Mortality due to acute myocardial infarction in China from 1987 to 2014: Secular trends and age-period-cohort effects☆
Introduction
Acute myocardial infarction (AMI), a major cause of mortality and morbidity globally, is associated with industrialization, urbanization, population aging, and lifestyle transitions [1]. In many Western countries, mortality due to coronary heart disease, including AMI, increased rapidly in the early 20th century and became the leading cause of death by the mid-century [2]. Encouragingly, this was followed by a marked decline in AMI mortality since the 1970s in most of these countries owing to lower exposure to lifestyle risk factors, the development of new effective treatments, and improvements in medical care access [2], [3], [4], [5], [6]. Similarly, newly industrialized countries and regions in East Asia, including South Korea, Hong Kong, and Taiwan, have also experienced declining trends in AMI mortality in recent years following a rapid increase after World War II [7], [8], [9].
China has experienced unprecedented economic growth since the adoption of market-orientated reforms in 1978 and its transition from a planned economy. While this process has caused an acceleration in urbanization and industrialization accompanied by improved living standards, it has also led to population aging and increased exposure to AMI risk factors owing to lifestyle changes and environmental pollution. Furthermore, the epidemiological transition and the attendant rise in the chronic disease burden have taken place more rapidly than other countries [10]. Consequently, mortality due to ischemic heart disease, including AMI, has increased sharply such that it has become one of the major causes of emergency hospitalization and death in China [11], [12].
To our knowledge, however, no previous study has examined the secular trend in AMI mortality in China as well as the effects of age, period, and cohort using a nationally representative population sample. Furthermore, efforts to implement the complex, wide-ranging, and targeted intervention strategies needed to effectively contain and reverse the increase in chronic disease burden in the world's most populous country have been hampered by a lack of useable and reliable population-level health statistics. We therefore examined the secular trend in AMI mortality in China from 1987 to 2014 among the general population, and by rural or urban residence, age group, and cohort, using APC analysis.
Section snippets
Data sources
Cases of AMI were defined using the International Classification of Diseases (ICD) codes. ICD-9 for data collected prior to 2002 and ICD-10 for data from 2002 onwards. Data on annual AMI mortality were obtained from the Chinese Health Statistics Annual Report (1987–2001) and the Chinese Health Statistics Yearbook (2003–2015). Data from these sources are used to compile China's official nationwide mortality statistics, which are based on events recorded by the Ministry of Health-Vital
Overall trends
Fig. 1 shows the secular trend in AMI mortality in China. Our results show a clear upward trend in age-adjusted AMI mortality with a 5.6-fold increase in mortality rates per 100,000 population from 11.40 in 1987 to 64.25 in 2014. A gradual decline in mortality was observed from 1987 through 2000 with fluctuations in this trend between 2000 and 2004. AMI mortality then rose sharply from 14.04 in 2004 to 64.25 in 2014 with fluctuations between 2008 and 2011. Trends in AMI mortality were similar
Discussion
The present study is the first to examine the secular trend in AMI mortality in China and to explore age, period, and cohort effects using APC analysis. In contrast with the steady declines reported in a number of other countries [2], [3], [4], [5], [6], [7], [8], [9], AMI mortality rates in China increased sharply in the past nearly three decades—particularly from 2004 onwards.
The age, period, and cohort effects identified by our analysis may indicate possible population-level factors driving
Any potential conflicts of interest
We declare that we have no conflict of interest.
Acknowledgement of grant support
The study was supported by the National Natural Science Foundation of China (71303012, 71503196), the China Postdoctoral Science Foundation (2015M580862, 2016T90935), and the Shaanxi Provincial Social Science Fund (2015R009).
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All authors participated in the manuscript's conception and design, data analysis and interpretation, take responsibility for the integrity of the work as a whole, and approved the final version for publication. YS and JC designed the study. YS did the statistical analyses. JC, XL and YS did the analysis of the literature and wrote the article, and all the authors revised it critically for important intellectual content. YS takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.