Burden of Cardiovascular Diseases Attributable to Diabetes among Chinese Adults from 1990 to 2019

Abstract

Background Against the backdrop of global aging, the number of patients with chronic diseases is increasing, and the multimorbidity is becoming more severe. Traditionally, cardiovascular diseases and type 2 diabetes are mostly considered diseases of the elderly. However, with changes in lifestyle patterns such as the pace of life and diet, many diseases are showing a trend of rejuvenation. Recent studies have also shown that individuals who develop diabetes at a young age have an increased relative risk of developing cardiovascular diseases and higher mortality rates compared to the general population. Objective To investigate the burden of cardiovascular diseases attributed to diabetes among Chinese adults from 1990 to 2019, so as to provide evidence for comorbidity prevention. Methods Based on the 2019 Global Burden of Disease (GBD) study data, indicators such as mortality rates, disability-adjusted life years (DALY) rates, and estimated annual percentage change (EAPC) were used to assess the burden of cardiovascular diseases in China (including ischemic heart disease, stroke, and peripheral arterial disease) attributed to diabetes. The analysis was stratified by age group (25-49 years, 50-69 years, ≥70 years) and gender, and the temporal trends in disease burden were finally analyzed. Results The number of cardiovascular disease deaths attributable to diabetes increased from 298 050 in 1990 to 700 340 in 2019 among people aged 25 years and older in China. The age-standardized mortality rate for CVD attributed to diabetes increased for males compared to 1990, while it decreased for females, with males consistently having higher rates than females. In 2019, the DALY for CVD attributed to diabetes was 13 585 850 person-years. The age-specific mortality rate and DALY rate increased with age. The downward trend in standardized DALY rate was more pronounced in females (EAPC=-0.32%, 95%CI=-0.49% to -0.11%) than in males (EAPC=-0.01%, 95%CI=-0.26% to 0.29%). The mortality and DALY rates for ischemic heart disease and peripheral arterial disease attributed to diabetes increased in the three age groups from 1990 to 2019, while the mortality rates for stroke attributed to diabetes declined in all three age groups in 2019 compared to 1990. The percentage of standardized DALY rates attributable to diabetes for the 3 cardiovascular diseases in cardiovascular disease fluctuated from 1990 to 2019. However, the percentage of standardized DALY rates for all 3 cardiovascular diseases attributable to diabetes was higher in 2019 than in 1990. Conclusion From 1990 to 2019, there has been an overall increasing trend in the mortality and DALY rates of cardiovascular diseases attributed to diabetes among adults in China. Population is at greater risk for comorbidities of diabetes and CVD, emphasizing the need to focus on screening for CVD among individuals with diabetes or those at high risk of developing CVD. Emphasis should be placed on males, the elderly, and younger individuals with unhealthy lifestyle habits for early health interventions to reduce the burden of comorbidities.

Keywords

• cardiovascular diseases|diabetes mellitus|adult|disease burden|mortality|disability-adjusted life years