Generational changes in cardiometabolic disease incidence by risk factor strata in the UK Biobank.

Abstract

We assessed generational changes in the incidence of coronary artery disease (CAD), acute myocardial infarction (AMI), ischemic stroke, peripheral artery disease (PAD), and type 2 diabetes (T2D) by risk factor strata. For each disease, we included baseline (2006-2010) disease-free UK Biobank participants and prospectively calculated age-specific incidence rates across seven consecutive five-year birth-cohorts (1936-1940 to 1966-1970). We applied Age-Period-Cohort models to examine age-independent birth-cohort effects in strata by sex, genetic risks, socioeconomic status, smoking history, and body mass index. CAD, AMI, PAD, and T2D incidence declined in more recent generations among both men and women, while stroke incidence remained stable. Compared to the 1936-1940 cohort, the incidence (95%CI) in the 1950-1955 cohort was 34.0% (22.4%, 45.7%) lower for CAD and 53.5% (31.2%, 75.8%) lower for PAD in the 65-69 age group. Age-Period-Cohort models suggested birth-cohort effects in observed declines. Birth-cohort effects on CAD and PAD were most evident among individuals with normal-weight, higher socioeconomic status, and ever-smoked, while T2D declines were strongest in individuals with overweight/obesity. CAD, AMI, PAD, and T2D incidences have decreased in more recent generations. However, the stable ischemic stroke incidence and diverse subgroup trends indicate disease-specific differences in preventive gains.