Beijing’s Cardiovascular Disease Burden Shows a Troubling Split Between Incidence and Mortality
A decade of health data from Beijing has revealed a complex and potentially consequential shift in cardiovascular disease across the Chinese capital. While the city’s age-standardized incidence of cardiovascular disease remained broadly stable between 2012 and 2022, the number of newly recorded cases in the population increased over time, and cardiovascular mortality showed a marked upward trend in crude analyses. The findings, drawn from a large prospective cohort of more than 42,000 adults, suggest that Beijing’s cardiovascular challenge is not simply a story of more disease, but of a changing population structure, persistent ischemic heart disease, and an especially concerning rise in stroke among several groups.
The study followed 42,548 Beijing residents aged 18 to 79 and combined information collected through face-to-face questionnaires with physical measurements and laboratory testing. Researchers then linked participants to records of cardiovascular hospitalizations and deaths through December 31, 2022. This linkage used the Beijing Hospital Discharge Information System and the Beijing Death Registry Reporting Information System, allowing the investigators to track serious cardiovascular events beyond what surveys or clinic visits alone could capture. The design is important because cardiovascular disease often develops silently before a hospitalization, while mortality records provide a separate measure of the disease’s ultimate impact.
Across the study period, the crude incidence of cardiovascular disease was 723.1 cases per 100,000 person-years. A person-year represents one individual being observed for one year, or several individuals being observed for shorter or longer periods; it allows researchers to account for differences in follow-up time. When the researchers standardized the data to the age and, where appropriate, gender distribution of Beijing’s 2020 census population, the incidence was 816.9 cases per 100,000 person-years. The crude rate increased at an annual rate of 5.5 percent, with a 95 percent confidence interval ranging from 4.1 to 7.0 percent. The standardized annual change was much smaller—1.5 percent, with a confidence interval from –1.1 to 4.1 percent—indicating that population aging and demographic change contributed substantially to the apparent long-term rise.
That distinction between crude and standardized rates is central to interpreting the results. A crude rate describes what happened in the population as it existed at each point in time. A standardized rate instead asks what the trend would look like if the population had the same reference age structure throughout the study. Because cardiovascular disease becomes more common with age, a growing or aging population can produce more cases even when the underlying age-specific risk changes little. The Beijing findings therefore point to a cardiovascular burden that is expanding in absolute terms, while the risk adjusted for population composition has remained relatively steady. For health systems, however, the number of people requiring diagnosis, treatment, rehabilitation and long-term monitoring still matters enormously.
Ischemic heart disease appeared to be the dominant component of the cardiovascular picture. Its standardized incidence rate was 507.7 cases per 100,000 person-years, compared with 436.2 cases per 100,000 person-years for stroke. Ischemic heart disease develops when narrowed or blocked coronary arteries restrict blood flow to the heart muscle, potentially causing angina, myocardial infarction or chronic damage. Stroke, by contrast, occurs when blood flow to the brain is interrupted by a clot or when a blood vessel ruptures. The study’s overall conclusion was that the long-term incidence pattern was predominantly driven by ischemic heart disease, even as stroke trends generated some of the sharpest warnings.
The researchers detected annual increases in adjusted stroke incidence among males, adults aged 18 to 59, people without diabetes, individuals with obesity and participants who had one chronic disease. These patterns complicate the assumption that stroke is mainly a disease of advanced age or of people already diagnosed with diabetes. They also suggest that prevention strategies focused only on older adults or on a single established risk factor could miss important changes in the population. The finding among younger and middle-aged adults is particularly significant because a stroke during working age can produce years or decades of disability, loss of income and dependence on family or social care.
The study also reported a striking contrast in mortality. The crude cardiovascular mortality rate was 73.2 deaths per 100,000 person-years, while the standardized rate was 137.5 per 100,000 person-years. Crude mortality increased by 13.0 percent annually, with a 95 percent confidence interval of 8.0 to 18.2 percent. The standardized annual change was 8.0 percent, but its confidence interval—from –1.8 to 18.7 percent—was wide enough that the authors did not establish a statistically definitive increase after standardization. These apparently counterintuitive values underscore how strongly the choice of denominator and adjustment method affects interpretation. They also mean that the mortality signal should be read as serious but not as proof of a precisely measured, uniform rise in age-adjusted death risk.
Another major result emerged after the first cardiovascular event: the 10-year cumulative recurrence rate was 52.8 percent. In practical terms, roughly half of the patients represented in the recurrence analysis experienced another cardiovascular event over a decade. Recurrence is not merely a statistical footnote. Cardiovascular disease often becomes a chronic condition involving damaged blood vessels, persistent inflammation, altered heart function or continuing exposure to risk factors. A first heart attack or stroke can therefore mark the beginning of a prolonged period of vulnerability rather than the end of a single episode. The high cumulative rate strengthens the case for sustained secondary prevention, follow-up care and rehabilitation after hospitalization.
To estimate recurrence in the presence of competing risks, the investigators used a Fine–Gray model. In longitudinal health research, a competing risk is an event such as death from another cause that prevents the outcome of interest from being observed in the usual way. Treating competing events incorrectly can distort estimates, particularly in older or medically complex populations. For the broader incidence analysis, the researchers used Poisson regression models to calculate adjusted rates, accounting for factors including age, gender and living area. They also standardized rates to the 2020 Beijing census population, enabling comparisons across years that are less affected by demographic shifts.
The findings do not by themselves identify why cardiovascular disease changed in Beijing or prove that any single exposure caused the observed patterns. The study does, however, provide a detailed population-level warning: cardiovascular disease remains a major burden, ischemic heart disease accounts for much of the incidence, and stroke is rising in groups that include men, younger adults and people with obesity. The authors argue that prevention and control efforts should reverse these stroke trends while addressing the large reservoir of recurrent disease. With data drawn from citywide hospital and death registries and from a substantial adult cohort, the results offer policymakers a sharper picture of where pressure on Beijing’s health system is likely to persist—and where earlier intervention may have the greatest effect.
Subject of Research: Cardiovascular disease incidence, mortality and recurrence among adults in Beijing from 2012 to 2022
Subject of Research: Medicine
Article Title: Trends in cardiovascular disease incidence and mortality in Beijing, 2012–2022
Article References: Ma, A., Zeng, Z., Li, X., Yang, C., Wang, J., Li, G., Guo, M., Lu, F., Nie, L., Xie, C., Jiang, B., Lv, J., & Li, L. (2026). Trends in cardiovascular disease incidence and mortality in Beijing, 2012–2022. BMC Public Health. https://doi.org/10.1186/s12889-026-29254-4
Image Credits: AI Generated
DOI: 10.1186/s12889-026-29254-4
Keywords: cardiovascular disease, ischemic heart disease, stroke, incidence, mortality, recurrence, Beijing, epidemiology
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Evelyn A. (August 29, 2026). Beijing Cardiovascular Disease Incidence and Mortality Trends, 2012–2022. Scienmag. https://scienmag.com/beijing-cardiovascular-disease-incidence-and-mortality-trends-2012-2022/
Evelyn A. “Beijing Cardiovascular Disease Incidence and Mortality Trends, 2012–2022.” Scienmag, 29 August 2026, https://scienmag.com/beijing-cardiovascular-disease-incidence-and-mortality-trends-2012-2022/. Accessed 29 August 2026.
Evelyn A. “Beijing Cardiovascular Disease Incidence and Mortality Trends, 2012–2022.” Scienmag. August 29, 2026. https://scienmag.com/beijing-cardiovascular-disease-incidence-and-mortality-trends-2012-2022/
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