A Vital Surveillance Based Descriptive Study:Death Of Main Cardiovascular Diseases And Its Influential Factors For Chinese Adults Aged Above 40

Objectives:To understand the mortality of major cardiovascular diseases in China,and to describe the mortality trends and geographical variations of ischemic heart disease(IHD)and cerebrovascular diseases for the Chinese adults over the age of 40.Combining with the data of behavioral risk factors,a multilevel statistical model analysis was conducted to explore the associations between geographical-differences of IHD mortality and cerebrovascular diseases and related risk factors in China.The findings of this study may lay a foundation for the prevention and control of cardiovascular diseases in China.Materials and Methods:Data were collected from the national death cause surveillance system of the Chinese Center for Disease Control and Prevention,surveillance of chronic diseases and risk factors in China in 2013,as well as the 2010 national census.Descriptive analysis was used to analyze the mortality of cardiovascular diseases in Chinese adults aged above 40 in 2015,and explore its trend of mortality of IHD and cerebrovascular diseases from 2010 to 2015.By setting us a multilevel negative binomial regression model,we probed the potential effects of these risk factors,such as urbanization rate,metabolic factors and behavioral risks on the IHD mortality and cerebrovascular diseases.Excel 2007 was used for data collection,and MLwiN2.30 software was used for multilevel analysis to obtain the relative risk(RR)with 95%confidence interval(95%CI).Results:The crude mortality rate was 273.17/100,000 with death totaled at 3.8 million deaths(2.09 million males,1.71 million females)in 2015.The crude mortality rate of IHD was 108.74/100,000,which was about 1.51 million deaths,accounted for 39.74%of all cardiovascular deaths.The crude mortality rate of cerebrovascular disease as 136.40/100,000,which was about 1.90 million deaths,accounted for 50%of all cardiovascular deaths.The standardized mortality rate for cardiovascular disease decreased from 2010 to 2015 for adults aged over 40 years old in China.Compared with that in 2010,the overall standardized mortality rate in 2015 decreased by 8.47%.Among which,cerebrovascular disease mortality decreased by 16.74%,particularly in males and among urban and eastern residents.IHD mortality generally showed a slow upward trend,as standardized mortality rate increased by 5.51%.The significance was observed in females,rural areas and western residents.The multilevel analysis results indicated there were significant differences by gender,urban/rural and regions for IHD and cerebrovascular disease mortality for adults aged above 40.Overall,mortality was higher in males than that in females,rural higher than urban,and the peak was observed in the central China.There were differences between the north and the south for IHD.Analysis on the associations between regional mortality differences and metabolic,economic,behavioral risk factors showed that the high urbanization rate was negatively associated with IHD and cerebrovascular disease mortality(RR 0.728,95%CI 0.631,0.840,RR 0.506,95%CI 0.446,0.575);mortality of IHD was significantly higher in those with higher proportion without medical insurance(RR= 1.218;Cl:1.007,1.473 95%).Higher household income was negatively associated with cerebrovascular disease mortality(RR 0.854,95%CI 0.737,0.989).The average level of BMI and SBP(systolic blood pressure)was positively correlated with the mortality of cardiovascular disease.The average level of HDL(high density lipoprotein)was negatively correlated with the mortality of cardiovascular disease.No statistical significance was observed for the relationship between other lifestyle factors and IHD/cerebrovasculardiseases mortality,such as the current smoking rate,excessive intake of red meat and vegetables and fruits intake rate.There were some uncertainties between the average sedentary duration and the mortality of cardiovascular diseases due to the some possible deviations of the data.Conclusion:The mortality of cardiovascular diseases showed a downward trend for Chinese adults aged above 40 during 2010 to 2015.The mortality of IHD showed an upward trend,and cerebrovascular diseases showed a downward trend.There were significant differences by gender,urban/rural and different regions for mortality of cardiovascular disease.The improvement of urbanization rate has some significant effects on reducing cardiovascular disease mortality.Systolic blood pressure(SBP)and overweight/obesity(BMI)are risk factors of cardiovascular diseases.HDL is a protective factor.Higher medical insurance ratio and family income level are beneficial to reduce the mortality of cardiovascular diseases.