Use of the Cardiovascular Health Index to assess cardiovascular health in China: an integral innovative approach

Background Sub-regions of China vary greatly in economic status and health resources. A comprehensive approach is needed to evaluate regional cardiovascular health status. The purpose of this study was to evaluate the status of prevention and treatment of cardiovascular disease (CVD) in different provinces across China through the application of the China Cardiovascular Health Index. Methods A comprehensive evaluation index—China Cardiovascular Health Index (CHI)—was developed through literature review, Delphi method, and Analytic Hierarchy Process, which included 52 indicators from five domains (prevalence of CVD, exposure to risk factors, prevention and control of risk factors, treatment of CVD, and public health policy and service capacity). Data related to the indicators were collected from several sources, including national surveillance, surveys, registration systems, and scientific research. Standard normal transformation was used to calculate the score of each indicator, and the total CHI score was summarised through accumulation of scores of the 52 indicators multiplied by their corresponding index weights. The CHI score ranged from 0 to 100. Findings The overall CHI for China in 2017 was 49·38, varying from 30·17 to 75·37 across all the sub-regions except Hong Kong, Macao, and Taiwan (for which data were not obtained). Among the 31 provinces, Beijing had the highest CHI score and Tibet had the lowest. The three provinces with the highest scores were Beijing (75·37), Shanghai (75·33), and Zhejiang (74·40), whereas the three with the lowest scores were Tibet (30·17), Guizhou (32·48), and Heilongjiang (33·63). Interpretation The CHI provides a means to assess cardiovascular health and identify strong and weak aspects of prevention and treatment of CVD in certain provinces in China. Targeted strategies and specific policies can be developed and recommended to improve CVD health status. Funding National Key R&D Program of China (2017YFC1310902).