Global, regional, and national temporal trends in mortality and disability-adjusted life years for cardiovascular disease attributable to low temperature during 1990–2019: an age-period-cohort analysis of the global burden of disease 2019 study (Preprint)

BACKGROUND Cardiovascular disease (CVD) is the most common non-communicable disease (NCD) burden attributable to low temperature. Few studies have focused on the worldwide region-specific relationship between CVDs and low temperature. OBJECTIVE We aimed to depict an overview of trends in mortality and disability-adjusted life years (DALYs) for CVDs and its subtypes attributable to low temperature over the past 30 years in 204 countries and regions, along with the associations of these trends with age, period, and birth cohorts. METHODS Data on the estimated burden of CVDs (including ischemic heart disease, hypertensive heart disease, and stroke) attributable to low temperature were obtained from the Global Burden of Disease Study 2019. We utilized an age-period-cohort model to estimate overall annual percentage changes in mortality (net drifts), annual percentage changes from 15~19 to 81~85 years (local drifts), period and cohort relative risk (period/cohort effects) between 1990 and 2019. RESULTS Among NCDs, CVDs had the highest mortality rate and DALY loss attributable to low temperature worldwide in 2019. China, Russia, India, the United States, and Ukraine reported the top five high numbers of death, accounting for 59.1% of global deaths in 2019. Although the number of CVDs death due to low temperature has increased by 35.9% (from 812 to 1104 million), an overall decreasing trend in mortality (net drift, -2.19%,95% CI [-2.34%,-2.05%] per year) and DALYs (net drift, -2.17%,95% CI[-2.26%,-2.09%] per year) loss was found. Countries or regions with high socio-demographic index (SDI) tend to have both high CVD mortality in 2019 (19.45%, 95% CI [14.54%,24.17%]) and mortality decline rate (from 1990 to 2019, net drift, -3.25% [-3.76%,-2.73%] per year), and deaths were concentrated in people over 80 years old (62.6%). The opposite outcome was found in those countries or regions with low SDI (mortality in 2019, 3.74%, 95%CI [2.46%,4.92%], net drift, -1.13% [-1.21%, -1.04%]). Similar trends were found in age-standardized rates and net drift for DALYs. Men have a higher disease burden and die at a younger age globally compared to women. CONCLUSIONS Mortality and DALY loss from CVD attributable to low temperature showed an overall decreasing trend globally, and SDI levels, sex, age, and geographic location contributed to the diversity of the disease burden worldwide. Countries and regions need to adopt individualized responses to tackle diseases.