The impact of demographic and risk factor changes on coronary heart disease deaths in Beijing, 1999-2010.
BACKGROUND
Recent, dramatic increases in coronary heart disease (CHD) mortality in China can be mostly explained by adverse changes in major cardiovascular risk factors. Our study aimed to assess the potential impact of subsequent changes in risk factors and population ageing on CHD deaths in Beijing between 1999 and 2010.


METHODS
The previously validated IMPACT model was used to estimate the CHD deaths expected in 2010, with treatment uptakes being held constant at levels measured in 1999, comparing three scenarios: a) taking into account the ageing of the population but assuming no further changes in major risk factor levels from 1999 or, b) if recent risk factor trends continued until 2010 or, c) if there was a 0.5% annual reduction in each risk factor.


RESULTS
Population ageing alone would result in approximately 1990 additional deaths in 2010 compared with 1999, representing an increase of 27%. Continuation of current risk factor trends would result in approximately 3,015 extra deaths in 2010, [a 40% increase]; three quarters of this increase would be attributable to rises in total cholesterol levels. Thus, demographic changes and worsening risk factors would together result in a 67% increase in CHD deaths. Conversely, assumed 0.5% annual reductions in risk factors (a mean population level decline of 0.3 mmol/L for total cholesterol in both genders, and smoking prevalence declining by 3.0% for men and 4.1% for women, body mass index by 1.3 kg/m2 for men and 1.4 kg/m2 for women, diabetes prevalence by 0.4% in both genders, and diastolic blood pressure by 4.7 mmHg for men and 4.4 mmHg for women) would result in some 3,730 fewer deaths, representing a 23% decrease overall. These findings remained consistent in sensitivity analyses.


CONCLUSIONS
CHD death rates are continuing to rise in Beijing. This reflects worsening risk factor levels, compounded by demographic trends. However, the adverse impact of population ageing on CHD burden could be completely offset by eminently feasible improvements in diet and smoking.
Cheng
Jun
J
Department of Epidemiology, Beijing Institute of Heart, Lung & Blood Vessel Diseases, Beijing Anzhen Hospital affiliated to the Capital Medical University, Beijing, PR China. wgcj5098@yahoo.com.cn
Zhao
Dong
D
Zeng
Zhechun
Z
Critchley
Julia Alison
JA
Liu
Jing
J
Wang
Wei
W
Sun
Jiayi
J
Capewell
Simon
S
D000328:Adult; D017677:Age Distribution; D000368:Aged; D002423:Cause of Death; D002681:China / Q000453:epidemiology; D003327:Coronary Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011336:Probability; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology; D014505:Urban Population