Xue Peng, Lin Ling, Li Peishan, Cheng Songyi, Chen Daohai, Fan Manlu, Zhuang Yanshuang, Chen Xiaohu
Department of Geriatrics Cardiology, Taizhou Affiliated Hospital of Nanjing University of Chinese Medicine, 86 Jichuan East Road, Taizhou, Jiangsu, 225300, People's Republic of China.
Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Nanjing, Jiangsu, 210029, People's Republic of China.
BMC Public Health. 2025 Mar 12;25(1):985. doi: 10.1186/s12889-025-22193-6.
The findings of the 2021 Global Burden of Disease (GBD) study can offer valuable insights for the development of screening and prevention strategies targeting ischemic heart disease (IHD). We aim to investigate trends in IHD incidence, mortality, and disability-adjusted life years (DALYs), while exploring associated risk factors for IHD-associated death from 1990 to 2021.
The cross-sectional study utilized data from the GBD 2021, covering 204 countries and regions. The analysis included individuals aged 55 and above. We analyzed the trends in IHD incidence, all cause and cause-specific deaths, DALYs, and corresponding estimated annual percentage changes (EAPCs) from 1990 to 2021. These indicators were further stratified by geographical region, country, age group, gender, and sociodemographic index (SDI).
The global incidence rate, mortality rate, and DALYs rate for individuals aged 55 and above with IHD have shown a decreasing trend. However, the number of incident cases, death cases, and DALYs has been increasing from 1990 to 2021. Both the high-middle and high SDI regions exhibit a significant decline in these rates from 1990 to 2021. However, the low SDI, low-middle SDI, and middle SDI regions show less noticeable changes. The region with low-middle SDI experiences the largest increase in mortality rate (EAPC: 0.38; 95%CI, 0.33-0.44) and DALYs rate (EAPC: 0.17; 95%CI, 0.12-0.22). The region with middle SDI experiences the largest increase in incidence rate (EAPC: 0.37; 95%CI, 0.27-0.46). Regionally, East Asia exhibits the greatest increase in incidence rate (EAPC: 0.94; 95% CI, 0.79-1.10), mortality rate (EAPC: 1.68; 95% CI, 1.40-1.94), and DALYs rate (EAPC: 0.94; 95% CI, 0.69-1.20). Among the 12 risk factors associated with mortality from IHD, high systolic blood pressure, dietary risks, high low-density lipoprotein (LDL) cholesterol levels, and air pollution are identified as the primary contributors to global mortality.
This study reveals that in high SDI regions, the incidence, mortality, and DALYs rate of IHD are declining. Conversely, in low to middle SDI regions, the disease burden of IHD is increasing. It highlights global inequality in IHD burden. Recommendations include early screening, risk management, and strengthening primary care, especially in middle and low SDI regions. Countries should also invest in environmental governance and air pollution control. Future research should focus on evaluating the effects of health policies in different countries, exploring the impact of socio-economic and cultural factors on the burden of IHD, and developing big data-based prediction models to optimize resource allocation and intervention strategies.
2021年全球疾病负担（GBD）研究结果可为制定针对缺血性心脏病（IHD）的筛查和预防策略提供有价值的见解。我们旨在调查1990年至2021年期间IHD发病率、死亡率和伤残调整生命年（DALYs）的趋势，同时探索IHD相关死亡的相关危险因素。
这项横断面研究利用了GBD 2021的数据，涵盖204个国家和地区。分析纳入了55岁及以上的个体。我们分析了1990年至2021年期间IHD发病率、全因死亡和死因别死亡、DALYs以及相应的估计年度百分比变化（EAPCs）的趋势。这些指标进一步按地理区域、国家、年龄组、性别和社会人口指数（SDI）进行分层。
55岁及以上IHD患者的全球发病率、死亡率和DALYs率呈下降趋势。然而，1990年至2021年期间，发病病例数、死亡病例数和DALYs数一直在增加。高-中SDI地区和高SDI地区在1990年至2021年期间这些率均显著下降。然而，低SDI、低-中SDI和中SDI地区的变化不太明显。低-中SDI地区的死亡率（EAPC：0.38；95%CI，0.33-0.44）和DALYs率（EAPC：0.17；95%CI，0.12-0.22）增幅最大。中SDI地区的发病率增幅最大（EAPC：0.37；95%CI，0.27-0.46）。在区域层面，东亚的发病率（EAPC：0.94；95%CI，0.79-1.10）、死亡率（EAPC：1.68；95%CI，1.40-1.94）和DALYs率（EAPC：0.94；95%CI，0.69-1.20）增幅最大。在与IHD死亡相关的12个危险因素中，收缩压升高、饮食风险、低密度脂蛋白（LDL）胆固醇水平升高和空气污染被确定为全球死亡的主要促成因素。
本研究表明，在高SDI地区，IHD的发病率、死亡率和DALYs率正在下降。相反，在低至中SDI地区，IHD的疾病负担正在增加。它凸显了IHD负担方面的全球不平等。建议包括早期筛查、风险管理和加强初级保健，特别是在中低SDI地区。各国还应投资于环境治理和空气污染控制。未来的研究应侧重于评估不同国家卫生政策的效果，探索社会经济和文化因素对IHD负担的影响，并开发基于大数据的预测模型以优化资源分配和干预策略。
