Global, regional, and national burden of ischaemic heart disease from 1990 to 2021: a comprehensive analysis based on the Global Burden of Disease study 2021

Background: Globally, the issue of ischaemic heart disease (IHD) has emerged as a prominent public health challenge in the ongoing process of ageing. Previous assessments relied upon data constrained by geographical scope and lacking a thorough worldwide evaluation. We aimed to present the incidence, prevalence, death, and disability-adjusted life years (DALYs) due to IHD at global, regional, and national levels from 1990 to 2021, emphasising decomposition and progressive analysis. We aim to provide relevant information to guide health policy decisions, allocate medical resources effectively, and improve patient care protocols for greater efficiency. Methods: We aimed to accurately depict the health impact of IHD by applying standardised Global Burden of Disease approaches and analysing four key epidemiological indicators: prevalence, incidence, mortality, and DALYs. We quantified temporal trends in the burden of IHD from 1990 to 2021 using the estimated annual percentage change (EAPC) metric. We conducted an in-depth examination of global trends, categorising them by age group, gender, and the sociodemographic index (SDI) to provide a more nuanced understanding. Decomposition analyses of IHD DALYs, which examine the effects of age distribution, population dynamics, and changes in disease patterns, enabled us to accurately quantify the specific contributions of each factor to the overall IHD burden. Using frontier analytical methods, we intended to pinpoint the minimal plausible burden of IHD, contingent on the level of development, as gauged by the SDI. Results: In 2021, the age-standardised incidence rate (ASIR) of IHD decreased compared with 1990 (EAPC = -0.44; 95% confidence interval = -0.47, -0.42). Moreover, the age-standardised mortality rates (ASMR) and DALYs (ASDR) decreased over time. The overall IHD burden was marginally higher in males than in females. The global rates for prevalence, incidence, deaths, and DALYs related to IHD demonstrated an overall rising trend along with age. Among all regions, the North Africa and Middle East region exhibited the highest ASIR (ASIR = 895.85; 95% uncertainty interval (UI) = 786.65, 1043.49) and age-standardised prevalence rate (ASPR) (ASPR = 6404.84; 95% UI = 5872.02, 7041.08) for IHD in 2021. Central Asia recorded the highest ASMR (ASMR = 265.51; 95% UI = 240.67, 290.42) and ASDR (ASDR = 4864.49; 95% UI = 4415.55, 5338.75) in 2021. Decomposition analysis revealed population growth and ageing as primary factors driving the rise in IHD DALYs. Frontier analysis illuminated ample room for enhancement across the entire development continuum. Conclusions: The variability in IHD burden is influenced by gender, age, and geographic location. The global burden of IHD has persistently increased during the last three decades, notably among older males. The escalating ageing population and demographic expansion underscore the importance of bolstering public health measures and optimising resource allocation, particularly in etiological investigation, prompt diagnosis, preventive measures, and locally tailored management for IHD.