Those comments were helpful and made our manuscript more meaningful. Based on your comments, we have revised our manuscript. Please see the attachment, which is our description on revision according to your comments.

Author Response File: Author Response.pdf

Reviewer 3 Report

This manuscript by Liu et al. described the secular trends of cause-specific mortality among adolescents aged 10 to 24 years from 2004 to 2019, and explored the association between mortality and economic status, education level as well as health investment. The topic of this study is interesting and the manuscript is well written. Nonetheless, I have several concerns and propose a revision be undertaken prior to its potential acceptance for publication.

1. Line 78-82, “Since 2004, the annual yearbook reported the cause-specific mortality data from 161 surveillance points (63 urban points and 98 rural points), covering approximately 73 million (6%) population, and since 2013 the coverage has been expanded to 605 surveillance points (208 urban points and 397 rural points), covering 323.8 million (24.3%) population.” The manuscript should address whether the expanded number of surveillance points during the 2004-2019 period may have influenced the distribution of characteristics within the study population (e.g., area, region, age groups, economic status, education level, health investment, and causes of death). Additionally, it should examine whether this change could have impacted the findings.

2. Line 102-103 “the causes that cannot be matched by ICD-10 were omitted from the analysis” Please provide the proportion of non-matching cases with regards to the ICD-10 classification.

3. Line 104-105 “For example, the three first-level classifications were recoded into “A”, “B”, and “C”, respectively.” It is recommended to summarize the meaning of “A”, “B”, and “C” in this section.

4. Figure 1 illustrates the national all-cause ASMRs among adolescents aged 10 to 24 years, showing variations across genders, areas, regions, and age groups. For the subsequent analysis of (AS)MR and APC, it is important to consider the combined gender, area, region, and age groups rather than examining them as an individual group.

5. Line 207-208, “Besides that, some diseases, such as HIV/AIDS, malnutrition, lymphoma, and multiple myeloma, showed higher ASMR in 2019 than in 2004” To enhance clarity, please note the HIV/AIDS, malnutrition, lymphoma, and multiple myeloma in the text using the disease codes in Figure 3.

6. In Figure 3, the ASMRs of several causes of death indicate “NA” during some period, e.g., C1-6 to C1-10 during 2009-2019. Please describe the cause of missing in the statistical methods section for better understanding.

The English usage in this paper is generally good. minor improvements in sentence structure, vocabulary choices, and eliminating redundancies could further enhance its clarity and readability.

Author Response

Dear Reviewer #3:

Thank you for your valuable comments on our manuscript. Those comments were helpful and made our manuscript more meaningful. Based on your comments, we have revised our manuscript. Please see the attachment, which is our description on revision according to your comments.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

All requested changes have been made, and the text seems to me to be ready for publication. Good work.

Author Response

 Thank you.

Reviewer 2 Report

The non-journal references like 1 and 2 should be referenced properly. Goal 4 should not come first but UNDP.

Author Response

Thanks for your suggestion. We have revised the references refer to the future-template provided in the submission system “Instructions for Authors” section of future, it seems that the reference format of web pages is “Title of Site. Available online: URL (accessed on Day Month Year).” So we didn’t add the UNDP here.

Reviewer 3 Report

I have no further comments.

Author Response

Thank you.