Globally in 2019, the age-standardized incidence, prevalence, DALY, and mortality rate per 100,000 people of overall CVDs were 129.85 (95% CI 129.72, 129.98), 1645.32 (1644.86, 1645.78), 990.64 (990.28, 990.99), and 15.12 (15.08, 15.16), respectively (Additional file 1: Table S1).
Globally in 2019, when stratified by SDI, low and low-middle SDI countries had the highest age-standardized prevalence, incidence, DALY, and mortality rate of CVDs, whereas high SDI countries had the lowest burden (Fig. 1 and Additional file 1: Table S1). At regional and national levels, countries/territories in regions of Eastern Sub-Saharan Africa, Southern Sub-Saharan Africa, Central Sub-Saharan Africa, and the Caribbean had the highest age-standardized incidence rate of CVDs, countries/territories in regions of Eastern Sub-Saharan Africa, Central Sub-Saharan Africa, Southern Sub-Saharan Africa, Western Sub-Saharan Africa had the highest prevalence rate, and countries/territories in regions of Eastern Europe and Oceania had the highest age-standardized DALY and mortality rate (Fig. 2 and Additional file 2: Figs. S1–2).
Temporal trends in age-standardized incidence, prevalence, DALYs, and mortality rate of cardiovascular diseases in youths and young adults overall and by sex (men and women) and sociodemographic index (high-income, high-middle income, middle income, low-middle income, and low-income categories) from 1990 to 2019. Note: DALY, disability-adjusted life years
Age-standardized burden of cardiovascular disease across 204 countries/territories among youths and young adults overall, in 1990 and 2019. A Age-standardized incidence and prevalence in the total population; B age-standardized disability-adjusted life years (DALYs) and mortality rate in the total population
Globally in 2019, when stratified by sex, the age-standardized prevalence rate was higher in women than that in men, whereas the incidence, DALY, and mortality rate were higher in men than that in women (Fig. 1 and Additional file 1: Table S1). When stratified by age, the age-standardized rate of overall and type-specific CVDs increased with age (Additional files 1 and 2: Figs. S3–35, and Table S2). When stratified by age, sex, and SDI, women had a higher prevalence rate across all ages and SDI categories, whereas men aged 20–39 years had a higher DALY and mortality rate, regardless of SDI (Fig. 3 and Table S2). For different types of CVDs, age and sex differences in age-standardized incidence, prevalence, DALY, and mortality rate for these metrics varied across different types of CVDs (Additional files 2: Figs. S14–45 and Table S2). Men had a higher incidence, DALY, and mortality rate of ischemic heart disease and cardiomyopathy and myocarditis, and a higher DALY and mortality rate of stroke than women, whereas women had a higher incidence and prevalence rate of rheumatic heart disease than men (Additional file 2: Fig. S46). The sex and region differences in age-standardized rate also varied by different types of specific CVDs (Additional file 2: Figs. S47–56).
Difference in age-standardized incidence, prevalence, DALY, and mortality rate of cardiovascular diseases in youths and young adults between men and women by age and sociodemographic index (high-income, high-middle income, middle income, low-middle income, and low-income categories), from 1990 to 2019. Note: DALY, disability-adjusted life years. The difference indicates the age-standardized rate in women minus that in men. A difference > 0 suggests that women have a higher rate than men
From 1990 to 2019, the age-standardized DALY rate of CVDs (per 100,000 population) among youths and young adults aged 15–39 years significantly decreased from 1257.51 (95% CI 1257.03, 1257.99) to 990.64 (990.28, 990.99) with an AAPC of − 0.81% (95% CI − 1.04%, − 0.58%, P < 0.0001), and the age-standardized mortality rate also significantly decreased from 19.83 (19.77, 19.89) to 15.12 (15.08, 15.16) with an AAPC of − 0.93% (− 1.21%, − 0.66%, P < 0.0001). However, the age-standardized incidence rate moderately increased from 126.80 (126.65, 126.95) in 1990 to 129.85 (129.72, 129.98) in 2019 with an AAPC of 0.08% (0.00%, 0.16%, P = 0.040), and age-standardized prevalence rate significantly increased from 1477.54 (1477.03, 1478.06) to 1645.32 (1644.86, 1645.78) with an AAPC of 0.38% (0.35%, 0.40%, P < 0.0001) (Figs. 1 and 4A–D; Additional file 1: Table S1).
Temporal trends in age-standardized incidence, prevalence, DALY, and mortality rate of type-specific cardiovascular diseases in youths and young adults by sex and sociodemographic index from 1990 to 2019. A Incidence, B prevalence, C DALYs, and D deaths. Note: DALY, disability-adjusted life years
When stratified by SDI and GBD region, from 1990 to 2019, low and middle SDI countries/territories and 10 of 21 GBD regions had increased prevalence rate of CVDs, and 5 of 21 regions had increased incidence rate. Compared with countries/territories with high SDI (AAPC of prevalence: 0.04% (− 0.05%, 0.13%)) and high-middle SDI (0.07% (0.05%, 0.10%)), countries/territories with low SDI (0.22% (0.12%, 0.33%)), low-middle SDI (0.27% (0.22%, 0.31%)), and middle SDI (0.14% (0.11%, 0.18%)) increased faster. Only the Eastern European region had increased rates of incidence, prevalence, DALY, and mortality, and this region had the fastest increase in incidence and prevalence rate. Similar results were found among both sexes (Additional files 1 and 2: Table S1; Figs. 1, 4, and 5; and Additional file 2: Fig. S1). When stratified by age, prevalence rate increased from 1990 to 2019 with the largest AAPC value at 15–19 years (0.74 vs. 0.63 at 20–24 years, 0.42 at 25–29 years, 0.22 at 30–34 years, and 0.12 at 35–39 years) and DALY and mortality rate decreased across almost all ages with the largest AAPC value at 15–19 years (DALY: − 1.1 vs. − 0.71 at 20–24 years, − 0.82 at 25–29 years, − 0.79 at 30–34 years, and − 0.87 at 35–39 years; mortality: − 1.41 vs. − 0.88 at 20–24 years, − 0.94 at 25–29 years, − 0.85 at 30–34 years, and − 0.94 at 35–39 years). However, the incidence rate increased at nearly all ages of 15–29 years but decreased at 30–39 years (AAPC: 0.52 at 15–19 years, 0.31 at 20–24 years, 0.10 at 25–29 years, − 0.11 at 30–34 years, and − 0.21 at 35–39 years) (Fig. 3 and Fig. S57). When stratified by sex, both women and men had increased incidence and prevalence rates but decreased DALY and mortality rates with more decreased AAPC of global DALY (− 1.19% vs. − 0.55%) and mortality (− 1.46% vs. − 0.56%) rate in women compared with that in men (Fig. 5). When stratified by age, sex, and SDI, changes in these metrics are shown in Additional files 1 and 2: Table S2 and Fig. S57. The DALY and mortality rate of CVDs decreased across almost all groups by age, sex, and SDI or region (Additional files 1 and 2: Table S2, Fig. S57, and Fig. S58). The burden of CVDs from 1990 to 2019 stratified by country is shown in Additional files 1 and 2: Table S3 and Fig. S59.
Average annual percent change in age-standardized incidence, prevalence, DALY, and mortality rate of cardiovascular diseases in youths and young adults by sex (men and women) and sociodemographic index (high-income, high-middle income, middle income, low-middle income, and low-income categories) from 1990 to 2019. Note: DALY, disability-adjusted life years
From 1990 to 2019, for different types of specific CVDs, the age-standardized incidence and prevalence rate (per 100,000 population) in rheumatic heart disease (41.81 to 50.37 and 637.47 to 765.19, respectively), the prevalence rate in ischemic heart disease (177.62 to 180.42), and the incidence rate in endocarditis (5.53 to 5.73) significantly increased globally, whereas the incidence rate in stroke (30.99 to 27.48), the prevalence rate in hypertensive heart disease (9.47 to 9.15), and incidence and prevalence rate in non-rheumatic valvular heart disease (7.85 to 6.46 and 62.64 to 50.03, respectively), cardiomyopathy and myocarditis (11.79 to 11.12 and 6.19 to 4.59, respectively), and atrial fibrillation and flutter significantly decreased (2.48 to 2.36 and 8.24 to 7.85, respectively) (all P for AAPC < 0.05, Fig. 4A–D, and Additional file 1: Table S1). Almost all the type-specific DALY and mortality rate decreased, whereas there was an increase in atrial fibrillation and flutter and a non-significant decrease in cardiomyopathy and myocarditis and a non-significant increase in aortic aneurysm and endocarditis (Additional file 1: Table S1).
For different types of specific CVDs, when stratified by sex only men had an increased incidence, prevalence, DALY, and mortality rate of endocarditis, a decreased incidence rate but an increased prevalence rate of ischemic heart disease. Women had an increase in the incidence and prevalence rate of ischemic heart disease and an increase in the DALY rate of atrial fibrillation and flutter (Additional file 1: Table S1). When stratified by age, young people of any age had an increased incidence and prevalence rate of rheumatic heart disease (Additional file 1: Table S2). When stratified by age and sex, both men and women at the age of 15–30 years had an increased incidence rate of ischemic heart disease, whereas only women at the age of 30–39 years had an increased incidence rate. Men aged 25–39 years had increased incidence, prevalence, DALY, and mortality rate of endocarditis. Women aged 30–39 years had an increased DALY and mortality rate of atrial fibrillation and flutter (Additional file 1: Table S2).
For different types of specific CVDs, when stratified by sex and SDI or GBD region, low and middle SDI countries/territories and regions such as Central and South Asia, Sub-Saharan Africa, and Eastern Europe had increased burden of rheumatic heart disease, ischemic heart disease (most pronounced in women), aortic aneurysms, and endocarditis from 1990 to 2019. High SDI countries/territories and the regions such as high-income North America had an increased burden of atrial fibrillation and flutter (most pronounced in women) (Additional files 1 and 2: Table S1 and Figs. S47–56). When stratified by age, sex, and SDI or region, the change in age-standardized incidence, prevalence, DALY, and mortality rate varied by different types of CVDs (Additional files 1 and 2: Table S2, Figs. S60–79).
Among the top 20 risk factors for overall CVDs quantified in the GBD, high systolic blood pressure (39.38%), high body mass index (30.32%), high low-density lipoprotein cholesterol (28.21%), ambient particulate matter pollution (17.23%), smoking (12.56%), and diet low in whole grains (10.76%) mainly accounted for the age-standardized rate of CVDs DALY in 2019 (Fig. 6). High systolic blood pressure, high body mass index, and high low-density lipoprotein cholesterol were the three most important contributors across all categories of SDI, sex, and ages (Additional files 1 and 2: Tables S4–6 and Fig. S80). Men with CVDs were more likely to be affected by almost all risk factors especially for smoking compared with women (Fig. 6 and Additional file 1: Table S4). However, in low and low-middle SDI countries/territories, DALY for CVDs was additionally attributable to household air pollution from solid fuels in 2019 compared with that in middle, high-middle, and high SDI countries/territories (Additional files 1 and 2: Table S5 and Fig. 6A–F).
Proportion of DALY of cardiovascular disease attributed to 20 main risk factors in 1990 and 2019 overall and by sex and sociodemographic index. A Global, B high-income, C high-middle income, D middle-income, E low-middle income, and F low-income. Note: DALY, disability-adjusted life years
Proportions of DALYs of overall CVDs attributed to 20 risk factors in 2019 by age (i.e., 15–19, 20–24, 25–29, 30–34, and 35–39 years) are shown in Additional files 1 and 2: Table S6 and Fig. S80. Although the age-standardized rate of DALY and mortality attributed to high systolic blood pressure decreased slightly, the absolute numbers increased from 1990 to 2019 (Additional file 2: Fig. S81). High body mass index and high low-density lipoprotein cholesterol are the most important risk factor for stroke and ischemic heart disease, respectively. High systolic blood pressure is the second most important risk factor for stroke and ischemic heart disease and is the most important risk factor for hypertensive heart disease, rheumatic heart disease, aortic aneurysm, cardiomyopathy and myocarditis, atrial fibrillation and flutter, and endocarditis. (Additional file 2: Fig. S82).
The proportion of DALYs attributable to household air pollution from solid fuels in 1990 was near twice the proportion in 2019, whereas the proportion attributable to ambient particulate matter pollution and high body mass index in 2019 was nearly 1.7 times that in 1990, regardless of sex. The proportion attributable to high systolic blood pressure and high low-density lipoprotein cholesterol remained high in 2019 (39.38% and 28.21%) compared with that in 1990 (34.68% and 25.43%) (Additional files 1 and 2: Table S4 and Fig. 6).
In 2019, age-standardized prevalence, incidence, DALY, and mortality rate of CVDs were inversely associated with the SDI (i.e., the higher the SDI, the lower the burden), whereas the AAPC for these metrics fluctuated with the SDI (Additional file 2: Fig. S83).
