The global estimate of premature cardiovascular mortality: a systematic review and meta-analysis of age-standardized mortality rate

Abstract

Background: Cardiovascular disease (CVD) is a significant cause of premature mortality worldwide, with a growing burden in recent years. Despite this, there is a lack of comprehensive meta-analyses that quantify the extent of premature CVD mortality. Study addressed this gap by estimating the pooled age-standardized mortality rate (ASMR) of premature CVD mortality.

Methods: We conducted a systematic review of published CVD mortality studies that reported ASMR as an indicator for premature mortality measurement. All English articles published as of October 2022 were searched in four electronic databases: PubMed, Scopus, Web of Science (WoS), and the Cochrane Central Register of Controlled Trials (CENTRAL). We computed pooled estimates of ASMR using random-effects meta-analysis. We assessed heterogeneity from the selected studies using the I² statistic. Subgroup analyses and meta regression analysis was performed based on sex, main CVD types, income country level, study time and age group. The analysis was performed using R software with the "meta" and "metafor" packages.

Results: A total of 15 studies met the inclusion criteria. The estimated global ASMR for premature mortality from total CVD was 96.04 per 100,000 people (95% CI: 67.18, 137.31). Subgroup analysis by specific CVD types revealed a higher ASMR for ischemic heart disease (ASMR = 15.57, 95% CI: 11.27, 21.5) compared to stroke (ASMR = 12.36, 95% CI: 8.09, 18.91). Sex-specific differences were also observed, with higher ASMRs for males (37.50, 95% CI: 23.69, 59.37) than females (15.75, 95% CI: 9.61, 25.81). Middle-income countries had a significantly higher ASMR (90.58, 95% CI: 56.40, 145.48) compared to high-income countries (21.42, 95% CI: 15.63, 29.37). Stratifying by age group indicated that the age groups of 20-64 years and 30-74 years had a higher ASMR than the age group of 0-74 years. Our multivariable meta-regression model suggested significant differences in the adjusted ASMR estimates for all covariates except study time.

Conclusions: This meta-analysis synthesized a comprehensive estimate of the worldwide burden of premature CVD mortality. Our findings underscore the continued burden of premature CVD mortality, particularly in middle-income countries. Addressing this issue requires targeted interventions to mitigate the high risk of premature CVD mortality in these vulnerable populations.

Keywords: Age standardized mortality rate; Cardiovascular diseases; Premature mortality.

Fig. 1

Flow diagram of the published articles evaluated for inclusion in this review

Fig. 2

Forest plot sex-specific premature mortality (ASMR per 100,000 population) from all CVD (ICD-10 codes I00-I99 or ICD-9 codes 350–459)

Fig. 3

Forest plot sex-specific premature mortality (ASMR per 100,000 population) from IHD (ICD-10 codes I20-I25 or ICD-9 codes 410–414)

Fig. 4

Forest plot sex-specific premature mortality (ASMR per 100,000 population) from cerebrovascular disease or stroke (ICD-10 codes I60-I69 or ICD-9 codes 430–438)

Fig. 5

Funnel plot to assess publication bias of overall studies (a) and total CVD (b). (Note: Values on the x-axis refer to ASMR per 100,000 where 1e-01 = 0.1, 1e + 00 = 1, 1e + 01 = 10, 1e + 02 = 100 and 1e + 03 = 1000 and 1e + 05 = 10,000)