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CVJAFRICA • Volume 26, No 2, H3Africa Supplement, March/April 2015
S6
AFRICA
Cardiovascular Topics
Mortality from cardiovascular diseases in sub-Saharan
Africa, 1990–2013: a systematic analysis of data from the
Global Burden of Disease Study 2013
George A Mensah, Gregory A Roth, Uchechukwu KA Sampson, Andrew E Moran, Valery L Feigin,
Mohammed H Forouzanfar, Mohsen Naghavi, Christopher JL Murray, for the GBD 2013 Mortality and
Causes of Death collaborators
Abstract
Background:
Cardiovascular disease (CVD) has been the
leading cause of death in developed countries for most of the
last century. Most CVD deaths, however, occur in low- and
middle-income, developing countries (LMICs) and there is
great concern that CVD mortality and burden are rapidly
increasing in LMICs as a result of population growth, ageing
and health transitions. In sub-Saharan Africa (SSA), where
all countries are part of the LMICs, the pattern, magnitude
and trends in CVD deaths remain incompletely understood,
which limits formulation of data-driven regional and national
health policies.
Objective:
The aim was to estimate the number of deaths,
death rates, and their trends for CVD causes of death in SSA,
by age and gender for 1990 and 2013.
Methods:
Age- and gender-specific mortality rates for CVD
were estimated using the Global Burden of Disease (GBD)
2010 methods with some refinements made by the GBD 2013
study to improve accuracy. Cause of death was estimated as
in the GBD 2010 study and updated with a verbal autopsy
literature review and cause of death ensemble modelling
(CODEm) estimation for causes with sufficient information.
For all quantities reported, 95% uncertainty intervals (UIs)
were also computed.
Results:
In 2013, CVD caused nearly one million deaths in
SSA, constituting 38.3% of non-communicable disease deaths
and 11.3% of deaths from all causes in that region. SSA
contributed 5.5% of global CVD deaths. There were more
deaths in women (512 269) than in men (445 445) and more
deaths from stroke (409 840) than ischaemic heart disease
(258 939). Compared to 1990, the number of CVD deaths in
SSA increased 81% in 2013. Deaths for all component CVDs
also increased, ranging from a 7% increase in incidence of
rheumatic heart disease to a 196% increase in atrial fibril-
lation. The age-standardised mortality rate (per 100 000) in
1990 was 327.6 (CI: 306.2–351.7) and 330.2 (CI: 312.9–360.0)
in 2013, representing only a 1% increase in more than two
decades.
Conclusions:
In SSA, CVDs are neither epidemic nor among
the leading causes of death. However, a significant increase
in the number of deaths from CVDs has occurred since 1990,
largely as a result of population growth, ageing and epide-
miological transition. Contrary to what has been observed
in other world regions, the age-adjusted mortality rate for
CVD has not declined. Another important difference in CVD
deaths in SSA is the predominance of stroke as the leading
cause of death. Attention to aggressive efforts in cardiovas-
cular health promotion and CVD prevention, treatment and
control in both men and women are warranted. Additionally,
investments to improve directly enumerated epidemiological
data for refining the quantitation of risk exposures, death
certification and burden of disease assessment will be crucial.
Keywords:
cardiovascular diseases, sub-Saharan Africa, epide-
miology, mortality rate, global burden of disease, developing
countries
Cardiovasc J Afr
2015;
26
: S6–S10
www.cvja.co.zaDOI:
10.5830/CVJA-2015-036
Cardiovascular disease (CVD), principally ischaemic heart
disease and stroke, constitute the leading cause of global
mortality, and accounted for 17.3 million deaths worldwide in
2013.
1
In high-income, developed countries, CVDs have been the
Center for Translation Research and Implementation
Science (CTRIS), National Heart, Lung, and Blood Institute,
National Institutes of Health, Bethesda, MD, USA
George A Mensah, MD,
George.Mensah@nih.govUchechukwu KA Sampson, MD
Institute for Health Metrics and Evaluation, University of
Washington, Seattle, WA, USA
Gregory A Roth, MD
Mohammed H Forouzanfar, MD
Mohsen Naghavi, MD
Christopher JL Murray, MD
Division of General Medicine, Columbia University Medical
Center, NewYork, NY, USA
Andrew E Moran, MD
Faculty of Health and Environmental Sciences, National
Institute for Stroke and Applied Neurosciences, Auckland
University of Technology, Auckland, New Zealand
Valery L Feigin, MD