The future impact of population growth and aging on coronary heart disease in China: projections from the Coronary Heart Disease Policy Model-China

BMC Public Health. 2008 Nov 27;8:394. doi: 10.1186/1471-2458-8-394.

Abstract

Background: China will experience an overall growth and aging of its adult population in coming decades. We used a computer model to forecast the future impact of these demographic changes on coronary heart disease (CHD) in China.

Methods: The CHD Policy Model is a validated state-transition, computer simulation of CHD on a national scale. China-specific CHD risk factor, incidence, case-fatality, and prevalence data were incorporated, and a CHD prediction model was generated from a Chinese cohort study and calibrated to age-specific Chinese mortality rates. Disability-adjusted life years (DALYs) due to CHD were calculated using standard methods. The projected population of China aged 35-84 years was entered, and CHD events, deaths, and DALYs were simulated over 2000-2029. CHD risk factors other than age and case-fatality were held at year 2000 levels. Sensitivity analyses tested uncertainty regarding CHD mortality coding, the proportion of total deaths attributable to CHD, and case-fatality.

Results: We predicted 7.8 million excess CHD events (a 69% increase) and 3.4 million excess CHD deaths (a 64% increase) in the decade 2020-2029 compared with 2000-2009. For 2030, we predicted 71% of almost one million annual CHD deaths will occur in persons >or=65 years old, while 67% of the growing annual burden of CHD death and disability will weigh on adults <65 years old. Substituting alternate CHD mortality assumptions led to 17-20% more predicted CHD deaths over 2000-2029, though the pattern of increases in CHD events and deaths over time remained.

Conclusion: We forecast that absolute numbers of CHD events and deaths will increase dramatically in China over 2010-2029, due to a growing and aging population alone. Recent data suggest CHD risk factor levels are increasing, so our projections may underestimate the extent of the potential CHD epidemic in China.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • China / epidemiology
  • Computer Simulation
  • Coronary Disease / epidemiology*
  • Coronary Disease / mortality*
  • Cost of Illness
  • Disabled Persons / statistics & numerical data
  • Female
  • Forecasting
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Models, Statistical
  • Population Dynamics*
  • Population Growth*
  • Prevalence
  • Proportional Hazards Models*
  • Quality-Adjusted Life Years
  • Risk Assessment / methods*
  • Risk Factors