Demographic and epidemiologic drivers of global cardiovascular mortality

Abstract

Background: Global deaths from cardiovascular disease are increasing as a result of population growth, the aging of populations, and epidemiologic changes in disease. Disentangling the effects of these three drivers on trends in mortality is important for planning the future of the health care system and benchmarking progress toward the reduction of cardiovascular disease.

Methods: We used mortality data from the Global Burden of Disease Study 2013, which includes data on 188 countries grouped into 21 world regions. We developed three counterfactual scenarios to represent the principal drivers of change in cardiovascular deaths (population growth alone, population growth and aging, and epidemiologic changes in disease) from 1990 to 2013. Secular trends and correlations with changes in national income were examined.

Results: Global deaths from cardiovascular disease increased by 41% between 1990 and 2013 despite a 39% decrease in age-specific death rates; this increase was driven by a 55% increase in mortality due to the aging of populations and a 25% increase due to population growth. The relative contributions of these drivers varied by region; only in Central Europe and Western Europe did the annual number of deaths from cardiovascular disease actually decline. Change in gross domestic product per capita was correlated with change in age-specific death rates only among upper-middle income countries, and this correlation was weak; there was no significant correlation elsewhere.

Conclusions: The aging and growth of the population resulted in an increase in global cardiovascular deaths between 1990 and 2013, despite a decrease in age-specific death rates in most regions. Only Central and Western Europe had gains in cardiovascular health that were sufficient to offset these demographic forces. (Funded by the Bill and Melinda Gates Foundation and others.).

Figure 1. Regions Analyzed in the Global Burden of Disease Study 2013

No estimates are provided for the areas in white.

Figure 2

Contribution of Changes in Population Growth, Population Aging, and Rates of Age-Specific Cardiovascular Death to Changes in Cardiovascular Mortality, 1990–2013.

Figure 3. Percentage Change in Cardiovascular Death Rate Owing to Changes in Age-, Sex-, and Cause-Specific Death Rates, According to Change in Country Income Level per Capita, 1990–2013

Every country included in the study is represented by a blue diamond, which indicates the country’s percentage change in the number of cardiovascular deaths as a result of changes in the age-, sex-, and cause-specific cardiovascular death rate alone, separate from the effect of population growth and aging, and the change in gross domestic product (GDP) per capita (in international dollars) between 1990 and 2013. Outlier countries are identified by their International Organization for Standards (ISO) country code. ARE denotes United Arab Emirates, BDI Burundi, BFA Burkina Faso, BGD Bangladesh, BHR Bahrain, BLR Belarus, BRN Brunei, GHA Ghana, ISR Israel, JOR Jordan, KOR South Korea, LUX Lux-embourg, MHL Marshall Islands, MUS Mauritius, QAT Qatar, RWA Rwanda, SGP Singapore, SRB Serbia, SYC Seychelles, and ZMB Zambia.