In regions for which we identified published data, pneumonia incidence in China appears to be declining and mortality is stable or declining from the 1980s to the 2000s. There are several factors that could have contributed to these changes over time. China experienced substantial economic growth during these years, a trend that was more pronounced in the coastal (Eastern) areas. From the beginning of economic reforms in 1978 to 2006, China's gross domestic product (GDP) increased 5,719% from 362.4 billion RMB to 21,087.1 billion RMB [54] . The income of the average Chinese person also improved during this time period; GDP per capita rose by 4,144% from 379 RMB to 16,084 RMB [54] . Economic development may have led to improvements in healthcare quality and access to health services.