Projected impact of urbanization on cardiovascular disease in China

Background: The influence of urbanization on cardiovascular disease in China has not been projected in detail. Objective: Project the impact of urbanization on cardiovascular disease using a national-scale computer model. Methodology: The Coronary Heart Disease (CHD) Policy Model-China is a computer simulation model of CHD and stroke in Chinese adults age 35-84 years old. Populations, risk factor distributions, and cardiovascular disease event and death rates were stratified into four submodels: North-Urban, South-Urban, North-Rural, and South-Rural. 2010 was the base year, and high and low urbanization rate scenarios were used to project 2030 populations. Event rates and age structures within geographic strata were assumed constant. Results: In 2010, China is predominantly rural and cardiovascular disease event rates are generally higher in the urban North and South compared to their rural counterparts (349 versus 279 per 100,000 and 180 versus 111 per 100,000, respectively). From 2010 to 2030, China's urban populations will grow by 50% or more, while rural populations will decline or increase slightly. Comparing 2030 with 2010, 85—100% of excess cardiovascular disease events were projected to occur in cities. Driven by urbanization, age-standardized CHD event rates were projected to increase from 213 to 219—233 per 100,000; stroke rates did not change. Conclusions: By 2030, more than 60% of China's population will live in cities, and urbanization may contribute to the epidemic of cardiovascular disease. Cardiovascular disease health care services and prevention may be more efficiently and effectively targeted toward China's cities.