Objective To analyze the changes in the disease burden of ischemic heart disease (IHD) attributable to high body mass index (hBMI) among Chinese residents from 1990 to 2021, to predict its future trends from 2022 to 2035, so as to provide data support for the development of targeted public health policies.

Methods Using data from the global burden of disease study 2021 (GBD 2021), stratified analyses of age-and gender-specific mortality rates and disability-adjusted life years (DALYs) for IHD attributable to hBMI among Chinese residents from 1990 to 2021 were conducted. The average annual percentage change (AAPC) and its 95% confidence intervals (CI) for both mortality rates and DALY were calculated using Joinpoint regression models to analyze trends in the disease burden of IHD attributable to hBMI in China, globally, and across regions with different socio-demographic index (SDI) levels from 1990 to 2021. Age-standardized mortality rates and age-standardized DALY rates were computed based on the GBD world population standard. Additionally, the Bayesian age-period-cohort (BAPC) model was used to predict the standardized mortality rates and standardized DALYs rates for IHD attributable to hBMI in China from 2022 to 2035.

Results Between 1990 and 2021, the age-standardized mortality rate for IHD attributable to hBMI among Chinese residents increased from 3.34/100 000 to 8.24 /100 000, representing a growth of 146.71%, while the age-standardized DALY rate rose from 79.21/100 000 to 175.05/100 000, with an increase of 120.99%. Age-and gender-specific stratified analyses revealed that the disease burden among individuals aged ≥75 years was higher than that of other age groups, with a greater increase in disease burden observed in males compared to females. Trend analyses indicated that, from 1990 to 2021, the overall age-standardized mortality rate for IHD attributable to hBMI in China rose annually (AAPC=3.41%, 95%CI: 3.02%‒3.80%), whereas the global age-standardized mortality rate declined annually (AAPC=-0.73%, 95% CI: -0.82%‒ -0.65%), and the age-standardized mortality rate in high-middle SDI regions decreased annually (AAPC=-1.05%, 95%CI: -1.36%‒ -0.74%). Concurrently, the overall age-standardized DALY rate in China increased annually (AAPC=2.97%, 95%CI :2.67%‒3.28%), while the global age-standardized DALY rate declined annually (AAPC=-0.47%, 95%CI: -0.56%‒ -0.39%), and the age-standardized DALY rate in high-middle SDI regions decreased annually (AAPC=-1.13%, 95%CI:-1.51%‒ -0.76%). Predictive results indicated that, from 2022 to 2035, both the age-standardized mortality rate (AAPC=2.31%, 95%CI: 2.11%‒2.51%) and age-standardized DALY rate (AAPC= 2.16%, 95%CI: 1.96%‒2.37%) for IHD attributable to hBMI among residents of China are expected to increase annually.

Conclusion The disease burden of IHD attributable to hBMI among Chinese residents continues to increase. It is essential to address the challenges posed by population aging and the large population base. Appropriate body weight management measures should be implemented at both the macro-policy making and individual health management levels to reduce the disease burden associated with hBMI and achieve the high-quality development of population health.