Gender‐specific prevalence and trend of heart failure in China from 1990 to 2019

**Background:** Heart failure (HF) is a major cause of disability and mortality worldwide, but comprehensive epidemiological data for China, particularly regarding gender differences, have been lacking. Previous studies, such as the InterASIA study in 2000, reported a chronic HF prevalence of 0.9% (0.7% for males, 1.0% for females), while a more recent study in 2017 found an age-adjusted prevalence of 1.1% with comparable rates between sexes. However, no population-level studies had examined temporal trends by gender. This study aimed to analyze gender-specific prevalence and temporal trends of HF in China from 1990 to 2019, and to explore attributable aetiologies and risk factors.

**Methods:** Data were obtained from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, which assessed HF prevalence and years lived with disability (YLD) for China. The analysis included all individuals defined as having HF impairment in China from 1990 to 2019. Age-standardized prevalence and YLD rates were calculated using the WHO World Standard Population Distribution (2000–2025). Temporal trends were analyzed using Joinpoint regression models, which calculate the annual percentage change (APC) for each segment. The underlying causes of HF were categorized as hypertensive heart disease (HHD), ischaemic heart disease (IHD), chronic obstructive pulmonary disease (COPD), rheumatic heart disease, non-rheumatic valvular heart disease, cardiomyopathy, and endocarditis. Metabolic risk factors examined included high systolic blood pressure, high body mass index (BMI), high LDL-cholesterol, and high fasting plasma glucose.

**Key Results:** Between 1990 and 2019, total prevalent HF cases in China increased from 7.03 million (95% UI: 5.70–8.84 million) to 18.51 million (95% UI: 14.07–23.02 million). The total age-standardized prevalence rate decreased from 1079.4 to 1032.8 per 100,000 individuals over the past two decades. However, since 2017, the prevalence trend has significantly increased, with an APC of 2.72 for females and 0.61 for males (P < 0.05). In 2019, the age-standardized prevalence rate in females (1019.44 per 100,000; 95% UI: 833.34–1267.34) surpassed that in males for the first time. The leading cause of HF was HHD, accounting for 42.65% of cases in females and 41.19% in males. From 2017 to 2019, high systolic pressure contributed most to HF-related HHD, with an APC of 2.68 for females and 0.48 for males (P < 0.05). For IHD, the top three metabolic risk factors were high systolic pressure, high LDL-cholesterol, and high fasting plasma glucose, each approximately tripling total YLD from 1990 to 2019. High BMI-related YLD for IHD doubled over the same period, from 6.01 to 14.00 per 100,000 in men and from 6.04 to 13.65 per 100,000 in women.

**Clinical Implications:** The study reveals a concerning reversal in the declining trend of HF prevalence in China since 2017, particularly among women, who now have higher age-standardized rates than men. Hypertensive heart disease, driven by high systolic blood pressure, is the predominant cause, underscoring the urgent need for improved hypertension detection and control, especially in women. The rising contribution of metabolic risks, including high BMI, highlights the importance of population-level interventions targeting lifestyle factors. Gender-specific screening programs and tailored management strategies are essential to address the growing burden of HF in China.