Unveiling China's heart disease challenges: a comprehensive retrospective study on national mortality burden

Heart disease has been the leading cause of death in China since 2020. With the development of the aging population, dietary habits changes, and extreme climate conditions, this study aimed to evaluate national and sub-national changes in the heart disease burden from 2013 to 2021 in china, using data from the National Mortality Surveillance System.

This study was mainly using the National Mortality Surveillance System, which covered 300 million, accounted for 24% of China's population, with national and provincial representativeness from 2013 to 2021. The data categories were modified in 2013 to contain individual classes for heart disease, and the classifications remained consist until 2021. Permutation test were used to identify the Joinpoints in the data. Trends for the study period were evaluated using the average annual percent change (AAPC) in mortality rates with 95% Confidence interval (CI). A decomposition analysis was used to analyse the drivers of mortality change due to heart disease.

The total number of heart disease related deaths increased from 277,312(2013) to 463,314(2021). The proportion of deaths due to heart disease increased from 21.81% to 25.45%. And the gender-standardized mortality of heart disease increased from 140.11/100,000 to 180.67/100,000 from 2013 to 2021. The average annual increase (AAI) was 4.46%. since 2020, the heart disease has become the leading cause of death, rising from the third place. Epidemic characteristics were as follows: First, the heart disease-related mortality was higher in males than in females. And the AAPC for males was 3.74% from 2013 to 2021 (AAPC = 3.744, 95% CI: 3.048 ~ 4.528, P < 0.01). The AAPC for females was 4.09% (AAPC = 4.088, 95% CI: 2.962 ~ 5.313, P < 0.01). Second, a rapid increase in heart disease related mortality has been observed among 15-44 years population in recent years. Third, the mortality of rural residents in the past 6 years has increased fast (from 151.19/100,000 to 188.58/100,000). The average annual increase in rural heart disease mortality was 3.49%. Fourth, heart disease mortality in Central China increased fast and reached the highest rate in China. Additionally, ischemic heart disease mortality showed the highest, with a rapidly increasing trend. Finally, most heart disease related deaths occurred from October of the first year to March of the following year, with peaks in January and February. And over 70% of these deaths occured at home or in hospital,.

The deaths due to heart disease indicated a remarkable continues increase in the burden of heart disease. This study results imply escalating healthcare expenses, with projections indicating even greater future challenges. These findings will also help identify gaps in heart disease healthcare and guide the prioritization of health programs dirven by the needs of China.