Trends of burden on ischemic heart disease and epidemiological transition of related risk factors in China, 1990-2017

Abstract

Objective: To examine the trend of burden on ischemic heart disease (IHD) and epidemiological transition on related risk factors among the Chinese population from 1990 to 2017. Methods: Based on open access data from the Global Burden of Disease (GBD) 2017 Study, we used years of life lost (YLD), years lived with disability (YLL), and disability-adjusted of life years (DALY) to describe the changes of IHD burden stratified by different sex and age groups from 1990 to 2017. We applied population-attributable faction (PAF) to analyze the burden attributable to risk factors and epidemiological transition. Results: In 2017, rates on YLD, YLL, and DALY for IHD were 74.2/100 000, 2 459.6/100 000, and 2 523.1/100 000, respectively. DALY rate and YLL rate for IHD in males were invariably higher than those in females except for YLD rate in females. 24 modifiable risk factors were causally associated with IHD. The top five risk factors that influencing DALYs, PAF, and DALY rate in 2017 appeared as: high blood pressure (16.429 million person years, 54.6%, 1 163.1/100 000), high LDL cholesterol (13 941 million person years, 46.3%, 987.0/100 000), diet high in sodium (10.900 million person years, 36.2%, 771.1/100 000), smoking (8.647 million person years, 28.7%, 612.2/100 000), and low-nut diet (7.452 million person years, 24.8%, 527.6/100 000). DALY rate for IHD showed an increase of 90.9%, from 1 116.4/100 000 in 1990 to 2 131.0/100 000 in 2017. Compared with 1990, the YLD rate experienced an evident increase in those aged 15-49 and over 70, in 2017. Annual average growth rate of YLD rate was higher in the ≥70 age group, between 2007 and 2017 (0.4%) than that between 1990 and 2007 (0.2%). The annual average increasing rates of both YLL and DALY were much lower from 2007 to 2017 (0.6%, 0.6%) than those from 1990 to 2007 (1.3%, 1.2%). From 1990 to 2017, DALYs attributed to meaty food (929.7%), beverages with high sugar content (822.7%), and high body-mass index (327.3%) experienced the highest increase. The largest increase in PAF occurred for beverages with high sugar content (400.0%). DALY rates increased for the 8 risk factors whereas decreased on the 7 risk factors, in consecutive rankings between 2007 and 2017. Conclusions: Despite the fact that burden on IHD-caused premature death had been reducing, related disabilities remain challenging with IHD the leading cause of burden, particularly in the ≥70 year-olds. Higher IHD burden from premature death was seen in males but disability appeared higher in females. It is significantly important to strengthen programs on prevention and control for hypertension including reducing modifiable risk factors such as smoking, unreasonable diet habits.