Temporal and spatial trends of ischemic heart disease burden in Chinese and subgroup populations from 1990 to 2016: socio-economical data from the 2016 global burden of disease study.

backgroundIschemic heart disease (IHD) is the leading cause of premature death which poses public health challenges worldwide. Previous studies focused on the overall population in China. However, variations in temporal and spatial patterns across subgroups remain unknown. This study was to analyze how the IHD burden among Chinese and subgroup populations changes in response to temporal and spatial trends from 1990 to 2016.

methodsBased on data from the updated estimate in the 2016 Global Burden of Disease (GBD) study, we used years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life years (DALYs) to describe the IHD burden. The percentage and annual average percentage changes were applied to illustrate temporal and spatial variations of the IHD burden stratified by age, sex, and province, over the periods 1990-2016, 1990-2005, and 2005-2016. We estimate population-attributable fraction (PAF) for 24 modifiable risk factors at the provincial level in 2016.

resultsYLD rates, YLL rates, and DALY rates for IHD underwent a notable increase among all age groups and increased by 119.4, 83.3, and 84.5% nationally from 1990 to 2016. In YLD rates, a greater increase was seen in females (124.4%) compared to males (114.0%), while males experienced a more substantial increase than that in females in YLL rates (99.3% vs. 60.5%) and DALY rates (99.7% vs. 63.2%) from 1990 to 2016. Compared with 1990-2005, annual average changes in the overall population in YLL rates (3.5% vs. 1.8%) and DALY rates (3.5% vs. 1.9%) showed a tardier increase whereas an opposite increasing trend of YLD rates (3.5% vs. 4.0%) was observed between 2005 and 2016. Geographically, all provinces saw declines in the YLLs/YLDs ratio from 2005 to 2016, with seventeen of thirty-three provinces showing an upward trend between 1990 and 2005. Most provinces witnessed a remarkable upsurge in the age-standardised DALY rate from 1990 to 2016 whereas the economically advantaged region Macao (52.2%) saw the most marked reduction. High systolic blood pressure and high LDL cholesterol remained the two leading risk factors of IHD in all provinces in 2016. Diet high in sodium was the leading behavioral risks in twenty-eight provinces with smoking heading the list in five provinces.

conclusionsChina has made significant achievements in preventing premature death from IHD along with the increased risk of disability. Substantial disparities in temporal and spatial trends of the IHD burden emphasize concerns for elderly men and those in economically disadvantaged regions with resource constraints. Regional differences in the IHD burden can be partly explained by modifiable risk factors. By having identified these disparities, targeted IHD prevention and control strategies will help to bridge these gaps.