Unveiling China's Heart Disease Challenges: a Comprehensive Retrospective Study on National Mortality Burden

Overview

Journal BMC Public Health

Publisher Biomed Central

Specialty Public Health

Date 2025 Mar 4

PMID 40038636

Authors

Yunjuan Yang

Jieqing Min

Yuanyi Zha

Affiliations

Soon will be listed here.

Abstract

Background: Heart disease has been the leading cause of death in China since 2020. With the development of the aging population, dietary habits changes, and extreme climate conditions, this study aimed to evaluate national and sub-national changes in the heart disease burden from 2013 to 2021 in china, using data from the National Mortality Surveillance System.

Methods: This study was mainly using the National Mortality Surveillance System, which covered 300 million, accounted for 24% of China's population, with national and provincial representativeness from 2013 to 2021. The data categories were modified in 2013 to contain individual classes for heart disease, and the classifications remained consist until 2021. Permutation test were used to identify the Joinpoints in the data. Trends for the study period were evaluated using the average annual percent change (AAPC) in mortality rates with 95% Confidence interval (CI). A decomposition analysis was used to analyse the drivers of mortality change due to heart disease.

Results: The total number of heart disease related deaths increased from 277,312(2013) to 463,314(2021). The proportion of deaths due to heart disease increased from 21.81% to 25.45%. And the gender-standardized mortality of heart disease increased from 140.11/100,000 to 180.67/100,000 from 2013 to 2021. The average annual increase (AAI) was 4.46%. since 2020, the heart disease has become the leading cause of death, rising from the third place. Epidemic characteristics were as follows: First, the heart disease-related mortality was higher in males than in females. And the AAPC for males was 3.74% from 2013 to 2021 (AAPC = 3.744, 95% CI: 3.048 ~ 4.528, P < 0.01). The AAPC for females was 4.09% (AAPC = 4.088, 95% CI: 2.962 ~ 5.313, P < 0.01). Second, a rapid increase in heart disease related mortality has been observed among 15-44 years population in recent years. Third, the mortality of rural residents in the past 6 years has increased fast (from 151.19/100,000 to 188.58/100,000). The average annual increase in rural heart disease mortality was 3.49%. Fourth, heart disease mortality in Central China increased fast and reached the highest rate in China. Additionally, ischemic heart disease mortality showed the highest, with a rapidly increasing trend. Finally, most heart disease related deaths occurred from October of the first year to March of the following year, with peaks in January and February. And over 70% of these deaths occured at home or in hospital,.

Conclusions: The deaths due to heart disease indicated a remarkable continues increase in the burden of heart disease. This study results imply escalating healthcare expenses, with projections indicating even greater future challenges. These findings will also help identify gaps in heart disease healthcare and guide the prioritization of health programs dirven by the needs of China.

References

Song P, Fang Z, Wang H, Cai Y, Rahimi K, Zhu Y . Global and regional prevalence, burden, and risk factors for carotid atherosclerosis: a systematic review, meta-analysis, and modelling study. Lancet Glob Health. 2020; 8(5):e721-e729. DOI: 10.1016/S2214-109X(20)30117-0. View

Godfrey K, Barker D . Fetal nutrition and adult disease. Am J Clin Nutr. 2000; 71(5 Suppl):1344S-52S. DOI: 10.1093/ajcn/71.5.1344s. View

Wang Y, Zhao L, Gao L, Pan A, Xue H . Health policy and public health implications of obesity in China. Lancet Diabetes Endocrinol. 2021; 9(7):446-461. DOI: 10.1016/S2213-8587(21)00118-2. View

Qi J, Adair T, Chowdhury H, Li H, McLaughlin D, Liu Y . Estimating causes of out-of-hospital deaths in China: application of SmartVA methods. Popul Health Metr. 2021; 19(1):25. PMC: 8097770. DOI: 10.1186/s12963-021-00256-1. View

Liu S, Li Y, Zeng X, Wang H, Yin P, Wang L . Burden of Cardiovascular Diseases in China, 1990-2016: Findings From the 2016 Global Burden of Disease Study. JAMA Cardiol. 2019; 4(4):342-352. PMC: 6484795. DOI: 10.1001/jamacardio.2019.0295. View

. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018; 392(10159):1859-1922. PMC: 6252083. DOI: 10.1016/S0140-6736(18)32335-3. View

Sun J, Qiao Y, Zhao M, Magnussen C, Xi B . Global, regional, and national burden of cardiovascular diseases in youths and young adults aged 15-39 years in 204 countries/territories, 1990-2019: a systematic analysis of Global Burden of Disease Study 2019. BMC Med. 2023; 21(1):222. PMC: 10294522. DOI: 10.1186/s12916-023-02925-4. View

Hawkes C, Ambikapathi R, Anastasiou K, Brock J, Castronuovo L, Fallon N . From food price crisis to an equitable food system. Lancet. 2022; 400(10350):413-416. DOI: 10.1016/S0140-6736(22)01348-4. View

Yoneoka D, Tanoue Y, Kawashima T, Nomura S, Shi S, Eguchi A . Large-scale epidemiological monitoring of the COVID-19 epidemic in Tokyo. Lancet Reg Health West Pac. 2021; 3:100016. PMC: 7546969. DOI: 10.1016/j.lanwpc.2020.100016. View

10.

Li Y, Cao G, Jing W, Liu J, Liu M . Global trends and regional differences in incidence and mortality of cardiovascular disease, 1990-2019: findings from 2019 global burden of disease study. Eur J Prev Cardiol. 2022; 30(3):276-286. DOI: 10.1093/eurjpc/zwac285. View

11.

Roth G, Mensah G, Johnson C, Addolorato G, Ammirati E, Baddour L . Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study. J Am Coll Cardiol. 2020; 76(25):2982-3021. PMC: 7755038. DOI: 10.1016/j.jacc.2020.11.010. View

12.

Xu X, Yan A, Wang Y, Shi Z . Dietary Patterns and Changes in Weight Status Among Chinese Men and Women During the COVID-19 Pandemic. Front Public Health. 2021; 9:709535. PMC: 8710477. DOI: 10.3389/fpubh.2021.709535. View

13.

Sun X, Yon D, Nguyen T, Tanisawa K, Son K, Zhang L . Dietary and other lifestyle factors and their influence on non-communicable diseases in the Western Pacific region. Lancet Reg Health West Pac. 2024; 43:100842. PMC: 10920053. DOI: 10.1016/j.lanwpc.2023.100842. View

14.

Peng W, Chen S, Chen X, Ma Y, Wang T, Sun X . Trends in major non-communicable diseases and related risk factors in China 2002-2019: an analysis of nationally representative survey data. Lancet Reg Health West Pac. 2024; 43:100809. PMC: 10920046. DOI: 10.1016/j.lanwpc.2023.100809. View

15.

. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018; 392(10159):1789-1858. PMC: 6227754. DOI: 10.1016/S0140-6736(18)32279-7. View

16.

Zhou M, Wang H, Zhu J, Chen W, Wang L, Liu S . Cause-specific mortality for 240 causes in China during 1990-2013: a systematic subnational analysis for the Global Burden of Disease Study 2013. Lancet. 2015; 387(10015):251-72. DOI: 10.1016/S0140-6736(15)00551-6. View

17.

Xu X, Shi Z, Zhou L, Lin J, Atlantis E, Chen X . Impact of COVID-19 on risks and deaths of non-communicable diseases in the Western Pacific region. Lancet Reg Health West Pac. 2024; 43:100795. PMC: 10920048. DOI: 10.1016/j.lanwpc.2023.100795. View

18.

Wei S, Bilodeau-Bertrand M, Liu S, Auger N . The impact of COVID-19 on pregnancy outcomes: a systematic review and meta-analysis. CMAJ. 2021; 193(16):E540-E548. PMC: 8084555. DOI: 10.1503/cmaj.202604. View

19.

Zheng J, Lv C, Zheng W, Zhang G, Tan H, Ma Y . Incidence, process of care, and outcomes of out-of-hospital cardiac arrest in China: a prospective study of the BASIC-OHCA registry. Lancet Public Health. 2023; 8(12):e923-e932. DOI: 10.1016/S2468-2667(23)00173-1. View

20.

. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021; 20(10):795-820. PMC: 8443449. DOI: 10.1016/S1474-4422(21)00252-0. View