Using data from GBD 2013, this study estimates the changes in health-adjusted life expectancy at birth (HALE ₀) between 1990 and 2013 in China, analyzes its influencing factors, and, for the first time, decomposes these changes into the contribution of 302 diseases and injuries. During this period, HALE ₀ increased by 7.39 years, ranging from 2.48 years in Hebei to 10.81 years in Tibet.Provinces with low HALE ₀ at base year (1990)and high human development index values were more likely to witness rapid increase in HALE ₀.Communicable diseases, non-communicable diseases, and injuries have contributed 3.17 years, 3.13 years and 1.10 years, respectively, to the growth of HALE ₀. The five top and positive causes to HALE ₀ changes include COPD, lower respiratory infections, stroke, preterm birth complications, and diarrheal diseases; and the five top and negative causes to HALE ₀ changes include diabetes mellitus, low back and neck pain, chronic kidney disease, interstitial lung disease and medication overuse headache. Mortality reduction was the predominant driver for population health improvement, accounting for 95.26% of HALE ₀ changes. This has resulted in a prolonged life expectancy with disability.