Global trends and regional differences in mortality of cardiovascular disease and its impact on longevity, 1980-2021: Age-period-cohort analyses and life expectancy decomposition based on the Global Burden of Disease study 2021

Objective: To investigate the temporal trend in cardiovascular disease (CVD) mortality and its impact on life expectancy (LE) gains across different Socio-demographic Index (SDI) regions.

Methods: Cause-specific mortality estimates during 1980-2021 were obtained from the Global Burden of Disease 2021 study. An age-period-cohort (APC) analysis was adopted to estimate the net/local drifts and the age/period/cohort effects of CVD mortality. CVD-specific contributions to LE gains were estimated with Arriaga's method.

Results: The global age-standardized mortality rate of CVD declined remarkably from 416.1 to 235.2 per 100,000 during 1980-2021, with slight increase in the proportion of CVD death to all-cause mortality. The net drift of CVD mortality was -1.25 % per year during 1980-2019, and we observed negative local drifts across all age groups, among which middle-aged individuals experienced more rapid declines in CVD mortality than their younger counterparts. Favorable period and cohort effects were generally noted, particularly in high SDI countries. Globally, CVD mortality improvements accounted for an increase of 2.28 years (38.89 %) in LE at 20 years during 1980-2019, with relative contributions increasing from 15.18 % in low SDI region (mostly intracerebral hemorrhage) to 64.66 % in high SDI countries (mostly ischemic heart disease). Notably, LE gaps between low and high SDI countries further widened over study period, and the corresponding proportion attributable to CVD increased remarkably.

Conclusion: Process in reducing CVD mortality contributed to longevity improvements over the past four decades globally, with expanded cardiovascular health disparities across various SDI regions. More attention should be paid to CVD epidemic in low SDI countries to mitigate regional inequalities.