Incidence trends and specific risk factors of ischemic heart disease and stroke: An ecological analysis based on the Global Burden of Disease 2019

Ruiqi Xia; Min Cai; Ziyang Wang; Xuebo Liu; Jianfeng Pei; Maryam Zaid; Wanghong Xu

doi:10.1371/journal.pgph.0003920

Incidence trends and specific risk factors of ischemic heart disease and stroke: An ecological analysis based on the Global Burden of Disease 2019

PLOS Glob Public Health. 2024 Nov 20;4(11):e0003920. doi: 10.1371/journal.pgph.0003920. eCollection 2024.

Authors

Ruiqi Xia¹, Min Cai¹, Ziyang Wang^{1

2}, Xuebo Liu³, Jianfeng Pei^{1

2}, Maryam Zaid¹, Wanghong Xu^{1

2}

Affiliations

¹ Fudan University School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education (Fudan University), Shanghai, China.
² Yiwu Research Institute, Fudan University, Yiwu, Zhejiang Province, China.
³ Department of Cardiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China.

PMID: 39565745
DOI: 10.1371/journal.pgph.0003920

Abstract

Distribution of risk factors for cardiovascular diseases has been changing globally, which may account for the discrepant temporal trends of ischemic heart disease (IHD) and stroke. To test the hypothesis and identify potential contributing factors, we designed an ecological study based on the GDB-2019 data and extracted age-standardized incidence rates (ASIRs) of IHD and stroke, and summary exposure values (SEVs) of 87 attributable factors. A declining trend was observed for ASIRs of stroke (globally from 181.4 to 150.8/100,000 during 1990 and 2019, with an average annual percentage change of -0.64%) and IHD (globally from 316.4 to 262.4/100,000, with an average annual percentage change of -0.67%). However, the ASIR of IHD increased in Eastern Sub-Saharan Africa, Western Sub-Saharan Africa, East Asia, Central Asia, and Oceania, particularly in Uzbekistan and other 55 countries experiencing rapid socioeconomic translation. Eight factors, i.e. diet high in trans-fatty acids, diet low in calcium, high body-mass index, household air pollution from solid fuels, non-exclusive breastfeeding, occupational ergonomic factors, Vitamin A deficiency, and occupational exposure to particulate matter, gases, and fumes, were reversely associated with the ASIR of IHD and stroke at the country level. Ecological trend analysis also illustrated significant reverse associations of the factors with the ASIRs of IHD and stroke in in Western Sub-Saharan Africa, East Asia, and Oceania, but consistent associations in countries classified by the World Bank income levels. The results indicate the contributions of altered exposures to the eight factors in the discrepant trends of IHD and stroke across regions and countries, and suggest the determinant role of socioeconomic development in covariant of the risk factors with the incidences of IHD and stroke.

Copyright: © 2024 Xia et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.