Temporal trends in heart failure burden among young adults in China: a systematic analysis from 1990 to 2021

Studies from several countries have reported an increasing trend in heart failure (HF) among young adults, but comprehensive data on HF burden among young Chinese adults are lacking.

Using data from the Global Burden of Disease Study 2021, we analyzed trends in prevalence and years lived with disability (YLDs) of HF among Chinese adults aged 20-49 years from 1990 to 2021. We examined age-standardized rates per 100,000 population, stratified by age groups, sex, severity levels, and underlying causes. Joinpoint regression, age-period-cohort analysis, decomposition analysis, frontier analysis and projection models were applied.

From 1990 to 2021, HF prevalence cases increased from 448,261.89 to 897,595.61, while YLDs rose from 44,025.76 to 88,416.28. Age-standardized prevalence rates increased from 88.44 to 141.27 per 100,000 population, and YLD rates increased from 8.70 to 13.90, with average annual percentage changes (AAPC) of 1.53 (95% CI: 1.40-1.65) and 1.52 (95% CI: 1.42-1.61), respectively. Ischemic heart disease remained the leading cause (51.68 per 100,000), followed by hypertensive heart disease (29.25) and cardiomyopathy (15.83), while atrial fibrillation showed the highest relative increase (446%). Frontier analysis revealed a moderate gap (effective difference: 51.68) between China's current and potentially achievable HF prevalence. Epidemiological changes (66.9%) drove the increased burden, with projections indicating continued rises through 2030.

The burden of HF among young Chinese adults has increased substantially over the past three decades, with traditional cardiovascular causes remaining predominant. These findings highlight the urgent need for enhanced prevention strategies targeting young adults in China.