Cardiometabolic-vascular mortality among Chinese adults aged 20 years and older: a national population-based surveillance study, 2013-2021

Background: Diabetes, hypertensive heart disease, ischaemic heart disease, and cerebrovascular disease share upstream cardiometabolic pathways, but whether they increasingly form a concentrated adult mortality architecture in China remains unclear. We examined how these four causes jointly shaped mortality among Chinese adults aged 20 years and older from 2013 to 2021 and assessed implications for primary prevention centred on glycaemic and blood-pressure management. Methods: We conducted a national population-based observational analysis using aggregated mortality surveillance data for Chinese adults aged 20 years and older from 2013 to 2021. Because adult-level estimates were synthesised from harmonised 20–59-year and ≥60-year analytic layers with different age-restricted standardisation frameworks, adult structural measures were based on deaths, the percentage of all adult deaths, and the percentage of total weighted adult age-standardised mortality contribution rather than on a pooled adults-20+-only ASMR. We further characterised 2021 life-stage patterns across ages 20–39, 40–59, 60–74, and ≥75 years, and examined later-life inequalities by sex, residence, and region. Results: Combined deaths from the four causes increased from 632,869 in 2013 to 945,427 in 2021. Their share of all adult deaths rose from 44.07% to 50.15%, and their share of total weighted adult ASMR contribution increased from 43.68% to 48.23%. In adults aged 20–59 years, diabetes ASMR increased from 2.83 to 3.78 per 100,000 and ischaemic heart disease ASMR from 19.53 to 21.18, whereas hypertensive heart disease declined from 3.30 to 2.60 and cerebrovascular disease from 28.20 to 24.11. In 2021, weighted rates increased from 0.77, 0.54, 5.37, and 4.51 per 100,000 at ages 20–39 years to 7.20, 4.93, 39.14, and 46.37 at ages 40–59 years, with further escalation in later life. Conclusions: Adult mortality in China is increasingly concentrated within a cardiometabolic–vascular continuum spanning diabetes, blood-pressure-related cardiac injury, and major vascular outcomes. These findings support integrated primary prevention strategies that prioritise glycaemic management, blood-pressure control, and early vascular-risk detection across the adult life course.