Interpretation of the Annual Report on Cardiovascular Health and Diseases in China 2020

Abstract

The Chinese edition of the Annual Report on Cardiovascular Health and Diseases in China 2023 has been published.[1] We present herein an interpretation of this report. 1. Epidemiology of cardiovascular diseases (CVD) and risk factors 1.1. Trends in CVD burden 1.1.1. CVD According to the Global Burden of Disease (GBD) study, from 1990 to 2019, the age-standardized incidence of CVD (which includes rheumatic heart disease, ischemic heart disease (IHD), stroke, hypertensive heart disease, non-rheumatic valvular heart disease, cardiomyopathy and myocarditis, atrial fibrillation and atrial flutter, aortic aneurysm, peripheral artery disease (PAD), endocarditis, and other cardiovascular and circulatory system diseases) in China for individuals aged 1 to 79 increased from 646.2 per 100,000 person-years to 652.2 per 100,000 person-years. The age-standardized incidence rate for coronary heart disease (CHD) increased from 177.1 per 100,000 person-years in 1990 to 203.7 per 100,000 person-years in 2010, and then slightly decreased to 197.4 per 100,000 person-years in 2019. Based on GBD study data, from 1990 to 2016, the disability-adjusted life years (DALY) due to CVD increased by 33.7%, with a 51.8% increase in males, far surpassing the 12.1% increase observed in females. The diseases contributing most significantly to the growing burden include atrial fibrillation and atrial flutter (147.0%), IHD (122.0%), PAD (108.9%), ischemic stroke (80.4%), and aortic aneurysm (49.1%). Despite the increasing absolute burden of CVD, the age-standardized DALY from 1990 to 2016 decreased by 33.3%, with a more pronounced reduction in females (–43.7%) compared to males (–24.7%). All other types of CVD showed a varying degree of decline in age-standardized DALY, with significant decreases in rheumatic heart disease (–77.6%), other CVD (–68.7%), hypertensive heart disease (–54.8%), and hemorrhagic stroke (–52.6%). According to the China Health Statistical Yearbook 2022, CVD was the leading cause of death for urban and rural residents. In 2021, CVD accounted for 48.98% of deaths in rural areas and 47.35% in urban areas [Figure 1].Figure 1: Proportion of major disease mortality causes among rural residents (A) and urban residents (B) in China, 2021. CVD: Cardiovascular disease.Since 2009, the CVD mortality rate in rural areas has surpassed and continued to exceed that of urban areas [Figure 2]. In 2021, the CVD mortality rate in rural areas was 364.16 per 100,000 population, with heart disease accounting for 188.58 per 100,000. In urban areas, the CVD mortality rate was 305.39 per 100,000, with heart disease contributing 165.37 per 100,000.Figure 2: Changes in cardiovascular disease mortality rates among urban and rural residents in China, 2000–2021.Data from the China Health Statistical Yearbook 2022 also show that in 2021, the mortality rate for CHD was 135.08 per 100,000 in urban areas, and 148.19 per 100,000 in rural areas. In both urban and rural regions, the CHD mortality rate for males was higher than for females. The reduction in CVD burden is closely linked to social development, with higher reductions observed in more economically advanced regions. From 1990 to 2016, Beijing, Macao, and Hong Kong, which had the highest Socio-Demographic Index scores in 2016, achieved reductions of over 45%, while Xizang, Guizhou, Gansu, and Yunnan, regions with lower Socio-Demographic Index scores, saw declines of less than 25%. [Figure 3]Figure 3: Scatter plot of reduction in age-standardized DALY rates for cardiovascular disease across provincial-level regions in China (1990–2016) and SDI in 2016. DALY: Disability-adjusted life years; SDI: Socio-Demographic Index.The CHD mortality rate continued to increase in 2021, following the upward trend since 2012 [Figure 4A]. The rise was particularly evident in rural areas, where the rate surpassed that of urban areas by 2016.Figure 4: Trends in mortality rates for coronary heart disease (A) and acute myocardial infarction (B) among urban and rural residents in China, 2002–2021.From July 2021 to June 2022, the China Cardiovascular and Cerebrovascular Event Surveillance project collected data from 103 surveillance points in 20 provinces (autonomous regions and municipalities). The analysis revealed that the crude incidence rate of CVD among Chinese residents aged 18 years and older was 600.9 per 100,000 (age-standardized rate: 411.8 per 100,000), with a higher incidence in males (crude rate: 689.5 per 100,000, age-standardized rate: 501.9 per 100,000) compared to females (crude rate: 510.7 per 100,000, age-standardized rate: 324.9 per 100,000). The crude incidence rate of acute myocardial infarction (AMI) was 79.7 per 100,000 (age-standardized rate: 55.8 per 100,000), with a higher incidence in males (99.0 per 100,000) than in females (60.1 per 100,000). The China Cardiovascular Disease and Risk Factor Surveillance project, conducted from 2020 to 2022 across 262 surveillance points in 31 provinces (autonomous regions and municipalities), reported preliminary findings showing that the prevalence of CHD (including AMI, patients receiving stent implantation, patients undergoing coronary artery bypass grafting (CABG), and those hospitalized due to unstable angina) was 758 per 100,000. The prevalence was higher in males (940 per 100,000) than in females (570 per 100,000), and higher in urban areas (892 per 100,000) than in rural areas (639 per 100,000). The prevalence of CHD increases significantly with age. From 2002 to 2021, the mortality rate of AMI showed an overall upward trend. Since 2005, the mortality rate of AMI has risen rapidly, and since 2012, the mortality rate in rural areas has shown a significant increase, continuously exceeding that of urban areas since 2013 [Figure 4B]. 1.1.2. Cerebrovascular diseases The results of the GBD study show that in 2019, stroke patients in China, an increase of compared to the of stroke, the increase in prevalence from 1990 to was observed in ischemic stroke by and In 2019, the age-standardized prevalence rate of stroke was per 100,000, with ischemic stroke per 100,000, per 100,000, and per 100,000. to the age-standardized prevalence of stroke increased by with ischemic stroke increasing by while and decreased by and From July 2021 to June 2022, the China Cardiovascular and Cerebrovascular Event Surveillance project data from 103 points in 20 provinces (autonomous regions and municipalities). The preliminary results showed that the incidence rate of stroke among residents aged 18 and older was per 100,000 (age-standardized rate: per 100,000), with a higher incidence in males than in females. According to the China Health Statistical Yearbook 2022, the mortality rate for diseases among urban residents in 2021 was per 100,000, accounting for of deaths in urban areas, the leading cause of In rural areas, the mortality rate for diseases was per 100,000, accounting for of the leading cause of The mortality rate from diseases was higher in males than in and higher in rural areas than in urban areas. From to 2021, the overall mortality rate for diseases to the mortality rate for diseases among urban residents increased to the rate by 2021, and in rural areas, increased to the In of the mortality rate for diseases in rural areas that of urban areas [Figure Trends in crude mortality rates of disease among urban and rural residents in China, results of the GBD study that in China from stroke in 2019. From 1990 to 2019, the of deaths from stroke increased by with deaths from ischemic stroke and increasing by and while deaths due to decreased by In 2019, the age-standardized mortality rate for stroke in China was per 100,000, with ischemic stroke per 100,000, per 100,000, and per 100,000. to the age-standardized mortality rate for stroke decreased by with a in ischemic stroke and reductions of and for and The Chinese showed that the rate among aged and older in China was [Figure rate among in China, study conducted by the Chinese of and the of from to aged to 79 from regions in China for a of The results that was significantly with the incidence of circulatory system diseases aortic aneurysm and and other heart diseases other AMI heart heart disease and other heart diseases IHD infarction and The China and Health Surveillance data showed that the overall of Chinese residents was In of the of Chinese residents has been with a significant decline in the of from the of from has been continuously Since the of urban residents has the of and for the in rural also this The China and Health Surveillance data from which aged 18 years and that among Chinese was with rates from to The highest rate was for by [Figure was and of Chinese the Health of in Chinese on The to the of Chinese the of Chinese residents from the China and the China Disease and Risk Factor Surveillance that from 2002 to the of and among Chinese aged 20 and older increased [Figure the of the of and the in the Chinese other the the of and was of the of Chinese on data from the China and the China Surveillance revealed that from 2002 to of and was a major risk for ischemic stroke, and hemorrhagic and other while of and was with IHD The and mortality rate of cardiovascular deaths to showed an upward higher in males than and significantly increasing with age. 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