The disease burden of ischemic heart disease attributable to second-hand smoke in China from 1990 to 2021

Exposure to second-hand smoke (SHS) is linked to ischemic heart disease (IHD), but research on burden in China and across socio-demographic index (SDI) regions is limited. Based on the Global Burden of Disease 2021, we used joinpoint regression and age-period-cohort model to analyze the trend in deaths and disability-adjusted life years (DALYs) of IHD attributable to SHS in China and five SDI regions from 1990 to 2021. Results showed that the age-standardized rates of death and DALY in China remained at a high level, and declined more slowly compared to the five SDI regions. The increasing trends in IHD death and DALY rates were found among Chinese men aged 25-94 and women aged 80-94, while the rates decreased in the five SDI regions. The period and cohort effects indicated a larger decline in deaths and DALYs among Chinese women than men, with the largest reduction in high SDI region. The population attributable fraction for IHD deaths and DALYs due to SHS in China decreased from 8.82% and 9.71% in 1990 to 7.45% and 8.09% in 2021, but remained the highest level compared to the five SDI regions. The findings highlight the need to reduce SHS exposure, especially among men and the elderly in China.