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Mortality from cardiovascular diseases in sub-Saharan Africa, 1990-2013: a systematic analysis of data from the Global Burden of Disease Study 2013.

Mensah GA, Roth GA, Sampson UK, Moran AE, Feigin VL, Forouzanfar MH, Naghavi M, Murray CJ, GBD 2013 Mortality and Causes of Death Collaborato - Cardiovasc J Afr (2015 Mar-Apr)

Bottom Line: Most CVD deaths, however, occur in low- and middle-income, developing countries (LMICs) and there is great concern that CVD mortality and burden are rapidly increasing in LMICs as a result of population growth, ageing and health transitions.In SSA, CVDs are neither epidemic nor among the leading causes of death.However, a significant increase in the number of deaths from CVDs has occurred since 1990, largely as a result of population growth, ageing and epidemiological transition.

View Article: PubMed Central - HTML - PubMed

Affiliation: Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA. George.Mensah@nih.gov.

ABSTRACT

Background: Cardiovascular disease (CVD) has been the leading cause of death in developed countries for most of the last century. Most CVD deaths, however, occur in low- and middle-income, developing countries (LMICs) and there is great concern that CVD mortality and burden are rapidly increasing in LMICs as a result of population growth, ageing and health transitions. In sub-Saharan Africa (SSA), where all countries are part of the LMICs, the pattern, magnitude and trends in CVD deaths remain incompletely understood, which limits formulation of data-driven regional and national health policies.

Objective: The aim was to estimate the number of deaths, death rates, and their trends for CVD causes of death in SSA, by age and gender for 1990 and 2013.

Methods: Age- and gender-specific mortality rates for CVD were estimated using the Global Burden of Disease (GBD) 2010 methods with some refinements made by the GBD 2013 study to improve accuracy. Cause of death was estimated as in the GBD 2010 study and updated with a verbal autopsy literature review and cause of death ensemble modelling (CODEm) estimation for causes with sufficient information. For all quantities reported, 95% uncertainty intervals (UIs) were also computed.

Results: In 2013, CVD caused nearly one million deaths in SSA, constituting 38.3% of non-communicable disease deaths and 11.3% of deaths from all causes in that region. SSA contributed 5.5% of global CVD deaths. There were more deaths in women (512,269) than in men (445,445) and more deaths from stroke (409,840) than ischaemic heart disease (258,939). Compared to 1990, the number of CVD deaths in SSA increased 81% in 2013. Deaths for all component CVDs also increased, ranging from a 7% increase in incidence of rheumatic heart disease to a 196% increase in atrial fibrillation. The age-standardised mortality rate (per 100,000) in 1990 was 327.6 (CI: 306.2-351.7) and 330.2 (CI: 312.9-360.0) in 2013, representing only a 1% increase in more than two decades.

Conclusions: In SSA, CVDs are neither epidemic nor among the leading causes of death. However, a significant increase in the number of deaths from CVDs has occurred since 1990, largely as a result of population growth, ageing and epidemiological transition. Contrary to what has been observed in other world regions, the age-adjusted mortality rate for CVD has not declined. Another important difference in CVD deaths in SSA is the predominance of stroke as the leading cause of death. Attention to aggressive efforts in cardiovascular health promotion and CVD prevention, treatment and control in both men and women are warranted. Additionally, investments to improve directly enumerated epidemiological data for refining the quantitation of risk exposures, death certification and burden of disease assessment will be crucial.

No MeSH data available.


Related in: MedlinePlus

Number of CVD deaths in men (A) and women (B) in 1990 and 2013 in sub-Saharan Africa, developing countries, and in developed countries. Age-standardised CVD death rates per 100 000 population are shown for men (C) and women (D) in 1990 and 2013 in sub-Saharan Africa, developing countries, and in developed countries.
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Figure 1: Number of CVD deaths in men (A) and women (B) in 1990 and 2013 in sub-Saharan Africa, developing countries, and in developed countries. Age-standardised CVD death rates per 100 000 population are shown for men (C) and women (D) in 1990 and 2013 in sub-Saharan Africa, developing countries, and in developed countries.

Mentions: As shown in Fig. 1 for both men and women, the number of CVD deaths in SSA was substantially lower than that seen for either the developed or developing countries. Contrary to the pattern seen for developed and developing countries (as a whole), the age-standardised mortality rate for CVD in both men and women in SSA did not decline during the period from 1990 to 2013 (Fig. 1). In fact, the age-standardised mortality rate for women in SSA, which was lower than the corresponding rate in women in developing countries in 1990, is now higher than the rate seen for women in developing countries, and substantially higher than the corresponding rates for both men and women in the developed world (Fig. 1).


Mortality from cardiovascular diseases in sub-Saharan Africa, 1990-2013: a systematic analysis of data from the Global Burden of Disease Study 2013.

Mensah GA, Roth GA, Sampson UK, Moran AE, Feigin VL, Forouzanfar MH, Naghavi M, Murray CJ, GBD 2013 Mortality and Causes of Death Collaborato - Cardiovasc J Afr (2015 Mar-Apr)

Number of CVD deaths in men (A) and women (B) in 1990 and 2013 in sub-Saharan Africa, developing countries, and in developed countries. Age-standardised CVD death rates per 100 000 population are shown for men (C) and women (D) in 1990 and 2013 in sub-Saharan Africa, developing countries, and in developed countries.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4557490&req=5

Figure 1: Number of CVD deaths in men (A) and women (B) in 1990 and 2013 in sub-Saharan Africa, developing countries, and in developed countries. Age-standardised CVD death rates per 100 000 population are shown for men (C) and women (D) in 1990 and 2013 in sub-Saharan Africa, developing countries, and in developed countries.
Mentions: As shown in Fig. 1 for both men and women, the number of CVD deaths in SSA was substantially lower than that seen for either the developed or developing countries. Contrary to the pattern seen for developed and developing countries (as a whole), the age-standardised mortality rate for CVD in both men and women in SSA did not decline during the period from 1990 to 2013 (Fig. 1). In fact, the age-standardised mortality rate for women in SSA, which was lower than the corresponding rate in women in developing countries in 1990, is now higher than the rate seen for women in developing countries, and substantially higher than the corresponding rates for both men and women in the developed world (Fig. 1).

Bottom Line: Most CVD deaths, however, occur in low- and middle-income, developing countries (LMICs) and there is great concern that CVD mortality and burden are rapidly increasing in LMICs as a result of population growth, ageing and health transitions.In SSA, CVDs are neither epidemic nor among the leading causes of death.However, a significant increase in the number of deaths from CVDs has occurred since 1990, largely as a result of population growth, ageing and epidemiological transition.

View Article: PubMed Central - HTML - PubMed

Affiliation: Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA. George.Mensah@nih.gov.

ABSTRACT

Background: Cardiovascular disease (CVD) has been the leading cause of death in developed countries for most of the last century. Most CVD deaths, however, occur in low- and middle-income, developing countries (LMICs) and there is great concern that CVD mortality and burden are rapidly increasing in LMICs as a result of population growth, ageing and health transitions. In sub-Saharan Africa (SSA), where all countries are part of the LMICs, the pattern, magnitude and trends in CVD deaths remain incompletely understood, which limits formulation of data-driven regional and national health policies.

Objective: The aim was to estimate the number of deaths, death rates, and their trends for CVD causes of death in SSA, by age and gender for 1990 and 2013.

Methods: Age- and gender-specific mortality rates for CVD were estimated using the Global Burden of Disease (GBD) 2010 methods with some refinements made by the GBD 2013 study to improve accuracy. Cause of death was estimated as in the GBD 2010 study and updated with a verbal autopsy literature review and cause of death ensemble modelling (CODEm) estimation for causes with sufficient information. For all quantities reported, 95% uncertainty intervals (UIs) were also computed.

Results: In 2013, CVD caused nearly one million deaths in SSA, constituting 38.3% of non-communicable disease deaths and 11.3% of deaths from all causes in that region. SSA contributed 5.5% of global CVD deaths. There were more deaths in women (512,269) than in men (445,445) and more deaths from stroke (409,840) than ischaemic heart disease (258,939). Compared to 1990, the number of CVD deaths in SSA increased 81% in 2013. Deaths for all component CVDs also increased, ranging from a 7% increase in incidence of rheumatic heart disease to a 196% increase in atrial fibrillation. The age-standardised mortality rate (per 100,000) in 1990 was 327.6 (CI: 306.2-351.7) and 330.2 (CI: 312.9-360.0) in 2013, representing only a 1% increase in more than two decades.

Conclusions: In SSA, CVDs are neither epidemic nor among the leading causes of death. However, a significant increase in the number of deaths from CVDs has occurred since 1990, largely as a result of population growth, ageing and epidemiological transition. Contrary to what has been observed in other world regions, the age-adjusted mortality rate for CVD has not declined. Another important difference in CVD deaths in SSA is the predominance of stroke as the leading cause of death. Attention to aggressive efforts in cardiovascular health promotion and CVD prevention, treatment and control in both men and women are warranted. Additionally, investments to improve directly enumerated epidemiological data for refining the quantitation of risk exposures, death certification and burden of disease assessment will be crucial.

No MeSH data available.


Related in: MedlinePlus