Key result
Urban Shanghai CVD mortality falls ~30% from 1974 to 2015.
Why the study?
The effect of socioeconomic factors on cause-specific mortality and burden of CVD is rarely evaluated in low- and middle-income countries, particularly in rapidly changing societies.
Observational (n=101,822)
No
Effect estimate: AAPC -1.0 (95% CI -1.7 to -0.2)
Absolute Event Rate: 100.7% vs 144.5%
Improvements in medical services, pollution control, and lifestyle in urban Shanghai over 4 decades were associated with a decrease in age-standardized CVD mortality, particularly hemorrhagic stroke, though ischemic heart disease mortality increased with aging.
Supports sustained prevention in urban China; leaves open relative contributions of medical, environmental, and lifestyle factors.
BACKGROUND: Cardiovascular disease (CVD) is the leading cause of mortality worldwide. The effect of socioeconomic factors on cause-specific mortality and burden of CVD is rarely evaluated in low- and middle-income countries, especially in a rapidly changing society. METHODS: Original data were derived from the vital registration system in Yangpu, a representative, population-stable district of urban Shanghai, China, during 1974-2015. Temporal trends for the mortality rates and burden of CVD during 1974-2015 were evaluated using Joinpoint Regression Software. The burden was evaluated using age-standardized person years of life loss per 100,000 persons (SPYLLs). Age-sex-specific CVD mortality rates were predicted by using age-period-cohort Poisson regression model. RESULTS: A total of 101,822 CVD death occurred during 1974-2015, accounting for 36.95% of total death. Hemorrhagic stroke, ischemic heart disease, and ischemic stroke were the 3 leading causes of CVD death. The age-standardized CVD mortality decreased from 144.5/100,000 to 100.7/100,000 in the residents (average annual percentage change [AAPC] -1.0, 95% confidence interval [CI] -1.7 to - 0.2), which was mainly contributed by women (AAPC -1.3, 95% CI - 2.0 to - 0.7), not by men. Hemorrhagic stroke, the major CVD death in the mid-aged population, decreased dramatically after 1991. The crude mortality of ischemic heart disease kept increasing but its age-adjusted mortality decreased continually after 1997. SPYLLs of CVD death increased from 1974 to 1986 (AAPC 2.1, 95% CI 0.4 to 3.8) and decreased after 1986 (AAPC 1.8, 95% CI - 2.3 to - 1.3). These changes were in concert with the implementation of policies including extended medical insurance coverage, pollution control, active prophylaxis of CVD including lifestyle promotion, and national health programs. The mortality of CVD increased in those born during 1937-1945, a period of the Japanese military occupation, and during 1958-1965, a period including the Chinese Famine. Sequelae of CVD and ischemic heart disease are predicted to be the leading causes of CVD death in 2029. CONCLUSIONS: Exposure to serious malnutrition in early life might increase CVD mortality in later life. Improvements in medical services, pollution control, and lifestyle could decrease CVD death. New strategy is needed to prevent the aging-related CVD death and burden in the future.
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Zhang et al. (2020) conducted an observational in Cardiovascular disease (n=101,822). Temporal trends and socioeconomic factors vs. Baseline (1974) was evaluated on Age-standardized CVD mortality rate (per 100,000 persons) (AAPC -1.0, 95% CI -1.7 to -0.2). The age-standardized cardiovascular disease mortality rate in urban Shanghai decreased from 144.5 to 100.7 per 100,000 persons (AAPC -1.0) between 1974 and 2015.
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