Global, regional and national cardiovascular mortality costs associated with non-optimal temperatures over two decades (2000–2021)

Background and Aims: We designed this study to investigate the mortality costs of cardiovascular disease (CVD) deaths associated with non-optimal, cold and hot temperatures—as an emerging environmental risk factor for CVD—globally, regionally, and nationally between 2000 and 2021. Methods: We obtained disease burden estimates from the Global Burden of Disease (GBD) 2021 study and estimated the cost of CVD deaths linked to non-optimal, cold and hot temperatures using two valuation measures: the age-adjusted and age-invariant value of a statistical life (VSL). To identify key drivers of mortality costs, we performed multiple linear regression (MLR) analysis, examining the effects of climate, socio-economic, and demographic factors. Results: The global mortality costs due to CVD increased by 51 %, rising from US$550.8 billion to US$833.2 billion using the age-adjusted VSL between 2000 and 2021. Cold temperatures accounted for the majority of the global mortality costs linked to non-optimal temperatures, between US$519.6 and US$745.5 billion over the study period. High-income GBD super-region demonstrated the greatest mortality costs, contributing 36–63 % of global mortality cost of CVD due to non-optimal temperatures over the study period. Among the top 5 countries (the USA, China, Russia, Japan, and Germany) with the greatest mortality cost of CVD deaths attributable to non-optimal temperatures, China experienced the most significant increase in mortality costs, rising by over 700 % during the study period and reaching nearly US$230 billion in 2021. Based on MLR findings, the primary factors influencing mortality costs were the age-standardized CVD death rate, gross domestic product (GDP) per capita, and population age structure. Conclusions: Our results underscore the importance of the growing global mortality costs from CVD associated with non-optimal temperatures. The findings should serve to alert the global community regarding the urgent need to develop policies that aim to protect the public, particularly in regions with the highest costs and aging populations.