by Taylor Lange
Heart disease is the leading cause of death and disability across the world. The Global Burden of Disease Study covers ten specific cardiovascular diseases and designates rarer ailments in an “other” category. The most prevalent and deadly diseases are ischemic heart disease, stroke, and hypertensive heart disease. In 2019, cardiovascular disease lead to the deaths of 18.6 million people globally.[i]
Is there a relationship between the prevalence of heart disease and economic growth? Economists from the University of Malta found that increases in per capita consumption—as opposed to GDP at large—in the EU initially caused increases in per capita mortality from cardiovascular disease before reaching a maximum. Thereafter, evidently, growing per capita consumption led to decreased cardiovascular disease mortality. The economists implied, in other words, that a “Kuznets curve” describes the relationship between GDP per capita and cardiovascular mortality.
More to the Story
While mortality is an important dimension of public health, so are incidence and prevalence of disease. In the Global Burden of Disease Study, incidence is defined as the number of new cases of a disease emerging each year, while prevalence refers to new cases plus cases continuing from previous years. Analyzing incidence and prevalence helps us develop a more holistic view of GDP’s relationship to public health and suggests that economic growth may be driving the pervasiveness of cardiovascular disease because of risks that accompany growth.
Risk factors for cardiovascular disease can be environmental or behavioral. One of the most prominent environmental risk factors for cardiovascular disease is ambient air pollution, which can cause a number of inflammatory responses and oxidative stress. Though many developed countries (such as the USA and EU) have decreased air pollution through regulation, political pressure for loosening such regulations is ever-present when GDP growth is a primary goal. Meanwhile, in countries with the most aggressive GDP growth policies, air pollution is hardly in check. In China, for example, air pollution increases the prevalence of multiple health conditions, including cardiovascular disease.
GDP growth can also bring cultural shifts in lifestyle that result in some increased behavioral risk factors for cardiovascular disease. The “big three” risk factors are dietary change, decreased physical activity, and smoking. With GDP growth often comes a reduction in physical activity and lower-fiber diets, increasing the probability of heart disease. On the other hand, smoking appears to be falling across the globe, though this is attributable to concerted global efforts to curb smoking, rather than increasing GDP.
Conflicting evidence, then, seems to muddle the relationship between GDP and cardiovascular disease. Mortality from cardiovascular disease appears to decrease after a certain level of GDP/capita, presumably due to investment in health services. On the other hand, environmental and behavioral risk factors increase. What do we make of this?
Cardiovascular disease data are available from the Global Burden of Disease Collaborative Network. The network compiles data from numerous national and subnational sources to estimate the impact of 369 diseases. My focus herein is on the global incidence of cardiovascular disease for all ages from 1990 to 2019 (the full extent of their data).
Global incidence of cardiovascular disease rose steadily throughout the study period, from 585 cases per 100,000 people in 1990 to 717 in 2019 (Figure 1). Global GDP rose substantially, too. The concurrent increase results in a tight correlation with a coefficient of 0.96. Such a high correlation coefficient (perfect positive correlation = 1) suggests a strong association between GDP and the incidence of cardiovascular disease.
The relationship is best visualized with a scatterplot. Using regression analysis, we determined the slope of the trend line. The slope indicates how many new cardiovascular disease cases arise per additional trillion dollars of GDP. The slope of this line, estimated at 1.65, means that an average of 1.65 new cases of cardiovascular disease arise per 100,000 people with every additional trillion dollars of global GDP. In other words, per capita heart health decreases with a growing GDP.
This trend is reflected at the national level, too, especially in China. Chinese rates of cardiovascular disease increased throughout the period and have a strong, positive correlation with GDP (coefficient of 0.95). This translates to 27 new cases of cardiovascular disease per additional trillion dollars of GDP. If this trend continues, the Chinese population will have over 16.6 million new cases of cardiovascular disease in 2025.[ii] That’s more patients with heart disease than the population of Maryland, Virginia, and the District of Columbia combined.
Case rates in the EU and USA are different. Cardiovascular disease fluctuates around a decreasing trend until 2006 in the USA and 2009 in the EU, when the trend inverts and rates increase. This pattern is also present in the relationship between heart disease and GDP, and is a characteristic of a positive quadratic relationship, which is the opposite of a Kuznets curve. In other words, continued economic growth is likely to facilitate further increases in cardiovascular disease.
[i] All statistics referenced in this article come from the Global Burden of Disease Study unless otherwise noted:
Vos, Theo, Stephen S. Lim, Cristiana Abbafati, Kaja M. Abbas, Mohammad Abbasi, Mitra Abbasifard, Mohsen
Abbasi-Kangevari, et al. 2020. “Global Burden of 369 Diseases and Injuries in 204 Countries and Territories,
1990–2019: A Systematic Analysis for the Global Burden of Disease Study 2019.” The Lancet 396 (10258):
Taylor Lange is CASSE’s ecological economist.