Objective To investigate the changes of life expectancy and diseases spectrum of death in residents in Hainan province from 2018 to 2022, analyze the impact of death from major diseases on life expectancy and provide evidence for the development of disease prevention and control policies.

Methods The surveillance data of death causes in Hainan from 2018 to 2022 were collected and the death data were adjusted according to the under-reporting status. Brief life table, cause eliminated life expectancy table, Joinpoint regression model and Arriaga differential decomposition method were used to analyze the changing trend of diseases spectrum of death in residents in Hainan from 2018 to 2022, and compare the effects of mortality in different age groups and different death causes on life expectancy.

Results The average life expectancy increased by 0.20 years in residents in Hainan from 2018 to 2022. Age group ≥60 years had largest contribution to the increase of life expectancy, accounting for 36.73% of the contribution in all age groups, followed by age group 35～59 years, accounting for 27.52%. Classified by disease type, circulatory system disease, malignant tumor, respiratory system disease and injury were the top 4 causes of death in Hainan, in which circulatory system disease caused the largest life expectancy loss, with crude mortality rate showing an increasing trend average annual percent change (AAPC)=9.78%, t=46.910, P<0.001. The decrease in crude mortality of injury (AAPC=−8.18%, t=−3.609, P=0.037) was the most important reason for the increase in life expectancy. Classified by specific disease, the top 5 causes of death were heart disease, cerebrovascular disease, chronic lower respiratory disease, liver cancer, and gastric cancer.

Conclusion Chronic disease was the main cause of death and life loss in residents in Hainan. In order to further improve the health status and life expectancy of residents, it is necessary to strengthen the health education and the construction of comprehensive prevention and control system of chronic diseases, and carry out targeted interventions in population aged ≥60 years to promote healthy aging.