Global, Regional, and National Burden of Cardiovascular Diseases Associated with Particulate Matter Pollution: A Systematic Analysis of Deaths and Disability-Adjusted Life Years with Projections to 2030

Abstract

Background: This research assesses how fine particulate matter (PM2.5) pollution influences cardiovascular diseases (CVDs) globally.

Methods: Utilizing data from the 2021 Global Burden of Disease (GBD) study, we assessed the impact of PM2.5 pollution on CVDs in individuals aged 25 and older. The health burden was quantified using measures such as disability-adjusted life years (DALYs), age-standardized rates (ASRs), and the effective annual percentage change (EAPC). Joinpoint regression models were used to describe the temporal trends of CVD burdens, while the Bayesian age-period-cohort (BAPC) models were employed to project the CVD burdens through 2030. Frontier analysis was conducted to identify potential areas for improvement and gaps between the development statuses of different countries. Decomposition analysis was applied to assess the impact of population growth, aging, and epidemiological changes on the burden of CVDs.

Results: Despite a decline in ASRs for both sexes, males continued to bear a disproportionate burden of CVDs. While substantial reductions in ASRs have been noted in Western Europe and High-income North America, smaller decreases in the EAPC have been seen in South Asia, Oceania, and Western Sub-Saharan Africa; however, Oceania faces the highest mortality burden. An inverse relationship between the sociodemographic index (SDI) and ASRs is evident nationally. Meanwhile, Afghanistan and Egypt reported elevated ASRs, and Iceland recorded the lowest rate. Projections suggest a potential reversal in ASRs by 2021. A decomposition analysis revealed that intracerebral hemorrhage poses the greatest burden in middle SDI regions, while ischemic heart disease is notably burdensome in high SDI and high-middle SDI regions.

Conclusions: This study highlights the disproportionate burden of CVDs associated with PM2.5 pollution, particularly in males and lower SDI regions, with significant regional disparities and projections indicating potential reversals in trends.

Keywords: Global Burden of Disease; cardiovascular diseases; fine particulate matter; ischemic heart disease; stroke.

Fig. 1.

The global CVDs burden associated with PM2.5 pollution for both sexes in 204 countries and territories. (A) Global distribution of ASDRs for CVDs associated with PM2.5 pollution in 2021. (B) Global distribution of EAPCs of ASDRs for CVDs related to PM2.5 pollution from 1990 to 2021. (C) Global distribution of ASMRs for CVDs pertaining to PM2.5 pollution in 2021. (D) Global distribution of EAPCs of ASMRs for CVDs associated with PM2.5 pollution from 1990 to 2021. ASDR, age-standardized disability rate; CVDs, cardiovascular diseases; PM2.5, fine particulate matter; EAPC, effective annual percentage change; ASMR, age-standardized mortality rate.

Fig. 2.

Temporal trends of ASDRs and ASMRs associated with PM2.5 pollution for CVDs, ischemic heart disease, and stroke by SDI regions from 1990 to 2021. SDI, sociodemographic index; ASDRs, age-standardized disability rates; CVDs, cardiovascular diseases; PM2.5, fine particulate matter; ASMRs, age-standardized mortality rates; DALYs, disability-adjusted life years.

Fig. 3.

Temporal trends of (A) ASDRs and (B) ASMRs associated with PM2.5 pollution for CVDs by gender from 1990 to 2021 using the joinpoint regression model. ASDRs, age-standardized disability rates; CVDs, cardiovascular diseases; PM2.5, fine particulate matter; ASMRs, age-standardized mortality rates; DALYs, disability-adjusted life years; APC, annual percentage change; AAPC, average annual percentage change. * indicates that the annual percent change (APC) is significantly different from zero at the alpha = 0.05 level.

Fig. 4.

Projects the ASRs and numbers of CVDs by gender from 1990 to 2030 based on the BAPC model. (A) ASDRs. (B) ASMRs. ASRs, age-standardized rates; BAPC, Bayesian age–period–cohort; CVDs, cardiovascular diseases; ASMRs, age-standardized mortality rates; ASDRs, age-standardized disability rates.

Fig. 5.

The frontier analysis, denoted by the solid black lines, examines the relationship between the SDI and ASRs for DALYs (A,B) and deaths (C,D) from CVDs associated with PM2.5 exposure. In graphs (A) and (C), the color gradient indicates the temporal progression, with the darkest shades representing the year 1990 and the lightest shades corresponding to 2021. In graphs (B) and (D), each point represents a specific country or territory in 2021, with the 15 countries exhibiting the greatest deviation from the frontier marked in black. Countries with low SDIs and minimal deviation from the frontier are highlighted in blue, while those with high SDIs but substantial deviation relative to their development level are emphasized in red. DALYs, disability-adjusted life years; SDI, sociodemographic index; CVDs, cardiovascular diseases; ASRs, age-standardized rates; PM2.5, fine particulate matter.