Global burden of cardiovascular diseases attributable to environmental and occupational risk factors, 1990-2021: an analysis for the global burden of disease study 2021.
The overall burden of CVD attributable to EORF has increased substantially in the current population, highlighting significant room for improvement in prevention and control strategies.
Abstract
Background
Cardiovascular disease (CVD) remains a leading cause of mortality worldwide. Emerging evidence indicates that environmental and occupational risk factors (EORF) are significantly associated with its onset. However, the current global burden of CVD attributable to these exposures remains unclear.
Method
Using data from the Global Burden of Disease (GBD) Study, we estimated the number of deaths, disability-adjusted life years (DALYs), age-standardized death and DALY rates attributable to EORF from 1990 to 2021. Estimates were stratified by sex, region, and year. Additionally, we assessed the association between the EORF-related CVD burden and sociodemographic index (SDI).
RESULT
We found that CVD mortality due to EORF increased from 4.42million in 1990 to 6.44 million in 2021 (95% UI: 4.99-7.77), representing a 45.7% increase, while DALYs rose from 103million in 1990 to 138 million in 2021 (95% UI: 109-165), marking a 34.0% rise. During this period, age-standardized death and DALY rates globally showed a downward trend, decreasing by 38.5% and 38.9% respectively. At the national and regional levels, Western Australia and high SDI regions in Australia demonstrated significant improvements in EORF-related CVD burden. Additionally, men exhibit higher CVD burdens compared to women.
Conclusion
Our findings indicate that the overall burden of CVD attributable to EORF has increased substantially in the current population, highlighting significant room for improvement in prevention and control strategies. There is an urgent need to implement effective interventions targeting major EORF to mitigate the global CVD burden associated with these modifiable risks.
Cardiovascular diseases (CVDs) remain the leading cause of mortality and disability worldwide. Asia bears a disproportionate share of this burden, with substantial heterogeneity across subregions.
Using data from the Global Burden of Disease 2023 study, we assessed the burden of CVDs in Asia and its subregions from 1990 to 2023, including prevalence, deaths, and disability-adjusted life years (DALYs), stratified by age and sex. Temporal trends were evaluated using Joinpoint regression, and decomposition analysis was performed to quantify the contributions of population growth, aging, and epidemiological changes. Population attributable fractions (PAFs) of level 2 risk factors and rankings of the most detailed risk exposures were assessed across subregions. Estimates for prevalence, deaths, DALYs, and PAFs with corresponding 95% uncertainty intervals (UI) were derived.
From 1990 to 2023, age-standardized mortality rates (ASMR) and DALY rates (ASDR) declined across all Asian subregions, whereas age-standardized prevalence rates (ASPR) remained stable or increased in several regions. Joinpoint regression analysis revealed transient increases in ASMR and ASDR during specific periods in certain subregions. In 2023, East Asia had the largest absolute burden (140.5 million cases [95% UI: 130.7 to 152.8]; 4.7 million deaths [4.1 to 5.2]), while South Asia recorded the highest DALYs (102.3 million [90.6 to 113.5]). Central Asia exhibited the highest age-standardized rates (ASMR: 400.7 [374.0 to 418.6]; ASDR: 8,111.4 [7,734.2 to 8,421.9] per 100,000), whereas high-income Asia Pacific had the lowest. Despite the declines in age-standardized rates, absolute CVD deaths increased in all subregions, with decomposition analysis showing this rise was primarily driven by population aging and population growth. Ischemic heart disease and stroke accounted for over 86% of deaths and DALYs in most subregions, with ischemic heart disease predominating in Central Asia and stroke contributing disproportionately in Southeast Asia. South Asia showed a notable burden of rheumatic heart disease, along with elevated early-life DALYs primarily driven by stroke and cardiomyopathy/myocarditis. Metabolic risk factors dominated across regions, with high systolic blood pressure and high low-density lipoprotein cholesterol as the leading contributors.
Although age-standardized CVD mortality and DALYs have declined across Asia, the overall burden remains substantial and heterogeneous. Region-specific strategies targeting dominant risk factors are essential to effectively reduce CVD burden across diverse Asian populations.
Yi-Ding Zhuang, Xue-Hua Hu, Lin Yang et al.· Cardiac Research· 0 citations
Chronic kidney disease (CKD) remains a major contributor to global mortality and morbidity. This study reports the global, regional, and national burden of CKD and its attributable risk factors from 1990 to 2021. Data were systematically analyzed using the Global Burden of Disease 2021 study. CKD prevalence, deaths, and disability-adjusted life years (DALYs), along with their attributable risk factors, were retrieved for 204 countries and territories from 1990 to 2021. Temporal trends were assessed using the percentage change in age‑standardized rates, with stratified analyses by Global Burden of Disease super‑region, country, age, sex, and sociodemographic index quintiles. In 2021, CKD affected 673.7 million people worldwide, resulting in 1.53 million deaths and causing 44.45 million DALYs. Key findings include: first, the global age-standardized prevalence rate of CKD was 8006 per 100,000 people, a 4.5% decrease since 1990. However, the age-standardized mortality rate increased by 24.6% to 18.5 per 100,000. Second, the highest CKD prevalence was observed in Central Asia, Southeast Asia, and South Asia, while the lowest was found in Western Europe and Eastern Sub-Saharan Africa. Third, high blood glucose, hypertension, and obesity were identified as the leading contributors to CKD-related DALYs globally. The global burden of CKD continues to rise, with mortality and DALYs increasing particularly in low- and middle-income countries. Urgent public health strategies targeting high blood glucose, hypertension, and obesity are critical to reducing the rising global burden of CKD.
OBJECTIVE
To estimate the global burden of type 2 diabetes mellitus (T2DM) attributable to dietary risks among working-age adults from 1990 to 2023, stratified by sex, age, region, and Socio-Demographic Index (SDI). Because Global Burden of Disease (GBD) 2023 data are not disaggregated for ages 15-24, analyses were restricted to adults aged 25-64 years, the core working-age group.
STUDY DESIGN
GBD 2023 data from 204 countries and territories were analyzed. Age-standardized mortality (ASMR) and disability-adjusted life-year rates (ASDR) attributable to seven dietary risks were estimated using population-attributable fractions and joinpoint regression.
RESULTS
During 1990-2023, global ASMR rose from 17.1 to 21.5 per 100,000 (average annual percentage change [AAPC] 0.69%), accelerating after 2010, and ASDR rose from 695.9 to over 800 per 100,000 (AAPC 0.50%). Sugar-sweetened beverages and processed meat were the fastest-growing risks; the low-fiber burden declined slightly. Males bore higher and faster-growing burdens. Pacific Island nations had the highest rates; Eastern Europe and the Middle East grew fastest. Crude DALYs rose most among 25-29-year-olds, largely reflecting demographic change.
CONCLUSION
Diet-related T2DM burden is rising among working-age adults, with sugar-sweetened beverages and processed meats growing fastest. Targeted interventions are urgently needed in high-burden regions, particularly for males and younger adults.
Xin Chen, Xi-Yue Xiong, L. W. Chan et al.· Diabetes Research and Clinic...· 0 citations
The persistence of absolute burden despite declining ASDR may warrant greater consideration in future tobacco-related burden assessments and rehabilitation planning, while causal and policy interpretations warrant cautious interpretation as this is an ecological modelling study.
Summary Background Understanding epidemiological trends of the cardiovascular risk factors is integral in designing effective countermeasures in tackling cardiovascular diseases (CVD) in the Asia–Pacific. The study aims to examine the cardiovascular risk factor burden in the Asia–Pacific from 1990 to 2023, stratified by geographic subregion, sociodemographic index, and age-sex strata, to identify the region-specific risk factor targets for CVD prevention. Methods Estimates from the Global Burden of Disease Study 2023 were used to quantify cardiovascular mortality and disability-adjusted life years (DALYs) attributable to environmental/occupational, behavioural, and metabolic risk factors across 39 Asia–Pacific countries. Findings In 2023, cardiovascular risk factors contributed to 197.1 million DALYs, with an age-standardised DALY rate of 4463.7 per 100,000 population in the Asia–Pacific, which is 16.4% higher than the global estimate. Between 1990 and 2023, age-standardised DALYs declined by 34.9%, yet crude risk-attributable DALYs rose by 61.5%, as the demographic forces of population ageing (87.3%) and growth (45.3%) overwhelmed the gains from risk exposure reduction (−71.1%). Among risk factor categories, metabolic risk factors contributed to the fastest rise in CVD morbidity (74.3%), followed by behavioural (49.5%), and environmental/occupational risk factors (44.6%). The leading risk factors were high systolic blood pressure, dietary risks, air pollution and high LDL cholesterol. Interpretation The improvements in cardiovascular risk factor exposure in the Asia–Pacific have been offset by population growth and ageing. The metabolic-centric pattern in risk factors demands for strategies in tackling the region's high priority metabolic risk factor targets. Funding SingHealth Duke-National University of Singapore Cardiovascular Sciences Academic Clinical Programme, the National Medical Research Council of Singapore, and the Stafford Fox Foundation.
Nicholas W. S. Chew, Yiming Chen, F. Cader et al.· The Lancet Regional Health -...· 0 citations
BACKGROUND
Second-hand smoke (SHS) exposure remains a major source of morbidity and mortality among non-smokers. This study presents the first dedicated Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) publication to systematically quantify SHS prevalence and evaluate its effect as a global risk factor across a broader range of outcomes.
METHODS
Using the GBD 2023 comparative risk assessment framework, we estimated SHS exposure prevalence and attributable disease burden across 204 countries and territories from 1990 to 2023, stratified by age and sex. Exposure estimates were derived by synthesising population-based surveys and household composition data through spatiotemporal Gaussian process regression. Relative risks for nine health outcomes, now including asthma, were estimated using the Burden of Proof methodology, and applied to calculate attributable deaths and disability-adjusted life-years (DALYs).
FINDINGS
In 2023, an estimated 2·71 billion (95% UI 2·44-3·02) people worldwide were exposed to SHS, including 767 million (687-858) children aged 0-14 years. Age-standardised prevalence was highest in southeast Asia, east Asia, and Oceania (48·4% [44·0-53·4]), with female individuals in some countries experiencing nearly 1·8 times the exposure prevalence of male individuals. Despite a 22·2% (10·6-32·4) decline in global age-standardised prevalence since 1990, this progress has not been sufficient to reduce the absolute number of exposed individuals, which has remained stable globally and has risen sharply in sub-Saharan Africa (98·5% [62·0-144·4] increase) and North Africa and the Middle East (72·1% [47·8-101·8] increase). In 2023, SHS exposure accounted for 1·66 million (1·33-2·07) deaths and 44·8 million (35·8-54·3) DALYs globally. Ischaemic heart disease was the leading contributor to SHS-attributable DALYs (12·0 million [9·31-15·2]) overall, while lower respiratory infections predominated among children (5·16 million [3·48-7·12]).
INTERPRETATION
We estimated that SHS remains a substantial driver of global health loss, particularly through cardiovascular and paediatric respiratory diseases. Persistent geographical disparities and growing absolute numbers of exposed individuals in several regions underscore the urgent need for accelerated implementation and enforcement of comprehensive tobacco control measures, particularly to protect women and children in both public and domestic environments.
FUNDING
Bloomberg Philanthropies and the Gates Foundation.
Luisa S. Flor, Jason A Anderson, Brooks W. Morgan et al.· Lancet Public Health· 0 citations
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