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ASIR for CVD in individuals aged 15-39 years

In 2019, the number of CVD cases among individuals aged 15 to 39 years worldwide was estimated at 3.87 million (95% UI: 332.70 to 446.79), with an ASIR of 129.85 per 100,000 (95% CI: 102.60). , 160.31). The highest ASIR was seen at low and low-medium SDI. (table 1). Countries with high ASIR were mainly distributed in sub-Saharan Africa, Central Asia, Western Asia, and northern East Asia. (Figure 1).

Table 1. Burden of CVD in 1990 and 2019 and temporal trends from 1990 to 2019 in adolescents and young adults.
Figure 1
Figure 1

Distribution of cardiovascular disease (CVD) burden among adolescents and young adults by country and region in 2019

Regarding trends, the change in ASIR attributable to CVD for people aged 15-39 showed a non-significant upward trend globally from 1990 to 2019, with an EAPC point estimate of 0.04 and a 95% CI of zero. It contained. Among the different SDI regions, the high-medium SDI region and the medium-SDI region showed a regional downward trend, while the other he SDI regions remained stable. Of the total 204 countries, 72 (35.29%) showed an increasing trend in ASIR, mainly distributed in West Asia, Southeast Asia, East Asia, North Africa, and Eastern Europe. Specifically, in Saudi Arabia, the EAPC for ASIR was 1.25 (95%CI: 1.21, 1.29). (Table 1, Figure 1).

From 1990 to 2019, ASIR attributable to CVD for different genders showed a slight upward trend for men aged 15-39 years, with an EAPC for ASIR of 0.09 (95% CI: 0.04, 0.14), but for women There was no such tendency. statistically significant. The EAPC of ASIR among different age groups was 0.52 (95% CI: 0.45, 0.60) and 0.11 (95% CI: 0.01, 0.21) for the 15–19 and 20–24 years groups, respectively. Although no significant decrease in ASIR was observed in the 25-29 age group, the burden of CVD showed a decreasing trend in other age groups. (Figure S1).

ASMR and ASDR of CVD in individuals aged 15-39 years

In 2019, the number of deaths due to CVD among people aged 15-39 was 455,850 (95%UI: 420.27-493.99), and the DALY was 29.78 million (95%UI: 27.62-32.14). ASMR and ASDR were 15.12 per 100,000 (95% CI: 13.89, 16.48) and 990.64 per 100,000 (95% CI: 911.06, 1076.46). (table 1). Countries with a heavier burden of ASMR and ASDR were concentrated in Eastern Europe, North Asia, Central Asia, West Asia, and North Africa. Kiribati had the highest ASMR, while Switzerland had the lowest at 90.11 per 100,000 people (95% CI: 70.64, 112.92) and 2.22 per 100,000 people (95% CI: 1.96, 2.52), respectively. (Figure 1).

This burden was greater for men than for women. Her ASMR for women and men was 19.70 per 100,000 (95% CI: 17.93, 21.67) and 10.46 per 100,000 (95% CI: 9.25, 11.63), respectively. Among all five age groups, individuals aged 35-39 years had the highest contribution, with corresponding mortality rates and DALYs of 34.93 per 100,000 (95% UI:32.24-37.80) and 1976.74 per 100,000 (95% UI). :1836.29-). 2125.87). (Table 1, Figure S1).

Changes in ASMR and ASDR due to CVD among 15-39 year olds showed a decreasing trend globally, with EAPC values ​​of 0.90 (95% CI: 1.01, 0.78) and 0.80 (95% CI: 0.90, 0.71), respectively. there were. (table 1). ASMR and ASDR showed the most obvious regional downward trends in high-SDI and high-medium SDI regions. The values ​​of EAPC for ASMR are – 1.46 (95%CI: -1.58, -1.34) and – 1.25 (95%CI: -1.45, -1.05), and the values ​​of ASDR are – 1.17 (95%CI: -1.28, -) was. 1.06) and – 1.15 (95%CI: -1.32, -0.98). (Figure 2).

Figure 2
Figure 2

Temporal trends in cardiovascular disease (CVD) burden among adolescents and young adults by country and region from 1990 to 2019

Out of the total 204 countries, 167 countries (81.86%) showed a downward trend and 23 countries (11.27%) showed an upward trend. The most notable was the Philippines, where the EAPC for ASMR was 5.80 (95%CI: 4.79, 6.81). ). Countries on the rise were mainly distributed in South Asia, Southeast Asia, East Asia, Sub-Saharan Africa, and Northern Europe. Similar to ASMR, most countries’ ASDR showed a decreasing trend, while 21 countries increased and 16 countries remained stable. (Figure 2).

ASMR and ASDR of different genders showed a decreasing trend, and the gap in ASMR decline was particularly pronounced for women. EAPC for ASMR was – 1.59 (95%CI: -1.76, -1.42) for women, – 1.34 (95%CI: -1.48, -1.20) for men, and EAPC for ASDR was – 0.48 (95%CI: -0.59, -0.38 for women) and -0.44 for men (95%CI: -0.54, -0.35). (Table 1, Figure 3)

Figure 3
Figure 3

Temporal trends in cardiovascular disease (CVD) burden in adolescents and young adults by gender and SDI from 1990 to 2019

Types of CVD in individuals aged 15–39 years.

Among individuals aged 15-39 years, RHD had the highest ASIR at 50.37 per 100,000 (95% CI: 28.88, 74.15), followed by stroke and ischemic heart disease (IHD). IHD was the highest for both ASMR and ASDR, with corresponding rates of 7.02 per 100,000 (95%CI: 6.41, 7.76) and 402.58 per 100,000 (95%CI: 367.59, 445.01). The burden of RHD was highest at ages 15–19 and decreased with age at ages 15–39. Some other types were characterized by an inverse age distribution. Additionally, the burden of RHD was highest at low and low-moderate SDIs. ASIR for non-rheumatic valvular heart disease was much higher at high SDI. (Figure 4, Figure S2).

Figure 4
Figure 4

Prevalence of cardiovascular disease (CVD) types in adolescents and young adults worldwide by SDI 2019

Risk factors attributable to DALYs for death and CVD in individuals aged 15-39 years

In the 2019 GBD, there were 27 detailed risk factors attributable to CVD deaths and DALYs in individuals aged 15 to 39 years. High systolic blood pressure, high BMI, and high LDL cholesterol were the top three risk factors. The PAF for ASMR was 43.60%, 32.73%, and 32.17%, and the PAF for ASDR was 40.41%, 30.97%, and 28.97%, respectively. PAFs for household air pollution from ambient particulate matter pollution, smoking, diets low in whole grains, and solid fuels range from 9 to 19%. (Figure 5).

Figure 5
Figure 5

Proportion of cardiovascular disease (CVD) deaths and disability-adjusted life years (DALYs) in adolescents and young adults attributable to 27 risk factors by gender and SDI in 2019

The distribution was gender and age specific. The PAF and DALY of smoking for death were 20.28% and 18.24% for men, nearly five times higher than for women. Other risk factors, such as ambient particulate pollution, diets low in whole grains, high sodium, and alcohol use, also play a more pronounced role in men. For women, secondhand smoke and household air pollution from solid fuels were the most typical influencing factors, with PAFs for ASMR of 7.29% and 11.48% and PAFs for ASDR of 6.10% and 10.24%, both higher than for men. In different age groups, increases in alcohol intake and systolic blood pressure became more pronounced with increasing age. The effect of temperature was more consistent across different age groups. (Figure 5, Figure S3).

Compared to areas with low SDI, the mortality burden from early-onset CVD in areas with high SDI was due to ambient particulate pollution (16.99%). v 8.15%), smoking (24.18%) v 6.54%), high body mass index (49.40%) v 19.32%), diet high in red meat (11.01%) v 2.68%), diet high in processed meat (4.18%) v 0.84%), diet high in sugary drinks (3.56%) v 0.69%), low physical activity (3.00%) v 0.68%) and high LDL cholesterol (36.69%) v 20.52%). In contrast, in areas with low SDI for household air pollution from solid fuels, the contribution to deaths was greater (18.48%) v higher SDI compared with lead exposure (2.57% vs. 0.36%) and a diet low in vegetables (7.03% vs. 4.25%). Risk factors attributable to DALYs were similar. (Figure 5, Figure S3).

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