Smoking-attributable ischemic heart disease burden in China from 1990 to 2021 and projections to 2036: A retrospective analysis and forecasting study

INTRODUCTION: Ischemic heart disease (IHD) remains a leading global health challenge, with smoking identified as a key modifiable risk factor. China, with its high smoking prevalence and aging population, faces a growing burden of smoking-related IHD. This study evaluates the disease burden of smoking-related IHD in China from 1990 to 2021 and projects future trends to inform targeted interventions. METHODS: Using data from the Global Burden of Disease (GBD) 2021 (1990-2021) and the cross-sectional baseline survey of the China Health and Retirement Longitudinal Study (CHARLS, Wave 1, 2011-2012), we analyzed trends in mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs). Joinpoint regression identified temporal trends, and an autoregressive integrated moving average (ARIMA) model forecast disease burden up to 2036. The CHARLS analysis included participants aged ≥45 years with complete smoking and health records. Multivariable logistic regression assessed the association between smoking status and heart disease likelihood in CHARLS participants. RESULTS: CHARLS data revealed that former smokers had an 84% higher likelihood of heart disease than never smokers (adjusted odds ratio, AOR=1.84; 95% CI: 1.50-2.25). GBD analysis showed that China's age-standardized mortality rate (ASMR) for smoking-related IHD surpassed global and US levels after 2005, with males bearing a significantly higher burden than females. Joinpoint regression identified key turning points, with male ASMR rising until 2010 before declining slightly, while female indicators consistently improved. ARIMA projections suggest male ASMR will remain high (39.01; 95% UI: 22.69-55.33) by 2036, indicating persistent challenges. CONCLUSIONS: The burden of smoking-related IHD in China exceeds the global average and reveals significant gender disparities, with a worsening burden for males and improvement for females. There is a critical need for more effective smoking control measures aimed at the male population to tackle this major public health issue.