The countries with higher ASIR were mainly distributed in sub-Saharan Africa, Central Asia, Western Asia, and northern part of East Asia.
In different SDI regions, high-middle SDI regions and middle SDI regions showed regional downward trends, while other SDI regions remained stable.
Countries with heavier burden of ASMR and ASDR were concentrated in Eastern Europe, North Asia, Central Asia, West Asia and North Africa.
The ASMR and ASDR showed the most obvious regional downward trend in high SDI regions and high-middle SDI regions.
The ASIR of Non-rheumatic valvular heart was much higher in high SDI.
The ASIR of CVD in individuals aged 15–39 years
In 2019, there were an estimated 3.87 million (95% UI: 332.70-446.79) incident CVD cases among individuals aged 15–39 years worldwide and the ASIR was 129.85 per 100 000 (95% CI: 102.60, 160.31). The highest ASIRs were seen in low SDI and low-middle SDI. (Table 1). The countries with higher ASIR were mainly distributed in sub-Saharan Africa, Central Asia, Western Asia, and northern part of East Asia. (Fig. 1).
Table 1 The burden of CVD in 1990 and 2019 and the temporal trends from 1990 to 2019 in adolescent and young adults Full size table
Fig. 1 The distribution of cardiovascular disease (CVD) burden in adolescent and young adults by countries and regions in 2019 Full size image
In terms of trends, the change in ASIR attributable to CVD among people aged 15–39 years showed a nonsignificant global upward trend from 1990 to 2019, with an EAPC point estimate of 0.04 and a 95%CI containing zero. In different SDI regions, high-middle SDI regions and middle SDI regions showed regional downward trends, while other SDI regions remained stable. In all 204 countries, 72 (35.29%) countries showed an increasing trend of ASIR, mainly distributed in Western Asia, Southeast Asia, East Asia, North Africa and Eastern Europe. Especially in Saudi Arabia, EAPC of ASIR was 1.25 (95%CI: 1.21, 1.29). (Table 1; Fig. 1).
In different genders, from 1990 to 2019, ASIR attributable to CVD showed a slight upward trend in male aged 15–39 years, and the EAPC of ASIR was 0.09 (95%CI: 0.04, 0.14), while the trend in female was not statistically significant. Among different age groups, EAPCs of ASIRs were 0.52 (95%CI: 0.45, 0.60) and 0.11 (95%CI: 0.01, 0.21) in age group 15–19 and 20–24, respectively. There was no significant decrease in ASIR in age group 25–29, while the burden of CVD in other age groups showed a downward trend. (Figure S1).
The ASMR and ASDR of CVD in individuals aged 15–39 years
In 2019, there were 455.85 thousand (95% UI: 420.27-493.99) deaths attributed to CVD among individuals aged 15–39 years and the DALYs were 29.78 million (95%UI: 27.62–32.14). The ASMR and ASDR were 15.12 per 100 000 (95% CI: 13.89, 16.48) and 990.64 per 100 000 (95% CI: 911.06, 1076.46). (Table 1). Countries with heavier burden of ASMR and ASDR were concentrated in Eastern Europe, North Asia, Central Asia, West Asia and North Africa. The highest ASMR was seen in Kiribati and it was nearly 41 times higher than that of the lowest country in Switzerland, which were 90.11 per 100 000 (95% CI: 70.64, 112.92) and 2.22 per 100 000 (95% CI: 1.96, 2.52), respectively. (Fig. 1).
Compared with female, this burden was heavier in male. The ASMRs of female and male were 19.70 per 100 000 (95% CI: 17.93, 21.67) and 10.46 per 100 000 (95% CI: 9.25, 11.63), respectively. Of all five age groups, individuals aged 35–39 years had the largest contribution, with corresponding rates of death and DALYs of 34.93 per 100 000 (95% UI:32.24–37.80) and 1976.74 per 100 000 (95% UI:1836.29-2125.87). (Table 1, Figure S1).
The changes of ASMR and ASDR attributable to CVD among people aged 15–39 years showed global downward trends and the values of EAPC were 0.90 (95% CI: 1.01, 0.78) and 0.80 (95% CI: 0.90, 0.71), respectively. (Table 1). The ASMR and ASDR showed the most obvious regional downward trend in high SDI regions and high-middle SDI regions. The values of EAPC of ASMR were − 1.46 (95%CI: -1.58, -1.34) and − 1.25 (95%CI: -1.45, -1.05), and of ASDR were − 1.17 (95%CI: -1.28,-1.06) and − 1.15 (95%CI: -1.32, -0.98). (Fig. 2).
Fig. 2 Temporal trend of cardiovascular disease (CVD) burden in adolescent and young adults by countries and regions from 1990 to 2019 Full size image
In all 204 countries, 167 (81.86%) countries showed a downward trend and 23 (11.27%) countries showed an upward trend, with the most obvious seen in the Philippines, where EAPC of ASMR was 5.80 (95%CI: 4.79, 6.81). The countries with an upward trend were mainly distributed in South Asia, Southeast Asia, East Asia, sub-Saharan Africa and Northern Europe. Similar to ASMR, the ASDR of most countries showed a downward trend, while 21 countries increased, and 16 countries kept stable. (Fig. 2).
The ASMR and ASDR of different genders showed a downward trend, and it was more obvious in female, especially in the gap of ASMR decline. EAPCs of ASMR were − 1.59 (95%CI:-1.76,-1.42) in female and − 1.34 (95%CI:-1.48,-1.20) in male, EAPCs of ASDR were − 0.48 (95%CI: -0.59, -0.38) in female and − 0.44 (95%CI: -0.54, -0.35) in male. (Table 1; Fig. 3)
Fig. 3 Temporal trend of cardiovascular disease (CVD) burden in adolescent and young adults by sex and SDI from 1990 to 2019 Full size image
CVD types in individuals aged 15–39 years.
RHD had the highest ASIR in individuals aged 15–39 years, which was 50.37 per 100 000 (95%CI: 28.88, 74.15), followed by Stroke and Ischemic heart disease (IHD). IHD was the highest in both ASMR and ASDR, with corresponding rates of 7.02 per 100 000 (95%CI: 6.41, 7.76) and 402.58 per 100 000 (95%CI: 367.59, 445.01). RHD had the highest burden in 15–19 years old and there was a decline with age in individuals aged 15–39 years. The other several types were characterized by the opposite age distribution. In addition, the burden of RHD was the highest in low SDI and low-middle SDI. The ASIR of Non-rheumatic valvular heart was much higher in high SDI. (Fig. 4, Figure S2).
Fig. 4 Proportion of Cardiovascular disease (CVD) types globally in adolescent and young adults by SDI in 2019 Full size image
Attributable risk factors for death and DALY of CVD in individuals aged 15–39 years
There were 27 detailed risk factors attributable to death and DALY in CVD in individuals aged 15–39 years in GBD 2019. High systolic blood pressure, high body-mass index and high LDL cholesterol were the top three risk factors. PAFs of ASMR were 43.60%, 32.73% and 32.17%, PAFs of ASDR were 40.41%, 30.97% and 28.97%, respectively. The PAFs for ambient particulate matter pollution, smoking, a diet low in whole grains, and household air pollution from solid fuels range from 9 to 19%. (Fig. 5).
Fig. 5 Proportion of cardiovascular disease (CVD) death and disability adjusted life years (DALYs) in adolescent and young adults attributable to 27 risk factors by sex and SDI in 2019 Full size image
The distribution had some gender and age characteristics. The PAFs of smoking for deaths and DALYs were 20.28% and 18.24% in male, which was nearly five times higher than that in female. Other risk factors such as ambient particulate matter pollution, diet low in whole grains, diet high in sodium and alcohol use also played a more obvious role in male. For female, secondhand smoke and household air pollution from solid fuels were the most typical influencing factors, which PAFs of ASMR were 7.29% and 11.48% and PAFs of ASDR were 6.10% and 10.24%, both higher than those of male. In different age groups, alcohol use and high systolic blood pressure were more obvious with the increase of age. The effect of temperature was more consistent in different age groups. (Fig. 5, Figure S3).
Compared with regions with a low SDI, death burden for early onset CVD in regions with a high SDI were more attributable to ambient particulate matter pollution (16.99% v 8.15%), smoking (24.18% v 6.54%), high body-mass index (49.40% v 19.32%), diet high in red meat (11.01% v 2.68%), diet high in processed meat (4.18% v 0.84%), diet high in sugar-sweetened beverages (3.56% v 0.69%), low physical activity (3.00% v 0.68%) and high LDL cholesterol (36.69% v 20.52%). In contrast, contributions to death were greater in regions with a low SDI for household air pollution from solid fuels (18.48% v 0.09%), lead exposure (2.57% v 0.36%) and diet low in vegetables (7.03% v 4.25%) compared with a high SDI. The attributable risk factors for DALYs were similar. (Fig. 5, Figure S3).
