Abstract 4369102: Unequal Declines in Cardiovascular Disease Burden by Socio-demographic Index: A Global Joinpoint Analysis

Abstract

Background: While cardiovascular disease (CVD) burden has declined globally, it is unclear whether this progress has been equitable across development levels. The Socio-demographic Index (SDI) allows for standardized comparison across income, education, and fertility strata. Methods: Age-standardized disability-adjusted life year (DALY) rates for CVD from 1990–2021 were obtained from the Global Burden of Disease 2021 database. Five SDI groups were included: High, High-middle, Middle, Low-middle, and Low SDI. Joinpoint regression was applied using fixed inflection points at 1995, 2005, and 2015 to estimate the Annual Percent Change (APC) within each period. Results: Between 1990 and 2021, all SDI groups experienced a reduction in age-standardized DALY rates for cardiovascular disease, but the rate and consistency of progress varied significantly. High SDI regions showed the most pronounced and sustained improvement, with an APC of −1.80% (95% CI −1.92 to −1.67) from 2006 to 2015, followed by −1.21% (−1.35 to −1.07) from 2016 to 2021. High-middle SDI countries improved steadily across all time segments, while middle SDI nations demonstrated fluctuating trends, with smaller and sometimes non-significant APCs. Low-middle SDI regions saw modest declines throughout, but Low SDI regions remained stagnant for over two decades, with a statistically significant decrease only emerging after 2015 (APC −0.83%, 95% CI −0.96 to −0.71). These patterns reflect widening inequities in the global fight against cardiovascular disease. Conclusion: Global CVD burden is decreasing, but disparities in the rate of improvement persist. Countries in lower SDI categories are not experiencing the same pace of decline as their higher SDI counterparts, highlighting an urgent need for equity-driven investment in cardiovascular prevention and care delivery.