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. 2025 Jan 9;83:2. doi: 10.1186/s13690-024-01454-7

Sociodemographic index–age differences in the global prevalence of cardiovascular diseases, 1990–2019: a population-based study

Xunliang Li 1,#, Channa Zhao 2,#, Mengqian Liu 1,#, Wenman Zhao 1, Haifeng Pan 2,✉, Deguang Wang 1,✉
PMCID: PMC11715713  PMID: 39780273

Abstract

Background

This study aims to assess the global burden and trends in cardiovascular diseases (CVDs) prevalence, stratified by sociodemographic index (SDI) categories and age groups, across 204 countries and territories.

Methods

Utilizing data from the Global Burden of Disease Study 2019, this study analyzed trends in the age-standardized prevalence rate of overall and type-specific CVDs, including rheumatic heart disease, ischemic heart disease, stroke, hypertensive heart disease, non-rheumatic valvular heart disease, cardiomyopathy and myocarditis, atrial fibrillation and flutter, peripheral artery disease, endocarditis, and other cardiovascular and circulatory diseases. Age-standardized prevalence rates were stratified by SDI categories (low, low-middle, middle, high-middle, and high) and age groups (0–14, 15–49, 50–69, and ≥ 70 years). The corresponding average annual percentage change was calculated to assess temporal trends.

Results

From 1990 to 2019, the global age-standardized prevalence rate per 100,000 population for CVD decreased from 6728.04 (95% UI 6394.55 to 7059.66) to 6431.57 (95% UI 6109.95 to 6759.8), with an average annual percent change of -0.15% (95% CI -0.17 to -0.13). When stratified by SDI category, the age-standardized prevalence rate of CVD decreased significantly in high-middle and high SDI countries but increased in middle, low-middle, and low SDI countries. By age group, the age-standardized prevalence rate of CVD declined in the 50–69 and ≥ 70 years groups but increased in the 0–14 and 15–49 years groups. SDI levels were negatively associated with faster increases in the age-standardized prevalence rate of CVD across all ages and age groups. Low SDI countries consistently showed the highest age-standardized prevalence rates of CVD in the younger age groups (0–14 and 15–49 years), while high-middle SDI countries had the highest rates in the older age groups (50–69 and ≥ 70 years). The age-standardized prevalence rate of CVD was negatively associated with SDI levels in the 0–14 and 15–49 years groups and positively associated with SDI levels in the 50–69 and ≥ 70 years groups. Type-specific CVDs such as rheumatic heart disease, other cardiovascular and circulatory diseases, non-rheumatic valvular heart disease, and hypertensive heart disease showed increased age-standardized prevalence rates from 1990 to 2019.

Conclusions

This study highlights significant disparities in CVD prevalence across sociodemographic and age groups. While the global prevalence of CVD has generally decreased, the rise in CVD prevalence in lower SDI countries and younger populations calls for tailored intervention strategies. Addressing these disparities is crucial to mitigating the growing burden of CVD and promoting cardiovascular health on a global scale.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-024-01454-7.

Text box 1. Contributions to the literature

• This study is the first to comprehensively assess cardiovascular disease (CVD) prevalence trends across all age groups and sociodemographic index (SDI) categories globally, from 1990 to 2019.

• It highlights growing disparities in CVD prevalence, with significant increases in low and middle SDI countries, particularly among younger age groups (0-14 and 15-49 years).

• The findings underscore the need for tailored public health interventions targeting younger populations and resource-limited settings to address the rising burden of CVD.

• This research provides valuable insights for global health policymakers, emphasizing the importance of equitable healthcare access and prevention strategies across diverse populations.
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Introduction

Cardiovascular diseases (CVDs) are the leading cause of morbidity and are a significant global public health problem [1]. According to the Global Burden of Disease Study (GBD) 2019, 523.2 million people worldwide had CVD in 2019, a 26% increase from 1990 [2]. One crucial aspect influencing the morbidity of CVDs is the sociodemographic index (SDI) [3]. The SDI, a composite measure encompassing income per capita, education, and fertility, is a crucial indicator of a population's overall socioeconomic development [4]. CVDs are not only severe diseases in high SDI countries; over 80% of CVD cases occur in low and middle SDI countries [5]. The relationship between lower SDI and higher CVD rates emphasizes the complex interaction between social and economic factors and cardiovascular health [6]. Several risk factors that contribute to the incidence of CVD include smoking, poor dietary habits, physical inactivity, hypertension, and obesity, and these risk factors are often influenced by SDI levels [5, 7]. For instance, lower SDI countries tend to have higher rates of smoking, as limited access to public health initiatives and education campaigns may result in weaker tobacco control measures [8, 9]. In contrast, in high SDI countries, smoking rates may be lower due to the implementation of more comprehensive public health policies [8, 9]. Similarly, dietary patterns, levels of physical activity, and access to healthcare services can vary substantially by SDI, further affecting the prevalence and management of CVD risk factors across populations [10]. Additionally, age plays a pivotal role in the prevalence of CVDs. Aging is a well-established risk factor, with the incidence of CVDs increasing as individuals age [11]. However, recent trends indicate a shift, with certain types of CVDs affecting younger populations. For instance, the prevalence of rheumatic heart disease peaks between the ages of 20 and 29 years [2]. This highlights the necessity of exploring how age differences intersect with sociodemographic factors to shape CVD prevalence.

The intersection of aging and sociodemographic factors in the context of CVD prevalence is particularly pertinent to the field of aging research. As human life expectancy increases, the impact of age-related diseases, including CVDs, becomes more pronounced. Despite the evident connections between SDI, age, and CVDs, comprehensive studies examining the prevalence of overall and type-specific CVDs across different SDI levels and age groups are scarce. This study aims to assess the prevalence and trends of overall and type-specific CVDs across all age groups stratified by SDI categories, for 204 countries and territories.

Methods

Data source

Prevalence data were obtained from the GBD 2019, which provided a comprehensive estimation of the health loss for 369 diseases, injuries, and impairments and 87 risk factors by age and sex across 204 countries and territories from 1990–2019. Details in the methodologies applied in GBD 2019 have been thoroughly explained in previous literature [1]. The estimated CVD analysis process and reproducible statistical codes can be collected from the following website: https://ghdx.healthdata.org/gbd-2019/code/cod-3. Briefly, CVD was defined as ten major type categories based on the 10th revision of the International Classification of Disease (ICD-10): rheumatic heart disease, ischemic heart disease, stroke, hypertensive heart disease, non-rheumatic valvular heart disease, cardiomyopathy and myocarditis, atrial fibrillation and flutter, peripheral artery disease, endocarditis, and other cardiovascular and circulatory disease [12]. The detailed standard definitions used to identify each major cause and related health states are described in previous publications [12]. Ethical approval and informed consent were waived because the GBD is publicly available, and no identifiable information was included in the analyses.

Data extraction

We extracted prevalence data related to overall and type-specific CVD from the GBD 2019 dataset using the GHDx query tool (https://vizhub.healthdata.org/gbd-results/). Metrics extracted from GBD 2019 include estimates and their 95% uncertainty intervals (UIs), defined by the 25th and 975th values of the ordered 1000 estimates according to the GBD's algorithm [1]. All rates are reported per 100,000 population.

SDI and geographical locations

The SDI is a summary indicator of a country’s lag-distributed income per capita, average years of schooling, and the fertility rate in females under age 25 years, which is calculated by rescaling each component by selected health indicators to obtain a value between 0.005 to 1, then taking the geometric mean of those rescaled values and multiplying by 100 [13]. It is used to capture background social and economic conditions that shape health outcomes in a given location, with higher values indicating more socioeconomically developed. When determining quintiles for analysis, country-level estimates of SDI for 2019, excluding countries with populations less than 1 million, were used to calculate the cutoff values. The 204 countries and territories covered in the GBD 2019 were divided into five SDI quintiles based on the following ranges: low SDI (0 to 0.4547), low-middle SDI (0.4547 to 0.6076), middle SDI (0.6076 to 0.7905), high-middle SDI (0.7905 to 0.8051), and high SDI (0.8051 to 1) [1]. Low SDI countries are characterized by low income, lower educational attainment, and higher fertility rates, with significant barriers to healthcare access. Low-middle SDI countries have slightly better economic and educational conditions but still face healthcare challenges. Middle SDI countries have more developed healthcare systems and improved economic resources, though disparities persist. High-middle SDI countries are more socioeconomically advanced but may still face certain public health issues, while high SDI countries are the most developed, with robust healthcare infrastructure) [1].

Statistical analysis

In this study, we selected four age groups for further analysis: 0–14, 15–49, 50–69, and ≥ 70 years. The age classification used in this study was selected to capture different stages of life, each with distinct CVD risk profiles. The age groups 0–14, 15–49, 50–69, and ≥ 70 years correspond to the pediatric population, adolescence and adulthood, middle-aged adults, and the elderly, respectively. This age classification is consistent with previous epidemiological studies [14, 15]. We calculated age-standardized rates and corresponding 95% confidence intervals (CIs) for people aged 0–14, 15–49, 50–69, and ≥ 70 years based on the age-specific rates and the composition ratio of each selected age group relative to the world standard population reported in the GBD Study 2019 [4]. Our estimates show rates per 100,000 population.

To assess the magnitude and direction of temporal trends in the age-standardized prevalence rate of overall and type-specific CVDs, we calculated average annual percent change and corresponding 95% confidence intervals by joinpoint regression [16]. The program started with the minimum number of joinpoints (e.g., a straight line of 0 joinpoints) and tested whether more joinpoints were significant and should be added to the model. We used a Monte Carlo permutation method for significance tests. The average annual percentage change (AAPC) was calculated from the annual percent change of each segment in the last significant model in a weighted manner.

We conducted comparisons between the SDI (high, high-middle, middle, low-middle, and low SDI categories) and age groups (0–14, 15–49, 50–69, and ≥ 70 years). Least squares regression and generalized additive models were applied to examine the possible linear or non-linear relations between SDI and age-standardized prevalence rate or corresponding average annual percent change. R software (version 4.1.0) was used for the statistical analyses. A P value < 0.05 was regarded as significant.

Results

Global CVD prevalence in 2019

In 2019, the global age-standardized prevalence rate per 100,000 population of CVDs was 6431.57 (95% UI 6109.95 to 6759.8) (Fig. 1 and Table S1). By SDI category, the age-standardized prevalence rate was highest in low SDI countries (6377.82, 5975.3 to 6811.49) and lowest in middle SDI countries (6282.16, 5940.85 to 6633.9) (Table S1). At the regional level, the greatest age-standardized prevalence rate was seen in North Africa and Middle East (8093.79, 7721.84 to 8460.94); at the national level, 9 of the 10 countries with the highest age-standardized prevalence rate were from North Africa and the Middle East (e.g., Egypt), making it the regions with the highest age-standardized prevalence rate of CVD (Table S1 and Figure S1).

Fig. 1.

Fig. 1

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Age-standardized prevalence rates of cardiovascular disease by SDI categories, 1990 and 2019. SDI = Socio-demographic index

CVD prevalence by age group and SDI category in 2019

In 2019, when stratified by age group, the age-standardized prevalence rate of CVD was highest at ≥ 75 years (95% CI 42665.56, 39,899.15 to 45,623.41) and lowest at 0–14 years (450.75, 314.95 to 626.57) (Table S2). When stratified by age group and SDI, low SDI countries had the highest age-standardized prevalence rate at 0–14 and 15–49 years (684.37, 471.81 to 968.62; and 3172.74, 2562.92 to 4004.95; respectively), while high SDI countries had the lowest age-standardized prevalence rate at 0–14 years (118.21, 85.29 to 162.03) and high-middle SDI countries had the lowest age-standardized prevalence rate at 15–49 years (1980.76, 1745.48 to 2266.66). At 50–69 and ≥ 70 years, the age-standardized prevalence rate is highest in high-middle SDI countries (16,772.7, 15,418.33 to 18,227.92; and 44,519.26, 41,567.33 to 47,625.29; respectively) and lowest in low SDI countries (14,629.8, 13,347.03 to 16,064.57; and 38,305.77, 35,304.67 to 41,552.09; respectively) (Fig. 2 and Table S2). Figure 3 shows that the age-standardized prevalence rate was negatively associated with SDI levels in the 0–14 and 15–49 years, and the age-standardized prevalence rate was positively associated with SDI levels in the 50–69 and ≥ 70 years (all models, P < 0.05).

Fig. 2.

Fig. 2

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Temporal trends and corresponding average annual percentage changes in age-standardized prevalence rates of cardiovascular disease by SDI categories and age groups, 1990–2019. A Temporal trends by SDI category for all ages. B Temporal trends by SDI category for 0–14 years. C Temporal trends by SDI category for 15–49 years. D Temporal trends by SDI category for 50–69 years. E Temporal trends by SDI category for ≥ 70 years. F Average annual percentage change by SDI categories and age groups. SDI = Socio-demographic index

Fig. 3.

Fig. 3

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Association between SDI and age-standardized prevalence rates of cardiovascular disease by age groups in 1990 and 2019 and the corresponding average annual percentage change from 1990 to 2019. A Association among all ages in 1990. B Association among all ages in 2019. C Association among all ages from 1990 to 2019. D Association among 0–14 years in 1990. E Association among 0–14 years in 2019. F Association among 0–14 years from 1990 to 2019. G Association among 15–49 years in 1990. (H) Association among 15–49 years in 2019. I Association among 15–49 years from 1990 to 2019. J Association among 50–69 years in 1990. K Association among 50–69 years in 2019. L Association among 50–69 years from 1990 to 2019. M Association among ≥ 70 years in 1990. N Association among ≥ 70 years in 2019. O Association among ≥ 70 years from 1990 to 2019. The dotted lines refer to the global level of rates (A, B, D, E, G, H, J, K, M, N) and zero (C, F, I, L, O), respectively. ASPR = age-standardized prevalence rate. SDI = Socio-demographic index

Prevalence of different types of CVDs in 2019

In 2019, for different types of CVDs, ischemic heart disease had the highest age-standardized prevalence rate (Fig. 4 and Table S3). When stratified by SDI category, the age-standardized prevalence rate of peripheral artery disease, atrial fibrillation and flutter, non-rheumatic valvular heart disease, and endocarditis was highest in high SDI countries, the age-standardized prevalence rate of stroke, and hypertensive heart disease was highest in middle SDI countries, the age-standardized prevalence rate of ischemic heart disease was highest in low-middle SDI countries, and the age-standardized prevalence rate of rheumatic heart disease, other cardiovascular and circulatory diseases, and cardiomyopathy and myocarditis was highest in low SDI countries (Fig. 4 and Table S3). When stratified by age group, the age-standardized prevalence rate of ischemic heart disease, peripheral artery disease, stroke, atrial fibrillation and flutter, other cardiovascular and circulatory diseases, non-rheumatic valvular heart disease, hypertensive heart disease, cardiomyopathy and myocarditis, and endocarditis was highest at ≥ 75 years, the age-standardized prevalence rate of rheumatic heart disease was highest at 15–49 years (Fig. 5 and Table S4).

Fig. 4.

Fig. 4

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Age-standardized prevalence rates of type-specific cardiovascular disease by SDI categories, 1990 and 2019, and corresponding average annual percentage change from 1990 to 2019. A Age-standardized prevalence rates of type-specific cardiovascular disease by SDI categories, 1990. B Age-standardized prevalence rates of type-specific cardiovascular disease by SDI categories, 2019. C Corresponding average annual percentage change from 1990 to 2019. SDI = Socio-demographic index

Fig. 5.

Fig. 5

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Age-standardized prevalence rates of type-specific cardiovascular disease by age groups, 1990 and 2019, and corresponding average annual percentage change from 1990 to 2019. A Age-standardized prevalence rates of type-specific cardiovascular disease by age groups, 1990. B Age-standardized prevalence rates of type-specific cardiovascular disease by age groups, 2019. C Corresponding average annual percentage change from 1990 to 2019

Global trends in CVD prevalence from 1990 to 2019

From 1990 to 2019, the global age-standardized prevalence rate per 100,000 population for CVD decreased from 6728.04 (95% UI 6394.55 to 7059.66) to 6431.57 (6109.95 to 6759.8), with an average annual percent change of -0.15% (95% CI -0.17 to -0.13) (Fig. 2 and Table S1). When stratified by SDI category, the age-standardized prevalence rates declined for high SDI and high-middle SDI, with an average annual percent change of -0.54% (-0.57 to -0.51) and -0.21% (-0.21 to -0.2), respectively; however, the age-standardized prevalence rates increased for middle SDI, low-middle SDI and low SDI, with an average annual percent change of 0.1% (0.09 to 0.11), 0.13% (0.12 to 0.13), and 0.08% (0.07 to 0.09), respectively (Fig. 2 and Table S1). At the regional level, the age-standardized prevalence rate increased in 8 of the 21 GBD regions, with Western Sub-Saharan Africa showing the fastest increase in age-standardized prevalence rate (0.19%, 0.16 to 0.21). At the national level, the age-standardized prevalence rate increased in 89 of 204 countries, with the fastest increase in Uzbekistan (0.43%, 0.41 to 0.46) (Table S1 and Figure S1).

Trends in CVD prevalence by age group and SDI category from 1990 to 2019

From 1990 to 2019, when stratified by age group, the age-standardized prevalence rate of CVD declined at 50–69 and ≥ 70 years and increased at 0–14 and 15–49 years (Fig. 2 and Table S2). When stratified by age group and SDI category, the age-standardized prevalence rate in high SDI countries declined at 15–49, 50–69 and ≥ 70 years; age-standardized prevalence in high-middle SDI countries declined at 15–49, 50–69, and ≥ 70 years and increased at 0–14 years; the age-standardized prevalence rates for middle SDI, low-middle SDI and low SDI countries increased in all age groups (Fig. 2 and Table S2). Figure 3 shows that the SDI level was negatively associated with faster increases in the age-standardized prevalence rate of CVD from 1990 to 2019 in all age and in all four age groups (all models, P < 0.05).

Trends in prevalence of different types of CVDs from 1990 to 2019

From 1990 to 2019, for different types of specific CVDs, the age-standardized prevalence rate in rheumatic heart disease (95% UI 451.56 to 513.68), other cardiovascular and circulatory diseases (392.22 to 432.73), non-rheumatic valvular heart disease (391.4 to 399.5), and hypertensive heart disease (219.54 to 233.77) significantly increased globally. In contrast, the age-standardized prevalence rate in ischemic heart disease (2538.6 to 2421.02), peripheral artery disease (1789.95 to 1401.85), stroke (1320.79 to 1240.26), atrial fibrillation and flutter (775.86 to 743.47), cardiomyopathy and myocarditis (65.06 to 51.5), and endocarditis (6.14 to 5.64) significantly decreased (all P for AAPC < 0.05, Fig. 4 and Table S3).

From 1990 to 2019, for different types of specific CVDs, when stratified by SDI category, the age-standardized prevalence rate of non-rheumatic valvular heart disease increased in high SDI countries; the age-standardized prevalence rate of other cardiovascular and circulatory diseases, non-rheumatic valvular heart disease, hypertensive heart disease, and endocarditis increased in high-middle SDI countries; the age-standardized prevalence rate of ischemic heart disease, peripheral artery disease, stroke, atrial fibrillation and flutter, other cardiovascular and circulatory diseases, non-rheumatic valvular heart disease, and endocarditis increased in middle SDI countries; the age-standardized prevalence rate of ischemic heart disease, atrial fibrillation and flutter, rheumatic heart disease, other cardiovascular and circulatory diseases, non-rheumatic valvular heart disease, hypertensive heart disease, and endocarditis increased in low-middle SDI countries; the age-standardized prevalence rate of ischemic heart disease, peripheral artery disease, atrial fibrillation and flutter, rheumatic heart disease, other cardiovascular and circulatory diseases, non-rheumatic valvular heart disease, hypertensive heart disease, and endocarditis increased in low SDI countries (all P for AAPC < 0.05, Fig. 4 and Table S3).

From 1990 to 2019, for different types of specific CVDs, when stratified by age group, the age-standardized prevalence rate of stroke, rheumatic heart disease, and other cardiovascular and circulatory diseases increased at 0–14 years; the age-standardized prevalence rate of ischemic heart disease, rheumatic heart disease, other cardiovascular and circulatory diseases, and hypertensive heart disease increased at 15–49 years; the age-standardized prevalence rate of other cardiovascular and circulatory diseases, hypertensive heart disease, and endocarditis increased at 50–69 years; the age-standardized prevalence rate of non-rheumatic valvular heart disease, and hypertensive heart disease increased at ≥ 70 years (all P for AAPC < 0.05, Fig. 4 and Table S4).

Discussion

Global trends in CVD prevalence

The global age-standardized prevalence rate of CVDs declined significantly from 1990 to 2019. In terms of type-specific CVDs, the age-standardized prevalence rate in rheumatic heart disease, other cardiovascular and circulatory diseases, non-rheumatic valvular heart disease, and hypertensive heart disease increased from 1990 to 2019. We found that the age-standardized prevalence rate of CVD decreased significantly in high-middle and high SDI countries and increased in middle, low-middle, and low SDI countries. Across age groups, the age-standardized prevalence rate of CVD declined at 50–69 and ≥ 70 years and increased at 0–14 and 15–49 years. SDI levels were negatively associated with faster increases in the age-standardized prevalence rate of CVD across all ages and all four age groups. We also found that low SDI countries consistently showed highest age-standardized prevalence rates in the younger age groups (0–14 and 15–49 years), and high-middle SDI countries had the highest age-standardized prevalence rates in the older age groups (50–69 and ≥ 70 years). The age-standardized prevalence rate of CVD was negatively associated with SDI levels in the 0–14 and 15–49 years and positively associated with SDI levels in the 50–69 and ≥ 70 years. The results of this study reveal complex patterns and trends in global CVD prevalence across SDI categories and age groups from 1990 to 2019, providing valuable insights for global policymakers and healthcare practitioners.

Impact of age group and SDI category in CVD prevalence

While the overall decline in the age-standardized prevalence rate of CVD is encouraging, disparities among SDI categories reveal distinct challenges. The age-standardized prevalence rate of CVD decreased significantly in high and high-middle SDI countries and increased in middle, low-middle, and low SDI countries. The significant decline in the age-standardized prevalence rate of CVD observed in high and high-middle SDI countries may be attributed to successful interventions and advances in health care [17]. These regions have likely benefited from well-established healthcare systems, widespread access to medical services, and effective public health campaigns [18]. Conversely, the increase in CVD prevalence rates in middle, low-middle, and low SDI countries highlights ongoing challenges and disparities. These regions may face barriers such as limited access to healthcare resources, inadequate infrastructure, and socioeconomic factors contributing to the rise in CVDs [18]. The disparities observed among SDI categories underscore the impact of socioeconomic determinants on health outcomes [19].

The age-stratified analysis further unveils dynamic patterns in cardiovascular health across different life stages. The observed decline in age-standardized prevalence rates of CVD among individuals aged 50–69 and ≥ 70 years suggests positive trends in cardiovascular health for the older population [20]. This decline may indicate improved healthcare access, advancements in medical treatments, and increased awareness and management of cardiovascular risk factors in the elderly [21]. Conversely, the increase in age-standardized prevalence rates of CVD in the 0–14 and 15–49 age groups calls for attention to the cardiovascular health of younger populations [22]. This rise may be influenced by lifestyle factors, changing dietary habits, and an increasing prevalence of risk factors such as obesity and sedentary behavior in younger age cohorts [23]. Early-onset cardiovascular issues pose a significant public health challenge, requiring targeted preventive measures and educational interventions to mitigate risk factors and improve cardiovascular health outcomes in these age groups [24]. When stratified by both age group and SDI, our findings reveal a concerning increase in the age-standardized prevalence rate of CVD across all age groups in middle SDI, low-middle SDI, and low SDI countries. This underscores the persistent challenges faced by regions with limited healthcare resources, inadequate infrastructure, and socioeconomic factors contributing to the rise in CVDs [20]. The rising burden of CVDs in younger age groups in low, low-middle and middle SDI countries may be partially attributed to ongoing demographic and socio-economic transitions, including urbanization, changes in dietary patterns, and increased exposure to cardiovascular risk factors such as hypertension, obesity, and sedentary lifestyles [25–27]. Furthermore, the increase in CVD cases among younger age groups may also be influenced by the expansion and progress of screening programs in recent years, which have improved early detection of cardiovascular conditions, compared to the limited availability of such programs in the 1990s [7]. In addition, we found that SDI levels were negatively associated with a faster increase in the age-standardized prevalence rate of CVD from 1990 to 2019 in all ages and all four age groups. Several factors may contribute to this trend. In regions with lower SDI levels, limited access to healthcare services, inadequate infrastructure, and socioeconomic challenges may exacerbate the burden of CVD [1]. Additionally, prevalent risk factors like unhealthy diets, physical inactivity, and tobacco use, which are more common in lower SDI settings, may further fuel the increase in CVD prevalence over time [28]. Conversely, regions with higher SDI levels likely benefit from better healthcare infrastructure, increased awareness of cardiovascular risk factors, and improved access to preventive measures and treatments [29]. These factors may help attenuate the rise in CVD prevalence and contribute to slower increase rates in these regions [30]. Comprehensive, context-specific strategies are imperative to address these disparities, ensuring equitable access to healthcare resources and improving cardiovascular health outcomes across diverse global populations [31].

The relationship between SDI levels and age-standardized prevalence rates of CVD reveals intriguing variations across different age groups. Notably, low SDI countries consistently exhibited higher prevalence rates in younger age groups, signaling potential challenges in early-life cardiovascular health [11]. This observation underscores the need for targeted interventions and preventive measures in resource-limited settings to address the early onset of CVD risk factors and promote healthier lifestyles among younger populations [32]. In contrast, the finding of high-middle SDI countries displaying the highest prevalence rates in the older age groups adds nuance to the relationship between socioeconomic development and the burden of aging-related CVD [17]. This suggests a complex interplay wherein higher socioeconomic status may contribute to increased longevity but also potentially elevate the risk of cardiovascular issues in the aging population [33]. In addition, we found that the age-standardized prevalence rate of CVD was negatively associated with SDI levels in the 0–14 and 15–49 years, indicating that lower SDI levels were linked to higher prevalence rates among the younger population [18]. This finding underscores the impact of socioeconomic factors on early-life cardiovascular health, suggesting that regions with lower SDI may face challenges related to healthcare access, education, and preventive measures for cardiovascular risk factors in younger age cohorts [34]. Conversely, a positive association between age-standardized prevalence rates of CVD and SDI levels was observed in the 50–69 and ≥ 70 age groups. Traditionally, higher SDI levels are associated with improved health outcomes, including lower rates of CVD [35]. However, our findings suggest a counterintuitive relationship in the older age brackets. One plausible interpretation could be that higher SDI levels indicate better overall health and healthcare access, leading to increased life expectancy [36]. Consequently, individuals in regions with higher SDI levels may be more likely to reach the older age groups where CVD prevalence tends to be higher due to the natural aging process [37]. As global demographics shift towards an aging society, understanding the intricate interplay between age, SDI levels, and CVD prevalence becomes imperative for shaping effective public health strategies tailored to the unique needs of older individuals in diverse socioeconomic contexts [38].

Based on our findings, we suggest that targeted interventions could help reduce the prevalence of CVDs across different age groups and SDI levels. In low and low-middle SDI countries, where the rising prevalence of CVDs, particularly among younger age groups, is a concern, strategies focused on promoting healthier diets, increasing physical activity, and enhancing tobacco control efforts may be beneficial. Strengthening healthcare systems to improve early detection through screening and addressing risk factors such as hypertension and diabetes could also play an important role. In high-middle and high SDI countries, where the prevalence of CVDs has declined but remains significant in older populations, efforts could be directed toward improving secondary prevention through comprehensive management of existing risk factors, patient education, and lifestyle promotion among older adults. For younger age groups, early intervention programs, including health education and expanded screening for hereditary conditions, may help prevent the development of risk factors. For older populations, routine cardiovascular assessments, better management of chronic conditions, and ensuring access to healthcare services could help reduce the burden. Tailoring interventions to the specific needs of each SDI level and age group may contribute to more effective prevention and control of CVDs globally.

Type-specific CVD trends

Furthermore, our analysis of type-specific CVDs reveals heterogeneous trends across different disease categories. While some conditions, such as ischemic heart disease, exhibited declining trends globally, others, including rheumatic heart disease and non-rheumatic valvular heart disease, showed concerning increases in prevalence rates. These trends highlight the dynamic nature of cardiovascular health and underscore the importance of monitoring and addressing specific disease categories individually [39]. The observed heterogeneity in trends across different disease categories also suggests variations in risk factors, pathophysiology, and response to interventions [40]. For instance, the decline in ischemic heart disease prevalence may reflect advancements in medical treatments, lifestyle modifications, and public health interventions targeting risk factors such as smoking and hypertension [20]. Conversely, the increase in rheumatic heart disease prevalence underscores persistent challenges in access to healthcare, particularly in low and middle SDI countries, where rheumatic fever remains a significant cause of morbidity and mortality [41]. The heterogeneous trends observed in type-specific CVDs underscore the importance of tailored interventions that address the unique challenges posed by each condition.

Strengths and limitations of this study

This study's main strength is that we systematically estimated overall and type-specific CVD prevalence from 1990 to 2019 worldwide, offering valuable insights into the interplay between sociodemographic factors, age, and the prevalence of overall and type-specific CVDs. In addition, the AAPC between 1990 and 2019 provides temporal trends rather than the total percentage change, which offers more accurate information. However, several limitations related to estimates from the GBD data should be considered [1, 2, 42]. First, although more explicit corrections for bias have been implemented to improve data using higher-resource settings, estimates of CVD burden are surrounded by different data availability between countries/territories with considerable uncertainties [1, 2]. High-quality population-based data on the prevalence of CVDs in several low and middle SDI countries/territories or regions are limited because they lack comprehensive surveillance systems and population-based registries [14, 43]. Although the GBD relies on predictive covariate values and statistical methods to estimate CVD burden in these locations, prevalence rate might be underestimated in low and middle SDI countries. Second, although GBD adjusted alternative case definitions and differential access to health care, ICD codes for extracting CVD cases might lead to compositional bias because a proportion of patients are different from the confirmed cases defined by standard criteria. Third, AAPC relies on the hypothesis that the age-standardized rate was constant over time. However, it might be influenced by possible sudden changes in national policies, the availability of preventive medicine services, medical innovations, and medications [44]. Fourth, several type-specific CVDs, such as data on pulmonary arterial hypertension, lower extremities peripheral arterial disease, and incidence estimate of hypertensive heart disease, were unavailable in the GBD database.

Conclusions

In conclusion, our analysis of global CVD prevalence trends from 1990 to 2019 reveals significant disparities across SDI categories and age groups. While the global prevalence of CVD declined overall during this period, there is a worrying increase in the prevalence of CVD in middle, low-middle, and low SDI countries and among young people aged 0–14 and 15–49 years. These results suggest an urgent need for targeted interventions and practical strategies to reduce health inequalities among different populations, focusing on vulnerable groups and young people in lower SDI countries.

Supplementary Information

Supplementary Material 1 (349.4KB, docx)

Acknowledgements

Not applicable.

Abbreviations

AAPC

Average annual percentage change

CI

Confidence interval

CVD

Cardiovascular disease

GBD

Global Burden of Disease Study

ICD-10

10Th revision of the International Classification of Disease

SDI

Sociodemographic index

UI

Uncertainty interval

Authors’ contributions

Conceptualization: X. Li, C. Zhao, M. Liu, H. Pan, D. Wang; Methodology: X. Li, C. Zhao; Formal analysis and investigation: X. Li, W. Zhao; Supervision: H. Pan, D. Wang. All authors read and approved the final manuscript.

Funding

Not applicable.

Data availability

Data from the Global Health Data Exchange are publicly available online (https://www.healthdata.org/).

Declarations

Ethics approval and consent to participate

Ethical approval and informed consent were waived because the GBD is publicly available and no identifiable information was included in the analyses.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Footnotes

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Xunliang Li, Channa Zhao and Mengqian Liu contributed equally to this work.

Contributor Information

Haifeng Pan, Email: panhaifeng@ahmu.edu.cn.

Deguang Wang, Email: wangdeguang@ahmu.edu.cn.

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Associated Data

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Supplementary Materials

Supplementary Material 1 (349.4KB, docx)

Data Availability Statement

Data from the Global Health Data Exchange are publicly available online (https://www.healthdata.org/).

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