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Cited by 1,188Healthcare Systems and Public HealthCardiovascular Health and Risk FactorsInsurance, Mortality, Demography, Risk Management

Demographic and epidemiologic drivers of global cardiovascular mortality

Open access
Roth, Gregory A., Forouzanfar, Mohammad H., Moran, Andrew E., Barber, Ryan, Nguyen, Grant, Feigin, Valery L., Naghavi, Mohsen, Mensah, George A. +1 more·2015·New England Journal of Medicine
DOI 10.1056/nejmoa1406656PMC PMC4482354
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Abstract

BACKGROUND: Global deaths from cardiovascular disease are increasing as a result of population growth, the aging of populations, and epidemiologic changes in disease. Disentangling the effects of these three drivers on trends in mortality is important for planning the future of the health care system and benchmarking progress toward the reduction of cardiovascular disease. METHODS: We used mortality data from the Global Burden of Disease Study 2013, which includes data on 188 countries grouped into 21 world regions. We developed three counterfactual scenarios to represent the principal drivers of change in cardiovascular deaths (population growth alone, population growth and aging, and epidemiologic changes in disease) from 1990 to 2013. Secular trends and correlations with changes in national income were examined. RESULTS: Global deaths from cardiovascular disease increased by 41% between 1990 and 2013 despite a 39% decrease in age-specific death rates; this increase was driven by a 55% increase in mortality due to the aging of populations and a 25% increase due to population growth. The relative contributions of these drivers varied by region; only in Central Europe and Western Europe did the annual number of deaths from cardiovascular disease actually decline. Change in gross domestic product per capita was correlated with change in age-specific death rates only among upper-middle income countries, and this correlation was weak; there was no significant correlation elsewhere. CONCLUSIONS: The aging and growth of the population resulted in an increase in global cardiovascular deaths between 1990 and 2013, despite a decrease in age-specific death rates in most regions. Only Central and Western Europe had gains in cardiovascular health that were sufficient to offset these demographic forces. (Funded by the Bill and Melinda Gates Foundation and others.).

Integrity signals

Registry

Crossref · 10.1056/nejmoa1406656

Cites

14 of 14 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 5 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    For ischemic heart disease, global deaths increased by 41.7% from 1990 to 2013.

    “For the most common cause of cardiovascular death, ischemic heart disease, the number of deaths increased by an estimated 41.7% from 1990 to 2013.”
    Quote in the paperSubstantial claim
  • Findingown data

    Global age-specific death rates for hemorrhagic stroke declined by more than 55% because of epidemiologic changes.

    “Even larger declines (more than 55%) were seen as a result of epidemiologic changes in the risk of hemorrhagic stroke.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Epidemiologic change led to an increase in cardiovascular deaths in only one region, western sub-Saharan Africa.

    “According to our estimates, epidemiologic change led to an increase in cardiovascular deaths in only one region of the world (western sub-Saharan Africa).”
    Quote in the paperNot a substantial claim
  • Findingown data

    The most common epidemiologic profile among specific cardiovascular causes was increases due to population growth and aging together with declines in age-specific death rates.

    “The combination of increases in the number of deaths due to population growth and population aging and declines in age-specific death rates represented the most common epidemiologic profile among the specific cardiovascular causes of death (Table 1).”
    Quote in the paperSubstantial claim
  • Findingown data

    Population growth contributed a 23.6% increase in global ischemic heart disease deaths from 1990 to 2013.

    “whereas population growth contributed to an estimated 23.6% increase.”
    Quote in the paperSubstantial claim
  • May combine two claims. 10
  • The quote only partly states this claim. 1
  • Classified as probably not a substantial claim. 8

  • May combine two claims.

    Findingown data

    Change in GDP per capita was correlated with change in age-specific cardiovascular death rates only among upper-middle-income countries, and the correlation was weak.

    “Change in gross domestic product per capita was correlated with change in age-specific death rates only among upper-middle income countries, and this correlation was weak; there was no significant correlation elsewhere.”
    • Also stated in: § CARDIOVASCULAR DEATHS AND NATIONAL INCOME PER CAPITA · plain
      “the two variables had a significant correlation only within the category of upper-middle income.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    Southern Latin America, Australasia, and high-income North America had no detectable change in cardiovascular deaths from 1990 to 2013.

    “Southern Latin America, Australasia, and high-income North America had no detectable change in the number of deaths from 1990 to 2013 (as indicated by an uncertainty interval crossing 0) because population aging and growth balanced out declines in age-specific death rates.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Deaths from atrial fibrillation or flutter and peripheral vascular disease increased dramatically between 1990 and 2013, driven by population growth, aging, and increases in age- and sex-specific death rates.

    “Atrial fibrillation or flutter and peripheral vascular disease are notable exceptions to the demographic and epidemiologic pattern for cardiovascular disease. Deaths from each of these conditions increased dramatically between 1990 and 2013, driven not only by population growth and aging but also by increases in age- and sex-specific death rates.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    South Asia had the largest absolute increase in cardiovascular deaths, with more than 1.7 million additional deaths in 2013 than in 1990, representing a 97.4% increase.

    “In absolute terms, South Asia had the largest estimated increase in deaths from cardiovascular disease, reporting more than 1.7 million more deaths in 2013 than in 1990. This change represents an increase of 97.4% (95% uncertainty interval, 72 to 126.1).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In the high-income Asia-Pacific region, there were 349,153 cardiovascular deaths in 1990 and 487,170 in 2013, which was less than the 910,042 expected if 1990 death rates had remained constant given 2013 population size and age structure.

    “For example, there were 349,153 cardiovascular deaths in the high-income Asia–Pacific region in 1990. In 2013, there were 487,170 cardiovascular deaths, which is less than the 910,042 that would have been expected if 1990 death rates had remained constant, given the population size and the age structure in that region in 2013.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Most countries had an increase in income per capita and a decline in the number of cardiovascular deaths due to epidemiologic change.

    “Most countries had an increase in income per capita and a decline in the number of cardiovascular deaths due to epidemiologic change.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    Global age-specific cardiovascular death rates fell by 39.3% between 1990 and 2013 because of epidemiologic changes.

    “despite a 39% decrease in age-specific death rates”
    • Also stated in: § GLOBAL DEATHS DUE TO CARDIOVASCULAR DISEASES · plain
      “despite a decrease in deaths attributable to epidemiologic changes of 39.3% (95% uncertainty interval, 33.6 to 44.1)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The pattern of increases due to population growth and aging with declines in age-specific death rates was present for ischemic heart disease, ischemic stroke, hemorrhagic and other nonischemic stroke, hypertensive heart disease, cardiomyopathy, myocarditis, aortic aneurysm, and endocarditis.

    “This pattern was also present in trends for ischemic heart disease, ischemic stroke, hemorrhagic and other nonischemic causes of stroke, hypertensive heart disease, cardiomyopathy, myocarditis, aortic aneurysm, and endocarditis.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Reductions in cardiovascular deaths due to epidemiologic change in high-income countries are probably due to decreased exposure to tobacco smoking, improvements in diet, and improved treatment of cardiovascular disease and cardio-metabolic risk factors.

    “These changes are probably due to the combined effect of birth cohorts’ decreased exposure to tobacco smoking, improvements in diet, and improved treatment of cardiovascular disease and cardio-metabolic risk factors targeting the prevention of cardiovascular disease, and improved treatment of cardiovascular disease.10”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    South Asia had a dramatic rise in cardiovascular deaths due to population growth and aging without a significant decline in cardiovascular deaths due to epidemiologic change.

    “In contrast, South Asia had a dramatic rise in cardiovascular deaths due to population growth and aging without a significant decline in cardiovascular deaths due to epidemiologic change.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The rigorous out-of-sample predictive validity testing used in GBD 2013 is cause for some confidence in the estimates.

    “However, the rigorous out-of-sample predictive validity testing used in GBD 2013 is cause for some confidence.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The classic model of epidemiologic transition does not fully reflect the heterogeneity of the burden of cardiovascular disease across countries.

    “As they have noted, the classic model of “epidemiologic transition” does not fully reflect the heterogeneity of the burden of cardiovascular disease across countries.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [13] source

      Not checked in the free run.

    • cites [14] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A deterministic health policy model indicated that 40 to 55% of the decline in coronary heart disease in high-income countries can be attributed to the effects of medical and surgical treatments.

    “A deterministic health policy model indicated that 40 to 55% of the decline in coronary heart disease in high-income countries can be attributed to the effects of medical and surgical treatments.12”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Patterns of disease burden vary within countries, so any summary at the level of a region or country may mask significant disparities within that area.

    “Finally, we recognize that patterns of disease burden vary not just between but also within countries. Any summary provided at the level of a region or country may mask significant disparities within that area.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Calculations made with the traditional Shapley method and other econometric methods may produce different results from the decomposition procedure used.

    “However, calculations made with the traditional Shapley method and other methods used in econometrics may produce different results.6”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Cause-specific mortality data are lacking or of limited quality in some countries.

    “First, cause-specific mortality data are lacking or of limited quality in some countries.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    The number of deaths resulting from rheumatic heart disease may not be completely captured by vital records in regions in which the condition is endemic.

    “Similarly, the number of deaths resulting from rheumatic heart disease may not be completely captured by vital records in regions in which the condition is endemic.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning

    The remarkable increase in the age-specific rate of death from atrial fibrillation probably reflects increases in the screening, recognition, and attribution of death to atrial fibrillation in addition to changes in disease epidemiology.

    “Furthermore, the remarkable increase in the age-specific rate of death from atrial fibrillation probably reflects increases in the screening, recognition, and attribution of death to atrial fibrillation in addition to changes in disease epidemiology.”
    Quote in the paperNot a substantial claim
18 of 18

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Cites

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Research works printed but not linked: 1

  1. GBD 2013 Mortality and Causes of Death Collaborators, 2014, Lancet, 385, 117

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Authors
Roth, G. A., Forouzanfar, M. H., Moran, A. E., Barber, R., Nguyen, G., Feigin, V. L., Naghavi, M., Mensah, G. A., & Murray, C. J. L.
Affiliations
  • National Institutes of Health (US)
  • University of Washington (US)
  • Columbia University (US)
  • Auckland University of Technology (NZ)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2015-04-02
Volume
372
Issue
14
Pages
1333-1341
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmoa1406656
PMC
PMC4482354
OpenAlex
W1986019364
Semantic Scholar
27a6b9a739f391969318dbfd3ffe6b84aa566d21
Cited by
1,188
References
14
Citations by year
2026: 30 · 2025: 87 · 2024: 115 · 2023: 110 · 2022: 117 · 2021: 123 · 2020: 141 · 2019: 118 · 2018: 105 · 2017: 110 · 2016: 98 · 2015: 31
FWCI
89.97
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Heart, Lung, and Blood Institute (K08HL089675)
Topics
  • Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
  • Social Sciences › Demography › Insurance, Mortality, Demography, Risk Management
Keywords
cardiovascular mortality, population aging, population growth, age-specific mortality, counterfactual scenarios, GDP per capita, global health trends, regional variation in mortality
MeSH terms
Age Factors, Cardiovascular Diseases, Demography, Humans, Income, Mortality, Sex Factors, Global Health

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