Epidemiological trends in cardiovascular disease mortality attributable to modifiable risk factors and its association with sociodemographic transition across BRICS-Plus (Preprint)

Abstract

BRICS-Plus (Brazil, Russia, India, China, South Africa, and 30 other countries) is a group of 35 countries with emerging economies making up more than half of the world’s population. We explored epidemiological trends of cardiovascular disease (CVD) mortality attributable to modifiable risk factors and its association with period and birth cohort effects and sociodemographic index (SDI) across BRICS-Plus.

To explore epidemiological trends of CVD mortality attributable to modifiable risk factors and its association with SDI across BRICS-Plus.

The CVD mortality data were extracted from the Global Burden of Disease (GBD) Study 2019. We used joinpoint regression analysis to determine trend analysis, period and cohort effects on CVD mortality were estimated by using age-period-cohort (APC) modeling from 1990 to 2019. The rate ratio was calculated using the Maximum Likelihood (ML) of the APC-model Poisson with log (Y) based on the natural spline function (RR). Furthermore, the link between SDI and CVD mortality was examined using the spearman correlation coefficient (r).

Between 1990 and 2019, the all-ages CVD deaths increased by 85.2% (6.1 million to 11.3 million) and age-standardized mortality rate (ASMR) of CVD decreased by 19.3% (367 to 296 per 100,000) across BRICS-Plus. BRICS-Plus accounted for 60.9%, 58.3%, and 64.4% of global CVD, ischemic heart diseases (IHD), and ischemic stroke (IS) deaths in 2019, respectively with India and China alone contributing ~ two-thirds of all CVD deaths. The CVD ASMR attributable to dietary risks and smoking significantly decreased across BRIC-Plus countries, with some exceptions. However, four-fifth of BRIC-Plus countries observed a remarkable increasing trend of high body mass-index (BMI)-related CVD deaths in particular among younger adults (25-49 years) and ≈3-fold higher CVD mortality in males than in females. Early birth cohorts and individuals aged greater than 50 years showed a higher risk of CVD mortality. Both China-ASEAN FTA and Mercosur regions stand out for their successful sociodemographic transition, with a significant reduction in CVD mortality over the study period.

The burden of CVD mortality varies remarkably among BRICS-Plus countries. Singapore and Brazil achieved great progress in CVD mortality reduction and the other BRICS-Plus countries should follow their lead in adopting public health policies and initiatives into practice.