| Background:Cardiovascular disease(CVD)as the leading cause of death in China,has become an important public health problem affecting the population health and life expectancy.However,given that the 31 provinces of mainland China have vastly different culture and socioeconomic development levels,temporal trends and geographical variations in CVD burden attributable to high systolic blood pressure(SBP)in China have not been fully elucidated.Therefore,it is important to conduct a more systematically comprehensive assessment for the CVD burden attributable to high SBP over an extended period at the provincial level.Objective:The current study was performed to quantify the CVD burden attributable to high SBP at national and provincial levels in China,assisting public policy makers in promoting blood pressure control measures.Methods:We pooled blood pressure data of 1.30 million adults from the China Chronic Disease and Risk Factor Surveillance,the China National Nutrition Survey and China Hypertension Survey.We applied a temporal-spatial Bayesian hierarchical model to estimate age-,sex-,province-,and year specific average SBP levels.The age-sexcause-specific mortality data at the provincial level from 2005-2018 were mainly derived from the Disease Surveillance Point system.The theoretical-minimum-risk exposure level of SBP was 110-115 mmHg based on the global burden of disease study(GBD),and the age-specific relative risks were consistent with GBD2019.Based on the counterfactual theory,population attributable fraction(PAF)and its 95%uncertainty interval(UI)for CVD and its subcategories(including ischaemia heart disease,ischaemia stroke,haemorrhagic stroke,and other cardiovascular diseases)attributable to high SBP at both national and provincial levels from 20052018 were calculated by age,sex,year and province.The years of life lost(YLLs)were obtained by multiplying the number of estimated deaths by the standard life expectancy at each age.Attributable deaths and YLLs for CVD were calculated by multiplying the total deaths and YLLs by age-,sex-,province-,and cause-specific PAF,respectively.Census data were obtained from the National Bureau of Statistics,and the population in 2010 was used to calculate age-standardised indicators.Moreover,we assessed the estimated annual percentage change(EAPC)of agestandardised mortality rate via a log-liner model to measure the trends of the disease burden.We also decomposed trends in CVD deaths attributable to high SBP into four explanatory components through counterfactual theory,including population growth,population aging,risk exposure to SBP,and SBP risk-deleted mortality rates for CVD.Results:1.The exposure level of SBPNationally,the age-standardised mean SBP was 132.5 mmHg(95%UI 124.6-140.3)for male and 129.4 mmHg(95%UI 121.7-137.2)for female in 2018.At the provincial level,the age-standardised mean SBP in 2005 and 2018 were lowest in the southern and southwestern provinces,such as Guangxi,Guangdong and Tibet for both male and female.2.Total CVD burden and trends attributable to high SBPThe SBP-related CVD mortality rates was 7.63(95%UI 7.15-8.07)per 100 000 people for male aged 25-29 years,4 628.57(95%UI 4 376.67-4 873.20)per 100 000 for those aged>80 years old;and for female,it was 1.93(95%UI 1.78-2.09)per 100000,4 617.07(95%UI 4 355.59-4 845.92)per 100 000,respectively.Approximately 2.67 million(95%UI 2.61-2.72)CVD deaths in China were attributable to high SBP in 2018.The age-standardised CVD mortality rates attributable to high SBP decreased by 17.90%in China between 2005(268.99[95%UI 264.11-273.51]per 100 000)and 2018(220.84[95%UI 216.30-224.76]per 100 000).The EAPC of age-standardised mortality rates for CVD was-1.50(95%UI-1.55 to-1.45).Overall,the estimated YLLs for the total CVD attributable to high SBP were 40.14 million(95%UI 39.7040.54)years in 2005 and 48.16 million(95%UI 47.44-48.80)years in 2018.The agestandardised YLL rates related to high SBP decreased by 20.99%for total CVD.There were marked variations of mortality rates for CVD deaths attributable to high SBP across the province.In 2018,the top-three age-standardised mortality rates attributable to high SBP was observed in Tibet,Heilongjiang and Hebei.The agestandardised CVD mortality rates attributable to high SBP in most provinces decreased from 2005-2018,with the percentage change ranging from-34.34%in Tianjin to-6.78%in Shandong,However,the age-standardised CVD mortality rates in Shanghai and Anhui had increased.YLL rates for total CVD caused by high SBP varied substantially across provinces,ranging from 3 078.33(95%UI 2 807.40-3303.57)per 100 000 people in Beijing to 7 189.98(95%UI 6 817.18-7 507.99)per 100 000 people in Heilongjiang in 2018.3.Different CVD subtypes burden and trends attributable to high SBPApproximately 1.12 million deaths from ischaemia heart disease,0.63 million(95%UI 0.60-0.65)deaths from ischaemia stroke,0.58 million deaths(95%UI 0.57-0.60)from haemorrhagic stroke and 0.34 million death(95%UI 0.32-0.36)from other CVD were caused by high SBP in China in 2018.We observed upward trends in the crude mortality rates for ischemic heart disease,ischemic stroke and other CVD from 20052018,ranging from 94.12 per 100 000,46.34 per 100 000,and 25.31 per 100 000 in 2005 to 118.82 per 100 000,66.49 per 100 000,and 36.45 per 100 000 in 2018,respectively.However,the age-standardised mortality rates for ischemic heart disease and hemorrhagic stroke related to high SBP had been steadily declining since 2005.The age-standardised YLL rates related to high SBP decreased by 16.03%,4.70%and 38.13%for ischaemia heart disease,ischaemia stroke and haemorrhagic stroke,respectively.For most provinces,the subtypes of CVD with greater impact of high SBP included ischaemia heart disease,ischaemia stroke,and haemorrhagic stroke in 2018.Age-standardised YLL rates for ischaemia heart disease and ischaemia stroke attributable to high SBP were particularly higher in northeastern provinces,such as Heilongjiang,Liaoning and Jilin.4.Decomposition analysis of changes in national and provincial mortalityNationally,compared to 2005,population aging and population size in 2018 were the primary drivers of increased SBP-related deaths due to CVD,which were partially offset by decrease in risk-deleted mortality rate.At the provincial level,population aging accounted for increases in the number of death due to SBP-related CVD for most provinces from 2005 to 2018,the contribution rate of population aging for Shanghai,Zhejiang,and Shandong were 51.54%,38.94%,and 43.31%,respectively.Conclusion:This study offers a comprehensive assessment of geographic variations and temporal trends of the SBP-related CVD burden from 2005-2018 at the national and provincial levels in China.In general,the absolute number of CVD deaths attributable to high SBP increased nationally from 1.98 million in 2005 to 2.67 million in 2018;and the estimated YLLs for the total CVD attributable to high SBP increased from 40.14 million in 2005 to 48.16 million in 2018.Although the total number of deaths and YLLs for CVD had continued to rise,the age-standardised CVD mortality rates caused by high SBP decreased from 2005 to 2018.There were geographical variations in the burden of CVD and its subcategories attributable to high SBP across provinces,and age-standardised YLL rates for CVD deaths attributable to high SBP were the highest in the northeastern and northwestern provinces of China.Additionally,population aging and population size in 2018 were the primary drivers of increased SBP-related deaths due to CVD.Effective and locally adapted preventive interventions should be implemented to lower the prevalence of high SBP and reduce the burden of SBP-related CVD in the population. |
PDF Full Text Request