Global, regional and national ischemic heart disease burden attributable to household air pollution from solid fuels, 1990-2021，with projections to 2036: A systematic analysis for the global burden of disease study

Background: Ischemic heart disease (IHD) remains one of the leading causes of death and disability worldwide. Household air pollution (HAP), particularly from incomplete combustion of solid fuels, contributes significantly to the progression of IHD. Understanding the impact of HAP on the global burden of IHD is considerable public health importance. Methods: Using data from the Global Burden of Disease Study 2021, we analyzed and quantified the global burden of IHD attributable to HAP. Key burden metrics, including deaths, disability-adjusted life years (DALYs), and corresponding age-standardized rates (ASRs), were evaluated from 1990 to 2021. The analysis was stratified by age, sex, Socio-demographic Index (SDI), and geographic regions and countries as defined by the GBD framework. Additionally, a Bayesian age-period-cohort (BAPC) model was employed to project future trends in HAP-attributable IHD burden. Results: Between 1990 and 2021, the global number of deaths and DALYs due to HAP-related IHD showed an initial slight increase followed by a decline, while ASRs demonstrated a consistent downward trend. Males consistently carried a higher burden compared to females. Adults aged 60–70 years were identified as the highest-risk age group. Substantial regional disparities were observed, with low-SDI regions such as East Asia and South Asia accounting for a disproportionately large share of the global burden. India, China, and Bangladesh reported the highest burden. A statistically significant negative correlation was observed between SDI and HAP-attributable IHD burden. Projections to 2036 indicate a continued decline in both absolute burden and ASRs, with males remaining more affected than females. Conclusion: The burden of IHD attributable to HAP varies considerably across sex, age, SDI levels, and geographic regions. Older adults and males are disproportionately affected. Low-SDI regions, constrained by limited healthcare infrastructure and inadequate control of HAP, face a heightened burden. Projected improvements by 2036 are anticipated, contingent upon enhanced healthcare systems, improved air quality, transition to cleaner energy, reduced exposure among high-risk populations, and strengthened international public health collaboration.