背景:了解年轻人和年轻人总体和类型特异性心血管疾病(CVD)负担的时间趋势及其可归因的危险因素对于有效和有针对性的预防策略和措施很重要。我们的目标是提供一个标准化和全面的患病率估计,发病率,残疾调整寿命年(DALY),在全球范围内,15-39岁的年轻人和年轻人的CVD死亡率及其相关危险因素,区域,和国家层面。
方法:我们应用了全球疾病负担,受伤,和风险因素研究(GBD)2019年分析工具,用于计算年龄标准化发病率,患病率,DALY,以及总体和特定类型心血管疾病的死亡率(即,风湿性心脏病,缺血性心脏病,中风,高血压性心脏病,非风湿性心脏瓣膜病,心肌病和心肌炎,心房颤动和扑动,主动脉瘤,和心内膜炎)在15-39岁的年轻人中,性别,区域,1990年至2019年204个国家/地区的社会人口统计学指数,以及归因于相关风险因素的CVD的比例DALY。
结果:青年和年轻人CVD的全球年龄标准化DALY(每100,000人口)从1990年的1257.51(95%置信区间1257.03,1257.99)显着下降到2019年的990.64(990.28,990.99),年均百分比变化(AAPC)为-0.81%(-1.04%,-0.58%,P<0.001),年龄标准化死亡率也从19.83(19.77,19.89)显着下降到15.12(15.08,15.16),AAPC为-0.93%(-1.21%,-0.66%,P<0.001)。然而,全球年龄标准化发病率(每10万人)从1990年的126.80(126.65,126.95)适度增加到2019年的129.85(129.72,129.98),AAPC为0.08%(0.00%,0.16%,P=0.040),年龄标准化患病率从1477.54(1477.03,1478.06)显着增加到1645.32(1644.86,1645.78),AAPC为0.38%(0.35%,0.40%,P<0.001)。就特定类型的CVD而言,风湿性心脏病的年龄标准化发病率和患病率,缺血性心脏病的患病率,从1990年到2019年,心内膜炎的发病率上升(均P<0.001)。当按社会人口统计学指数(SDI)分层时,SDI低和中低的国家/地区的CVD负担高于SDI高和中高的国家/地区。女性心血管疾病的患病率高于男性,而男性的DALY和死亡率高于女性。高收缩压,高体重指数,和低密度脂蛋白胆固醇是所有纳入国家和地区心血管疾病DALY的主要归因危险因素.固体燃料造成的家庭空气污染是低SDI和中SDI国家CVDALY的另一个可归因于风险因素,中高,和高SDI国家。与女性相比,男性心血管疾病的DALY更有可能受到几乎所有风险因素的影响,尤其是吸烟。
结论:2019年,年轻人和年轻人的心血管疾病在全球范围内负担很大。总体和特定类型的CVD的负担因年龄而异,性别,SDI,区域,和国家。年轻人的心血管疾病在很大程度上是可以预防的,在有针对性地实施有效的一级预防策略和扩大年轻人的响应式医疗保健系统方面,这值得更多关注。
Understanding the temporal trends in the burden of overall and type-specific cardiovascular diseases (CVDs) in youths and young adults and its attributable risk factors is important for effective and targeted prevention strategies and measures. We aimed to provide a standardized and comprehensive estimation of the prevalence, incidence, disability-adjusted life years (DALY), and mortality rate of CVDs and its associated risk factors in youths and young adults aged 15-39 years at
global, regional, and national levels.
We applied
Global Burden of Disease, Injuries, and Risk Factors
Study (GBD) 2019 analytical tools to calculate the age-standardized incidence, prevalence, DALY, and mortality rate of overall and type-specific CVDs (i.e., rheumatic heart disease, ischemic heart disease, stroke, hypertensive heart disease, non-rheumatic valvular heart disease, cardiomyopathy and myocarditis, atrial fibrillation and flutter, aortic aneurysm, and endocarditis) among youths and young adults aged 15-39 years by age, sex, region, sociodemographic index and across 204 countries/territories from 1990 to 2019, and proportional DALY of CVDs attributable to associated risk factors.
The
global age-standardized DALY (per 100,000 population) for CVDs in youths and young adults significantly decreased from 1257.51 (95% confidence interval 1257.03, 1257.99) in 1990 to 990.64 (990.28, 990.99) in 2019 with an average annual percent change (AAPC) of - 0.81% (- 1.04%, - 0.58%, P < 0.001), and the age-standardized mortality rate also significantly decreased from 19.83 (19.77, 19.89) to 15.12 (15.08, 15.16) with an AAPC of - 0.93% (- 1.21%, - 0.66%, P < 0.001). However, the
global age-standardized incidence rate (per 100,000 population) moderately increased from 126.80 (126.65, 126.95) in 1990 to 129.85 (129.72, 129.98) in 2019 with an AAPC of 0.08% (0.00%, 0.16%, P = 0.040), and the age-standardized prevalence rate significantly increased from 1477.54 (1477.03, 1478.06) to 1645.32 (1644.86, 1645.78) with an AAPC of 0.38% (0.35%, 0.40%, P < 0.001). In terms of type-specific CVDs, the age-standardized incidence and prevalence rate in rheumatic heart disease, prevalence rate in ischemic heart disease, and incidence rate in endocarditis increased from 1990 to 2019 (all P < 0.001). When stratified by sociodemographic index (SDI), the countries/territories with low and low-middle SDI had a higher burden of CVDs than the countries/territories with high and high-middle SDI. Women had a higher prevalence rate of CVDs than men, whereas men had a higher DALY and mortality rate than women. High systolic blood pressure, high body mass index, and low-density lipoprotein cholesterol were the main attributable risk factors for DALY of CVDs for all included countries and territories. Household air pollution from solid fuels was an additional attributable risk factor for DALY of CVDs in low and low-middle SDI countries compared with middle, high-middle, and high SDI countries. Compared with women, DALY for CVDs in men was more likely to be affected by almost all risk factors, especially for smoking.
There is a substantial
global burden of CVDs in youths and young adults in 2019. The burden of overall and type-specific CVDs varied by age, sex, SDI, region, and country. CVDs in young people are largely preventable, which deserve more attention in the targeted implementation of effective primary prevention strategies and expansion of young-people\'s responsive healthcare systems.