Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015

Gregory A Roth, Catherine Johnson, Amanuel Abajobir, Foad Abd-Allah, Semaw Ferede Abera, Gebre Abyu, Muktar Ahmed, Baran Aksut, Tahiya Alam, Khurshid Alam, François Alla, Nelson Alvis-Guzman, Stephen Amrock, Hossein Ansari, Johan Ärnlöv, Hamid Asayesh, Tesfay Mehari Atey, Leticia Avila-Burgos, Ashish Awasthi, Amitava Banerjee, Aleksandra Barac, Till Bärnighausen, Lars Barregard, Neeraj Bedi, Ezra Belay Ketema, Derrick Bennett, Gebremedhin Berhe, Zulfiqar Bhutta, Shimelash Bitew, Jonathan Carapetis, Juan Jesus Carrero, Deborah Carvalho Malta, Carlos Andres Castañeda-Orjuela, Jacqueline Castillo-Rivas, Ferrán Catalá-López, Jee-Young Choi, Hanne Christensen, Massimo Cirillo, Leslie Cooper Jr, Michael Criqui, David Cundiff, Albertino Damasceno, Lalit Dandona, Rakhi Dandona, Kairat Davletov, Samath Dharmaratne, Prabhakaran Dorairaj, Manisha Dubey, Rebecca Ehrenkranz, Maysaa El Sayed Zaki, Emerito Jose A Faraon, Alireza Esteghamati, Talha Farid, Maryam Farvid, Valery Feigin, Eric L Ding, Gerry Fowkes, Tsegaye Gebrehiwot, Richard Gillum, Audra Gold, Philimon Gona, Rajeev Gupta, Tesfa Dejenie Habtewold, Nima Hafezi-Nejad, Tesfaye Hailu, Gessessew Bugssa Hailu, Graeme Hankey, Hamid Yimam Hassen, Kalkidan Hassen Abate, Rasmus Havmoeller, Simon I Hay, Masako Horino, Peter J Hotez, Kathryn Jacobsen, Spencer James, Mehdi Javanbakht, Panniyammakal Jeemon, Denny John, Jost Jonas, Yogeshwar Kalkonde, Chante Karimkhani, Amir Kasaeian, Yousef Khader, Abdur Khan, Young-Ho Khang, Sahil Khera, Abdullah T Khoja, Jagdish Khubchandani, Daniel Kim, Dhaval Kolte, Soewarta Kosen, Kristopher J Krohn, G Anil Kumar, Gene F Kwan, Dharmesh Kumar Lal, Anders Larsson, Shai Linn, Alan Lopez, Paulo A Lotufo, Hassan Magdy Abd El Razek, Reza Malekzadeh, Mohsen Mazidi, Toni Meier, Kidanu Gebremariam Meles, George Mensah, Atte Meretoja, Haftay Mezgebe, Ted Miller, Erkin Mirrakhimov, Shafiu Mohammed, Andrew E Moran, Kamarul Imran Musa, Jagat Narula, Bruce Neal, Frida Ngalesoni, Grant Nguyen, Carla Makhlouf Obermeyer, Mayowa Owolabi, George Patton, João Pedro, Dima Qato, Mostafa Qorbani, Kazem Rahimi, Rajesh Kumar Rai, Salman Rawaf, Antônio Ribeiro, Saeid Safiri, Joshua A Salomon, Itamar Santos, Milena Santric Milicevic, Benn Sartorius, Aletta Schutte, Sadaf Sepanlou, Masood Ali Shaikh, Min-Jeong Shin, Mehdi Shishehbor, Hirbo Shore, Diego Augusto Santos Silva, Eugene Sobngwi, Saverio Stranges, Soumya Swaminathan, Rafael Tabarés-Seisdedos, Niguse Tadele Atnafu, Fisaha Tesfay, J S Thakur, Amanda Thrift, Roman Topor-Madry, Thomas Truelsen, Stefanos Tyrovolas, Kingsley Nnanna Ukwaja, Olalekan Uthman, Tommi Vasankari, Vasiliy Vlassov, Stein Emil Vollset, Tolassa Wakayo, David Watkins, Robert Weintraub, Andrea Werdecker, Ronny Westerman, Charles Shey Wiysonge, Charles Wolfe, Abdulhalik Workicho, Gelin Xu, Yuichiro Yano, Paul Yip, Naohiro Yonemoto, Mustafa Younis, Chuanhua Yu, Theo Vos, Mohsen Naghavi, Christopher Murray, Gregory A Roth, Catherine Johnson, Amanuel Abajobir, Foad Abd-Allah, Semaw Ferede Abera, Gebre Abyu, Muktar Ahmed, Baran Aksut, Tahiya Alam, Khurshid Alam, François Alla, Nelson Alvis-Guzman, Stephen Amrock, Hossein Ansari, Johan Ärnlöv, Hamid Asayesh, Tesfay Mehari Atey, Leticia Avila-Burgos, Ashish Awasthi, Amitava Banerjee, Aleksandra Barac, Till Bärnighausen, Lars Barregard, Neeraj Bedi, Ezra Belay Ketema, Derrick Bennett, Gebremedhin Berhe, Zulfiqar Bhutta, Shimelash Bitew, Jonathan Carapetis, Juan Jesus Carrero, Deborah Carvalho Malta, Carlos Andres Castañeda-Orjuela, Jacqueline Castillo-Rivas, Ferrán Catalá-López, Jee-Young Choi, Hanne Christensen, Massimo Cirillo, Leslie Cooper Jr, Michael Criqui, David Cundiff, Albertino Damasceno, Lalit Dandona, Rakhi Dandona, Kairat Davletov, Samath Dharmaratne, Prabhakaran Dorairaj, Manisha Dubey, Rebecca Ehrenkranz, Maysaa El Sayed Zaki, Emerito Jose A Faraon, Alireza Esteghamati, Talha Farid, Maryam Farvid, Valery Feigin, Eric L Ding, Gerry Fowkes, Tsegaye Gebrehiwot, Richard Gillum, Audra Gold, Philimon Gona, Rajeev Gupta, Tesfa Dejenie Habtewold, Nima Hafezi-Nejad, Tesfaye Hailu, Gessessew Bugssa Hailu, Graeme Hankey, Hamid Yimam Hassen, Kalkidan Hassen Abate, Rasmus Havmoeller, Simon I Hay, Masako Horino, Peter J Hotez, Kathryn Jacobsen, Spencer James, Mehdi Javanbakht, Panniyammakal Jeemon, Denny John, Jost Jonas, Yogeshwar Kalkonde, Chante Karimkhani, Amir Kasaeian, Yousef Khader, Abdur Khan, Young-Ho Khang, Sahil Khera, Abdullah T Khoja, Jagdish Khubchandani, Daniel Kim, Dhaval Kolte, Soewarta Kosen, Kristopher J Krohn, G Anil Kumar, Gene F Kwan, Dharmesh Kumar Lal, Anders Larsson, Shai Linn, Alan Lopez, Paulo A Lotufo, Hassan Magdy Abd El Razek, Reza Malekzadeh, Mohsen Mazidi, Toni Meier, Kidanu Gebremariam Meles, George Mensah, Atte Meretoja, Haftay Mezgebe, Ted Miller, Erkin Mirrakhimov, Shafiu Mohammed, Andrew E Moran, Kamarul Imran Musa, Jagat Narula, Bruce Neal, Frida Ngalesoni, Grant Nguyen, Carla Makhlouf Obermeyer, Mayowa Owolabi, George Patton, João Pedro, Dima Qato, Mostafa Qorbani, Kazem Rahimi, Rajesh Kumar Rai, Salman Rawaf, Antônio Ribeiro, Saeid Safiri, Joshua A Salomon, Itamar Santos, Milena Santric Milicevic, Benn Sartorius, Aletta Schutte, Sadaf Sepanlou, Masood Ali Shaikh, Min-Jeong Shin, Mehdi Shishehbor, Hirbo Shore, Diego Augusto Santos Silva, Eugene Sobngwi, Saverio Stranges, Soumya Swaminathan, Rafael Tabarés-Seisdedos, Niguse Tadele Atnafu, Fisaha Tesfay, J S Thakur, Amanda Thrift, Roman Topor-Madry, Thomas Truelsen, Stefanos Tyrovolas, Kingsley Nnanna Ukwaja, Olalekan Uthman, Tommi Vasankari, Vasiliy Vlassov, Stein Emil Vollset, Tolassa Wakayo, David Watkins, Robert Weintraub, Andrea Werdecker, Ronny Westerman, Charles Shey Wiysonge, Charles Wolfe, Abdulhalik Workicho, Gelin Xu, Yuichiro Yano, Paul Yip, Naohiro Yonemoto, Mustafa Younis, Chuanhua Yu, Theo Vos, Mohsen Naghavi, Christopher Murray

Abstract

Background: The burden of cardiovascular diseases (CVDs) remains unclear in many regions of the world.

Objectives: The GBD (Global Burden of Disease) 2015 study integrated data on disease incidence, prevalence, and mortality to produce consistent, up-to-date estimates for cardiovascular burden.

Methods: CVD mortality was estimated from vital registration and verbal autopsy data. CVD prevalence was estimated using modeling software and data from health surveys, prospective cohorts, health system administrative data, and registries. Years lived with disability (YLD) were estimated by multiplying prevalence by disability weights. Years of life lost (YLL) were estimated by multiplying age-specific CVD deaths by a reference life expectancy. A sociodemographic index (SDI) was created for each location based on income per capita, educational attainment, and fertility.

Results: In 2015, there were an estimated 422.7 million cases of CVD (95% uncertainty interval: 415.53 to 427.87 million cases) and 17.92 million CVD deaths (95% uncertainty interval: 17.59 to 18.28 million CVD deaths). Declines in the age-standardized CVD death rate occurred between 1990 and 2015 in all high-income and some middle-income countries. Ischemic heart disease was the leading cause of CVD health lost globally, as well as in each world region, followed by stroke. As SDI increased beyond 0.25, the highest CVD mortality shifted from women to men. CVD mortality decreased sharply for both sexes in countries with an SDI >0.75.

Conclusions: CVDs remain a major cause of health loss for all regions of the world. Sociodemographic change over the past 25 years has been associated with dramatic declines in CVD in regions with very high SDI, but only a gradual decrease or no change in most regions. Future updates of the GBD study can be used to guide policymakers who are focused on reducing the overall burden of noncommunicable disease and achieving specific global health targets for CVD.

Keywords: cause of death; epidemiology; global health.

Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Figures

Graphical abstract
Graphical abstract
Figure 1
Figure 1
Global Map, Age-Standardized Prevalence of CVD in 2015 Choropleth map showing the estimated age-standardized prevalence of total CVD in 2015 for each country. ATG = Antigua and Barbuda; BRB = Barbados; COM = Comoros; CVD = cardiovascular diseases; DMA = Dominica; E Med = Eastern Mediterranean; FJI = Fiji; FSM = Federated States of Micronesia; GRD = Grenada; KIR = Kiribati; KS = Kaposi sarcoma; LCA = Saint Lucia; MDV = Maldives; MHL = Marshall Islands; MLT = Malta; MUS = Mauritius; NMSC = nonmelanoma skin cancer; SGP = Singapore; SLB = Solomon Islands; SYC = Seychelles; TLS = Timor-Leste; TON = Tonga; TTO = Trinidad and Tobago; VCT = Saint Vincent and the Grenadines; VUT = Vanuatu; W Africa = West Africa; WSM = Samoa.
Central Illustration
Central Illustration
Global Map, Age-Standardized Death Rate of CVD in 2015 Choropleth map showing the estimated age-standardized mortality rate of total CVD in 2015 for each country. ATG = Antigua and Barbuda; BRB = Barbados; COM = Comoros; CVD = cardiovascular diseases; DMA = Dominica; E Med = Eastern Mediterranean; FJI = Fiji; FSM = Federated States of Micronesia; GRD = Grenada; KIR = Kiribati; KS = Kaposi sarcoma; LCA = Saint Lucia; MDV = Maldives; MHL = Marshall Islands; MLT = Malta; MUS = Mauritius; NMSC = nonmelanoma skin cancer; SGP = Singapore; SLB = Solomon Islands; SYC = Seychelles; TLS = Timor-Leste; TON = Tonga; TTO = Trinidad and Tobago; VCT = Saint Vincent and the Grenadines; VUT = Vanuatu; W Africa = West Africa; WSM = Samoa.
Figure 2
Figure 2
Age-Standardized CVD Mortality Rate, From 1990 to 2015, of 21 GBD World Regions by SDI Relationship between age-standardized mortality rate for CVD and SDI over time. Each colored line represents a time trend of the relationship for the specified region. Each point represents a specific year for that region. The black line represents the overall global trend for age-standardized death rate of CVD in relation to SDI. CVD = cardiovascular diseases; GBD = Global Burden of Disease; SDI = sociodemographic index.
Figure 3
Figure 3
Relationship Between Age-Standardized Mortality Rate, CVD Cause, and SDI, by Sex This figure displays the distribution of age-standardized death rate by causes of CVD mortality by SDI. Abbreviations as in Figure 1.
Figure 4
Figure 4
Percent of Age-Standardized Prevalent Cases per 100,000 for CVD Causes, 2015 This figure displays the relative distribution of age-standardized prevalence by CVD cause for 21 GBD world regions. Abbreviations as in Figure 1.
Figure 5
Figure 5
Percent of Age-Standardized Deaths per 100,000 for CVD Causes, 2015 This figure displays the relative distribution of age-standardized prevalence by CVD cause for 21 GBD world regions. Abbreviations as in Figure 1.

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