Gu Jianhua, Zheng Zhaolei, Li Jiqing, Wu Shuo, Sun Heming, Pang Jiaojiao, Chen Yuguo
Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan, China.
Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China.
Eur Heart J Qual Care Clin Outcomes. 2025 Jun 20. doi: 10.1093/ehjqcco/qcaf047.
BACKGROUND: Heart failure (HF) is a major global public health concern, particularly in older adults (aged ≥65 years). Despite its growing prevalence, comprehensive analyses of HF burden in this population, including trends, causes, and socioeconomic disparities, remain limited. METHODS: Using data from the Global Burden of Disease (GBD) Study 2021, we analyzed the burden of HF among older adults from 1990 to 2021, including prevalence, years lived with disability (YLDs), and underlying causes. We conducted a decomposition analysis to quantify the contributions of population growth, aging, and epidemiological changes and projected future trends to 2035 using Bayesian Age-Period-Cohort modeling. RESULTS: From 1990 to 2021, global HF cases among older adults increased from 14.1 million to 36.2 million, whereas YLDs rose from 1.34 million to 3.45 million. Population growth accounted for 89.0% of the increase in both prevalence and YLDs, while the aging effect varied by Sociodemographic Index (SDI) quintiles, , showing negative contributions (-39.4%) in high-SDI regions and positive contributions (+28.7%) in middle-SDI regions. Globally, ischemic heart disease was the leading cause of death (37.6%) across all SDI quintiles, followed by hypertensive heart disease (24.1%). The low-to-middle SDI regions experienced the fastest growth in HF burden (EAPC=0.22), with socioeconomic inequality widening over time. Projections suggest that age-standardized prevalence and YLDs will rise to 4,935 cases and 473 years lived with disability per 100,000 population, respectively, by 2035. CONCLUSIONS: Global heart failure burden in older adults is escalating fastest in low-middle SDI regions due to population growth and healthcare inequities. Mitigating this crisis requires prioritizing equitable access to evidence-based therapies and addressing socioeconomic disparities in aging populations.
背景:心力衰竭(HF)是一个重大的全球公共卫生问题,在老年人(年龄≥65岁)中尤为突出。尽管其患病率不断上升,但对该人群心力衰竭负担的全面分析,包括趋势、病因和社会经济差异,仍然有限。 方法:利用2021年全球疾病负担(GBD)研究的数据,我们分析了1990年至2021年老年人中的心力衰竭负担,包括患病率、残疾生存年数(YLDs)和潜在病因。我们进行了分解分析,以量化人口增长、老龄化和流行病学变化的贡献,并使用贝叶斯年龄-时期-队列模型预测到2035年的未来趋势。 结果:从1990年到2021年,全球老年人中的心力衰竭病例从1410万增加到3620万,而YLDs从134万增加到345万。人口增长占患病率和YLDs增加的89.0%,而老龄化效应因社会人口指数(SDI)五分位数而异,在高SDI地区显示出负贡献(-39.4%),在中等SDI地区显示出正贡献(+28.7%)。在全球范围内,缺血性心脏病是所有SDI五分位数中主要的死亡原因(37.6%),其次是高血压性心脏病(24.1%)。低至中等SDI地区的心力衰竭负担增长最快(EAPC=0.22),社会经济不平等随着时间的推移而扩大。预测表明,到2035年,年龄标准化患病率和YLDs将分别上升至每10万人口4935例和473个残疾生存年。 结论:由于人口增长和医疗保健不平等,全球老年人心力衰竭负担在低至中等SDI地区增长最快。缓解这一危机需要优先确保公平获得循证治疗,并解决老年人群中的社会经济差异。
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