The impact of behavioral risks on cardiovascular disease mortality in China between 1990 and 2019

<h2>Abstract</h2><h3>Aims</h3> Behavioral risks including tobacco use, alcohol use, low physical activity and dietary risks had been proven to contribute to the pathological process in cardiovascular diseases (CVD). Herein the lethal effects attributable to behavioral risks on CVD in China were investigated. <h3>Methods</h3> Data were obtained from the Global Burden of Disease Study 2019. Joinpoint regression analyses and age-period-cohort models were applied. <h3>Results</h3> In China, the total number of CVD deaths attributable to tobacco use, alcohol use, low physical activity and dietary risks in 2019 was 0.98, 0.19, 0.13 and 1.76 million, with an age-standardized rate of 51.2, 9.9, 8.9 and 101.9 per 100 000 people, respectively. Joinpoint analyses suggested a general favorable trend in age-standardized rate of attributable CVD mortality for tobacco use (average annual percent change [AAPC]: -0.9 %, <i>P</i> < 0.001), alcohol use (AAPC: -0.8 %, <i>P</i> < 0.001) and dietary risks (AAPC: -1.3 %, <i>P</i> < 0.001), but unchanged trend for low physical activity (AAPC: 0.2 %, <i>P</i> = 0.525) since 1990. Period effects suggested an improvement in attributable CVD mortality rate across the study period for alcohol use and dietary risks, but more favorable period trends were observed over the past 15 years for tobacco use and before the period 2000–2004 for low physical activity. The patterns for cohort effects differed markedly between men and women. In women, cohort effects revealed an inverted hook-shaped pattern for all these behavioral risks, with the highest risk in cohort born around 1915. In men, the improvement was mainly observed in cohorts born before 1980 for tobacco use and dietary risks, in cohorts born before 1965 for alcohol use, and in cohorts born between 1925 and 1955 for low physical activity. <h3>Conclusion</h3> Behavioral risks, especially the dietary risks, brought out huge burden of CVD in China, and their trajectories differed along with time and genders. Much more priorities should be established to ameliorate the impact of behavioral risks on CVD in China.