Abstract 12516: Explaining the Increase Mortality From Cardiovascular Disease in Indonesia: Unraveling the Trends in the Influence of Metabolic and Behavioral Risk Factors (2000-2019)

Abstract

Background: CVD burden has shifted from developed to developing countries; it decreased from 48% in 1990 to 43% in 2010, while in developing countries, it increased from 18% to 25%. According to several studies, current behavioural and metabolic risk factors enhance the risk of cardiovascular disease risk. Aims: We investigated whether changes in the risk factors—hyperglycemia, obesity, dyslipidemia, hypertension, and smoking—caused the rise in CVD mortality and incidence from 2000 to 2019 in Indonesia. Methods: Data from 34 province-year observations for CVD outcomes and changes in risk factors between 2000 and 2019 in Indonesia were obtained from IHME. A statistical model calculated risk factor fatalities using population-attributable fractions and baseline year death data. Multivariate regression on Summary Exposure Values of risk factors with mortality and incidence rates and lag year analysis was performed using R, measuring heteroscedasticity-consistent standard errors. Covariates, including the Socio-demographic Index, Primary healthcare, and GDP per capita, were added. Results: The age-standardized mortality rate per 100,000 for CVD from 2000 to 2019 in Indonesia increased from 356 to 412 among men and decreased from 357 to 354 among women. There was an increase in exposure to risk factors; obesity by 9%, smoking by 1%, dyslipidemia by 1.3%, hyperglycemia by 2%, and hypertension by 1.2%. An additional 14,517 men and 17,917 women died from CVD, attributable to obesity. Multivariate regression with province-fixed and year-fixed analysis shows a strong correlation between hyperglycemia in women (6;95% CI 0 to 12) with an increasing death rate in IHD. Notably, the association between hyperglycemia and IHD mortality was regardless of socioeconomic class and healthcare coverage. The association between a 10-year lag of high LDL and incidence of IHD was five times stronger compared to other risk factors, particularly in men (5;95%CI 2 to 8, incidence per 1-point increase). Conclusion: Female hyperglycemia increases CVD mortality risk. However, the prior-year analysis showed that high LDL levels increase incidence in men and women. These findings imply policymakers should prevent high LDL risk factors and hyperglycemia 10 years earlier.