Global, regional, and national burden of cardiovascular diseases attributable to secondhand smoke, 1990–2021

From 1990 to 2021, the global, regional, and national burden of CVD-SHS showed a paradoxical trend: while ASMR and ASDR declined, the absolute number of deaths and DALYs continued to rise. The burden and its growth rate were negatively correlated with SDI, with the highest impacts observed in low- and middle-SDI regions, males, and older populations. Moreover, stroke-SHS showed a stronger negative correlation with SDI than IHD-SHS, suggesting subtype-specific disparities. These findings highlight the persistent and uneven burden of CVD-SHS worldwide and underscore the need for targeted, region- and disease-specific prevention strategies.