School of International Development, University of East Anglia, Norwich, UK.
London School of Hygiene and Tropical Medicine, London, UK.
Lancet Glob Health. 2019 May;7(5):e604-e612. doi: 10.1016/S2214-109X(19)30069-5.
In accordance with the age parameters specified in Sustainable Development Goal target 3.4, current policy and monitoring of non-communicable disease (NCD) mortality trends focus on people aged 30-69 years. This approach excludes the majority of NCD deaths, which occur at older ages. We aimed to compare cardiovascular mortality for different age groups in the WHO Region of the Americas.
We extracted mortality data from the Pan American Health Organization regional mortality database for 36 countries for the period 2000 to 2015. We calculated age-standardised mortality rates (ASMRs) from cardiovascular diseases for different age groups for these countries. Joinpoint regression models were used to estimate mortality trends, providing estimates of the average annual percentage change for the period 2000-15.
Individuals aged 70 years or older accounted for the majority of cardiovascular disease deaths in all countries (range 52-82%). Considerable variation in cardiovascular deaths was observed between countries for all age categories. Between 2000 and 2015, in most countries, the largest reductions in ASMR were observed in the older age groups (aged ≥70 years). The total number of regional cardiovascular disease deaths that hypothetically could have been averted in 2015 for people aged 30-79 years was 440 777, of which 211 365 (48%) occurred among people aged 70-79 years.
Data for the WHO Region of the Americas are sufficiently robust to permit comparative analysis of cardiovascular disease mortality trends for people aged 70 years and older over time and across countries. Although the reduction of cardiovascular disease mortality in individuals aged 30-69 years is a valid policy goal for the Americas region, this objective should be expanded to include people at older ages.
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根据可持续发展目标 3.4 规定的年龄参数，当前非传染性疾病（NCD）死亡率趋势的政策和监测重点关注 30-69 岁人群。这种方法排除了发生在老年人群的大多数 NCD 死亡。我们旨在比较世卫组织美洲区域不同年龄组的心血管死亡率。
我们从泛美卫生组织区域死亡率数据库中提取了 2000 至 2015 年 36 个国家的死亡率数据。我们为这些国家的不同年龄组计算了心血管疾病的年龄标准化死亡率（ASMR）。使用 Joinpoint 回归模型来估计死亡率趋势，提供 2000-15 年期间的平均年变化百分比估计值。
在所有国家中，70 岁及以上人群占心血管疾病死亡人数的大多数（52-82%）。在所有年龄组中，各国之间的心血管死亡差异很大。在 2000 年至 2015 年期间，在大多数国家中，年龄较大的年龄组（≥70 岁）的 ASMR 降幅最大。假设 2015 年 30-79 岁人群中可以避免的区域心血管疾病死亡人数总计为 440777 人，其中 211365 人（48%）发生在 70-79 岁人群中。
世卫组织美洲区域的数据足够可靠，可以对随着时间的推移和国家之间 70 岁及以上人群的心血管疾病死亡率趋势进行比较分析。虽然减少 30-69 岁人群的心血管疾病死亡率是美洲区域的一个有效政策目标，但这一目标应扩大到包括年龄较大的人群。
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