Premature mortality projection for cardiovascular diseases to 2030: a sub-national evaluation towards the SDG 3.4 goals in China

Background: Sustainable Development Goal (SDG) 3.4 aims to reduce premature mortality from non-communicable diseases (NCDs) by one-third by 2030 compared to 2015 levels. To assess whether achieving the goal in China by 2030 is feasible, we investigated the subnational progress in reducing premature mortality rates from cardiovascular diseases (CVD) in China by 2030. Methods: We used national and provincial results of China from the Global Burden of Disease (GBD) 2023 as empirical data for projections. For each sex, province, and year, the probability of death due to CVD was calculated from these life tables with 5-year age-specific mortality rates. We estimated age-standardized premature mortality and average annual percentage changes for 1990-2023 by sex, province, and CVD subtypes. Furthermore, we predicted premature mortality for CVD through 2030 according to the average annual change rate from 2010 to 2023. Findings: During 2015-2030, premature mortality from CVD is projected to reduce by 37.4% (31.3% for males; 47.2% for females), given the current trend. The absolute number of premature CVD mortality also decreased over the period from 1990 to 2023. Among all CVD subtypes, stroke and ischemic heart disease remain the leading causes of premature CVD mortality among males and females. Rheumatic heart disease was projected to have the fastest decline in premature death rates (AAPC = -7.4%, 95% CI: -7.9 to -6.9%), while premature mortality rates for aortic aneurysm showed a significant increase (AAPC = 0.8%, 95% CI: 0.3-1.4%). Premature mortality from CVD varied regionally, with rates differing more than two-fold between the northeastern and eastern regions of China. China is projected to have a high probability of achieving the premature mortality target set by SDG 3.4, although it faces challenges for males. Interpretation: In general, the projection in China suggests that a one-third reduction in premature mortality from CVD will be achievable. These findings underscore the importance of sustained public health efforts, with particular attention needed to address the higher burden in males, the growing burden of aortic aneurysm, and persistent regional inequalities in CVD outcomes. Funding: Noncommunicable Chronic Diseases-National Science and Technology Major Project (2023ZD0503900, 2023ZD0503901).