The burden of cardiovascular disease in adolescents in China and globally due to sugar-sweetened beverage consumption from 1990 to 2021: results from the global burden of disease study 2021.

objectiveThis study aims to analyze the cardiovascular disease (CVD) burden attributable to sugar-sweetened beverage (SSB) consumption among young people worldwide and in China from 1990-2021,in order to provide reference data for strengthening the prevention and treatment of CVD among the general youth population.

method2021 Global Burden of Disease (GBD2021) data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. Based on theGBD2021database, data on the CVD burden attributable to SSB consumption among young people worldwide and in China from 1990 to 2021 were collected. The data were analyzed via R 4.3.3 software, and descriptive analysis was conducted via indicators such as the number of deaths, age-standardized mortality rate (ASMR), disability-adjusted life years (DALYs), age-standardized DALY rate (ASDR), and estimated annual percentage change (EAPC). Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021.

resultsCompared to 1990, the number of CVD deaths among young people attributable to high SSB consumption increased both globally and in China in 2021. However, the global ASMR has decreased, whereas China's ASMR has increased. The global ASMR decreased from 0.249 (0.044-0.441)/100,000 individuals to 0.17 (0.024-0.313)/100,000 individuals, and China's ASMR increased from 0.039 (0.01-0.071)/100,000 individuals to 0.12 (0.027-0.215)/100,000 individuals. The global DALY count rose, but the ASDR fell, whereas in China, both the DALY count and the ASDR changed consistently. Between 1990 and 2021, there were variations in mortality rates from CVDs attributed to high SSB intake. Notably, stroke mortality rates increased significantly, whereas ischemic heart disease mortality rates decreased significantly. An analysis of health inequalities indicated that the burden of CVDs due to SSB intake was primarily concentrated in countries with higher sociodemographic index (SDI) levels. However, there was a declining trend in the concentration index in 2021, suggesting an increasing disease burden in countries with lower SDI levels. In 1990, the slope index of mortality relative to the SDI was 2, which decreased to 1.2 in 2021. This finding indicates that with societal development, the disease burden in countries with higher economic levels has increased, whereas the burden in countries with lower economic levels has decreased (According to World Bank classifications, China transitioned from a lower-middle-income economy in 1990 to an upper-middle-income economy by 2021, with its per capita GNI increasing from $310 to $12,850).

conclusionThis study reveals a pronounced disparity in the burden of SSB-attributable cardiovascular disease among youth aged 15-39 years, with China experiencing a worsening trend in sharp contrast to the overall global decline. To avert a potential youth CVD crisis, it is imperative that economic transformation in China is accompanied by comprehensive preventive health policies.