Abstract
Background
Cardiovascular diseases (CVD), including coronary artery disease, ischemic heart disease, stroke, cardiomyopathy, and atrial fibrillation and flutter, are the leading cause of mortality worldwide, resulting in significant economic and health costs. Recognizing trends and geographical differences in the global burden of CVD facilitates health authorities in particular nations to assess the disease burden and forecast future epidemiological trends. Public health authorities in each country can better understand the differences in disease data and, by learning from the experiences and practices of successful countries and considering the characteristics of their diseases, allocate health resources more rationally and formulate more targeted healthcare strategies to reduce the disease burden. This study aims to comprehensively assess CVD trends and geographic variations from 1990 to 2021.
Methods
This study focuses on analyzing global trends in the epidemiology of all-age CVD incidence and death over the past 30 years. A vital registration system, cause-of-death inference records, and a cause-of-death ensemble model (CODEm) were used to estimate cause-specific mortality for CVD, with CODEm estimates adjusted using a cause-of-death correction (CoDCorrect) algorithm. Incidence data were extracted from insurance claims and inpatient discharge sources and analyzed with Disease Modeling Meta-Regression, Version 2.1 (DisMod-MR 2.1). Data were extracted from the 2021 Global Burden of Disease Study (GBD 2021) on the number of incident cases and deaths, as well as age-standardized incidence rates (ASIR) and age-standardized death rates (ASDR) for CVD for each year from 1990 to 2021. We visualized and reported this data at the global, regional, and national levels. To explore the association between the burden of CVD and sociodemographic factors, we used the sociodemographic index (SDI), which categorizes the world's 204 nations into five SDI regions. Because the GBD results are a combination of data and estimates, 95% uncertainty intervals (UI) are provided for each count and rate (per 100,000 populations).
Results
Globally, the number of CVD incident cases and deaths increased from 34.74 million and 12.33 million in 1990 to 66.81 million and 19.42 million in 2021, representing a 92.3% and 57.5% rise, respectively. However, the global ASIR and ASDR for CVD have decreased by 10.4% and 34.3%, respectively, since 1990. Notably, among the 21 regions of the world, the ASIR for CVD is on a downward trend from 1990 to 2021, except for East and Central Asia, where the ASIR for CVD increased by 3% and 14.3%, respectively. Similarly, the global ASDR for CVD is only on an upward trend in sub-Saharan Africa, increasing by 12%, while all other regions are on a downward trend. Among the five SDI regions, the high SDI region has much lower ASIR and ASDR compared to the world average, and these rates have decreased significantly over the years.
Conclusion
Despite a significant increase in the number of CVD incident cases and deaths worldwide over the last three decades, ASIR and ASDR have been declining. Over the past 30 years, both ASIR and ASDR for CVD have declined significantly in high SDI areas, while CVD continues to pose a serious public health threat in regions with low SDI.
Keywords: cardiovascular disease, death, epidemiology, global burden, incidence, public health
Introduction
Cardiovascular diseases (CVD), primarily ischemic heart disease and stroke, are the leading cause of global mortality and a major contributor to disability [1]. As of 2017, more than 17 million people have died from CVD, and over 360 million disability-adjusted life years (DALYs) have been attributed to it, making CVD the highest-burden disease in the world [2]. The distribution of the CVD burden is influenced by a variety of factors, including socioeconomic status, lifestyles, the prevalence of risk factors, and access to healthcare [3]. The primary risk factors for CVD vary by region; for example, CVD mortality from smoking is highest in Oceania, CVD deaths from high-sodium diets are most common in Asia, and CVD deaths from high systolic blood pressure are highest in Central Asia. In contrast, particulate matter pollution and low-fruit, low-vegetable diets pose the most danger in low- and middle-income countries [2]. The prevalence of CVD increased rapidly in the first half of the 20th century as a result of industrialization, urbanization, rising prosperity, and social unrest in high-income countries, followed by a significant decrease in CVD mortality in the second half of the century. As globalization and population aging continue, changes in lifestyle and dietary trends will have a significant influence on the burden of CVD. Previous studies published under the Global Burden of Disease Study (GBD) 2019 have highlighted geographic differences in the burden of CVD [4]. GBD 2021 is an upgrade and expansion of GBD 2019, using advanced statistical methods and models to improve data quality and dependability; the time range has been expanded from 1990 to 2021, providing a longer period to analyze health trends. However, since the GBD 2021 database was updated, there has been a lack of analysis of the most recent data on CVD incidence and deaths, as well as comparisons between the five sociodemographic index (SDI) regions. In this study, we retrieved data on CVD incidence and mortality from the GBD 2021 and conducted a thorough evaluation and comparison at the global, regional, and national levels. Our objective was to examine worldwide trends and regional variations in CVD incidence and death rates from 1990 to 2021. This analysis will help public health authorities and stakeholders identify data gaps, assess unmet needs, and effectively implement and scale up intervention services.
Materials and methods
Data source
All data used in this study can be extracted through the Global Health Data Exchange query tool (https://ghdx.healthdata.org/gbd-2021). The Institute for Health Metrics and Evaluation (IHME) at the University of Washington leads and updates the database. Population censuses, household surveys, civil registration and vital statistics, disease registries, healthcare utilization, air pollution monitoring, satellite imaging, disease notification, and other sources provided input data [4]. Meanwhile, because the GBD database incorporates a variety of raw data sources, the quality of the individual studies that contribute to the data may have an impact on the accuracy and dependability of the estimates. Details of the GBD study's data sources, modeling techniques, and tools have already been published previously [5-7].
Case definition
According to the International Classification of Diseases (ICD) system, CVD is defined in 11 major etiologic categories: ischemic heart disease, stroke, hypertensive heart disease, peripheral arterial disease, atrial fibrillation and atrial flutter, cardiomyopathy and myocarditis, endocarditis, rheumatic heart disease, non-rheumatic valvular heart disease, aortic aneurysm, and other cardiovascular and circulatory diseases [2,4,8]. Although ICD codes are commonly recognized for obtaining information on CVD cases, the version utilized changes by location and over time, resulting in the overestimation or underestimation of CVD.
SDI
The GBD study provides the SDI, which is an equally weighted geometric mean of per capita income, educational attainment, and total fertility. SDI scores range from 0 to 1, and based on SDI values, the world is divided into five SDI regions: low SDI (SDI < 0.25), medium-low SDI (0.25 ≤ SDI < 0.50), medium SDI (0.50 ≤ SDI < 0.75), medium-high SDI (0.75 ≤ SDI < 0.90), and high SDI (SDI ≥ 0.90). Generally, the higher the SDI value, the higher the per capita income, the higher the level of education, and the lower the fertility rate of women under 25 years of age. This also indirectly reflects the level of development of the region, the availability of medical resources, and the public's awareness of diseases. Based on the 2021 SDI values, the 204 countries and territories were categorized into five SDI regions: low SDI (e.g., Afghanistan, Niger, and Somali), medium-low SDI (e.g., Bangladesh, Cameroon, and Ethiopia), medium SDI (e.g. China, India, and Egypt), medium-high SDI (e.g., Chile, Malaysia, and Turkey), and high SDI (e.g. Australia, Japan, and Norway).
Statistical analysis
Our study aims to analyze global trends and regional differences in CVD incidence and death from 1990 to 2021. A vital registration system, cause-of-death inference records, and a cause-of-death ensemble model (CODEm) were used to estimate cause-specific mortality for CVD, with CODEm estimates adjusted using a cause-of-death correction (CoDCorrect) algorithm [9]. Incidence data were extracted from insurance claims and inpatient discharge sources and analyzed with Disease Modeling Meta-Regression, Version 2.1 (DisMod-MR 2.1) [9]. At each modeling phase, 500-1,000 draws were made from the posterior distribution to establish the 95% uncertainty ranges for the final load estimates. To ensure standardized comparisons between populations with different age structures and over time, we introduced age-standardized rates (ASR), which primarily include age-standardized incidence rates (ASIR) and age-standardized death rates (ASDR). We extracted data from the GBD 2021 on CVD incidence and death from 1990 to 2021 at the global, 21 regional, and 204 country levels, all of which were collated and visualized using R (Version 4.3.3, RStudio, R Foundation for Statistical Computing, Vienna, Austria (https://www.R-project.org/)).
Results
Global trends of CVD
It can be observed from Table 1 that, globally, the number of CVD incident cases increased from 34.74 million in 1990 to 66.81 million in 2021, representing a 92.31% increase. During the same period, the ASIR of CVD fell from 878.8 cases per 100,000 in 1990 to 787 cases per 100,000 in 2021, a decline of 10.4%. Additionally, the number of CVD deaths rose from 12.33 million in 1990 to 19.42 million in 2021, an increase of 57.5%. Over the same period, the ASDR of CVD decreased from 358.1 cases per 100,000 in 1990 to 235.2 cases per 100,000 in 2021, marking a 34.3% reduction (Table 1 provides detailed data at the global level).
Table 1. ASIR, ASDR, and the number of incident cases and deaths of cardiovascular disease in 1990 and 2021 at the global level and for 21 regions.
ASIR: age-standardized incidence rates; ASDR: age-standardized death rates; ASR: age-standardized rates; 95% UI: 95% uncertainty intervals
Number of incident cases=numbers×100,000
Number of deaths=numbers×100,000
Percentage change in ASR from 1990 to 2021=(the ASR in 2021-the ASR in 1990)/the ASR in 1990
| Incidence | Deaths | |||||||||
| Numbers in 100,000 (95% UI) | ASR per 100,000 (95% UI) | Percentage change in ASR from 1990 to 2021 | Numbers in 100,000 (95% UI) | ASR per 100,000 (95% UI) | Percentage change in ASR from 1990 to 2021 | |||||
| 1990 | 2021 | 1990 | 2021 | 1990 | 2021 | 1990 | 2021 | |||
| Global | 347.4 (318.5, 379.8) | 668.1 (609.1, 731) | 878.8 (808.2, 959.9) | 787 (719.7, 859.7) | -10.4 (-11.5, -9.4) | 123.3 (116.2, 127.9) | 194.1 (177.8, 206.7) | 358.1 (333.7, 372.6) | 235.2 (214.6, 250.5) | -34.3 (-37.8, -30.7) |
| Australasia | 1.8 (1.7, 1.9) | 2.9 (2.6, 3.2) | 772.1 (719.9, 830.2) | 553 (505.7, 607.8) | -28.4 (-31.3, -25.1) | 0.6 (5.8, 6.5) | 0.6 (0.5, 0.6) | 280 (256.8, 291.9) | 94.2 (80.8, 101.2) | -66.4 (-68.6, -65) |
| Caribbean | 2.1 (2, 2.4) | 3.9 (3.5, 4.3) | 796.1 (728.5, 874.5) | 736.4 (671.4, 810.1) | -7.5 (-8.9, -6) | 0.8 (7.8, 8.5) | 1.2 (1.1, 1.4) | 342 (324.2, 354.2) | 228.4 (203.3, 254.9) | -33.2 (-40.2, -25.8) |
| Central Asia | 5.2 (4.8, 5.7) | 9.7 (9, 10.5) | 1120.4 (1033.2, 1214.4) | 1280.2 (1202.2, 1376.2) | 14.3 (11.6, 17) | 2.1 (20.4, 22.0) | 2.9 (2.7, 3.2) | 512.9 (484.2, 529.8) | 436.1 (395.7, 474.5) | -15 (-21.7, -8) |
| Central Europe | 13.4 (12.3, 14.5) | 15.1 (14.1, 16.3) | 935.3 (867.4, 1006.7) | 700 (653.4, 751.2) | -25.2 (-27.2, -23.3) | 7.2 (69.6, 73.8) | 6.8 (6.2, 7.3) | 542.8 (516.1, 555.8) | 288 (262.8, 306.1) | -46.9 (-49.9, -44.1) |
| Central Latin America | 6.2 (5.7, 6.8) | 15.5 (14, 17.3) | 694.6 (630.3, 771.4) | 620.1 (558.5, 689.3) | -10.7 (-12, -9.6) | 1.7 (15.8, 16.9) | 3.9 (3.5, 4.3) | 230.6 (217.5, 236.6) | 163.7 (145.6, 180.7) | -29 (-35.3, -22.3) |
| Central Sub-Saharan Africa | 2.4 (2.2, 2.7) | 5.7 (5.1, 6.3) | 853.2 (775.4, 937.9) | 786.4 (721.7, 859.2) | -7.8 (-10.5, -5.5) | 0.7 (6.2, 8.5) | 1.5 (1.2, 1.8) | 410.9 (351.6, 468.3) | 361.4 (292.1, 444.2) | -12.1 (-27.7, 7.2) |
| East Asia | 65 (59.6, 71.3) | 165.8 (149.4, 183.7) | 785.6 (719.7, 858.4) | 809.3 (734.4, 888.7) | 3 (0.8, 5.2) | 25.8 (228.1, 286.0) | 52.3 (44.5, 60.6) | 403.3 (358.4, 445.9) | 276.2 (235.1, 318.3) | -31.5 (-42.4, -18.1) |
| Eastern Europe | 30.8 (27.3, 34.6) | 39.1 (34.2, 44.5) | 1177.9 (1049, 1316.1) | 1135.6 (1000.2, 1279.3) | -3.6 (-5.9, -1.1) | 14.0 (133.6, 142.3) | 14.9 (13.5, 16.2) | 570.1 (540.1, 583.5) | 421.6 (381.3, 458.3) | -26 (-31.4, -20.5) |
| Eastern Sub-Saharan Africa | 7.6 (6.8, 8.4) | 16.8 (15, 18.7) | 782.8 (708.8, 860.2) | 737.7 (670, 813.8) | -5.8 (-7.2, -4.5) | 2.1 (19.5, 22.9) | 3.6 (3.2, 4.0) | 330.3 (302.7, 356.9) | 256 (231.4, 285.4) | -22.5 (-29.8, -13.4) |
| High-income Asia Pacific | 11.4 (10.7, 12.2) | 18.2 (16.8, 19.6) | 576.2 (541.2, 614.8) | 422.7 (395.2, 451.9) | -26.6 (-28.6, -24.8) | 3.6 (32.6, 37.5) | 4.6 (3.6, 5.1) | 204.1 (182.1, 214.9) | 73.4 (61.3, 79.8) | -64 (-66.4, -62.5) |
| High-income North America | 34.4 (30.5, 38.2) | 42.9 (40.5, 45.6) | 986.6 (881.2, 1101.4) | 670.2 (635.1, 708.8) | -32.1 (-37, -27.2) | 9.4 (85.0, 98.8) | 9.8 (8.5, 10.5) | 260.4 (234.8, 272.6) | 139.5 (122.5, 148.1) | -46.4 (-48.2, -45.3) |
| North Africa and the Middle East | 22.9 (20.6, 25.8) | 56.6 (51, 63.8) | 1336.5 (1212.7, 1504.3) | 1232.3 (1117.9, 1378.3) | -7.8 (-9.7, -5.8) | 7.5 (69.9, 79.6) | 13.5 (12.1, 15.0) | 529.2 (486.4, 560.6) | 363.5 (322.3, 397.3) | -31.3 (-37.1, -25) |
| Oceania | 0.3 (0.2, 0.3) | 0.6 (0.6, 0.7) | 821.1 (735.9, 920.8) | 807.5 (724.6, 906.9) | -1.7 (-3.5, 0.2) | 0.1 (0.9, 1.3) | 0.2 (0.2, 0.3) | 449.5 (384.7, 525.9) | 377.8 (321.2, 438.3) | -15.9 (-29.1, -0.2) |
| South Asia | 57.4 (50.5, 65.1) | 135.7 (119.7, 153.6) | 957 (838.1, 1087.4) | 912.2 (805.6, 1032.6) | -4.7 (-5.8, -3.6) | 15.6 (140.3, 167.4) | 36.7 (33.8, 39.6) | 302.5 (271.1, 326.8) | 278.1 (256.5, 299.6) | -8 (-17.7, 2.6) |
| Southeast Asia | 18.3 (17, 19.7) | 43.1 (40, 46.7) | 699.3 (649.8, 758.4) | 675.1 (627.4, 730.3) | -3.5 (-4.7, -2.2) | 7.8 (70.8, 84.8) | 17.2 (15.6, 18.6) | 355.5 (318.9, 388.7) | 302.9 (273.2, 326.1) | -14.8 (-23.9, -3.4) |
| Southern Latin America | 3.5 (3.3, 3.8) | 4.8 (4.5, 5.2) | 770 (721.9, 826.2) | 575.2 (540.1, 617.2) | -25.3 (-27.3, -23.2) | 1.3 (12.7, 13.7) | 1.2 (1.1, 1.3) | 315.6 (297.1, 324.9) | 137.6 (126.1, 144.6) | -56.4 (-58, -54.9) |
| Southern Sub-Saharan Africa | 2.7 (2.4, 3) | 4.9 (4.4, 5.5) | 864.6 (773.9, 965.8) | 815.5 (732.5, 910.4) | -5.7 (-7.1, -4.2) | 0.6 (5.3, 6.4) | 1.3 (1.2, 1.4) | 245.7 (217.5, 269.4) | 275.1 (256.6, 292.1) | 12 (4.1, 25.2) |
| Tropical Latin America | 7 (6.5, 7.6) | 13.6 (12.5, 14.7) | 671.3 (624.6, 724.5) | 547.1 (505, 592.5) | -18.5 (-20.3, -16.6) | 2.6 (25.0, 27.0) | 3.9 (3.5, 4.1) | 331.7 (308, 343) | 154.6 (140.5, 162.8) | -53.4 (-55.3, -52.1) |
| Western Europe | 45.6 (42.8, 48.7) | 51 (48, 54.6) | 800.6 (757.2, 854.4) | 576.7 (542, 619.3) | -28 (-29.6, -26.4) | 16.7 (152.4, 173.1) | 12.6 (10.6, 13.7) | 280.7 (256.2, 292.2) | 106.8 (91.8, 114.4) | -62 (-64.3, -60.7) |
| Western Sub-Saharan Africa | 8.1 (7.3, 8.9) | 18.8 (17, 20.7) | 785.2 (705, 874.6) | 765.8 (689, 848.5) | -2.5 (-4.1, -1.1) | 2.7 (23.9, 29.7) | 4.7 (4.0, 5.3) | 354.3 (315.9, 393.3) | 291.9 (260.9, 326.2) | -17.6 (-27.7, -5.5) |
| Latin America and the Caribbean | 16.8 (15.5, 18.2) | 36.3 (33.2, 39.9) | 686.8 (632.6, 750.4) | 590.9 (542, 647.6) | -14 (-15.2, -12.7) | 5.5 (52.2, 56.1) | 9.6 (8.7, 10.4) | 281.7 (264.6, 289.5) | 160.9 (145.5, 172.7) | -42.9 (-46.1, -39.4) |
The number of incidences and deaths from CVD continues to increase globally as a result of a combination of the global population explosion of the past 30 years, the progression of population aging, and advances in diagnostic technology. At the same time, developments in medical technology, the adoption of public health measures, effective risk factor control, and the improvement of socioeconomic situations have all contributed to a decrease in the ASIR and ASDR of CVD.
Regional and national trends of CVD
In 2021, the regions with the highest number of CVD incident cases were East Asia (16.6 million cases) and South Asia (13.6 million cases), which accounted for 24.9% and 20.4%, respectively, of the total number of global CVD incident cases. In East Asia, China has the most incident cases, with 16 million instances, accounting for 24% of the global total number of CVD incident cases. In South Asia, India has the most incident cases, with 10.8 million instances, accounting for 16.2% of the total number of CVD incident cases worldwide (Table 1). During the same duration, the areas with the largest number of CVD deaths were East Asia (5.23 million cases) and South Asia (3.67 million cases), accounting for 26.8% and 19.1%, respectively, of total CVD deaths. China had the most deaths in East Asia, accounting for 5.1 million cases and 26.2% of overall CVD deaths globally. India had the largest number of deaths in South Asia, with 2.9 million cases, accounting for 14.9% of global CVD deaths (Table 1).
In 2021, the highest ASIR for CVD are in Central Asia (1280.2 per 100,000), North Africa and the Middle East (1232.3 per 100,000), and Eastern Europe (1135.6 per 100,000), and the lowest are in high-income Asia Pacific (422.7 per 100,000), Tropical Latin America (547.1 per 100,000), and Australasia (553 per 100,000) (Table 1). The countries with the highest ASIR for CVD were Uzbekistan (1721.9 per 100,000), the Syrian Arab Republic (1480.4 per 100,000), and the United Arab Emirates (1464.5 per 100,000), and the lowest were Portugal Republic (415.7 per 100,000), Korea (423.5 per 100,000), and Japan (424.2 per 100,000) (Table 2 and Figure 1). During the same period, the highest ASDR for CVD was found in Central Asia (436.1 per 100,000), Eastern Europe (421.6 per 100,000), and Oceania (377.8 per 100,000), while the lowest was found in high-income Asia Pacific (73.4 per 100,000), Australasia (94.2 per 100,000), and Western Europe (106.8 per 100,000) (Table 1). The countries with the highest ASDR for CVD were Nauru (748.3 per 100,000), Egypt (612.1 per 100,000), and Afghanistan (567.4 per 100,000), and the lowest were the Republic of San Marino (66.9 per 100,000), Japan (72.5 per 100,000), and Singapore (75.8 per 100,000) (Table 3 and Figure 2).
Table 2. The number of incident cases of cardiovascular disease and their ASIR for 204 countries worldwide in 1990 and 2021 and the percentage change in ASIR from 1990 to 2021 were calculated.
ASIR: age-standardized incidence rates (per 100,000); 95% UI: 95% uncertainty intervals
The number of incident cases=incident cases×1
Percentage change in the ASIR per 100,000=(the ASIR in 2021-the ASIR in 1990)/the ASIR in 1990
| Incident cases (95% UI) | ASIR (95% UI) (per 100,000) | Percentage change in the ASIR per 100,000 | |||
| 1990 | 2021 | 1990 | 2021 | ||
| Global | 34742351 (31845969, 37984786) | 66809837 (60907604, 73102151) | 878.8 (808.2, 959.9) | 787 (719.7, 859.7) | -10.4 (-11.5, -9.4) |
| Andean Latin America | 141785 (128822, 155290) | 331735 (301294, 366360) | 587.6 (538.8, 648.2) | 545.8 (495.3, 604.3) | -7.1 (-8.9, -5.1) |
| Plurinational State of Bolivia | 23674 (21431, 26133) | 54876 (49654, 60634) | 626.8 (569.6, 694.4) | 581.2 (528.2, 641.2) | -7.3 (-9.8, -5) |
| Republic of Ecuador | 37457 (33916, 41098) | 95814 (87115, 105871) | 597.3 (544.6, 660) | 577.4 (525.3, 637.6) | -3.3 (-5.7, -0.8) |
| Republic of Peru | 80654 (73144, 88298) | 181045 (164618, 199669) | 572.4 (523.8, 631.2) | 523.9 (474.7, 580.1) | -8.5 (-11.2, -5.6) |
| Australasia | 179287 (166588, 193524) | 287698 (263280, 315014) | 772.1 (719.9, 830.2) | 553 (505.7, 607.8) | -28.4 (-31.3, -25.1) |
| Australia | 144380 (135657, 154532) | 237889 (217030, 261342) | 747.2 (703.1, 799) | 543.7 (497.1, 599.7) | -27.2 (-31.1, -22.6) |
| New Zealand | 34907 (30727, 39748) | 49809 (45922, 54467) | 896.8 (794.5, 1020.3) | 602.3 (556.1, 652.7) | -32.8 (-36.9, -28.2) |
| Caribbean | 214934 (196274, 235252) | 389258 (354166, 429816) | 796.1 (728.5, 874.5) | 736.4 (671.4, 810.1) | -7.5 (-8.9, -6) |
| Antigua and Barbuda | 426 (379, 481) | 758 (668, 870) | 766.9 (680.3, 861.7) | 748.7 (662.6, 847) | -2.4 (-5, 0.2) |
| Commonwealth of the Bahamas | 1314 (1174, 1460) | 3029 (2667, 3458) | 769.5 (685.3, 868.6) | 764.4 (675.2, 867) | -0.7 (-3.4, 2) |
| Barbados | 2171 (1925, 2464) | 3602 (3149, 4136) | 760 (679.7, 852.9) | 766 (680.1, 866.5) | 0.8 (-1.9, 3.6) |
| Belize | 791 (707, 880) | 2323 (2069, 2634) | 705.6 (623.4, 798.2) | 722.4 (637.5, 824.1) | 2.4 (-0.3, 5.3) |
| Bermuda | 419 (369, 476) | 852 (736, 994) | 684.8 (605.7, 779.1) | 653.7 (571.7, 749.6) | -4.5 (-7.3, -1.4) |
| Republic of Cuba | 83816 (76435, 91976) | 124061 (112720, 137800) | 818.9 (751.2, 897.7) | 689.6 (630.2, 759.2) | -15.8 (-18.3, -13) |
| Commonwealth of Dominica | 460 (410, 520) | 597 (521, 682) | 751.2 (667.8, 847.2) | 752.5 (662.1, 853.2) | 0.2 (-2.7, 2.8) |
| Dominican Republic | 30587 (27538, 33955) | 77964 (71336, 85287) | 712.4 (641.7, 788.2) | 767.9 (701, 837.5) | 7.8 (3.4, 12.5) |
| Grenada | 626 (560, 701) | 865 (767, 982) | 821.6 (735, 917.3) | 804 (717, 906) | -2.1 (-5.2, 0.6) |
| Republic of Guyana | 4160 (3780, 4561) | 5427 (4885, 6082) | 950.8 (858.9, 1058.1) | 843.7 (756.4, 943) | -11.3 (-13.6, -8.9) |
| Republic of Haiti | 32305 (29433, 35430) | 67163 (60777, 73994) | 909.3 (829, 992.5) | 840.1 (767.6, 918.6) | -7.6 (-10.4, -4.9) |
| Jamaica | 14046 (12594, 15711) | 23355 (20749, 26286) | 737.6 (656.8, 829.8) | 749.8 (665.9, 842.5) | 1.7 (-1.1, 4.3) |
| Puerto Rico | 24260 (21643, 27195) | 42153 (37144, 47911) | 682.4 (609.3, 761.7) | 617.3 (544.8, 698.5) | -9.5 (-13.5, -6) |
| Saint Kitts and Nevis | 302 (267, 343) | 480 (420, 551) | 831.5 (744.2, 934.6) | 725.7 (638.1, 824.5) | -12.7 (-15.3, -9.7) |
| Saint Lucia | 816 (731, 909) | 1785 (1579, 2027) | 872.9 (777.9, 978.4) | 785.2 (699.6, 882.4) | -10.1 (-12.5, -7.7) |
| Saint Vincent and the Grenadines | 604 (541, 678) | 1016 (895, 1152) | 779.7 (697.6, 879.7) | 750.5 (668.9, 844.2) | -3.7 (-6.1, -1) |
| Republic of Suriname | 2230 (2001, 2501) | 4943 (4370, 5597) | 812.3 (724.8, 916.5) | 801.4 (712, 905.4) | -1.3 (-4, 1.5) |
| Republic of Trinidad and Tobago | 7776 (6985, 8681) | 14526 (12671, 16572) | 886.3 (794.3, 994.8) | 797.7 (704, 902.1) | -10 (-12.6, -7.3) |
| United States Virgin Islands | 549 (486, 625) | 1186 (1028, 1373) | 660.4 (581.5, 755.4) | 685.7 (602.3, 781.9) | 3.8 (0.6, 6.6) |
| Central Asia | 524031 (482897, 571795) | 965082 (898449, 1048195) | 1120.4 (1033.2, 1214.4) | 1280.2 (1202.2, 1376.2) | 14.3 (11.6, 17) |
| Republic of Armenia | 28771 (25858, 32271) | 40763 (36203, 46207) | 1092.8 (986.2, 1212) | 976 (869.4, 1092.1) | -10.7 (-14, -7.5) |
| Republic of Azerbaijan | 54086 (49350, 59616) | 115026 (106165, 125594) | 1088.1 (994.3, 1193) | 1267.9 (1179, 1367.6) | 16.5 (10.6, 22.3) |
| Georgia | 76781 (71271, 84336) | 63829 (57791, 70504) | 1301.7 (1215.7, 1416.7) | 1097.4 (995.2, 1205.6) | -15.7 (-19.8, -10.7) |
| Republic of Kazakhstan | 136008 (125659, 147550) | 172143 (157680, 189509) | 1120.9 (1040.7, 1215) | 1032.1 (951.4, 1122.2) | -7.9 (-11.1, -4.7) |
| Kyrgyz Republic | 32976 (29936, 36607) | 47608 (42989, 52748) | 1083 (979.5, 1210.2) | 1005.4 (914.6, 1110.5) | -7.2 (-10.9, -3.6) |
| Mongolia | 13968 (12620, 15613) | 26603 (23827, 29685) | 1259.2 (1125.7, 1416.3) | 1185.2 (1060.3, 1322.5) | -5.9 (-9, -2.5) |
| Republic of Tajikistan | 30587 (27728, 34201) | 68040 (62426, 74963) | 1033.4 (925.8, 1158.9) | 1249.2 (1150.4, 1357.4) | 20.9 (14.7, 27.1) |
| Turkmenistan | 23114 (20834, 25648) | 46517 (42266, 51634) | 1180.4 (1062.1, 1298.9) | 1178 (1075.5, 1286.1) | -0.2 (-3.9, 3.8) |
| Republic of Uzbekistan | 127740 (118470, 138723) | 384553 (361440, 413202) | 1042.3 (965.9, 1129.3) | 1721.9 (1633.5, 1826.6) | 65.2 (56.6, 75.2) |
| Central Europe | 1335444 (1233135, 1448390) | 1509555 (1406290, 1627138) | 935.3 (867.4, 1006.7) | 700 (653.4, 751.2) | -25.2 (-27.2, -23.3) |
| Republic of Albania | 17065 (15614, 18809) | 30220 (27562, 33457) | 777.4 (709.2, 858.6) | 749.3 (690.4, 820.3) | -3.6 (-6.3, -0.8) |
| Bosnia and Herzegovina | 30959 (28108, 34046) | 44580 (40348, 49222) | 788 (716.7, 864) | 738.7 (671.9, 811.4) | -6.3 (-9.2, -3.1) |
| Republic of Bulgaria | 116700 (108789, 126091) | 116404 (108736, 125477) | 1049.2 (990.3, 1118.8) | 847.8 (795.8, 909.1) | -19.2 (-21.9, -16.1) |
| Republic of Croatia | 48931 (45214, 53368) | 52927 (49434, 56579) | 850.1 (789.8, 916.7) | 611.1 (572.4, 650.3) | -28.1 (-31.6, -25.4) |
| Czech Republic | 135237 (126484, 144025) | 160691 (148242, 173601) | 1005.3 (944.9, 1068.5) | 779.1 (718.9, 845.1) | -22.5 (-26.2, -18.5) |
| Hungary | 150578 (139697, 164171) | 143743 (132540, 156485) | 1062 (987.8, 1151.2) | 752 (697.8, 816.7) | -29.2 (-31.8, -26.1) |
| Montenegro | 4824 (4355, 5374) | 7560 (6815, 8544) | 790.5 (714.5, 879.3) | 806.6 (733.8, 903.4) | 2 (-0.8, 4.8) |
| North Macedonia | 16008 (14483, 17622) | 26508 (23900, 29361) | 892.9 (813.9, 977.9) | 895 (818.5, 980.7) | 0.2 (-3.2, 3.6) |
| Republic of Poland | 360591 (316377, 410371) | 386318 (355918, 417727) | 853.9 (752.7, 965.2) | 557.5 (516.9, 600.3) | -34.7 (-39.8, -29.2) |
| Romania | 256354 (239135, 276125) | 278115 (261535, 298194) | 993 (934.7, 1059.2) | 760.2 (714.9, 816.8) | -23.4 (-26.2, -20.7) |
| Republic of Serbia | 102498 (95233, 109906) | 144855 (134369, 157601) | 974.7 (914.9, 1040.6) | 901.6 (838.4, 981.5) | -7.5 (-11.8, -2.2) |
| Slovak Republic | 55882 (51727, 60234) | 67735 (62464, 73256) | 952.5 (886.2, 1024.4) | 730.3 (677, 788.4) | -23.3 (-25.8, -20.2) |
| Republic of Slovenia | 18462 (16634, 20541) | 27928 (25018, 31265) | 763.1 (690.9, 847) | 655.9 (591.9, 727.9) | -14.1 (-17.6, -10.6) |
| Central Latin America | 622819 (567817, 683933) | 1549589 (1397891, 1727219) | 694.6 (630.3, 771.4) | 620.1 (558.5, 689.3) | -10.7 (-12, -9.6) |
| Republic of Colombia | 119971 (110197, 132442) | 300821 (274738, 334143) | 671.8 (616.7, 737.5) | 539 (491.9, 598.1) | -19.8 (-22.4, -17.1) |
| Republic of Costa Rica | 14724 (13314, 16324) | 37160 (33231, 41958) | 744.8 (666.2, 832.8) | 687.5 (615.9, 771.4) | -7.7 (-10.5, -5.2) |
| Republic of El Salvador | 22510 (20376, 24845) | 40117 (36240, 44513) | 648.1 (584.8, 720.1) | 625 (561.7, 695.8) | -3.6 (-6.3, -0.8) |
| Republic of Guatemala | 27118 (24486, 30000) | 75119 (68172, 83816) | 633.1 (578, 700.9) | 632.8 (578.2, 702.1) | -0.1 (-3.6, 2.9) |
| Republic of Honduras | 17349 (15507, 19306) | 50013 (45101, 54932) | 692.8 (622.8, 776.6) | 736.1 (670.8, 807.7) | 6.2 (1.9, 10.4) |
| United Mexican States | 325922 (294549, 360111) | 798458 (705368, 897139) | 705.6 (631.8, 789.8) | 636.9 (565.7, 714.5) | -9.7 (-11.1, -8.3) |
| Republic of Nicaragua | 13907 (12536, 15319) | 34396 (31072, 38101) | 715 (643.5, 794.4) | 662.9 (597.4, 739.5) | -7.3 (-10.7, -4.1) |
| Republic of Panama | 11392 (10353, 12682) | 28778 (25883, 32257) | 693.6 (628.4, 773.1) | 647.6 (582.5, 725.6) | -6.6 (-9.3, -4.1) |
| Bolivarian Republic of Venezuela | 69926 (63867, 77202) | 184727 (169173, 203845) | 707.1 (641.7, 777.2) | 620 (570.4, 680.7) | -12.3 (-15.2, -9.4) |
| Central Sub-Saharan Africa | 239984 (215804, 265235) | 570416 (509190, 630884) | 853.2 (775.4, 937.9) | 786.4 (721.7, 859.2) | -7.8 (-10.5, -5.5) |
| Republic of Angola | 43627 (39163, 48334) | 127483 (112646, 142159) | 880.4 (792, 969.5) | 791.3 (720.2, 874.1) | -10.1 (-13.4, -6.7) |
| Central African Republic | 12431 (11102, 13896) | 24352 (21493, 27106) | 886.2 (789.8, 990.4) | 859.9 (769.7, 959.9) | -3 (-5.6, -0.2) |
| Republic of the Congo | 11758 (10564, 13048) | 26944 (24202, 29968) | 913.3 (820.3, 1011.1) | 853.3 (765.8, 950.2) | -6.6 (-9.1, -4) |
| Democratic Republic of the Congo | 164943 (147973, 183125) | 376581 (336066, 417861) | 840.6 (767.3, 921.2) | 775.5 (712.5, 844.8) | -7.7 (-11.1, -4.7) |
| Republic of Equatorial Guinea | 2024 (1816, 2240) | 5719 (5085, 6409) | 882.7 (793.3, 988.6) | 797.1 (706.6, 903.4) | -9.7 (-12.5, -6.9) |
| Gabonese Republic | 5201 (4653, 5814) | 9337 (8346, 10354) | 816.3 (732.4, 910.3) | 799 (711, 890.7) | -2.1 (-5.2, 0.8) |
| East Asia | 6501316 (5959780, 7129047) | 16582690 (14941764, 18372360) | 785.6 (719.7, 858.4) | 809.3 (734.4, 888.7) | 3 (0.8, 5.2) |
| People's Republic of China | 6248590 (5727577, 6853739) | 16039153 (14443325, 17780115) | 783.9 (718.4, 857.6) | 811.8 (736.1, 892) | 3.6 (1.3, 5.8) |
| Democratic People's Republic of Korea | 130274 (119503, 141471) | 263609 (243181, 286046) | 847.8 (778, 919.6) | 845.4 (781.6, 914.7) | -0.3 (-3.9, 4) |
| Taiwan (Province of China) | 122452 (111061, 134407) | 279928 (251341, 313048) | 817.1 (742.1, 899.3) | 676.1 (610.6, 750.3) | -17.3 (-20.2, -14.3) |
| Eastern Europe | 3084133 (2725612, 3457128) | 3914587 (3418554, 4446707) | 1177.9 (1049, 1316.1) | 1135.6 (1000.2, 1279.3) | -3.6 (-5.9, -1.1) |
| Republic of Belarus | 129309 (120204, 140349) | 157859 (147479, 170692) | 1033.3 (966, 1115.9) | 997.9 (936.3, 1075.8) | -3.4 (-7.5, -0.1) |
| Republic of Estonia | 20755 (19270, 22468) | 23789 (20790, 27257) | 1051.1 (980.5, 1132) | 908.4 (798.8, 1034.6) | -13.6 (-21.3, -3.5) |
| Republic of Latvia | 34143 (31410, 37096) | 30802 (28204, 33805) | 976.8 (903.5, 1057.8) | 778.6 (712.5, 855.5) | -20.3 (-23.6, -17.2) |
| Republic of Lithuania | 45009 (42182, 48345) | 47169 (43685, 51195) | 1013.1 (951, 1090) | 812.3 (751.6, 882.7) | -19.8 (-23.8, -16.2) |
| Republic of Moldova | 42153 (38658, 46002) | 51445 (47126, 56196) | 1066.5 (986.7, 1150.9) | 873 (801.6, 950.6) | -18.1 (-21.1, -14.7) |
| Russian Federation | 2034167 (1786246, 2295087) | 2718586 (2366402, 3102561) | 1212.2 (1071.7, 1365.3) | 1160.7 (1018.9, 1312.7) | -4.2 (-6.8, -1.6) |
| Ukraine | 778596 (684066, 878099) | 884937 (764962, 1018392) | 1153.1 (1018.3, 1296) | 1156.2 (1012.7, 1316.9) | 0.3 (-3.4, 3.7) |
| Eastern Sub-Saharan Africa | 756878 (681693, 838703) | 1681501 (1503975, 1866178) | 782.8 (708.8, 860.2) | 737.7 (670, 813.8) | -5.8 (-7.2, -4.5) |
| Republic of Burundi | 24894 (22607, 27454) | 50648 (44934, 57024) | 852.6 (775, 937.9) | 743.7 (672.5, 826.7) | -12.8 (-15.3, -10.2) |
| Union of the Comoros | 1975 (1775, 2201) | 4006 (3594, 4460) | 802.7 (721.6, 894.9) | 751.5 (669.9, 845.7) | -6.4 (-9.1, -3.7) |
| Republic of Djibouti | 1514 (1351, 1703) | 5881 (5261, 6598) | 790.2 (707, 881.7) | 793.6 (706.4, 896.4) | 0.4 (-2.7, 3.3) |
| State of Eritrea | 13488 (11937, 15136) | 28174 (25276, 31436) | 842 (762.5, 930.2) | 762.9 (689.1, 846.9) | -9.4 (-12.1, -6.5) |
| Federal Democratic Republic of Ethiopia | 189902 (171973, 210976) | 395452 (352699, 444180) | 763.7 (691.5, 844.8) | 657.5 (590.6, 732.6) | -13.9 (-16.3, -11.6) |
| Republic of Kenya | 85623 (76509, 95183) | 212853 (189715, 237157) | 766.4 (680.1, 861.4) | 756.7 (672.9, 852.1) | -1.3 (-2.3, -0.2) |
| Republic of Madagascar | 54431 (49588, 59857) | 123654 (111247, 137407) | 861.8 (786.6, 941.9) | 834.8 (764.6, 912.6) | -3.1 (-5.6, -0.3) |
| Republic of Malawi | 39716 (35611, 44187) | 79754 (70462, 89234) | 792.8 (714.5, 877.2) | 774.7 (705.2, 863) | -2.3 (-5.4, 0.6) |
| Republic of Mozambique | 60629 (54535, 67254) | 128787 (114919, 143296) | 822.8 (737.8, 906.2) | 825.1 (748.7, 908.8) | 0.3 (-3.1, 3.3) |
| Republic of Rwanda | 31318 (28376, 34568) | 56228 (50223, 62474) | 869.3 (792, 952.7) | 724.7 (655.7, 800.9) | -16.6 (-19.3, -14.3) |
| Federal Republic of Somalia | 29101 (25978, 32470) | 75887 (66863, 85412) | 822.9 (738.5, 913.8) | 780.7 (706.5, 862) | -5.1 (-8.1, -2.3) |
| Republic of South Sudan | 23940 (21481, 26674) | 37693 (33440, 42242) | 741.7 (667.9, 825.2) | 734 (657.5, 818.2) | -1 (-3.5, 1.6) |
| Republic of Uganda | 66848 (59713, 74528) | 153801 (136915, 172409) | 768.3 (696, 847.9) | 716.3 (652.8, 795.1) | -6.8 (-9.7, -4) |
| United Republic of Tanzania | 101809 (91380, 112600) | 251723 (226768, 277798) | 725.5 (659.1, 803) | 761.1 (696.6, 836.6) | 4.9 (1.6, 8.6) |
| Republic of Zambia | 31148 (27851, 34851) | 75495 (67331, 84656) | 792 (716.2, 881.4) | 776.6 (705.6, 852.6) | -1.9 (-5, 0.9) |
| High-income Asia Pacific | 1140579 (1066155, 1220532) | 1818385 (1684621, 1958696) | 576.2 (541.2, 614.8) | 422.7 (395.2, 451.9) | -26.6 (-28.6, -24.8) |
| Brunei Darussalam | 760 (709, 807) | 1770 (1641, 1896) | 674 (624.2, 723.5) | 500.4 (464.2, 539.7) | -25.8 (-28, -23.3) |
| Japan | 896727 (834584, 962749) | 1399673 (1289572, 1512181) | 540.1 (505.1, 578.4) | 424.2 (395.9, 454.3) | -21.4 (-23.6, -19.3) |
| Republic of Korea | 228140 (214240, 243480) | 380688 (355710, 409284) | 798.6 (752.4, 850.1) | 423.5 (399, 452.4) | -47 (-49.2, -44.9) |
| Republic of Singapore | 14952 (13773, 16185) | 36254 (32996, 40136) | 671.9 (616.4, 732.9) | 428.7 (389.8, 472.1) | -36.2 (-38.4, -34) |
| High-income North America | 3435273 (3053923, 3822225) | 4293532 (4048636, 4558009) | 986.6 (881.2, 1101.4) | 670.2 (635.1, 708.8) | -32.1 (-37, -27.2) |
| Canada | 306643 (285774, 332016) | 446471 (412942, 486276) | 944.7 (881.7, 1020.8) | 638.4 (592, 694.3) | -32.4 (-35.1, -29.6) |
| Greenland | 309 (285, 335) | 504 (458, 556) | 943.8 (867.6, 1021.5) | 747.5 (685.1, 817.6) | -20.8 (-23.1, -18.4) |
| United States of America | 3128242 (2768304, 3503017) | 3846490 (3627397, 4079395) | 991.8 (881, 1113.7) | 673.9 (638.8, 712.3) | -32.1 (-37.5, -26.6) |
| North Africa and the Middle East | 2293414 (2062501, 2581476) | 5660724 (5097761, 6383725) | 1336.5 (1212.7, 1504.3) | 1232.3 (1117.9, 1378.3) | -7.8 (-9.7, -5.8) |
| Islamic Republic of Afghanistan | 105721 (95044, 119582) | 153468 (137323, 169849) | 1563.5 (1416.2, 1753) | 1346.9 (1215.6, 1512.5) | -13.9 (-18.1, -8.7) |
| People's Democratic Republic of Algeria | 177773 (158849, 203333) | 428016 (383679, 485882) | 1482.4 (1340.6, 1672.8) | 1210.5 (1095.9, 1357.3) | -18.3 (-22.5, -14) |
| Kingdom of Bahrain | 2499 (2102, 2974) | 12805 (10322, 15944) | 1377 (1138.9, 1642.9) | 1284.5 (1057.5, 1553) | -6.7 (-11, -3.1) |
| Arab Republic of Egypt | 387391 (349382, 432242) | 924213 (828860, 1022544) | 1420 (1288.7, 1570.3) | 1441.1 (1301.8, 1590.9) | 1.5 (-4.9, 8.5) |
| Islamic Republic of Iran | 355774 (301352, 420979) | 923522 (782697, 1088275) | 1337.4 (1121.7, 1559.6) | 1197.1 (1008.8, 1398.4) | -10.5 (-12.1, -8.8) |
| Republic of Iraq | 123556 (111584, 137878) | 354990 (318470, 399941) | 1440.1 (1293.6, 1624.8) | 1455.3 (1320, 1620.4) | 1.1 (-3.9, 6.6) |
| Hashemite Kingdom of Jordan | 18136 (15394, 21400) | 96120 (81239, 114894) | 1347 (1145.5, 1571.6) | 1249.5 (1067.8, 1467.6) | -7.2 (-11.5, -3.2) |
| State of Kuwait | 8826 (7302, 10579) | 42798 (35413, 51761) | 1360.6 (1116.8, 1655.5) | 1336 (1108.7, 1604.3) | -1.8 (-6.6, 3.4) |
| Lebanese Republic | 27568 (23451, 32243) | 74515 (64102, 85145) | 1313.4 (1125.7, 1505.1) | 1238.3 (1059.5, 1428.4) | -5.7 (-10.1, -1.2) |
| State of Libya | 24092 (20732, 28132) | 67336 (57907, 78283) | 1178.1 (1000.4, 1380.6) | 1249.9 (1076, 1448.3) | 6.1 (0.8, 11.2) |
| Kingdom of Morocco | 200345 (181169, 223397) | 458284 (412957, 512733) | 1369.2 (1236.8, 1532) | 1362.5 (1240.8, 1513.1) | -0.5 (-5.8, 4.5) |
| Sultanate of Oman | 9139 (7910, 10473) | 28740 (24193, 34172) | 1320.8 (1129.1, 1527.4) | 1333.2 (1133.8, 1564.9) | 0.9 (-4, 5.8) |
| Palestine | 12063 (10395, 13945) | 34287 (29309, 40196) | 1331.3 (1137.8, 1543.6) | 1309.2 (1127.2, 1524.8) | -1.7 (-5.4, 1.9) |
| State of Qatar | 1939 (1620, 2320) | 16434 (13220, 20056) | 1394.5 (1155.5, 1671.6) | 1312.8 (1075.8, 1587.5) | -5.9 (-9.4, -2.3) |
| Kingdom of Saudi Arabia | 70666 (61531, 81442) | 266935 (231937, 309504) | 1184.1 (1027.4, 1365) | 1218.1 (1076.5, 1379.6) | 2.9 (-2.3, 8.5) |
| Republic of Sudan | 137550 (123162, 154163) | 278907 (252231, 312105) | 1436.5 (1284.8, 1618.3) | 1337 (1206.4, 1495.4) | -6.9 (-11.3, -2.4) |
| Syrian Arab Republic | 81790 (73540, 92727) | 185427 (165398, 212313) | 1467.4 (1323.2, 1656.3) | 1480.4 (1334.6, 1657) | 0.9 (-4.2, 6) |
| Republic of Tunisia | 56032 (47630, 65542) | 148809 (129495, 173415) | 1155.8 (996.5, 1336) | 1138.7 (1000.8, 1311.2) | -1.5 (-6.7, 3.3) |
| Republic of Turkey | 408497 (369327, 460163) | 872143 (776615, 992314) | 1163.3 (1055.6, 1300.7) | 939.2 (837.9, 1058.4) | -19.3 (-24.6, -13.6) |
| United Arab Emirates | 8807 (7520, 10267) | 85873 (69396, 104217) | 1516.4 (1265.8, 1796) | 1464.5 (1235.1, 1723.2) | -3.4 (-7.5, 1.6) |
| Republic of Yemen | 73997 (65832, 83114) | 201823 (180652, 226895) | 1397.5 (1244.8, 1567.5) | 1318.7 (1187.1, 1480.5) | -5.6 (-10.6, -0.1) |
| Oceania | 26088 (23695, 28857) | 63908 (57780, 70688) | 821.1 (735.9, 920.8) | 807.5 (724.6, 906.9) | -1.7 (-3.5, 0.2) |
| Independent State of Samoa | 847 (767, 938) | 1353 (1213, 1511) | 917.7 (821.7, 1024.3) | 908.7 (809, 1031.9) | -1 (-3.3, 1.4) |
| American Samoa | 211 (191, 232) | 403 (360, 454) | 858 (765.7, 957.9) | 881.5 (785.6, 993.9) | 2.7 (0, 5.5) |
| Cook Islands | 89 (80, 100) | 190 (166, 217) | 735.2 (654, 829.3) | 754.6 (665.3, 855.1) | 2.6 (-0.3, 5.9) |
| Republic of Fiji | 3441 (3101, 3826) | 6657 (5930, 7467) | 920.5 (818.1, 1032.8) | 910.5 (815, 1021) | -1.1 (-3.8, 1.6) |
| Guam | 578 (523, 639) | 1622 (1435, 1852) | 726.1 (650.4, 814.2) | 788.7 (700.2, 897) | 8.6 (5.5, 11.7) |
| Republic of Kiribati | 427 (392, 468) | 779 (707, 857) | 1060.6 (963.4, 1178.4) | 1036.8 (933.5, 1157.6) | -2.2 (-4.7, 0.3) |
| Republic of the Marshall Islands | 179 (163, 197) | 323 (292, 355) | 910.6 (823.4, 1019.1) | 921.3 (827.5, 1025.3) | 1.2 (-1.4, 3.8) |
| Federated States of Micronesia | 513 (465, 567) | 678 (613, 756) | 952.1 (854.6, 1060.3) | 940.2 (843.7, 1046.6) | -1.3 (-3.5, 1.3) |
| Republic of Nauru | 41 (38, 46) | 51 (46, 57) | 906.3 (811.3, 1014.9) | 875.1 (774.1, 990.8) | -3.4 (-6.4, -0.4) |
| Republic of Niue | 19 (17, 21) | 17 (15, 20) | 837.1 (746.3, 933.2) | 822.3 (734.9, 927.7) | -1.8 (-4.2, 1) |
| Northern Mariana Islands | 163 (147, 180) | 392 (345, 449) | 808.5 (720.4, 909.8) | 822 (724.1, 934.8) | 1.7 (-1.5, 4.6) |
| Republic of Palau | 77 (69, 85) | 174 (155, 197) | 808 (726.8, 900) | 834.7 (746.1, 945.5) | 3.3 (0, 6.4) |
| Independent State of Papua New Guinea | 15018 (13588, 16665) | 41827 (37886, 46261) | 764.7 (683.6, 860) | 754.9 (677.2, 849.2) | -1.3 (-4, 1.6) |
| Solomon Islands | 1569 (1441, 1709) | 3931 (3601, 4289) | 1039.8 (942.1, 1153.3) | 1065.9 (965.3, 1183.1) | 2.5 (0, 5.1) |
| Tokelau | 10 (9, 11) | 11 (10, 13) | 754.2 (674.7, 846.5) | 755.9 (665.8, 859.4) | 0.2 (-3.2, 3.2) |
| Kingdom of Tonga | 505 (454, 564) | 720 (643, 808) | 832 (741.5, 939.6) | 855.7 (760, 968.7) | 2.9 (0.4, 5.7) |
| Tuvalu | 52 (47, 58) | 83 (74, 93) | 834.1 (751.3, 931.9) | 831.1 (741.9, 938.4) | -0.4 (-3.2, 2.7) |
| Republic of Vanuatu | 684 (620, 752) | 1828 (1660, 2022) | 966.5 (863.5, 1083.5) | 998.9 (892.9, 1121.6) | 3.3 (0.3, 6.3) |
| South Asia | 5735469 (5054475, 6512753) | 13568431 (11969604, 15355222) | 957 (838.1, 1087.4) | 912.2 (805.6, 1032.6) | -4.7 (-5.8, -3.6) |
| People's Republic of Bangladesh | 467609 (426063, 513611) | 1165216 (1067985, 1282289) | 902.6 (823.7, 995.1) | 839.1 (770.1, 917.3) | -7 (-11.2, -2.8) |
| Kingdom of Bhutan | 2458 (2126, 2868) | 5492 (4683, 6421) | 914.2 (777, 1071.6) | 893 (761.5, 1048.3) | -2.3 (-5.8, 1) |
| Republic of India | 4549273 (3985465, 5206859) | 10778160 (9415354, 12273924) | 954.2 (831, 1089.7) | 905.2 (791.7, 1031.3) | -5.1 (-6.2, -4.1) |
| Federal Democratic Republic of Nepal | 87161 (76787, 99295) | 195886 (175366, 220311) | 878.7 (771, 999.1) | 833.1 (746.7, 931.6) | -5.2 (-9.4, -0.7) |
| Islamic Republic of Pakistan | 628968 (557541, 706496) | 1423677 (1256930, 1608264) | 1039.7 (906.6, 1177.1) | 1066.2 (931.9, 1212.4) | 2.6 (0.4, 4.9) |
| Southeast Asia | 1825627 (1702564, 1967343) | 4308638 (3998289, 4666767) | 699.3 (649.8, 758.4) | 675.1 (627.4, 730.3) | -3.5 (-4.7, -2.2) |
| Kingdom of Cambodia | 34617 (32054, 37555) | 85900 (79634, 92848) | 704.6 (651.3, 764.8) | 706.8 (659.2, 760.2) | 0.3 (-2.7, 3.9) |
| Republic of Indonesia | 710354 (655103, 770122) | 1741176 (1595929, 1900154) | 717.8 (659.2, 782.2) | 764 (699.4, 834.5) | 6.4 (4.8, 8) |
| Lao People's Democratic Republic | 17625 (16240, 19137) | 34953 (32385, 37807) | 791.2 (731.3, 860.7) | 730.7 (676.4, 792.1) | -7.7 (-10.3, -4.9) |
| Malaysia | 80931 (75320, 87143) | 210378 (195372, 228094) | 806.4 (746.9, 876.1) | 752.2 (699.3, 812.3) | -6.7 (-10, -3.4) |
| Republic of Maldives | 745 (685, 805) | 2197 (2013, 2382) | 737.8 (674.8, 805.2) | 611.1 (553.6, 675.2) | -17.2 (-19.6, -14.6) |
| Republic of Mauritius | 5723 (5250, 6247) | 10749 (9743, 11992) | 776.8 (709.9, 847.6) | 624.7 (569.2, 689.4) | -19.6 (-22.1, -17) |
| Republic of the Union of Myanmar | 200262 (185723, 217259) | 337485 (314883, 363217) | 825.9 (770.2, 889.2) | 705.2 (661.8, 757.4) | -14.6 (-17.4, -12) |
| Republic of the Philippines | 195612 (179712, 214616) | 509136 (472200, 552124) | 602.6 (547.4, 668.5) | 603.3 (555.6, 656.4) | 0.1 (-3, 2.8) |
| Republic of Seychelles | 390 (357, 429) | 715 (650, 791) | 661.1 (603.6, 727.9) | 640.1 (581.8, 709) | -3.2 (-5.4, -0.6) |
| Democratic Socialist Republic of Sri Lanka | 67974 (62786, 73949) | 159631 (146999, 173450) | 661.6 (606.8, 720.8) | 614.5 (570.2, 665.7) | -7.1 (-9.9, -4.2) |
| Kingdom of Thailand | 245611 (229463, 264903) | 558997 (520071, 608408) | 664.6 (624.1, 719.3) | 552.2 (516.1, 595.4) | -16.9 (-18.9, -14.8) |
| Democratic Republic of Timor-Leste | 2138 (1958, 2327) | 5999 (5486, 6576) | 635 (579.6, 699.1) | 663.3 (604.3, 728) | 4.5 (1.4, 7.1) |
| Socialist Republic of Viet Nam | 261006 (244156, 280861) | 645311 (603236, 693316) | 655.6 (613.2, 703.4) | 670 (629.8, 715) | 2.2 (-1, 5.9) |
| Southern Latin America | 351406 (328339, 377804) | 484587 (454629, 520245) | 770 (721.9, 826.2) | 575.2 (540.1, 617.2) | -25.3 (-27.3, -23.2) |
| Eastern Republic of Uruguay | 26559 (24405, 28733) | 30725 (28129, 33734) | 694.5 (641.7, 749.2) | 566.2 (520.2, 620.9) | -18.5 (-21.4, -15.8) |
| Argentine Republic | 264664 (247684, 285402) | 342036 (318177, 370019) | 834.3 (783.7, 897.7) | 631.9 (587.9, 684.8) | -24.3 (-26.7, -21.8) |
| Republic of Chile | 60167 (55941, 65015) | 111799 (105251, 119350) | 605.4 (561.7, 654.7) | 443.2 (418.2, 472.7) | -26.8 (-30.7, -22.8) |
| Southern Sub-Saharan Africa | 272173 (244832, 301425) | 489804 (440661, 546039) | 864.6 (773.9, 965.8) | 815.5 (732.5, 910.4) | -5.7 (-7.1, -4.2) |
| Republic of Botswana | 5705 (5111, 6344) | 13477 (12143, 14965) | 851 (764.5, 949.4) | 865.5 (773.7, 964.3) | 1.7 (-1.3, 4.7) |
| Kingdom of Eswatini | 2980 (2657, 3328) | 5240 (4703, 5808) | 792.6 (710, 883.4) | 826.8 (738.6, 925.3) | 4.3 (1.2, 7.2) |
| Kingdom of Lesotho | 7056 (6310, 7826) | 9662 (8664, 10713) | 731.9 (655.1, 815.7) | 829.2 (749.3, 920.3) | 13.3 (10, 16.3) |
| Republic of Namibia | 6389 (5736, 7088) | 11939 (10706, 13295) | 854.6 (769.5, 955.8) | 790.9 (708.8, 881.7) | -7.5 (-10.3, -4.8) |
| Republic of South Africa | 211079 (189973, 234480) | 382412 (342670, 430376) | 895.9 (800.3, 1003.3) | 816.4 (731.4, 912.9) | -8.9 (-10.5, -7.3) |
| Republic of Zimbabwe | 38966 (34787, 43241) | 67075 (60158, 74386) | 745.6 (671.8, 831.7) | 814.2 (735.4, 897.2) | 9.2 (5.4, 12.9) |
| Tropical Latin America | 698032 (646962, 758025) | 1358155 (1252037, 1473102) | 671.3 (624.6, 724.5) | 547.1 (505, 592.5) | -18.5 (-20.3, -16.6) |
| Federative Republic of Brazil | 682363 (632348, 741093) | 1323880 (1220719, 1436092) | 673 (626.1, 726.3) | 546.9 (504.9, 592.1) | -18.7 (-20.6, -16.9) |
| Republic of Paraguay | 15669 (14327, 17048) | 34274 (31528, 37432) | 602.5 (555.8, 659.3) | 558.7 (512.8, 610.3) | -7.3 (-9.5, -4.9) |
| Western Europe | 4557942 (4280054, 4869798) | 5102835 (4795711, 5455074) | 800.6 (757.2, 854.4) | 576.7 (542, 619.3) | -28 (-29.6, -26.4) |
| Principality of Andorra | 338 (307, 373) | 757 (686, 838) | 588.9 (535.3, 647.5) | 501 (456.3, 554.3) | -14.9 (-16.8, -12.8) |
| Republic of Austria | 85835 (81283, 90984) | 122031 (116153, 129637) | 736.1 (699.7, 777.1) | 701.1 (663.9, 745.8) | -4.8 (-8.1, -0.8) |
| Kingdom of Belgium | 115940 (108126, 125641) | 123195 (114166, 133819) | 771.3 (719.7, 835.9) | 549.7 (509.8, 597.1) | -28.7 (-32.3, -24.9) |
| Republic of Cyprus | 5128 (4711, 5612) | 9841 (9100, 10715) | 626.2 (577.6, 681.6) | 486.9 (450.9, 526.6) | -22.2 (-24.6, -19.8) |
| Kingdom of Denmark | 53256 (49837, 57010) | 62318 (57264, 67780) | 666.7 (627.1, 712.1) | 552.9 (511.3, 599.5) | -17.1 (-21, -12.6) |
| Republic of Finland | 72799 (68060, 78240) | 79407 (73650, 85753) | 1042.4 (976.2, 1120.1) | 652 (604, 704.6) | -37.4 (-40.8, -34) |
| French Republic | 570641 (532976, 612203) | 716849 (664529, 776256) | 698.7 (656, 745) | 533.7 (494.5, 580.2) | -23.6 (-27.2, -19.6) |
| Federal Republic of Germany | 1208411 (1143814, 1278359) | 1233101 (1161365, 1314707) | 966.5 (917.5, 1020.3) | 673.4 (633.7, 720.2) | -30.3 (-33.8, -26.6) |
| Hellenic Republic | 107091 (100144, 115979) | 122897 (115496, 132239) | 719.4 (673.7, 775.3) | 526.3 (493, 566.3) | -26.8 (-29.4, -24.2) |
| Republic of Iceland | 2048 (1859, 2261) | 3150 (2865, 3472) | 725.9 (659.1, 799) | 560.8 (512.2, 615.1) | -22.7 (-26.5, -19.2) |
| Ireland | 32953 (30363, 36023) | 39516 (36009, 43442) | 809.7 (750, 882.5) | 511.4 (467, 560.8) | -36.8 (-39.6, -34.4) |
| State of Israel | 35792 (32805, 39227) | 65365 (60275, 70938) | 740.5 (683.5, 805) | 540 (498.9, 586.4) | -27.1 (-29.9, -24.1) |
| Republic of Italy | 699729 (638117, 764176) | 810477 (754270, 873104) | 807.3 (740.5, 878.2) | 606.9 (567.5, 651.6) | -24.8 (-27.8, -21.9) |
| Grand Duchy of Luxembourg | 3396 (3145, 3672) | 5377 (4973, 5807) | 633 (587.7, 682.6) | 522.9 (484.5, 564.8) | -17.4 (-19.8, -14.9) |
| Republic of Malta | 2575 (2366, 2807) | 4280 (3923, 4672) | 608.3 (560, 660.9) | 461.5 (426, 499.4) | -24.1 (-26.9, -21.6) |
| Principality of Monaco | 429 (392, 471) | 473 (429, 524) | 637.8 (586.2, 695.5) | 519.1 (474.3, 575) | -18.6 (-20.7, -16.6) |
| Kingdom of the Netherlands | 158038 (147352, 169780) | 185253 (170861, 202243) | 799.8 (746.4, 861.1) | 549.5 (508.2, 597.9) | -31.3 (-34.3, -28.1) |
| Kingdom of Norway | 56878 (51967, 62434) | 60406 (55408, 65786) | 848.8 (779.4, 921.2) | 623.5 (575.1, 677.7) | -26.5 (-28.4, -24.7) |
| Portuguese Republic | 93725 (87052, 101395) | 98432 (91958, 105411) | 692.9 (646.3, 745.2) | 415.7 (390.1, 448.4) | -40 (-42.4, -37.5) |
| Republic of San Marino | 213 (194, 234) | 365 (331, 403) | 618.3 (565, 676.2) | 517.4 (471.7, 568.1) | -16.3 (-18.4, -14.2) |
| Kingdom of Spain | 381598 (357691, 410285) | 475967 (449473, 506557) | 713.2 (672.6, 762.8) | 514.5 (485.4, 548.8) | -27.9 (-31, -25.1) |
| Kingdom of Sweden | 115354 (108469, 123702) | 143524 (129190, 158822) | 768.1 (724.9, 818.5) | 695 (630.6, 763.9) | -9.5 (-15.5, -3.1) |
| Swiss Confederation | 68559 (64182, 73596) | 86856 (80928, 93880) | 666.3 (624.1, 712.6) | 496 (459.5, 537.3) | -25.6 (-28.7, -22.6) |
| United Kingdom of Great Britain and Northern Ireland | 683470 (622013, 752170) | 648507 (602407, 699222) | 771.3 (705.2, 844.9) | 526.6 (489.7, 566.8) | -31.7 (-34.3, -29.5) |
| Western Sub-Saharan Africa | 805740 (731481, 887909) | 1878727 (1699128, 2071910) | 785.2 (705, 874.6) | 765.8 (689, 848.5) | -2.5 (-4.1, -1.1) |
| Republic of Benin | 19280 (17447, 21203) | 49258 (44100, 54360) | 789.4 (707.8, 885.1) | 749.4 (672.9, 838.1) | -5.1 (-8.3, -2) |
| Burkina Faso | 35382 (31877, 39474) | 79207 (71573, 87566) | 695.3 (623.3, 775.4) | 683.9 (613, 761.4) | -1.6 (-5.5, 2.3) |
| Republic of Cabo Verde | 1885 (1675, 2143) | 3467 (3081, 3914) | 730.6 (645.7, 834.8) | 753.2 (668, 859.6) | 3.1 (-0.3, 6.7) |
| Republic of Cameroon | 37566 (34051, 41478) | 116593 (105708, 128555) | 709.7 (640.5, 785.2) | 739.1 (671.9, 814.1) | 4.2 (-0.2, 8.1) |
| Republic of Chad | 25686 (23229, 28481) | 59824 (53774, 65855) | 779.1 (702.5, 867.5) | 772.4 (693.1, 857.8) | -0.9 (-4.4, 2.4) |
| Republic of Côte d'Ivoire | 43057 (39008, 47431) | 108576 (98219, 119275) | 827.2 (744.4, 916.3) | 787.6 (710.7, 867.5) | -4.8 (-8.4, -1.3) |
| Republic of the Gambia | 3618 (3246, 4015) | 9846 (8850, 10966) | 816.5 (717.6, 930.2) | 820.3 (730.6, 927.8) | 0.5 (-3.2, 3.4) |
| Republic of Ghana | 65176 (59527, 70956) | 161240 (147776, 176611) | 879.9 (798.7, 968.7) | 834.8 (766, 911.4) | -5.1 (-8.2, -2.4) |
| Republic of Guinea-Bissau | 4080 (3684, 4537) | 7703 (6935, 8498) | 852.9 (758.9, 962.8) | 832.4 (743.8, 936.5) | -2.4 (-5.1, 0.5) |
| Republic of Guinea | 26871 (24481, 29638) | 52093 (47329, 57451) | 746.9 (673.9, 826.7) | 770.2 (699.7, 850.2) | 3.1 (-0.5, 6.6) |
| Republic of Liberia | 10774 (9715, 11914) | 20849 (18708, 23193) | 805.3 (714.3, 901.1) | 774.5 (686.3, 870.4) | -3.8 (-6.7, -1) |
| Republic of Mali | 34830 (31501, 38880) | 82605 (73699, 91378) | 759.1 (682.3, 846.7) | 721 (651.2, 805.6) | -5 (-8.1, -2.1) |
| Islamic Republic of Mauritania | 9529 (8586, 10601) | 19083 (17158, 21395) | 837.6 (747.1, 940.1) | 763.9 (679.1, 864.4) | -8.8 (-11.4, -5.8) |
| Republic of the Niger | 27504 (24835, 30370) | 80657 (72201, 89100) | 771.9 (690.2, 862.2) | 728.2 (658.7, 811.8) | -5.7 (-9.4, -2.3) |
| Federal Republic of Nigeria | 394291 (355832, 436046) | 883956 (792082, 979330) | 780.6 (697.7, 871.8) | 766.6 (682.9, 862.3) | -1.8 (-3.4, -0.3) |
| Democratic Republic of São Tomé and Príncipe | 586 (527, 657) | 1040 (938, 1150) | 798.6 (711.8, 904.8) | 814.5 (724.1, 921.9) | 2 (-0.5, 4.8) |
| Republic of Senegal | 32285 (29139, 35753) | 70386 (63449, 77577) | 832.8 (742.2, 931.9) | 777.6 (699.2, 860.9) | -6.6 (-10, -3.5) |
| Republic of Sierra Leone | 20086 (18178, 22105) | 37124 (33458, 41042) | 852.5 (760.8, 955.1) | 797.4 (715.5, 892.6) | -6.5 (-9.1, -3.7) |
| Togolese Republic | 13226 (11919, 14498) | 35199 (31666, 39216) | 823.7 (736.3, 922) | 788.8 (710.1, 880.3) | -4.2 (-7.6, -1) |
Table 3. The number of total deaths of cardiovascular disease and their ASDR for 204 countries worldwide in 1990 and 2021 and the percentage change in ASDR from 1990 to 2021 were calculated.
ASDR: age-standardized death rates (per 100,000); 95% UI: 95% uncertainty intervals
The number of total deaths=total deaths×1
Percentage change in the ASDR per 100,000=(the ASDR in 2021-the ASDR in 1990)/the ASDR in 1990
| Total deaths (95% UI) | ASDR per 100,000 (95% UI) | Percentage change in the ASDR per 100,000 | |||
| 1990 | 2021 | 1990 | 2021 | ||
| Global | 12330009 (11626405, 12787472) | 19414853 (17775807, 20668512) | 358.1 (333.7, 372.6) | 235.2 (214.6, 250.5) | -34.3 (-37.8, -30.7) |
| Andean Latin America | 37599 (34861, 40794) | 65684 (56153, 77453) | 196.8 (182.5, 212.8) | 115.4 (98.7, 135.8) | -41.4 (-50.5, -31.4) |
| Plurinational State of Bolivia | 8730 (7327, 10872) | 14174 (10843, 19020) | 309.7 (262.9, 378) | 183.4 (142, 244.3) | -40.8 (-51.5, -24.8) |
| Republic of Ecuador | 10207 (9781, 10514) | 21306 (17545, 25848) | 215 (204.7, 222.2) | 143.4 (119.1, 172.2) | -33.3 (-44.1, -20.8) |
| Republic of Peru | 18661 (16554, 20980) | 30204 (24016, 37316) | 163.5 (144.6, 183.6) | 89.6 (71.4, 110.7) | -45.2 (-57.9, -30.5) |
| Australasia | 62954 (58249, 65359) | 58243 (49260, 62867) | 280 (256.8, 291.9) | 94.2 (80.8, 101.2) | -66.4 (-68.6, -65) |
| Australia | 51657 (47830, 53668) | 47254 (39856, 51110) | 277.1 (254.3, 288.8) | 89.7 (76.8, 96.4) | -67.6 (-69.9, -66.3) |
| New Zealand | 11297 (10464, 11759) | 10989 (9387, 11830) | 294.6 (270.2, 307.6) | 119.1 (102.6, 127.8) | -59.6 (-62.4, -57.8) |
| Caribbean | 82020 (78133, 84989) | 124209 (110467, 138460) | 342 (324.2, 354.2) | 228.4 (203.3, 254.9) | -33.2 (-40.2, -25.8) |
| Antigua and Barbuda | 179 (166, 189) | 203 (192, 213) | 313.1 (291.8, 331.6) | 219.2 (206, 230.4) | -30 (-34, -25.6) |
| Commonwealth of the Bahamas | 443 (414, 472) | 834 (695, 1018) | 307.3 (284.4, 326.9) | 228.4 (191.3, 275.9) | -25.7 (-38.7, -9.7) |
| Barbados | 868 (813, 908) | 933 (778, 1107) | 288.4 (269.9, 301.4) | 181 (151.1, 214.7) | -37.2 (-48.3, -25.2) |
| Belize | 212 (199, 223) | 450 (400, 498) | 225.9 (212.3, 237.7) | 167.2 (148.1, 185.1) | -26 (-33.9, -18.2) |
| Bermuda | 215 (204, 225) | 211 (180, 250) | 378.4 (356.7, 396.1) | 139.1 (119.7, 165.3) | -63.2 (-68, -56.2) |
| Republic of Cuba | 30651 (29328, 31388) | 41280 (36208, 46169) | 320 (304.3, 328.3) | 198.3 (173.8, 221.5) | -38 (-45, -30.7) |
| Commonwealth of Dominica | 214 (202, 225) | 212 (191, 245) | 374 (352.5, 392.8) | 276.3 (250, 317.2) | -26.1 (-33.8, -15.2) |
| Dominican Republic | 9028 (8010, 10064) | 24509 (20033, 30077) | 284.2 (253.4, 315.2) | 251.4 (205.5, 307.8) | -11.6 (-29.8, 12.2) |
| Grenada | 285 (262, 309) | 256 (226, 284) | 367.3 (337.8, 398) | 260.6 (229.8, 286.2) | -29.1 (-38, -20.6) |
| Republic of Guyana | 2109 (1920, 2302) | 2126 (1701, 2638) | 611.3 (558.1, 665.2) | 378.7 (307.8, 461.8) | -38.1 (-51.4, -22.8) |
| Republic of Haiti | 17022 (14724, 19527) | 27803 (21259, 36230) | 617.7 (539.6, 702.2) | 466.4 (362.3, 594.9) | -24.5 (-41.7, -2.6) |
| Jamaica | 4723 (4444, 4910) | 6394 (5148, 7971) | 254.7 (239.5, 264.8) | 192 (154.2, 240.1) | -24.6 (-39, -6.5) |
| Puerto Rico | 8284 (7865, 8563) | 8163 (6634, 9464) | 247.2 (233.3, 256) | 96.2 (79.6, 111.3) | -61.1 (-67.4, -55.4) |
| Saint Kitts and Nevis | 190 (180, 199) | 150 (129, 170) | 530 (501.3, 553.9) | 278 (241.9, 308.2) | -47.6 (-54.3, -41.7) |
| Saint Lucia | 327 (312, 341) | 474 (398, 549) | 448.7 (424.7, 466.2) | 207.9 (173.3, 240.3) | -53.7 (-61, -46.6) |
| Saint Vincent and the Grenadines | 260 (245, 274) | 351 (316, 389) | 396.1 (371.4, 417.6) | 277.1 (250.7, 306.5) | -30 (-36.9, -22.5) |
| Republic of Suriname | 836 (776, 885) | 1339 (1050, 1635) | 351.1 (324.7, 371) | 222.2 (174.2, 271.5) | -36.7 (-50.5, -21.7) |
| Republic of Trinidad and Tobago | 3155 (3035, 3250) | 4021 (3165, 5016) | 443.8 (423.4, 457.7) | 217.1 (171.6, 270) | -51.1 (-61, -39.7) |
| United States Virgin Islands | 240 (207, 269) | 295 (241, 356) | 361.4 (316.4, 401) | 176.2 (144.3, 211.6) | -51.2 (-60.1, -40.6) |
| Central Asia | 214255 (203736, 220441) | 293313 (266420, 320330) | 512.9 (484.2, 529.8) | 436.1 (395.7, 474.5) | -15 (-21.7, -8) |
| Republic of Armenia | 10810 (10231, 11220) | 13535 (12102, 14992) | 469 (440, 488.1) | 314.8 (281, 348.5) | -32.9 (-38.5, -26.7) |
| Republic of Azerbaijan | 23003 (21569, 24332) | 35723 (31654, 39800) | 539.6 (501.6, 569.4) | 449.6 (401.1, 498.4) | -16.7 (-24.6, -7.5) |
| Georgia | 33204 (31669, 34242) | 22784 (20473, 24951) | 583.1 (553.7, 602.5) | 355.2 (319.9, 387.9) | -39.1 (-44.1, -33.9) |
| Republic of Kazakhstan | 55977 (52827, 58985) | 65091 (59485, 71178) | 506.2 (474.9, 533.5) | 461.4 (420.3, 501.6) | -8.9 (-17, -0.7) |
| Kyrgyz Republic | 13099 (12116, 14074) | 15679 (13223, 18086) | 492.6 (454.7, 527.5) | 404.2 (344.3, 463.4) | -17.9 (-29.5, -5.1) |
| Mongolia | 5274 (4828, 5754) | 6905 (6175, 7619) | 585.7 (536.4, 634.2) | 390.3 (346.6, 430.3) | -33.4 (-40.8, -24.8) |
| Republic of Tajikistan | 12777 (11781, 13731) | 17364 (14978, 19635) | 519.6 (477, 557.6) | 414.5 (356.4, 467.1) | -20.2 (-31.1, -9.3) |
| Turkmenistan | 9596 (9241, 9852) | 18841 (15329, 23236) | 589.7 (559.9, 607.4) | 552.2 (453.6, 672.8) | -6.4 (-23.5, 14.8) |
| Republic of Uzbekistan | 50515 (47558, 52168) | 97390 (84880, 110365) | 475.2 (445.3, 492) | 478.5 (417.3, 539.4) | 0.7 (-11.6, 13.1) |
| Central Europe | 723472 (695750, 737744) | 682174 (621708, 724976) | 542.8 (516.1, 555.8) | 288 (262.8, 306.1) | -46.9 (-49.9, -44.1) |
| Republic of Albania | 7195 (6737, 7498) | 14053 (12122, 16166) | 428.5 (399.2, 446.7) | 345.2 (299.2, 396.8) | -19.4 (-30.2, -8.4) |
| Bosnia and Herzegovina | 13799 (13040, 14359) | 18769 (15476, 21612) | 413.6 (386.4, 432.1) | 294.6 (241.9, 340.2) | -28.8 (-40.4, -18.4) |
| Republic of Bulgaria | 70055 (67655, 72286) | 75617 (67014, 84127) | 784.4 (752.7, 807.3) | 530.3 (471.8, 589.1) | -32.4 (-39.4, -25.1) |
| Republic of Croatia | 27939 (26684, 28863) | 23393 (20722, 25530) | 542.8 (514.9, 561.3) | 236.7 (209.4, 258.1) | -56.4 (-60, -52.6) |
| Czech Republic | 70630 (67457, 72491) | 46794 (40858, 51444) | 526.2 (499.8, 540.8) | 200.8 (175.6, 221) | -61.8 (-65.5, -58.4) |
| Hungary | 73830 (70803, 75786) | 57964 (51068, 63709) | 544.3 (518.2, 560.4) | 272.7 (240.5, 300.1) | -49.9 (-54.8, -45.4) |
| Montenegro | 2353 (2171, 2495) | 4327 (3936, 4757) | 408.2 (375, 432.9) | 512.8 (466.6, 562.4) | 25.6 (14.5, 38.3) |
| North Macedonia | 9219 (8743, 9587) | 13288 (11439, 15226) | 569.4 (539.4, 593) | 560.2 (491.4, 627.4) | -1.6 (-13.4, 9.8) |
| Republic of Poland | 201973 (192540, 206796) | 168854 (149611, 183007) | 498.3 (470.9, 511.7) | 217.8 (194, 236) | -56.3 (-59.6, -53.2) |
| Romania | 139226 (134082, 142069) | 146016 (132456, 159320) | 613 (585.1, 627.8) | 359.5 (326.6, 392.4) | -41.4 (-46.5, -36.6) |
| Republic of Serbia | 58483 (55936, 60530) | 68868 (60551, 78048) | 719.7 (687.7, 744.6) | 397.9 (349.3, 450.8) | -44.7 (-51, -37.7) |
| Slovak Republic | 29134 (27751, 30176) | 27057 (23757, 30077) | 509.6 (482.2, 528.6) | 285.3 (250.3, 317.1) | -44 (-49.7, -38.2) |
| Republic of Slovenia | 8067 (7551, 8427) | 7245 (6078, 8110) | 333.5 (310.6, 349.3) | 131.9 (111.7, 147.7) | -60.4 (-64.7, -56.5) |
| Central Latin America | 165207 (157754, 168746) | 389477 (347068, 430749) | 230.6 (217.5, 236.6) | 163.7 (145.6, 180.7) | -29 (-35.3, -22.3) |
| Republic of Colombia | 42075 (40060, 43156) | 74747 (62393, 87648) | 271.1 (255.1, 279.2) | 132.4 (110.9, 155.4) | -51.2 (-58.2, -43.4) |
| Republic of Costa Rica | 3369 (3113, 3532) | 6130 (5324, 6838) | 205.1 (188.3, 215.4) | 108.9 (95.1, 121) | -46.9 (-52.6, -41.5) |
| Republic of El Salvador | 5802 (5433, 6089) | 9641 (7913, 11495) | 198.5 (185.4, 208.5) | 143 (117.5, 170.7) | -28 (-39.9, -14.7) |
| Republic of Guatemala | 6379 (6166, 6536) | 14509 (12661, 16432) | 240.8 (230.9, 247.2) | 155.2 (136.3, 174.6) | -35.6 (-42.9, -28.1) |
| Republic of Honduras | 4449 (3915, 4986) | 17452 (15256, 20595) | 248.4 (218.3, 277.9) | 336.4 (294.3, 391.9) | 35.5 (15.6, 62.8) |
| United Mexican States | 72046 (69579, 73360) | 189716 (168616, 209944) | 209.7 (200.3, 214.2) | 165.9 (148, 183.3) | -20.9 (-28.2, -13.1) |
| Republic of Nicaragua | 2439 (2260, 2577) | 5685 (4852, 6702) | 176.2 (162, 186.8) | 134.7 (114.9, 157.3) | -23.5 (-33.9, -10.7) |
| Republic of Panama | 2789 (2604, 2909) | 5598 (4368, 6678) | 201.6 (186.9, 210.8) | 122.2 (96, 146.1) | -39.4 (-51.2, -28.6) |
| Bolivarian Republic of Venezuela | 25859 (24597, 26634) | 65999 (52290, 82492) | 296.8 (278.7, 307) | 234.1 (186.7, 290.9) | -21.1 (-37.4, -2.8) |
| Central Sub-Saharan Africa | 73256 (61934, 84984) | 149151 (118950, 183436) | 410.9 (351.6, 468.3) | 361.4 (292.1, 444.2) | -12.1 (-27.7, 7.2) |
| Republic of Angola | 13695 (11313, 16496) | 31833 (24654, 39289) | 435.9 (367, 518.8) | 364.1 (289.8, 447.6) | -16.5 (-35.5, 8.7) |
| Central African Republic | 4777 (3945, 5668) | 7621 (5825, 9710) | 523.2 (441.7, 606.6) | 456.8 (358.2, 556.6) | -12.7 (-28.8, 4.8) |
| Republic of the Congo | 4643 (3933, 5452) | 8368 (6703, 10206) | 544.2 (468, 629.2) | 413.5 (342.4, 487.6) | -24 (-36.8, -7.6) |
| Democratic Republic of the Congo | 47260 (38298, 56786) | 97266 (75161, 123949) | 385.1 (315.1, 453.6) | 352.5 (275.2, 445.5) | -8.5 (-29.3, 16.4) |
| Republic of Equatorial Guinea | 805 (648, 977) | 1283 (876, 1759) | 501.3 (408, 599.8) | 330 (238.7, 438.1) | -34.2 (-51.3, -8.7) |
| Gabonese Republic | 2076 (1742, 2467) | 2780 (2152, 3468) | 419.4 (355.2, 498.7) | 344.8 (275.5, 421.8) | -17.8 (-33.6, 3.8) |
| East Asia | 2576813 (2280964, 2859920) | 5231174 (4452990, 6056337) | 403.3 (358.4, 445.9) | 276.2 (235.1, 318.3) | -31.5 (-42.4, -18.1) |
| People's Republic of China | 2497062 (2206621, 2780395) | 5085458 (4311063, 5904298) | 407.7 (361.4, 452.1) | 280.1 (237.9, 323.9) | -31.3 (-42.4, -17.4) |
| Democratic People's Republic of Korea | 48468 (37984, 58996) | 106571 (87571, 126680) | 383.4 (302.7, 455.9) | 358.9 (296.6, 426.3) | -6.4 (-24, 17.4) |
| Taiwan (Province of China) | 31283 (30098, 32091) | 39146 (34278, 42155) | 252.1 (236.9, 260.4) | 89.4 (78.7, 95.8) | -64.5 (-67.2, -62.5) |
| Eastern Europe | 1396707 (1336338, 1422675) | 1490606 (1348329, 1620589) | 570.1 (540.1, 583.5) | 421.6 (381.3, 458.3) | -26 (-31.4, -20.5) |
| Republic of Belarus | 60596 (57107, 62440) | 76018 (64619, 87746) | 496.6 (465.5, 512.1) | 466.9 (396.6, 539.2) | -6 (-20.1, 8.7) |
| Republic of Estonia | 11237 (10638, 11605) | 7252 (6305, 8033) | 579.5 (545.5, 598.7) | 223.7 (195.9, 247.8) | -61.4 (-65.1, -57.5) |
| Republic of Latvia | 19969 (18963, 20607) | 14911 (13233, 16316) | 577.1 (545, 596.5) | 330.5 (294.1, 362) | -42.7 (-47.7, -38) |
| Republic of Lithuania | 21557 (20416, 22228) | 20227 (17988, 22140) | 491.1 (464.3, 507.2) | 302.7 (272.3, 331.5) | -38.4 (-43.9, -33.2) |
| Republic of Moldova | 20851 (20075, 21394) | 21918 (19953, 23889) | 605.1 (575.8, 622) | 363.5 (331.3, 395.8) | -39.9 (-44.6, -34.8) |
| Russian Federation | 900491 (861889, 917006) | 939256 (864841, 1010874) | 579.5 (549.1, 593.1) | 394.8 (363.6, 424.8) | -31.9 (-36.1, -27.6) |
| Ukraine | 362006 (346443, 370151) | 411023 (320290, 505529) | 565.8 (535.2, 580.3) | 521.5 (405.7, 642.5) | -7.8 (-27.3, 12.8) |
| Eastern Sub-Saharan Africa | 210769 (194576, 228570) | 356706 (321397, 398574) | 330.3 (302.7, 356.9) | 256 (231.4, 285.4) | -22.5 (-29.8, -13.4) |
| Republic of Burundi | 9552 (7689, 11438) | 11266 (9095, 13669) | 450.6 (365.4, 535.3) | 284.4 (230, 346.3) | -36.9 (-49.5, -18) |
| Union of the Comoros | 577 (450, 711) | 1018 (811, 1278) | 349 (283.8, 422.8) | 248 (199, 308) | -28.9 (-44.6, -6.7) |
| Republic of Djibouti | 336 (259, 425) | 1308 (993, 1703) | 321.3 (256.8, 394.4) | 278.9 (221.1, 352.3) | -13.2 (-34.4, 16) |
| State of Eritrea | 3917 (3226, 4668) | 7027 (5467, 8898) | 435.5 (367.6, 509.9) | 335.3 (272.5, 408.6) | -23 (-37.1, -6.3) |
| Federal Democratic Republic of Ethiopia | 58002 (50698, 68834) | 69072 (59589, 79851) | 341.6 (299.3, 392.4) | 184.5 (159.3, 213.3) | -46 (-56.2, -35.9) |
| Republic of Kenya | 13304 (10820, 15471) | 37904 (30758, 46409) | 192.9 (155.6, 225.4) | 218.9 (176.5, 268.5) | 13.5 (-6.7, 40.6) |
| Republic of Madagascar | 20860 (18837, 23010) | 37628 (29042, 47282) | 459.1 (414.1, 504.9) | 415.7 (326.7, 510.4) | -9.4 (-29.3, 12.8) |
| Republic of Malawi | 9594 (8429, 10804) | 18374 (15649, 21696) | 297.2 (260.5, 336.4) | 301.1 (259.4, 351.3) | 1.3 (-14.7, 21.3) |
| Republic of Mozambique | 16408 (14379, 18837) | 33677 (25907, 41702) | 333.9 (294.8, 378.1) | 370.6 (286.3, 452.7) | 11 (-16.1, 36.7) |
| Republic of Rwanda | 12314 (10590, 14251) | 12385 (9732, 15752) | 508.4 (442.6, 584) | 254.6 (201, 321.1) | -49.9 (-60.3, -35.9) |
| Federal Republic of Somalia | 7739 (6046, 9610) | 14663 (10824, 19176) | 386.8 (309.3, 466.2) | 299.2 (222.2, 380.9) | -22.7 (-40.8, -2.1) |
| Republic of South Sudan | 7469 (6061, 9289) | 8701 (6515, 11420) | 324 (264.3, 397.3) | 270.6 (209, 341.2) | -16.5 (-35.6, 9.2) |
| Republic of Uganda | 16259 (13219, 20014) | 27121 (21730, 34223) | 292.2 (237.1, 355.4) | 222.8 (180.4, 277.7) | -23.8 (-41.3, -0.1) |
| United Republic of Tanzania | 25991 (22620, 29503) | 56908 (47315, 70470) | 281.9 (246.9, 317.8) | 267.7 (225.7, 326.9) | -5.1 (-21.9, 19.3) |
| Republic of Zambia | 8294 (7118, 9555) | 19343 (14693, 24367) | 352.7 (304.4, 403.6) | 354 (276, 430.5) | 0.4 (-21.5, 25.1) |
| High-income Asia Pacific | 358928 (325960, 375092) | 455990 (363781, 507729) | 204.1 (182.1, 214.9) | 73.4 (61.3, 79.8) | -64 (-66.4, -62.5) |
| Brunei Darussalam | 310 (283, 344) | 496 (443, 556) | 355 (322.8, 391.6) | 198.5 (176.9, 222.7) | -44.1 (-50.8, -35.6) |
| Japan | 283723 (254249, 297702) | 371917 (292380, 416609) | 186.4 (164.9, 196.8) | 72.5 (60.8, 78.8) | -61.1 (-63.2, -59.8) |
| Republic of Korea | 69566 (63580, 73806) | 77286 (63726, 86294) | 330.2 (297.6, 353.1) | 85.9 (70.7, 95.9) | -74 (-76.9, -71.6) |
| Republic of Singapore | 5328 (5105, 5467) | 6291 (5606, 6712) | 275 (259.5, 283.5) | 75.8 (67.4, 80.9) | -72.4 (-74.4, -71) |
| High-income North America | 943627 (849457, 988434) | 981390 (850396, 1048167) | 260.4 (234.8, 272.6) | 139.5 (122.5, 148.1) | -46.4 (-48.2, -45.3) |
| Canada | 74193 (68204, 77148) | 75621 (65538, 81313) | 232.8 (213.2, 242.5) | 92.8 (81.5, 99.2) | -60.1 (-62.2, -58.7) |
| Greenland | 112 (104, 120) | 100 (88, 118) | 445.6 (409.2, 480) | 185.4 (161.1, 218.7) | -58.4 (-64.1, -51.6) |
| United States of America | 869300 (780978, 911407) | 905653 (785640, 966939) | 263.2 (237.2, 275.8) | 145.3 (127.7, 154.3) | -44.8 (-46.5, -43.7) |
| North Africa and the Middle East | 750006 (698871, 796221) | 1354626 (1210244, 1496618) | 529.2 (486.4, 560.6) | 363.5 (322.3, 397.3) | -31.3 (-37.1, -25) |
| Islamic Republic of Afghanistan | 45396 (36453, 54432) | 47557 (38096, 57568) | 746.1 (609.1, 884.7) | 567.4 (460.6, 672.2) | -23.9 (-38.1, -6) |
| People's Democratic Republic of Algeria | 45402 (40240, 51069) | 97643 (82937, 113387) | 570 (509.2, 632.3) | 392.6 (340.3, 448.7) | -31.1 (-40.8, -19.5) |
| Kingdom of Bahrain | 718 (677, 761) | 1396 (1208, 1586) | 637.4 (596.4, 674.5) | 289.9 (257.3, 325) | -54.5 (-60, -48.3) |
| Arab Republic of Egypt | 164978 (158655, 172941) | 275665 (234643, 323108) | 798.8 (756.6, 839.5) | 612.1 (530, 700.1) | -23.4 (-34.6, -11.9) |
| Islamic Republic of Iran | 86527 (81551, 91001) | 169582 (154574, 180461) | 446.3 (411.5, 471.3) | 254.5 (230.2, 271.3) | -43 (-45.9, -40.1) |
| Republic of Iraq | 39014 (33523, 44756) | 87555 (70317, 102687) | 507.9 (436.1, 582.8) | 477.6 (397.1, 553.4) | -6 (-25.8, 13.7) |
| Hashemite Kingdom of Jordan | 4546 (3969, 5195) | 11652 (9620, 14064) | 419.6 (366.5, 479.2) | 213.4 (177.5, 252.6) | -49.2 (-58.7, -36.5) |
| State of Kuwait | 1543 (1424, 1646) | 4201 (3483, 5031) | 302.2 (273.5, 323.2) | 167.8 (138, 200.2) | -44.5 (-53.3, -34.2) |
| Lebanese Republic | 8140 (7058, 9654) | 10855 (9133, 12611) | 441.7 (381.2, 521.6) | 164.5 (138.9, 191.8) | -62.8 (-69.3, -55.2) |
| State of Libya | 5348 (4339, 6286) | 14048 (11138, 17773) | 292.1 (233.6, 345.4) | 313.7 (251.1, 390.8) | 7.4 (-15.7, 41) |
| Kingdom of Morocco | 67431 (58948, 75052) | 134920 (110214, 150427) | 522.4 (453.8, 578.8) | 463.2 (379.8, 513.3) | -11.3 (-28.4, 2.6) |
| Sultanate of Oman | 3108 (2441, 3811) | 4618 (3832, 5480) | 524 (415.3, 637.6) | 326.4 (272.3, 379.8) | -37.7 (-52.2, -17.6) |
| Palestine | 4163 (3458, 5007) | 6461 (5648, 7232) | 568.2 (477.6, 676.4) | 356.8 (311.7, 397.1) | -37.2 (-48.9, -24) |
| State of Qatar | 399 (345, 461) | 1048 (817, 1312) | 610 (535.1, 685.8) | 207 (166.7, 247.5) | -66.1 (-73, -58.2) |
| Kingdom of Saudi Arabia | 23580 (18359, 29083) | 54791 (45276, 65801) | 471.8 (367.4, 576.7) | 353.3 (305.3, 408.4) | -25.1 (-40.5, -0.3) |
| Republic of Sudan | 53530 (44463, 62765) | 74499 (59370, 97051) | 629.9 (527.3, 733.4) | 445.7 (363.7, 569.4) | -29.3 (-43.8, -9.4) |
| Syrian Arab Republic | 28726 (24188, 34094) | 51846 (40783, 65825) | 602.1 (507.3, 708.3) | 521.6 (422.6, 639.1) | -13.4 (-34.1, 14.3) |
| Republic of Tunisia | 15785 (13906, 17637) | 35009 (27179, 44423) | 403.7 (352.5, 449.3) | 300.7 (234.7, 378.2) | -25.5 (-42.3, -2.9) |
| Republic of Turkey | 122591 (111143, 133494) | 205740 (171192, 240575) | 413.6 (370.4, 449.5) | 247.9 (206.2, 288.5) | -40.1 (-49.9, -30.3) |
| United Arab Emirates | 1609 (1307, 1978) | 5123 (4113, 6192) | 473.2 (391.5, 567.4) | 314.1 (261.1, 366.1) | -33.6 (-42, -24.6) |
| Republic of Yemen | 27064 (21809, 33255) | 59153 (46524, 74392) | 646.8 (526.5, 780.4) | 517.8 (415.8, 637.9) | -19.9 (-37.3, 3.6) |
| Oceania | 11290 (9435, 13443) | 24587 (20668, 28675) | 449.5 (384.7, 525.9) | 377.8 (321.2, 438.3) | -15.9 (-29.1, -0.2) |
| Independent State of Samoa | 344 (289, 395) | 16622 (13257, 20730) | 467.8 (394.2, 529.1) | 336.1 (271.2, 411.3) | -8.6 (-24.6, 14.6) |
| American Samoa | 69 (63, 75) | 139 (122, 161) | 369.6 (340.1, 395.9) | 335.7 (295.9, 383.6) | -9.2 (-21, 4.1) |
| Cook Islands | 45 (41, 50) | 60 (50, 69) | 419.8 (382.9, 459.5) | 240.4 (202.4, 278.6) | -42.7 (-51.9, -31.8) |
| Republic of Fiji | 1655 (1462, 1894) | 2815 (2225, 3485) | 521.3 (464.3, 590) | 450.5 (364.4, 544.6) | -13.6 (-30.6, 8.1) |
| Guam | 208 (196, 220) | 395 (350, 435) | 375.7 (347.6, 395.2) | 186.1 (166.2, 204.4) | -50.5 (-54.9, -45.5) |
| Republic of Kiribati | 152 (127, 177) | 275 (225, 341) | 447.6 (366.6, 519.6) | 434.4 (370.1, 515) | -2.9 (-20.2, 23.5) |
| Republic of the Marshall Islands | 87 (78, 97) | 159 (125, 198) | 601.8 (540.6, 667.2) | 546.8 (446.7, 659.4) | -9.1 (-25.5, 9.7) |
| Federated States of Micronesia | 276 (229, 323) | 331 (266, 414) | 624.6 (521.8, 728.3) | 532 (440.4, 646.2) | -14.8 (-32.1, 8) |
| Republic of Nauru | 32 (26, 38) | 39 (31, 48) | 780 (651.5, 901.4) | 748.3 (624.7, 892.4) | -4.1 (-20.8, 19.8) |
| Republic of Niue | 11 (10, 13) | 9 (7, 10) | 483.9 (412.3, 565.6) | 430 (367.5, 489.9) | -11.1 (-26.6, 6.8) |
| Northern Mariana Islands | 46 (38, 57) | 118 (103, 124) | 324.7 (278.3, 389.2) | 286.9 (255.5, 306.4) | -11.6 (-27.2, 3.7) |
| Republic of Palau | 41 (34, 49) | 72 (59, 86) | 476 (401.7, 561.7) | 407.2 (341.7, 476.1) | -14.4 (-31.4, 6.4) |
| Independent State of Papua New Guinea | 6439 (5006, 8192) | 15878 (12501, 19674) | 413.4 (328.7, 516) | 364.9 (289, 449.1) | -11.7 (-33.9, 19.1) |
| Solomon Islands | 670 (471, 846) | 1591 (1292, 2015) | 610.2 (490.4, 727) | 550.3 (464.4, 674.5) | -9.8 (-28.1, 13.8) |
| Tokelau | 6 (5, 7) | 6 (5, 7) | 509.4 (433.9, 591) | 384.7 (312.8, 461.2) | -24.5 (-38.2, -7.1) |
| Kingdom of Tonga | 126 (107, 144) | 188 (154, 226) | 260.5 (219.9, 298.5) | 243.3 (200, 291.9) | -6.6 (-27.5, 19.6) |
| Tuvalu | 36 (31, 41) | 46 (40, 54) | 637.8 (553.8, 716.7) | 502.8 (440.1, 581.6) | -21.2 (-31.4, -9.6) |
| Republic of Vanuatu | 324 (270, 401) | 813 (690, 948) | 606.5 (517.8, 718.4) | 545 (465.7, 625) | -10.1 (-25.9, 8.6) |
| South Asia | 1554655 (1402490, 1674222) | 3666331 (3381322, 3957645) | 302.5 (271.1, 326.8) | 278.1 (256.5, 299.6) | -8 (-17.7, 2.6) |
| People's Republic of Bangladesh | 176069 (156197, 196602) | 377200 (309884, 453235) | 396.7 (351.6, 442.7) | 313 (259.9, 372.7) | -21.1 (-36.8, -2.5) |
| Kingdom of Bhutan | 597 (468, 743) | 1302 (1065, 1530) | 282.1 (216.4, 353) | 233.1 (192.1, 272.4) | -17.4 (-36.3, 9.4) |
| Republic of India | 1191436 (1057016, 1303879) | 2873266 (2625504, 3154720) | 287.5 (252.1, 315.6) | 267.6 (243.2, 293.4) | -6.9 (-18.4, 5.4) |
| Federal Democratic Republic of Nepal | 26752 (22424, 32156) | 55697 (46416, 67871) | 325.6 (271, 389.5) | 278.3 (234.6, 336.6) | -14.5 (-32.9, 9.9) |
| Islamic Republic of Pakistan | 159801 (133369, 177964) | 358866 (304004, 436445) | 310.9 (258, 348.5) | 342 (292.3, 416.6) | 10 (-8.2, 35.8) |
| Southeast Asia | 779349 (707641, 847500) | 1721549 (1556629, 1858463) | 355.5 (318.9, 388.7) | 302.9 (273.2, 326.1) | -14.8 (-23.9, -3.4) |
| Kingdom of Cambodia | 15703 (13631, 18284) | 33261 (27055, 39723) | 411.5 (357.5, 479.1) | 341.8 (281, 398.6) | -16.9 (-34.2, 1.8) |
| Republic of Indonesia | 300490 (256841, 336013) | 765660 (647217, 876429) | 356 (295.9, 409.4) | 409.9 (343.7, 459.4) | 15.1 (-6.4, 39.6) |
| Lao People's Democratic Republic | 11117 (9113, 13252) | 15701 (12642, 19048) | 610.9 (502.4, 717.9) | 410.9 (337.2, 485.9) | -32.7 (-47.5, -13.1) |
| Malaysia | 29630 (28066, 30853) | 66779 (62583, 70162) | 347.1 (325.9, 363.5) | 267.9 (250.1, 282.6) | -22.8 (-27.1, -17.7) |
| Republic of Maldives | 322 (298, 346) | 513 (426, 599) | 434 (394.6, 466.6) | 180.5 (150.5, 208.3) | -58.4 (-64.8, -51.5) |
| Republic of Mauritius | 2960 (2842, 3054) | 3554 (3292, 3692) | 469.8 (447.8, 486) | 210.5 (194.9, 219.2) | -55.2 (-57.6, -53.6) |
| Republic of the Union of Myanmar | 111990 (91339, 134638) | 152058 (126346, 184972) | 551 (456.3, 654.9) | 363.6 (306.7, 439) | -34 (-49, -14.3) |
| Republic of the Philippines | 83879 (77590, 89946) | 225939 (193234, 259965) | 363.2 (337.5, 388.7) | 315.1 (272, 359.8) | -13.2 (-24.9, 0.2) |
| Republic of Seychelles | 210 (196, 222) | 242 (220, 265) | 374.3 (349.1, 396) | 238.7 (217.3, 260.5) | -36.2 (-41.6, -29.5) |
| Democratic Socialist Republic of Sri Lanka | 31473 (29226, 33607) | 54797 (38914, 71914) | 370.6 (342.9, 394.5) | 232.3 (167.8, 299.8) | -37.3 (-55.4, -18.6) |
| Kingdom of Thailand | 66429 (58187, 74763) | 136761 (108137, 167205) | 225.5 (196.6, 254.1) | 128 (101.4, 156.2) | -43.2 (-55.4, -28) |
| Democratic Republic of Timor-Leste | 846 (678, 1010) | 2782 (2235, 3395) | 368.5 (296.2, 433.2) | 380.4 (308.9, 458.4) | 3.2 (-20.6, 34.9) |
| Socialist Republic of Viet Nam | 123174 (101742, 151159) | 261099 (218650, 297128) | 342.2 (283, 418.5) | 310.5 (262.2, 351.1) | -9.3 (-28.4, 13) |
| Southern Latin America | 133794 (127096, 137287) | 124512 (113757, 131073) | 315.6 (297.1, 324.9) | 137.6 (126.1, 144.6) | -56.4 (-58, -54.9) |
| Eastern Republic of Uruguay | 12030 (11340, 12435) | 9942 (8921, 10562) | 314.2 (295.3, 325) | 154.8 (140.9, 163.7) | -50.7 (-52.9, -48.8) |
| Argentine Republic | 99491 (94663, 102344) | 87402 (80136, 91960) | 335.8 (316.4, 346.2) | 151.1 (138.8, 158.9) | -55 (-56.8, -53.3) |
| Republic of Chile | 22267 (21231, 22885) | 27161 (24492, 28692) | 251.3 (237.5, 259.3) | 103.8 (93.8, 109.5) | -58.7 (-60.9, -57.2) |
| Southern Sub-Saharan Africa | 58586 (52618, 63696) | 130763 (121926, 139194) | 245.7 (217.5, 269.4) | 275.1 (256.6, 292.1) | 12 (4.1, 25.2) |
| Republic of Botswana | 1668 (1288, 2068) | 2890 (2350, 3532) | 387.5 (304, 473.9) | 256.6 (215.5, 309) | -33.8 (-48.3, -10) |
| Kingdom of Eswatini | 864 (721, 1018) | 1612 (1187, 2146) | 376.7 (314.3, 445.6) | 360.7 (274.8, 460.5) | -4.2 (-28.5, 27) |
| Kingdom of Lesotho | 2083 (1685, 2500) | 3653 (2805, 4566) | 287.5 (230.1, 348.4) | 412.9 (327.8, 500.9) | 43.6 (7.7, 96.3) |
| Republic of Namibia | 1976 (1708, 2247) | 3752 (2964, 4602) | 392.9 (340.2, 447.1) | 347.4 (281.8, 418.2) | -11.6 (-29.5, 9.6) |
| Republic of South Africa | 43378 (38357, 47166) | 98605 (92046, 104928) | 230.5 (201.4, 252.2) | 256.1 (236.8, 272.3) | 11.1 (3, 24.3) |
| Republic of Zimbabwe | 8617 (7189, 9989) | 20252 (16536, 24375) | 277.2 (229.4, 320.7) | 370.1 (309.7, 430.8) | 33.5 (7.5, 68.7) |
| Tropical Latin America | 263566 (250152, 270019) | 385370 (351507, 405260) | 331.7 (308, 343) | 154.6 (140.5, 162.8) | -53.4 (-55.3, -52.1) |
| Federative Republic of Brazil | 258237 (245353, 264534) | 374765 (342776, 394079) | 333.7 (310.1, 345) | 153.7 (140.1, 161.9) | -53.9 (-55.7, -52.5) |
| Republic of Paraguay | 5329 (4713, 5948) | 10606 (8239, 13103) | 258.3 (226.9, 288.5) | 194.6 (151.5, 240.1) | -24.7 (-40.8, -7.9) |
| Western Europe | 1665937 (1523644, 1730875) | 1262954 (1058669, 1367244) | 280.7 (256.2, 292.2) | 106.8 (91.8, 114.4) | -62 (-64.3, -60.7) |
| Principality of Andorra | 79 (59, 104) | 156 (115, 200) | 167.5 (126.4, 215.5) | 88.3 (65.6, 112.9) | -47.3 (-62.4, -25.8) |
| Republic of Austria | 40057 (36825, 41552) | 29290 (24708, 31703) | 326.9 (299.2, 339.5) | 128.6 (110.6, 138.2) | -60.7 (-63.3, -59) |
| Kingdom of Belgium | 39795 (36237, 41720) | 26402 (21716, 28854) | 254.3 (230.8, 266.9) | 90 (76.3, 97.4) | -64.6 (-66.8, -63) |
| Republic of Cyprus | 2803 (2619, 2978) | 3038 (2625, 3395) | 554.7 (518.8, 587.5) | 184.9 (162.5, 205.1) | -66.7 (-70.2, -63) |
| Kingdom of Denmark | 27160 (25237, 28152) | 12978 (11142, 13937) | 314.1 (292.6, 325.5) | 95.2 (82.5, 101.9) | -69.7 (-71.6, -68.3) |
| Republic of Finland | 24339 (22436, 25277) | 22551 (18811, 24561) | 338.8 (311, 352.7) | 143.3 (122, 154.8) | -57.7 (-61, -55.6) |
| French Republic | 176601 (160734, 184160) | 152728 (128083, 166336) | 199.4 (181.5, 208) | 78.7 (67.7, 85) | -60.6 (-63.2, -58.7) |
| Federal Republic of Germany | 440017 (402261, 458425) | 319026 (268347, 345701) | 332.1 (303, 346.6) | 132.8 (114, 142.7) | -60 (-62.5, -58.5) |
| Hellenic Republic | 46916 (43321, 48610) | 48088 (41397, 51375) | 328.5 (301.4, 341.5) | 154 (136.3, 163) | -53.1 (-54.9, -51.7) |
| Republic of Iceland | 755 (682, 801) | 701 (572, 780) | 247.9 (225, 262.7) | 101.4 (84.3, 112.3) | -59.1 (-62.8, -55.5) |
| Ireland | 13986 (13182, 14444) | 8293 (6971, 9021) | 356.1 (331.6, 368.8) | 97.6 (82.5, 105.9) | -72.6 (-75, -70.9) |
| State of Israel | 12208 (11305, 12659) | 10554 (8916, 11439) | 270.3 (247.8, 281.8) | 75.2 (64.4, 81.2) | -72.2 (-74.3, -70.6) |
| Republic of Italy | 222138 (199096, 233114) | 216272 (175532, 238313) | 257.3 (229.2, 271.1) | 109.1 (91, 118.9) | -57.6 (-60.3, -56.1) |
| Grand Duchy of Luxembourg | 1718 (1623, 1783) | 1275 (1107, 1404) | 326.2 (306.5, 338.6) | 103.9 (91.1, 114.5) | -68.1 (-70.9, -65.3) |
| Republic of Malta | 1319 (1230, 1385) | 1307 (1102, 1452) | 333.7 (307.7, 351.2) | 117.5 (100.7, 130) | -64.8 (-67.9, -61.7) |
| Principality of Monaco | 200 (157, 233) | 150 (119, 182) | 247.2 (195.9, 287.4) | 123.1 (98.2, 149.2) | -50.2 (-60.2, -35.3) |
| Kingdom of the Netherlands | 51266 (46643, 53650) | 40439 (34331, 43711) | 251.8 (228.8, 263.8) | 100.9 (86.4, 108.8) | -59.9 (-62.3, -58.3) |
| Kingdom of Norway | 21254 (19409, 22228) | 10906 (9160, 11813) | 283.7 (260.5, 296.2) | 90 (76.9, 96.9) | -68.3 (-70.5, -67) |
| Portuguese Republic | 46500 (43626, 48030) | 32680 (27559, 35442) | 375.4 (348.8, 389.1) | 106.4 (92.1, 114.3) | -71.7 (-73.5, -70.4) |
| Republic of San Marino | 72 (62, 81) | 70 (49, 94) | 193.2 (164.5, 217.8) | 66.9 (45.4, 90.4) | -65.4 (-75.2, -53.2) |
| Kingdom of Spain | 124681 (113975, 130453) | 115285 (94382, 126132) | 236.7 (215.3, 248.2) | 90 (75.9, 97.3) | -62 (-64.2, -60.2) |
| Kingdom of Sweden | 46749 (42812, 48805) | 29625 (24644, 33050) | 279.5 (256.8, 291.6) | 107.4 (91.3, 119.4) | -61.6 (-65.4, -58.4) |
| Swiss Confederation | 26458 (23954, 27739) | 20297 (16421, 22375) | 234.3 (213.3, 245.3) | 84.1 (69.6, 91.8) | -64.1 (-67.4, -62.1) |
| United Kingdom of Great Britain and Northern Ireland | 297499 (277475, 306303) | 159730 (139629, 169392) | 315.8 (294.6, 325.4) | 106.6 (94.6, 112.4) | -66.2 (-67.9, -65.4) |
| Western Sub-Saharan Africa | 267218 (238738, 296709) | 466045 (403943, 528620) | 354.3 (315.9, 393.3) | 291.9 (260.9, 326.2) | -17.6 (-27.7, -5.5) |
| Republic of Benin | 5982 (5293, 6780) | 11863 (10058, 14035) | 327.2 (288.4, 372.6) | 277.4 (238.4, 323.2) | -15.2 (-28.2, 2.8) |
| Burkina Faso | 10643 (9232, 12326) | 22379 (18746, 26771) | 288.1 (250.4, 331.8) | 288.1 (244.3, 343.1) | 0 (-17.2, 24.2) |
| Republic of Cabo Verde | 540 (467, 612) | 1139 (961, 1318) | 225.3 (194.6, 256.2) | 274 (231.1, 315.8) | 21.6 (-1.4, 52.1) |
| Republic of Cameroon | 12112 (10307, 14172) | 32549 (25085, 42444) | 324.3 (279.7, 375.8) | 318.2 (256.7, 408.7) | -1.9 (-21.1, 29.7) |
| Republic of Chad | 8219 (7031, 9378) | 16593 (13047, 20576) | 316.1 (270.5, 362.6) | 334.5 (270.6, 402.2) | 5.8 (-14.6, 31.9) |
| Republic of Côte d'Ivoire | 11435 (9510, 13597) | 29124 (22858, 37210) | 357 (307.1, 409.6) | 326.4 (271.2, 405.2) | -8 (-21.3, 11.4) |
| Republic of the Gambia | 1050 (840, 1300) | 3230 (2532, 3896) | 353.3 (289, 431.9) | 386.8 (306.4, 464.1) | 9.5 (-17, 39.9) |
| Republic of Ghana | 22994 (19309, 27275) | 48155 (38389, 58063) | 437.3 (372.8, 513.3) | 355.3 (286.8, 425.3) | -18.8 (-36.6, 3) |
| Republic of Guinea-Bissau | 1817 (1492, 2193) | 2730 (2153, 3250) | 516 (429.9, 609.4) | 469.9 (379.5, 543.7) | -8.9 (-29.1, 13.2) |
| Republic of Guinea | 10078 (8410, 11839) | 550 (468, 654) | 330.7 (275.1, 390.6) | 430.4 (371.5, 505.3) | 1.6 (-20.6, 34.3) |
| Republic of Liberia | 3700 (3167, 4312) | 5792 (4629, 7469) | 356.9 (308.2, 410.3) | 334.4 (275.2, 419.5) | -6.3 (-24.8, 22.1) |
| Republic of Mali | 9841 (8672, 11176) | 17755 (14455, 21412) | 292 (254.5, 330) | 239.9 (200.4, 285.6) | -17.8 (-32.9, 0.2) |
| Islamic Republic of Mauritania | 3727 (3102, 4461) | 5698 (4526, 7122) | 424.4 (352.3, 504.9) | 311.4 (248.9, 386.9) | -26.6 (-41.4, -6.7) |
| Republic of the Niger | 7015 (5741, 8352) | 17576 (13464, 22193) | 295.4 (242.2, 348.9) | 265.5 (210.6, 329) | -10.1 (-26.8, 12.3) |
| Federal Republic of Nigeria | 136164 (114977, 160014) | 190897 (157963, 230762) | 359.9 (304.9, 420.6) | 262.5 (226.8, 308) | -27.1 (-40.2, -8.5) |
| Democratic Republic of São Tomé and Príncipe | 166 (148, 184) | 272 (236, 315) | 282 (253.1, 310.5) | 296.9 (263.6, 340) | 5.3 (-7.6, 20.4) |
| Republic of Senegal | 10731 (9145, 12385) | 21857 (17613, 26979) | 373.8 (319.9, 426.8) | 336 (274.9, 409.7) | -10.1 (-28.6, 11.6) |
| Republic of Sierra Leone | 7145 (5990, 8419) | 11281 (8954, 14096) | 373.9 (314.2, 435) | 344.8 (280.3, 418.7) | -7.8 (-25, 16.5) |
| Togolese Republic | 3849 (3336, 4469) | 10529 (8049, 13411) | 365.3 (318.7, 423.2) | 353 (281.6, 438.5) | -3.4 (-23.5, 23.2) |
Figure 1. Global trends in ASIR (A) and ASDR (B) of cardiovascular disease in 204 countries and territories in 2021.
ASIR: age-standardized incidence rates; ASDR: age-standardized death rates
Figure 2. Global and five SDI region trends in ASIR (per 100,000 population) (A) and ASDR (per 100,000 population) (B) of cardiovascular disease from 1990 to 2021 (each point indicates the age-standardized rate for that year).
ASIR: age-standardized incidence rates; ASDR: age-standardized death rates; SDI: sociodemographic Index
From 1990 to 2021, the ASIR of CVD showed a decreasing trend globally, except in Central Asia and East Asia. The region with the largest decrease in ASIR was high-income North America, where the rate declined from 986.6 per 100,000 in 1990 to 670.2 per 100,000 in 2021, a reduction of 32.1% (Table 1). Similarly, from 1990 to 2021, the ASDR of CVD also showed a decreasing trend globally, except in Southern Sub-Saharan Africa. The region with the largest decrease in ASDR was Australasia, where the rate declined from 280 cases per 100,000 in 1990 to 94.2 cases per 100,000 in 2021, a reduction of 66.4% (Table 1) (Table 1 provides detailed data for the 21 GBD regions, Table 2 provides detailed data for the 204 countries, and Figure 1 provides a global view of the CVD ASIR and ASDR).
In summary, we find that Asia is the hardest hit by CVD due to high population density and the progression of population aging. The regions with the highest number of CVD incidence and deaths are East and South Asia, especially China and India, which are the most populous countries. Secondly, diets high in salt, fat, and sugar are prevalent in East and South Asia, and these are risk factors for CVD [10]. In addition, these regions and countries suffer from unbalanced economic development and uneven distribution of healthcare resources, with a large number of patients with CVD in the population that are not adequately reported and treated. In 2021, we find that regions with higher ASIR for CVD are dominated by low- and middle-income developing countries. Similarly, these regions also have higher ASDR for CVD. The most likely explanation is that the region has experienced rapid economic development and urbanization in recent decades, resulting in lifestyle changes such as westernization of dietary habits, reduced physical activity, smoking, and increased body mass index, all of which contribute to a higher ASIR for CVD [11]. However, these places also suffer from financial inequality and unequal distribution of healthcare resources, making it difficult for low-income residents to get high-quality healthcare services and health education [12,13]. The presence of a large number of patients with CVD in the population who do not receive standardized care makes the ASDR high. In contrast, the ASIR and ASDR for CVD in high-income regions, represented by the high-income Asia-Pacific region, Australasia, high-income North America, and Western Europe, are both at lower levels. The high-income Asia Pacific area has the lowest ASIR and ASDR for CVD, high-income North America has the highest reduction in ASIR, and Australasia has the largest decrease in ASDR. The possible reasons for this are as follows. Firstly, these locations are primarily developed countries, which often have tighter environmental protection regulations, resulting in healthier living and working conditions. Secondly, the residents of these nations are typically highly informed about CVD risk factors and preventative techniques, allowing them to comprehend and adopt healthy lifestyles more effectively [14]. These help to reduce ASIR in CVD. Furthermore, people from high-income nations have higher levels of income and easier access to healthcare [8]. Finally, high-income nations have improved and sophisticated healthcare systems that ensure enough access to high-quality medical services, such as early detection, prompt treatment, and effective rehabilitation approaches [8,11]. These help reduce the ASDR of CVD. It is worth noting that, globally, only Southern Sub-Saharan Africa has shown an increasing trend in CVD deaths over the past 30 years. CVD is the second biggest killer in sub-Saharan Africa, the first being poverty-related malnutrition and infectious diseases [4]. However, these nations frequently lack national policies and continue to have inadequate, underfunded, and under-resourced primary healthcare systems, resulting in a higher ASDR for CVD [15].
Association with SDI
Figure 2 shows ASIR and ASDR for CVD across time between the global and five SDI regions from 1990 to 2021. Overall, the ASIR of CVD has shown a declining trend globally, as well as in high SDI and high-middle SDI regions. In contrast, the ASIR in middle SDI, low-middle SDI, and low SDI regions has remained relatively stable. The ASIR in high SDI regions is significantly lower than the global average and has shown the largest decline. In high-middle SDI regions, the ASIR did not change much before 2000 but has since shown a clear downward trend (Figure 2). During the same period, the ASDR for CVD has shown a declining trend globally and in all five SDI regions. The ASDR in high SDI regions is significantly lower than the global average and has shown the largest decline. The differences in ASDR among the other four SDI regions are relatively small (Figure 2).
We observed that among the five SDI regions, the ASIR and ASDR for CVD were the lowest and decreased the greatest in the high SDI regions. For example, in Sweden, Australia, Japan, and Canada, the common characteristics of these countries are a well-developed healthcare system, excellent health education, and a high rate of promotion of public health policies. It is noteworthy that in high-middle SDI regions, the ASIR for CVD remained stable until 2000, while there was a significant downward trend after 2000, which may be related to the promotion and implementation of public health policies in these places. For example, after 2000, the World Health Organization launched a global campaign against smoking. With the publication of the Framework Convention on Tobacco Control (FCTC) on May 21, 2003, as of January 2005, nearly 90% of the world's countries have signed the FCTC [16]. In 2006, the Russian government introduced a series of alcohol control measures. Furthermore, the public health departments of Poland, Russia, Chile, and Malaysia have implemented health programs, expanded health insurance coverage, and increased funding in primary healthcare facilities. These measures are effective in reducing the risk of CVD by providing health guidance and support. In contrast, middle SDI regions, low-middle SDI regions, and low SDI regions with low SDI face problems such as insufficient investment in medical resources, weak health awareness, and low accessibility to medical care, which make the morbidity and mortality of CVD remain high [8].
Discussion
In this study, we systematically assessed global trends and regional differences in CVD incidence and mortality from 1990 to 2021. We also evaluated disease trends across five SDI regions worldwide. First, our findings indicate that from 1990 to 2021, the ASIR and ASDR for CVD decreased by 10.4% and 34.3%, respectively. However, the absolute number of CVD incident cases and deaths increased by 92.3% and 57.5%, reaching 66.81 million and 19.42 million cases, respectively. Additionally, we observed significant geographical and country-specific variations in CVD incidence and mortality. Developing countries in Central Asia, North Africa, and the Middle East also exhibit high incidence and death rates. Finally, the high SDI region has much lower ASIR and ASDR compared to the global average and has shown the most significant declines among the five SDI regions.
Studies based on GBD 2017 [2] and GBD 2019 [4] have reported differences in CVD across regions and countries worldwide. The GBD 2017 shows that the death rate from CVD is on a downward trend in most countries around the world. The decrease in CVD mortality between 1990 and 2017 was positively connected with the SDI, with higher SDI resulting in bigger declines in CVD mortality [2]. The GBD 2019 research found similar results, with ASIR and ASDR for CVD in high SDI regions falling the most dramatically between 1990 and 2019 [4]. Overall, the findings of this study are highly consistent with previous studies.
A key finding of this study is that there are significant geo-socioeconomic differences in CVD. This indicates that socioeconomic factors play an important role in the onset, progression, and regression of CVD. Geographic inequalities in socioeconomic status are linked to differences in the allocation of resources for healthcare and education, which leads to differences in disease perceptions, access to healthcare, living and working environments, and policymaker decisions [3,14,17,18]. In high-income countries, patients with CVD are more likely to be reported and treated due to their strong healthcare systems, adequate healthcare resources, and increased awareness of the disease [19]. In contrast, in low-income countries with limited access to healthcare, a significant proportion of patients with asymptomatic or insidious CVD may remain neglected [20]. A prospective study of over 150,000 participants from developing countries found that patients in low-income countries had the lowest cardiovascular risk but the highest rates of CVD, morbidity, and mortality, whereas patients in high-income countries had the opposite [21]. Therefore, recognizing the disease patterns of CVD prevalence among different countries and regions is essential for public health authorities to develop effective strategies to reduce the disease burden. The underlying principle of the theoretical framework for epidemiological transition is that the health status and spectrum of diseases that characterize different countries are related to their socioeconomic environment [22]. Nations at various phases of economic growth may have disease profiles with varying transitional stages in CVD spread [22]. Therefore, recognizing the features of the various transitory phases of the CVD epidemic in different nations is critical for guiding the identification of priority concerns in public health, resource allocation, and research in those countries. It is noteworthy that both previous studies [2] and the present study found that Uzbekistan has a high incidence and death rate of CVD. This might be attributed to Uzbekistan's poor medical resources, high smoking rates, a salt-, fat-, and sugar-rich diet, and a lack of social support and health education [23].
There are also limitations in this study. First, some of the heterogeneity in the reporting of observed and expected causes of early deaths in different regions may be artificial due to differences in data quality and the use of different methodologies and have changed over time. This change over time is not accurately captured in the creation of cause-of-death databases, which may be underestimating the burden of disease. Second, CVD includes a variety of subtypes, such as atrial fibrillation/flutter, coronary artery disease, and stroke, but this study did not analyze for subtypes, as well as lacked data related to treatment. For example, gender differences in CVD have been demonstrated, with men having a higher burden of ischemic heart disease and stroke than women and women having higher mortality rates from rheumatic heart disease and atrial fibrillation and flutter. Therefore, studies targeting subtypes of CVD are necessary.
Conclusions
The ASIR and ASDR for CVD have been declining globally over the past 30 years as a result of health promotion in public health policies and technological advances in disease diagnosis and treatment. At the same time, the absolute number of CVD incidences and deaths worldwide continues to rise as a result of changes in lifestyle and risk factors due to globalization, as well as progress in population aging. The distribution of the burden of CVD varies considerably between regions and countries, which is related to socioeconomics, living and working environments, prevalence of risk factors, and accessibility of healthcare. The ASIR and ASDR for CVD in high SDI regions are much lower than in other SDI regions and have declined the most. This is linked to these countries' well-developed healthcare systems, strong health education, healthy lifestyles, and promotion of health programs. The accuracy of GBD estimates depends largely on the quality and quantity of data, and the relatively low coverage of high-quality CVD registries in countries with low SDI, as well as in low- and middle-income developing countries, renders the accuracy and comparability of data in these countries relatively low. It is suggested that these nations learn from successful strategies in developed nations while devising more effective ways to lessen the burden of CVD, taking into consideration their specific disease patterns and socioeconomic status. Finally, we recommend that there be further research on CVD subtypes and risk factors, which will help to develop more targeted public health strategies to promote global health.
Acknowledgments
We sincerely thank all those who contributed to the Global Burden of Disease Study 2021 public database.
Disclosures
Human subjects: All authors have confirmed that this study did not involve human participants or tissue.
Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue.
Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following:
Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work.
Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work.
Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.
Author Contributions
Concept and design: Yue Wang, Xin Wang, Changfen Wang, Jianzhong Zhou
Acquisition, analysis, or interpretation of data: Yue Wang, Xin Wang, Jianzhong Zhou
Drafting of the manuscript: Yue Wang
Critical review of the manuscript for important intellectual content: Yue Wang, Xin Wang, Changfen Wang, Jianzhong Zhou
Supervision: Jianzhong Zhou
References
- 1.Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 Study. Roth GA, Mensah GA, Johnson CO, et al. J Am Coll Cardiol. 2020;76:2982–3021. doi: 10.1016/j.jacc.2020.11.010. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Global, regional, and national death, and disability-adjusted life-years (DALYs) for cardiovascular disease in 2017 and trends and risk analysis from 1990 to 2017 using the Global Burden of Disease Study and implications for prevention. Li Z, Lin L, Wu H, Yan L, Wang H, Yang H, Li H. Front Public Health. 2021;9:559751. doi: 10.3389/fpubh.2021.559751. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Socioeconomic factors and cardiovascular disease: a review of the literature. Kaplan GA, Keil JE. Circulation. 1993;88:1973–1998. doi: 10.1161/01.cir.88.4.1973. [DOI] [PubMed] [Google Scholar]
- 4.Global trends and regional differences in incidence and mortality of cardiovascular disease, 1990-2019: findings from 2019 Global Burden of Disease Study. Li Y, Cao GY, Jing WZ, Liu J, Liu M. Eur J Prev Cardiol. 2023;30:276–286. doi: 10.1093/eurjpc/zwac285. [DOI] [PubMed] [Google Scholar]
- 5.Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396:1204–1222. doi: 10.1016/S0140-6736(20)30925-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950-2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021. Lancet. 2024;403:1989–2056. doi: 10.1016/S0140-6736(24)00476-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024;403:2133–2161. doi: 10.1016/S0140-6736(24)00757-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Global, regional, and national burden of cardiovascular diseases in youths and young adults aged 15-39 years in 204 countries/territories, 1990-2019: a systematic analysis of Global Burden of Disease Study 2019. Sun J, Qiao Y, Zhao M, Magnussen CG, Xi B. BMC Med. 2023;21:222. doi: 10.1186/s12916-023-02925-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Trends and levels of the global, regional, and national burden of appendicitis between 1990 and 2021: findings from the Global Burden of Disease Study 2021. Lancet Gastroenterol Hepatol. 2024;9:825–858. doi: 10.1016/S2468-1253(24)00157-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Modifiable risk factors for cardiovascular disease in Korea and Japan. Arafa A, Lee HH, Eshak ES, et al. Korean Circ J. 2021;51:643–655. doi: 10.4070/kcj.2021.0121. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Global, regional, and national burden of disease study of atrial fibrillation/flutter, 1990-2019: results from a Global Burden of Disease Study, 2019. Li H, Song X, Liang Y, et al. BMC Public Health. 2022;22:2015. doi: 10.1186/s12889-022-14403-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Global burden of ischemic heart disease and attributable risk factors, 1990-2017: a secondary analysis based on the Global Burden of Disease Study 2017. Wang F, Yu Y, Mubarik S, et al. Clin Epidemiol. 2021;13:859–870. doi: 10.2147/CLEP.S317787. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Development-assistance strategies for stroke in low- and middle-income countries. Lee H, Nam YS, Lee KM. J Korean Med Sci. 2015;30:0–42. doi: 10.3346/jkms.2015.30.S2.S139. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Social determinants of atrial fibrillation. Essien UR, Kornej J, Johnson AE, Schulson LB, Benjamin EJ, Magnani JW. Nat Rev Cardiol. 2021;18:763–773. doi: 10.1038/s41569-021-00561-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Cardiovascular diseases in sub-Saharan Africa compared to high-income countries: an epidemiological perspective. Yuyun MF, Sliwa K, Kengne AP, Mocumbi AO, Bukhman G. Glob Heart. 2020;15:15. doi: 10.5334/gh.403. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Towards the world-wide ban of indoor cigarette smoking in public places. Rivero LR, Persson JL, Romine DC, Taylor JT, Toole TC, Trollman CJ, Au WW. Int J Hyg Environ Health. 2006;209:1–14. doi: 10.1016/j.ijheh.2005.07.003. [DOI] [PubMed] [Google Scholar]
- 17.Social determinants of cardiovascular health in Asian Americans: a scientific statement from the American Heart Association. Shah NS, Kandula NR, Commodore-Mensah Y, et al. Circulation. 2024;150:0–315. doi: 10.1161/CIR.0000000000001278. [DOI] [PubMed] [Google Scholar]
- 18.Measuring socioeconomic position in health research. Galobardes B, Lynch J, Smith GD. Br Med Bull. 2007;81-2:21–37. doi: 10.1093/bmb/ldm001. [DOI] [PubMed] [Google Scholar]
- 19.Socioeconomic status and risk of cardiovascular disease in 20 low-income, middle-income, and high-income countries: the Prospective Urban Rural Epidemiologic (PURE) study. Rosengren A, Smyth A, Rangarajan S, et al. Lancet Glob Health. 2019;7:0–60. doi: 10.1016/S2214-109X(19)30045-2. [DOI] [PubMed] [Google Scholar]
- 20.Global burden of atrial fibrillation/atrial flutter and its attributable risk factors from 1990 to 2021. Cheng S, He J, Han Y, Han S, Li P, Liao H, Guo J. Europace. 2024;26:0. doi: 10.1093/europace/euae195. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Cardiovascular risk and events in 17 low-, middle-, and high-income countries. Yusuf S, Rangarajan S, Teo K, et al. N Engl J Med. 2014;371:818–827. doi: 10.1056/NEJMoa1311890. [DOI] [PubMed] [Google Scholar]
- 22.Epidemiological features of cardiovascular disease in Asia. Zhao D. JACC Asia. 2021;1:1–13. doi: 10.1016/j.jacasi.2021.04.007. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Burden of ischemic heart disease in Central Asian countries, 1990-2017. Lui M, Safiri S, Mereke A, et al. Int J Cardiol Heart Vasc. 2021;33:100726. doi: 10.1016/j.ijcha.2021.100726. [DOI] [PMC free article] [PubMed] [Google Scholar]