Research article

The future impact of population growth and aging on coronary heart disease in China: projections from the Coronary Heart Disease Policy Model-China

Andrew Moran^{* 1,2} , Dong Zhao^3,4 , Dongfeng Gu^5,6 , Pamela Coxson^{* 7} , Chung-Shiuan Chen^{* 8} , Jun Cheng^{* 3} , Jing Liu^{* 3} , Jiang He^{* 8,9} and Lee Goldman^{* 2}

¹Division of General Internal Medicine, Columbia University Medical Center, New York, USA

²Columbia University College of Physicians and Surgeons, New York, USA

³Department of Epidemiology, Beijing Institute of Heart, Lung, & Blood Vessel Diseases, Beijing, PR China

⁴Capital University of Medical Sciences, Beijing, PR China

⁵Department of Evidence Based Medicine, Cardiovascular Institute and Fu Wai Hospital of the Chinese Academy of Medical Sciences, Beijing, PR China

⁶National Center for Cardiovascular Diseases, Beijing, PR China

⁷University of California at San Francisco, San Francisco, USA

⁸Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, USA

⁹Department of Medicine, Tulane University School of Medicine, New Orleans, USA

author email corresponding author email* Contributed equally

BMC Public Health 2008, 8:394doi:10.1186/1471-2458-8-394

Published:	27 November 2008

Abstract

Background

China will experience an overall growth and aging of its adult population in coming decades. We used a computer model to forecast the future impact of these demographic changes on coronary heart disease (CHD) in China.

Methods

The CHD Policy Model is a validated state-transition, computer simulation of CHD on a national scale. China-specific CHD risk factor, incidence, case-fatality, and prevalence data were incorporated, and a CHD prediction model was generated from a Chinese cohort study and calibrated to age-specific Chinese mortality rates. Disability-adjusted life years (DALYs) due to CHD were calculated using standard methods. The projected population of China aged 35–84 years was entered, and CHD events, deaths, and DALYs were simulated over 2000–2029. CHD risk factors other than age and case-fatality were held at year 2000 levels. Sensitivity analyses tested uncertainty regarding CHD mortality coding, the proportion of total deaths attributable to CHD, and case-fatality.

Results

We predicted 7.8 million excess CHD events (a 69% increase) and 3.4 million excess CHD deaths (a 64% increase) in the decade 2020–2029 compared with 2000–2009. For 2030, we predicted 71% of almost one million annual CHD deaths will occur in persons ≥65 years old, while 67% of the growing annual burden of CHD death and disability will weigh on adults <65 years old. Substituting alternate CHD mortality assumptions led to 17–20% more predicted CHD deaths over 2000–2029, though the pattern of increases in CHD events and deaths over time remained.

Conclusion

We forecast that absolute numbers of CHD events and deaths will increase dramatically in China over 2010–2029, due to a growing and aging population alone. Recent data suggest CHD risk factor levels are increasing, so our projections may underestimate the extent of the potential CHD epidemic in China.