January 22, 2009BMC Public Health48 citationsOpen Access
The impact of demographic and risk factor changes on coronary heart disease deaths in Beijing, 1999–2010
Key Result
A modeled 0.5% annual reduction in major cardiovascular risk factors would prevent approximately 3,730 coronary heart disease deaths in Beijing by 2010, representing a 23% overall decrease.
Structured PICO
How do demographic changes and risk factor trends impact expected coronary heart disease deaths in Beijing?
P
Population
Population of Beijing, China, modeled between 1999 and 2010
I
Intervention
Modeled scenarios of risk factor changes (continuation of recent trends vs. 0.5% annual reduction in each risk factor) and population ageing
C
Comparator
Baseline CHD deaths in 1999
O
Outcome
Expected coronary heart disease (CHD) deaths in 2010hard clinical
The adverse impact of population ageing on coronary heart disease mortality in Beijing could be completely offset by feasible improvements in cardiovascular risk factors such as diet and smoking.
Limitations
- Considers only mortality, not years of life lost or morbidity
- Potential interactions among risk factors and potential lag effects were not considered
- Considered only CHD deaths, not competing causes
- Treatment uptakes in 2010 were assumed to remain constant at levels measured in 1999
Abstract
BACKGROUND: Recent, dramatic increases in coronary heart disease (CHD) mortality in China can be mostly explained by adverse changes in major cardiovascular risk factors. Our study aimed to assess the potential impact of subsequent changes in risk factors and population ageing on CHD deaths in Beijing between 1999 and 2010. METHODS: The previously validated IMPACT model was used to estimate the CHD deaths expected in 2010, with treatment uptakes being held constant at levels measured in 1999, comparing three scenarios: a) taking into account the ageing of the population but assuming no further changes in major risk factor levels from 1999 or, b) if recent risk factor trends continued until 2010 or, c) if there was a 0.5% annual reduction in each risk factor. RESULTS: Population ageing alone would result in approximately 1990 additional deaths in 2010 compared with 1999, representing an increase of 27%. Continuation of current risk factor trends would result in approximately 3,015 extra deaths in 2010, a 40% increase; three quarters of this increase would be attributable to rises in total cholesterol levels. Thus, demographic changes and worsening risk factors would together result in a 67% increase in CHD deaths. Conversely, assumed 0.5% annual reductions in risk factors (a mean population level decline of 0.3 mmol/L for total cholesterol in both genders, and smoking prevalence declining by 3.0% for men and 4.1% for women, body mass index by 1.3 kg/m2 for men and 1.4 kg/m2 for women, diabetes prevalence by 0.4% in both genders, and diastolic blood pressure by 4.7 mmHg for men and 4.4 mmHg for women) would result in some 3,730 fewer deaths, representing a 23% decrease overall. These findings remained consistent in sensitivity analyses. CONCLUSION: CHD death rates are continuing to rise in Beijing. This reflects worsening risk factor levels, compounded by demographic trends. However, the adverse impact of population ageing on CHD burden could be completely offset by eminently feasible improvements in diet and smoking.
Cite This Study
Cheng et al. (2009) studied Coronary heart disease mortality (n=6,322,396). 0.5% annual reduction in major cardiovascular risk factors vs. Continuation of current risk factor trends was evaluated on Projected change in coronary heart disease deaths in 2010. A modeled 0.5% annual reduction in major cardiovascular risk factors would prevent approximately 3,730 coronary heart disease deaths in Beijing by 2010, representing a 23% overall decrease.