PDF(Pubmed)
Abstract：
BACKGROUND: Ischemic heart disease (IHD) is the leading cause of death among noncommunicable diseases worldwide, but data on current epidemiological patterns and associated risk factors are lacking.
OBJECTIVE: This study assessed the global, regional, and national trends in IHD mortality and attributable risks since 1990.
METHODS: Mortality data were obtained from the Global Burden of Disease 2019 Study. We used an age-period-cohort model to calculate longitudinal age curves (expected longitudinal age-specific rate), net drift (overall annual percentage change), and local drift (annual percentage change in each age group) from 15 to >95 years of age and estimate cohort and period effects between 1990 and 2019. Deaths from IHD attributable to each risk factor were estimated on the basis of risk exposure, relative risks, and theoretical minimum risk exposure level.
RESULTS: IHD is the leading cause of death in noncommunicable disease-related mortality (118.1/598.8, 19.7%). However, the age-standardized mortality rate for IHD decreased by 30.8% (95% CI -34.83% to -27.17%) over the past 30 years, and its net drift ranged from -2.89% (95% CI -3.07% to -2.71%) in high sociodemographic index (SDI) region to -0.24% (95% CI -0.32% to -0.16%) in low-middle-SDI region. The greatest decrease in IHD mortality occurred in the Republic of Korea (high SDI) with net drift -6.06% (95% CI -6.23% to -5.88%), followed by 5 high-SDI nations (Denmark, Norway, Estonia, the Netherlands, and Ireland) and 2 high-middle-SDI nations (Israel and Bahrain) with net drift less than -5.00%. Globally, age groups of >60 years continued to have the largest proportion of IHD-related mortality, with slightly higher mortality in male than female group. For period and birth cohort effects, the trend of rate ratios for IHD mortality declined across successive period groups from 2000 to 2004 and birth cohort groups from 1985 to 2000, with noticeable improvements in high-SDI regions. In low-SDI regions, IHD mortality significantly declined in female group but fluctuated in male group across successive periods; sex differences were greater in those born after 1945 in middle- and low-middle-SDI regions and after 1970 in low-SDI regions. Metabolic risks were the leading cause of mortality from IHD worldwide in 2019. Moreover, smoking, particulate matter pollution, and dietary risks were also important risk factors, increasingly occurring at a younger age. Diets low in whole grains and legumes were prominent dietary risks in both male and female groups, and smoking and high-sodium diet mainly affect male group.
CONCLUSIONS: IHD, a major concern, needs focused health care attention, especially for older male individuals and those in low-SDI regions. Metabolic risks should be prioritized for prevention, and behavioral and environmental risks should attract more attention to decrease IHD mortality.
OBJECTIVE: This study assessed the global, regional, and national trends in IHD mortality and attributable risks since 1990.
METHODS: Mortality data were obtained from the Global Burden of Disease 2019 Study. We used an age-period-cohort model to calculate longitudinal age curves (expected longitudinal age-specific rate), net drift (overall annual percentage change), and local drift (annual percentage change in each age group) from 15 to >95 years of age and estimate cohort and period effects between 1990 and 2019. Deaths from IHD attributable to each risk factor were estimated on the basis of risk exposure, relative risks, and theoretical minimum risk exposure level.
RESULTS: IHD is the leading cause of death in noncommunicable disease-related mortality (118.1/598.8, 19.7%). However, the age-standardized mortality rate for IHD decreased by 30.8% (95% CI -34.83% to -27.17%) over the past 30 years, and its net drift ranged from -2.89% (95% CI -3.07% to -2.71%) in high sociodemographic index (SDI) region to -0.24% (95% CI -0.32% to -0.16%) in low-middle-SDI region. The greatest decrease in IHD mortality occurred in the Republic of Korea (high SDI) with net drift -6.06% (95% CI -6.23% to -5.88%), followed by 5 high-SDI nations (Denmark, Norway, Estonia, the Netherlands, and Ireland) and 2 high-middle-SDI nations (Israel and Bahrain) with net drift less than -5.00%. Globally, age groups of >60 years continued to have the largest proportion of IHD-related mortality, with slightly higher mortality in male than female group. For period and birth cohort effects, the trend of rate ratios for IHD mortality declined across successive period groups from 2000 to 2004 and birth cohort groups from 1985 to 2000, with noticeable improvements in high-SDI regions. In low-SDI regions, IHD mortality significantly declined in female group but fluctuated in male group across successive periods; sex differences were greater in those born after 1945 in middle- and low-middle-SDI regions and after 1970 in low-SDI regions. Metabolic risks were the leading cause of mortality from IHD worldwide in 2019. Moreover, smoking, particulate matter pollution, and dietary risks were also important risk factors, increasingly occurring at a younger age. Diets low in whole grains and legumes were prominent dietary risks in both male and female groups, and smoking and high-sodium diet mainly affect male group.
CONCLUSIONS: IHD, a major concern, needs focused health care attention, especially for older male individuals and those in low-SDI regions. Metabolic risks should be prioritized for prevention, and behavioral and environmental risks should attract more attention to decrease IHD mortality.
摘要：
背景：缺血性心脏病（IHD）是全球非传染性疾病的主要死亡原因，但是缺乏有关当前流行病学模式和相关危险因素的数据。
目的：本研究评估了全球，区域,以及自1990年以来IHD死亡率和可归因风险的国家趋势。
方法：死亡率数据来自2019年全球疾病负担研究。我们使用年龄-周期-队列模型来计算纵向年龄曲线（预期的纵向特定年龄比率），净漂移(总体年度百分比变化)，和从15岁到>95岁的局部漂移（每个年龄组的年百分比变化），并估计1990年至2019年之间的队列和时期影响。可归因于每个风险因素的IHD死亡是根据风险暴露进行估计的。相对风险，和理论最低风险暴露水平。
结果：IHD是非传染性疾病相关死亡率的主要死因（118.1/598.8，19.7%）。然而,在过去30年中，IHD的年龄标准化死亡率下降了30.8%(95%CI-34.83%至-27.17%)，其净漂移范围从高社会人口统计学指数（SDI）地区的-2.89％（95％CI-3.07％至-2.71％）到低-中-SDI地区的-0.24％（95％CI-0.32％至-0.16％）。IHD死亡率下降幅度最大的是大韩民国（高SDI），净漂移为-6.06％（95％CI-6.23％至-5.88％），其次是5个高SDI国家(丹麦，挪威,爱沙尼亚,荷兰,和爱尔兰）和2个中高SDI国家（以色列和巴林），净漂移低于-5.00%。全球范围内,>60岁的年龄组继续有IHD相关死亡率的最大比例，男性死亡率略高于女性组。对于时期和出生队列的影响，在2000年至2004年的连续期间组和1985年至2000年的出生队列组中,IHD死亡率的比率趋势下降,在高SDI地区有显著改善.在低SDI地区，女性组的IHD死亡率显着下降，但男性组的IHD死亡率在连续时期内有所波动；1945年以后在中，中，中，中，SDI地区和1970年以后在低SDI地区出生的人的性别差异更大。代谢风险是2019年全球IHD死亡的主要原因。此外，吸烟,颗粒物污染，饮食风险也是重要的风险因素，越来越多地发生在年轻的时候。在男性和女性群体中，低谷物和豆类的饮食是突出的饮食风险。吸烟和高钠饮食主要影响男性群体。
结论：IHD，一个主要的问题，需要重点关注医疗保健，尤其是对于老年男性个体和低SDI地区的个体。代谢风险应优先预防，行为和环境风险应引起更多关注，以降低IHD死亡率。
目的：本研究评估了全球，区域,以及自1990年以来IHD死亡率和可归因风险的国家趋势。
方法：死亡率数据来自2019年全球疾病负担研究。我们使用年龄-周期-队列模型来计算纵向年龄曲线（预期的纵向特定年龄比率），净漂移(总体年度百分比变化)，和从15岁到>95岁的局部漂移（每个年龄组的年百分比变化），并估计1990年至2019年之间的队列和时期影响。可归因于每个风险因素的IHD死亡是根据风险暴露进行估计的。相对风险，和理论最低风险暴露水平。
结果：IHD是非传染性疾病相关死亡率的主要死因（118.1/598.8，19.7%）。然而,在过去30年中，IHD的年龄标准化死亡率下降了30.8%(95%CI-34.83%至-27.17%)，其净漂移范围从高社会人口统计学指数（SDI）地区的-2.89％（95％CI-3.07％至-2.71％）到低-中-SDI地区的-0.24％（95％CI-0.32％至-0.16％）。IHD死亡率下降幅度最大的是大韩民国（高SDI），净漂移为-6.06％（95％CI-6.23％至-5.88％），其次是5个高SDI国家(丹麦，挪威,爱沙尼亚,荷兰,和爱尔兰）和2个中高SDI国家（以色列和巴林），净漂移低于-5.00%。全球范围内,>60岁的年龄组继续有IHD相关死亡率的最大比例，男性死亡率略高于女性组。对于时期和出生队列的影响，在2000年至2004年的连续期间组和1985年至2000年的出生队列组中,IHD死亡率的比率趋势下降,在高SDI地区有显著改善.在低SDI地区，女性组的IHD死亡率显着下降，但男性组的IHD死亡率在连续时期内有所波动；1945年以后在中，中，中，中，SDI地区和1970年以后在低SDI地区出生的人的性别差异更大。代谢风险是2019年全球IHD死亡的主要原因。此外，吸烟,颗粒物污染，饮食风险也是重要的风险因素，越来越多地发生在年轻的时候。在男性和女性群体中，低谷物和豆类的饮食是突出的饮食风险。吸烟和高钠饮食主要影响男性群体。
结论：IHD，一个主要的问题，需要重点关注医疗保健，尤其是对于老年男性个体和低SDI地区的个体。代谢风险应优先预防，行为和环境风险应引起更多关注，以降低IHD死亡率。
