Zhang Yue, Lin Changjian, Liu Ming, Zhang Wei, Xun Xiaoyun, Wu Jinyi, Li Xiaopan, Luo Zheng
School of Public Health, Department of Epidemiology, Shanxi Medical University, Taiyuan, China.
Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Front Cardiovasc Med. 2023 Feb 15;10:1067072. doi: 10.3389/fcvm.2023.1067072. eCollection 2023.
Cardiovascular disease (CVD) is a global public health concern, but its disease burden and trend have been poorly studied in people younger than 20 years. This study aimed to fill this gap by evaluating the CVD burden and trend in China, Western Pacific Region, and the world from 1990 to 2019.
We applied the 2019 Global Burden of Diseases (GBD) analytical tools to compare the incidence, mortality, and prevalence of CVD, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life years (DALYs) among people younger than 20 years from 1990 to 2019 in China, the Western Pacific Region, and the world. The trends of disease burden between 1990 and 2019 evaluated using the average annual percent change (AAPC) and the 95% uncertainty interval (UI) were reported.
Globally, in 2019, there were 2.37 (95% UI: 1.82 to 3.05) million incidence of CVD, 16.85 (95% UI: 12.56 to 22.03) million prevalence of CVD, and 74386.73 (95% UI: 64543.82 to 86310.24) deaths due to CVD among people under 20 years of age. The trends for DALYs decreased among children and adolescents in China, Western Pacific Region, and the world (AAPC = -4.29, 95% CI: -4.38% to -4.20%; AAPC = -3.37, 95% CI: -3.48% to -3.26%; AAPC = -2.17, 95% CI: -2.24% to -2.09%; < 0.001, respectively) between 1990 and 2019. With the increase in age, the AAPC values of mortality, YLLs, and DALYs showed a notable downward trend. The AAPC values of mortality, YLLs, and DALYs in female patients were significantly greater than those in male patients. For all subtypes of CVD, the AAPC values showed a downward trend, with the largest reduction observed for stroke. From 1990 to 2019, a decline in the DALY rate for all CVD risk factors was observed, with a significant decrease in environmental/occupational risk factors.
Our study shows a decline in the burden and trend of CVD among people younger than 20 years, which reflects the success in reducing disability, premature death, and the early incidence of CVD. More effective and targeted preventive policies and interventions aimed at mitigating preventable CVD burden and addressing risk factors from childhood are urgently needed.
心血管疾病（CVD）是一个全球公共卫生问题，但在20岁以下人群中，其疾病负担和趋势尚未得到充分研究。本研究旨在通过评估1990年至2019年中国、西太平洋地区和全球的心血管疾病负担及趋势来填补这一空白。
我们应用2019年全球疾病负担（GBD）分析工具，比较了1990年至2019年中国、西太平洋地区和全球20岁以下人群中心血管疾病的发病率、死亡率和患病率、伤残调整生命年（YLDs）、寿命损失年（YLLs）和伤残调整生命年（DALYs）。报告了使用平均年度百分比变化（AAPC）和95%不确定性区间（UI）评估的1990年至2019年疾病负担趋势。
在全球范围内，2019年，20岁以下人群中心血管疾病的发病率为237万（95%UI：182万至305万），患病率为1685万（95%UI：1256万至2203万），心血管疾病死亡人数为74386.73（95%UI：64543.82至86310.24）。中国、西太平洋地区和全球儿童及青少年的伤残调整生命年趋势有所下降（AAPC=-4.29，95%CI：-4.38%至-4.20%；AAPC=-3.37，95%CI：-3.48%至-3.26%；AAPC=-2.17，95%CI：-2.24%至-2.09%；P<0.001），时间跨度为1990年至2019年。随着年龄的增长，死亡率、寿命损失年和伤残调整生命年的AAPC值呈显著下降趋势。女性患者的死亡率、寿命损失年和伤残调整生命年的AAPC值显著高于男性患者。对于所有心血管疾病亚型而言，AAPC值呈下降趋势，其中中风下降幅度最大。从1990年到2019年，所有心血管疾病危险因素的伤残调整生命年率均呈下降趋势，环境/职业危险因素显著下降。
我们的研究表明，20岁以下人群中心血管疾病的负担和趋势有所下降，这反映了在减少残疾、过早死亡和心血管疾病早期发病方面取得的成功。迫切需要更有效、更有针对性的预防政策和干预措施，以减轻可预防的心血管疾病负担，并从儿童时期就应对危险因素。
