Key result
From 1990 to 2021, the global age-standardized death rate for ischemic heart disease attributable to active smoking declined, with an estimated annual percentage change of -1.81.
Why the study?
Ischemic heart disease remains a leading cause of death and disability globally, prompting evaluation of the spatiotemporal trends in IHD burden attributable to smoking across diverse sociodemographic regions.
Observational
Effect estimate: EAPC -1.81 (95% CI -2.31 to -1.30)
While global smoking-attributable IHD mortality has declined over the past three decades, significant disparities remain, with males, older populations, and low-SDI regions bearing a disproportionate burden.
Smoking-attributable IHD trends highlight persistent disparities; leaves open causal drivers and targeted policy effects.
INTRODUCTION: Ischemic heart disease (IHD) remains a leading cause of death and disability worldwide. This study evaluates the trends in IHD burden attributable to smoking, utilizing Global Burden of Disease Study 2021 (GBD 2021) data, across 204 countries and territories from 1990 to 2021. By examining age-standardized death rates (ASDR) and disability-adjusted life years (ASRDALYs), the study provides insights into the spatiotemporal variations associated with smokingattributable IHD in different sociodemographic regions. METHODS: Data on smoking-attributable IHD mortality and DALYs were obtained from the GBD 2021 database. This secondary analysis examined ASDR and ASRDALYs for IHD as primary outcomes, with active smoking as the primary exposure. Temporal trends were analyzed using estimated annual percentage changes (EAPCs). The burden was stratified by age, sex, and sociodemographic index (SDI) to identify disparities across regions. RESULTS: Over the last three decades, global ASDR and ASRDALYs for smokingrelated IHD have generally declined. High-SDI regions had the largest reductions, with EAPCs of -4.31 (95% CI: -5.73 - -2.87) and -4.02 (95% CI: -5.40 - -2.62), respectively. In contrast, low-SDI regions experienced slower declines, with EAPCs of -0.54 (95% CI: -1.41-0.33) and -0.80 (95% CI: -1.52 - -0.08), respectively. Older age groups and males consistently had a higher burden across all regions. Global death rates for populations aged 15-49, 50-74, and ≥75 years were 4.31, 46.57, and 142.52 per 100000, respectively. The global ASDR for males (30.24) was 8.54 times higher than that for females (3.54). Regional disparities were most pronounced in low- and middle-income areas, particularly in Eastern Europe and Central Asia, where smoking related IHD burden remains high. CONCLUSIONS: While global reductions in smoking-related IHD burden are encouraging, sustained disparities remain, particularly in low-SDI regions. Males and older populations continue to have a disproportionately higher burden, emphasizing the need for targeted interventions and sustained efforts to address these inequities.
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Wang et al. (2025) conducted an observational in Ischemic heart disease. Active smoking was evaluated on Age-standardized death rates (ASDR) for IHD attributable to smoking (EAPC -1.81, 95% CI -2.31 to -1.30). From 1990 to 2021, the global age-standardized death rate for ischemic heart disease attributable to active smoking declined, with an estimated annual percentage change of -1.81.
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