Mortality due to acute myocardial infarction in China from 1987 to 2014: Secular trends and age-period-cohort effects

Background In contrast with most developed countries, mortality from acute myocardial infarction (AMI) continues to rise in China. We examined secular trends and age, period, and cohort effects in mortality from AMI in China from 1987 to 2014. Methods Data on deaths from AMI between 1987 and 2014 were obtained from the Chinese Health Statistics Annual Report (1987–2001) and the Chinese Health Statistics Yearbook (2003–2015). We then conducted an age-period-cohort analysis using the intrinsic estimator approach. Results There was an upward trend in AMI mortality in both urban and rural populations that accelerated from 2004 onwards. AMI mortality increased 5.6-fold from 1987 to 2014. The net age effect on AMI mortality increased exponentially. AMI mortality risk in the 80–84 years of age bracket was 220.15 and 190.70 times higher than in the 15–19 years of age bracket in urban and rural populations, respectively. There was a V-shaped trend in the net period effect between 1999 and 2009. Meanwhile, although there was a global reduction in the cohort effect in urban and rural AMI mortality, we found a modest increase among urban populations born between 1975 and 1989 and rural populations born between 1990 and 1999. Conclusion The changes in exposure to lifestyle-related risk factors and triggers such as air pollution have contributed to the increase in AMI mortality in China over recent decades. The sharp increase in AMI mortality since 2004 is primarily attributable to population aging and the rise in AMI deaths among younger generations.