Increasing mortality from ischaemic heart disease in China from 2004 to 2010: disproportionate rise in rural areas and elderly subjects. 438 million person-years follow-up.

Aims: We sought to ascertain the changes in mortality from ischaemic heart disease (IHD) from 2004 to 2010 in China as the sheer size of China's population makes disease patterns relevant globally.

Methods and results: Data on IHD mortality were obtained from the Chinese Centre for Disease Control and Prevention National Disease Surveillance Point System, which includes 161 counties and a population of over 73 million-a representative sample of over 6% of the entire population of China. Both crude and World Health Organization (WHO)-standardized IHD mortality increased, in both men and women and in both urban and rural locations, during the study period, demonstrating the effect of urbanization, economic growth, and epidemiological transition on cardiovascular health. WHO-standardized IHD mortality increased for rural males by 9.2% per year (95% CI: 6.7-11.7%; P < 0.0001), and the trend was statistically significantly higher (P = 0.0001) than in urban males by 6.4% per year (95% CI: 3-10%; P = 0.02). WHO-standardized IHD mortality rate increased for rural females by 7.0% per year (95% CI: 4.6-9.4%; P < 0.0001); this was statistically significantly higher than urban females by 4.3% per year (95% CI: 1-8%; P = 0.02). The age group over 80 years showed the greatest increase in IHD mortality.

Conclusions: Mortality from IHD is increasing in China, in contrast to decreasing in other countries. This is largely driven by increasing IHD mortality in rural areas and subjects over 80 years old. This needs urgent attention by public health workers and policymakers.