Key result
High SBP drives rising CVD incidence in older Chinese adults, though mortality and DALYs decline.
Why the study?
Cardiovascular disease is a leading cause of death in China's aging population, but understanding of its long-term burden trends, risk factor contributions, and future projections among middle-aged and older adults remains limited.
CVD incidence and prevalence are rising among Chinese adults ≥45 years despite declining mortality, emphasizing the need for chronic disease management and targeted interventions for high blood pressure, LDL cholesterol, and blood glucose.
Rising CVD incidence despite falling mortality in Chinese adults ≥45 supports risk factor monitoring; leaves open causal confirmation from prospective data.
This study assessed epidemiological trends from 1990 to 2021, quantified risk factors contributions to CVD burden, and predicted risk-attributable mortality. Our study combines data from the 2021 Global Burden of Disease and the China Health and Retirement Longitudinal Study (CHARLS). Joinpoint regression analyzed trends in incidence, prevalence, mortality, and disability-adjusted life years (DALYs). Based on CHARLS database, logistic regression was used for comorbidity analysis. BAPC models projected mortality to 2036. From 1990 to 2021, ASIR and ASPR increased significantly (APC = 0.12, P = 0.004; APC = 0.33, P < 0.001), while ASDR and DALYs declined (APC = −1.01, P < 0.001; APC = −1.34, P < 0.001), with males exhibiting consistently higher burden than females (P < 0.001). Among individuals aged >75 years, mortality rates exceeded 4000 per 100,000 population, and the DALYs surpassed 60,000 per 100,000 population. High systolic blood pressure was the predominant risk factor. Logistic regression analysis of CHARLS data revealed significant associations between CVD and chronic lung disease (OR = 1.78), liver disease (OR = 1.49), and kidney disease (OR = 1.85). The BAPC prediction model indicates that all CVD risk factors show declining mortality trajectories over 15 years, with sex-specific variation in contributions. Declining CVD mortality and rising incidence and prevalence among Chinese individuals ≥45 years marks a transition towards chronic disease management. Despite overall declines, persistently high mortality due to elevated LDL cholesterol and blood glucose necessitates targeted interventions to optimize resource allocation. • Cardiovascular disease is a leading cause of death in China's aging population, and there is a limited understanding of its long-term burden trends, risk factor contributions, and future projections, particularly among middle-aged and older adults. • Rising CVD incidence/prevalence occurs alongside declining mortality/DALYs, signifying a shift towards chronic disease management. Key drivers include high systolic blood pressure, and CVD is significantly linked to comorbidity with chronic lung, liver, and kidney diseases. Projections show declining mortality across all risk factors by 2036, but reductions attributed specifically to high LDL cholesterol and high fasting blood glucose lag significantly behind. • The findings necessitate optimizing healthcare resource allocation towards chronic disease management paradigms. Crucially, urgent, targeted interventions are required to address the disproportionately large and persistent mortality burden specifically associated with elevated LDL cholesterol and blood glucose levels to effectively manage the evolving CVD epidemic in China's aging population.
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Wu et al. (2026) studied this question. From 1990-2021, CVD incidence and prevalence rose in Chinese adults ≥45, but mortality and DALYs declined, with high systolic blood pressure and comorbidities significantly increasing risk.
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