title: Demographic and epidemiologic drivers of global cardiovascular mortality.
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.).
authors.affiliation: From the Department of Medicine, Division of Cardiology (G.A.R.), and the Institute for Health Metrics and Evaluation (G.A.R., M.H.F., R.B., G.N., M.N., C.J.L.M.), University of Washington, Seattle; Department of Medicine, Division of General Medicine, Columbia University, New York (A.E.M.); National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand (V.L.F.); and the Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.).
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Roth
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Forouzanfar
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Moran
authors.forename: Ryan
authors.initials: R
authors.lastname: Barber
authors.forename: Grant
authors.initials: G
authors.lastname: Nguyen
authors.forename: Valery L
authors.initials: VL
authors.lastname: Feigin
authors.forename: Mohsen
authors.initials: M
authors.lastname: Naghavi
authors.forename: George A
authors.initials: GA
authors.lastname: Mensah
authors.forename: Christopher J L
authors.initials: CJ
authors.lastname: Murray
mesh_terms: D000367:Age Factors; D002318:Cardiovascular Diseases / Q000401:mortality*; D003710:Demography; D014943:Global Health; D006801:Humans; D007182:Income; D009026:Mortality / Q000639:trends; D012737:Sex Factors
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