关键词: 心血管疾病, 全球疾病负担研究, 死因构成, 伤残调整寿命年, 年龄-时期-队列模型

Abstract: Objective To systematically assess the burden of cardiovascular diseases （CVDs） globally and in China from 1990 to 2021 using data from the Global Burden of Disease （GBD） 2021 study, and to evaluate temporal trends, cause-of-death composition, years of life lost （YLL） contribution, and age-period-cohort effects, so as to provide a scientific basis for differentiated prevention and treatment strategies. Methods CVD data for the globe and China from 1990 to 2021 were extracted from the GBD 2021 database, including incidence, mortality, age-standardized mortality rate （ASMR）, disability-adjusted life years （DALYs）, YLL, and years lived with disability （YLD）. The annual percentage change （APC） and average annual percentage change （AAPC） were calculated to analyze temporal trends. Pareto analysis was used to identify leading causes of death. YLL contribution was calculated to assess the contribution of each cause of death. An age-period-cohort model was constructed to quantify the effects of age, period, and birth cohort on CVD mortality. Results Temporal trend analysis： From 1990 to 2021, the relative changes in ASMR and age-standardized DALY rate for CVDs were negative for both the globe and China. The ASMR for CVDs showed a declining trend, with a greater decline globally （AAPC=-1.336%） than in China （AAPC=-1.216%）. In both regions, the decline in mortality was smaller in males than in females. Cause-of-death composition analysis： From 1990 to 2021, CVDs were the leading cause of death globally and in China. Ischemic heart disease, stroke, and hypertensive heart disease were the top three causes of CVD deaths, collectively accounting for more than 80% of total CVD mortality; however, their rankings differed （globally： ischemic heart disease > stroke > hypertensive heart disease; in China： stroke > ischemic heart disease > hypertensive heart disease）. Premature mortality burden analysis： Although the contribution of YLL showed a gradual decline over the years, it consistently remained at a high level of 90%.Age-period-cohort effects analysis： The results showed that the net drift, age, period, and cohort effects for global CVD mortality were all statistically significant （all P<0.05）. The age effect exhibited a J-shaped increase with advancing age. Both period and cohort effects showed a sustained downward trend over time and across successive birth cohorts. Conclusion Although the age-standardized mortality burden of CVDs has declined overall in both the globe and China, the absolute burden continues to increase, and the problem of premature death remains substantial. China faces distinct challenges in terms of leading causes （stroke vs. ischemic heart disease） and gender disparities compared with the globe. Future prevention and control efforts should take into account the risk characteristics associated with specific ages, periods, and birth cohorts to develop precise and differentiated intervention strategies.

Key words: cardiovascular diseases, Global Burden of Disease（GBD）, cause-of-death composition, disability-adjusted life years, age-period-cohort model