The Global Burden of Ischemic Heart Disease in Females: Data from the 10 Most Populous Low-and Middle-Income Countries

Ischemic heart disease (IHD) is a major contributor to mortality in low-and middle-income countries (LMICs). However, the burden of IHD in females in LMICs is not well described.

Methods

We analyzed trends in incidence, prevalence, mortality and age-standardized mortality rates (ASMRs) among females from IHD from the ten most-populous LMICs using data from the Global Burden of Disease (GBD) Study from 1990 to 2019. We used Joinpoint Regression Program to analyze trends in mortality and ASMR among females from IHD and permutation tests to estimate the average annual percentage change (AAPC).

Results

In females in the 10 LMICs from 1990 to 2019, IHD incidence increased from 950,000 cases/year to 1.6 million/year, IHD prevalence increased from 8 million to 22.5 million (181% increase) and IHD mortality from 428,320 to 1,040,817 (143% increase). IHD mortality for each country increased with the greatest shift in AAPC seen in the Philippines (5.8%, 95% CI 5.4-6.1) and India (3.7%, 95% CI 3.0-4.4). IHD accounted for 6.2% of all deaths among females in 1990, doubling to 13.2% in 2019. IHD ASMR for females declined in all countries except in Indonesia (AAPC 0.4%), Pakistan (AAPC 0.5%) and the Philippines (AAPC 1.0%). Reductions in ASMR were greater for males than females in Afghanistan, Iran, Egypt, Ethiopia and Nigeria (all p<0.001).

Conclusions

The incidence, prevalence and mortality from IHD among females in LMIC has increased in the 10 most populous LMICs from 1990 to 2019. While the ASMR from IHD across most countries is declining, this was not uniformly noted. Furthermore, several countries noted lesser improvement in ASMR amongst females compared to males. Public policies must acknowledge the increasing burden of IHD among females in LMICs, and target interventions that pursue improving preventive health care, and access to safe food environments among females globally.